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The high costs of "penicillin allergy"

April 2014

Published in the April 2014 issue of Today’s Hospitalist

The high costs of “penicillin allergy”

NEW DATA SHOW that the most frequent drug allergy reported at admission “penicillin allergy “is associated with a significant bump up not only in patients’ number of hospital days, but their use of antibiotics and infection rates.

That’s according to a study published in the March issue of The Journal of Allergy and Clinical Immunology. The retrospective study looked at nearly 52,000 patients in Kaiser hospitals in southern California from 2010 through 2012 who self-reported a penicillin allergy, which authors noted is often inaccurate.

Compared to controls, patients with a history of penicillin allergy chalked up 10% more total hospital days and had significantly greater use of fluoroquinolones, clindamycin and vancomycin.

Those patients also had 30% more VRE infections than controls, 23% more C. diff infections and 14% more cases of MRSA than patients without a self-reported penicillin allergy. The authors concluded that a history of penicillin allergy “is not a benign finding at hospital admission.”

Do EMRs reduce clinician face time?

WHILE ELECTRONIC MEDICAL RECORDS (EMRs) are supposed to enhance clinical communication, a study by hospitalists at the University of South Florida found that face-to-face communication among clinicians suffered after they began using an EMR.

Published online in February by BMJ Quality & Safety, the study looked at communication patterns on general medical wards among 75 physician-nurse-patient triads before the implementation of an EMR and 123 triads after. While nurses communicated with physicians just as frequently after the EMR was in place, the amount of communication that was done face-to-face dropped from 67% to 51%.

After the EMR was implemented, researchers also found that fewer patients were able to accurately predict their expected length of stay. That was taken as an indication that there was less shared agreement on patients’ care plan.

The authors noted that cues available during face-to-face communication “such as tone of voice, gestures and facial expression “may convey important information. They also concluded that EMR use may reduce the quality of communication between nurses and physicians.

Low marks for skilled nursing care

THE HHS OFFICE OF THE INSPECTOR GENERAL has issued a scathing report on adverse events in skilled nursing facilities (SNFs), saying that nearly 22,000 SNF patients suffered an injury and more than 1,500 died in a single month.

The report, which was released in February, claimed that one in three SNF patients experience some harm, such as an infection, medication error, fall or exacerbation of a condition related to omission of care.

The report also found that 59% of those injuries and errors were preventable “and that more than one-half of patients with adverse events in SNFs were readmitted to hospitals. According to ProPublica coverage of the report, the estimated cost of those readmissions in August 2011 totaled $200 million. For fiscal year 2011, those readmissions cost a total of $2.8 billion.

The report recommended that the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality collaborate to apply the same patient-safety methods used to promote better safety in hospitals to SNFs.

Antibiotic prescribing: Doctors need to improve

A CDC REPORT issued last month found that antibiotic overprescribing is still rampant in hospitals, with some doctors prescribing three times more antibiotics than their colleagues.

Those results came from a CDC survey of more than 300 hospitals. According to the report, one-third of the antibiotics prescribed for UTIs and for vancomycin contained potential errors, including a lack of appropriate testing and drugs being prescribed for too long.

The report also noted that a 30% reduction in the use of high-risk antibiotics “fluoroquinolones, beta-lactams with beta-lactamase inhibitors and extended-spectrum cephalosporins “would result in a 26% reduction in C. diff infections. The CDC called for hospital stewardship programs and urged doctors to order recommended cultures before prescribing; to document dosages, indications, and expected duration; and to reassess antibiotic use within 48 hours.

In related news, hospitalists writing about antibiotic overuse in an online viewpoint piece posted last month by JAMA Internal Medicine described antibiotic best practices, including adopting 72-hour “time-outs” for hospitalized patients taking antibiotics.

Parenting, housework and women physicians

A STUDY SUGGESTS that women physician-researchers may not achieve the same rate of career success as their male colleagues, at least early in their careers, because they take on a bigger share of domestic labor.

Researchers publishing in the March 4 issue of Annals of Internal Medicine surveyed more than 1,000 physician researchers with NIH grants and an active academic affiliation. Among married or partnered respondents with children, researchers found that women reported spending 8.5 more hours per week on domestic activities than men, while male respondents were almost four times more likely to have a spouse or partner who either didn’t work or worked only part time. Women respondents were also much more likely than men to report taking time off for disruptions in child care (41.6% vs. 12.4%).

However, an editorial noted that those disparities may reflect the preferences of the women physicians themselves. The editorial also pointed out that women physicians may choose research positions in part because those positions offer more scheduling flexibility than strictly clinical or teaching positions.