2018 Publications
A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters
JAMA Intern Med
From a patient’s perspective, how common are infectious and noninfectious indwelling urethral catheter–associated complications?
From a patient’s perspective, how common are infectious and noninfectious indwelling urethral catheter–associated complications?
Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals
JAMA Intern Med
What circumstances lead to active failures in transmission-based precautions to reduce the transmission of infectious agents by health care personnel?
What circumstances lead to active failures in transmission-based precautions to reduce the transmission of infectious agents by health care personnel?
Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals
JAMA Network Open
How has the proportion of US hospitals requiring receipt of annual influenza vaccination among health care personnel changed in recent years?
How has the proportion of US hospitals requiring receipt of annual influenza vaccination among health care personnel changed in recent years?
Starving the Hungry Tapeworm: How Businessmen May Reform Health Care Cost
Ann Intern Med
In 2016, U.S. health care spending reached $3.3 trillion, a figure representing 17.9% of the nation's gross domestic product. Sadly, the skyrocketing cost of health care is not headline news.
In 2016, U.S. health care spending reached $3.3 trillion, a figure representing 17.9% of the nation's gross domestic product. Sadly, the skyrocketing cost of health care is not headline news.
Use of Venous Thromboembolism Prophylaxis in Hospitalized Patients
JAMA Intern Med
National guidelines recommend objective risk stratification for venous thromboembolism (VTE) in hospitalized medical patients. ... Using data from the HMS we sought to determine whether patients in this cohort were receiving appropriate VTE prophylaxis.
National guidelines recommend objective risk stratification for venous thromboembolism (VTE) in hospitalized medical patients. ... Using data from the HMS we sought to determine whether patients in this cohort were receiving appropriate VTE prophylaxis.
Mentoring Millennials
JAMA
The surgical case was straightforward: a young man had experienced a radial nerve injury from a broken humerus, now without neurological recovery. Tendon transfers to restore wrist and finger extension were planned. The surgeon, resident, and medical...
The surgical case was straightforward: a young man had experienced a radial nerve injury from a broken humerus, now without neurological recovery. Tendon transfers to restore wrist and finger extension were planned. The surgeon, resident, and medical...
The Wrong Frame of Mind
N Engl J Med
A 62-year-old woman with hypertension and depression presented to a urology clinic with a 15-month history of episodic dysuria, hematuria, and polyuria. She reported suprapubic discomfort but no flank pain, nausea, or early satiety.
A 62-year-old woman with hypertension and depression presented to a urology clinic with a 15-month history of episodic dysuria, hematuria, and polyuria. She reported suprapubic discomfort but no flank pain, nausea, or early satiety.
Home Sweet Home
N Engl J Med
A 25-year-old woman presented to the emergency department with a 2-day history of fever, chills, and sweats. These symptoms began abruptly and were accompanied by malaise, headache, dry cough, myalgias, and decreased appetite.
A 25-year-old woman presented to the emergency department with a 2-day history of fever, chills, and sweats. These symptoms began abruptly and were accompanied by malaise, headache, dry cough, myalgias, and decreased appetite.
Can Infection Prevention Programs in Hospitals and Nursing Facilities Be Integrated?
JAMA
Dissemination and implementation of evidence-based interventions have successfully reduced central line–associated bloodstream infections, surgical site infections, and Clostridium difficile in many acute care hospitals partly as a result of resourceful, diverse...
Dissemination and implementation of evidence-based interventions have successfully reduced central line–associated bloodstream infections, surgical site infections, and Clostridium difficile in many acute care hospitals partly as a result of resourceful, diverse...
Comparative thrombosis risk of vascular access devices among critically ill medical patients
Thromb Res
Central venous catheters (CVC) and peripherally inserted central catheters (PICCs) are central vascular access devices (CVADs) that facilitate administration of medications among critically ill patients. Both are associated with risk of venous thromboembolism (VTE). The relative risk of VTE between these catheter types is not well defined.
Central venous catheters (CVC) and peripherally inserted central catheters (PICCs) are central vascular access devices (CVADs) that facilitate administration of medications among critically ill patients. Both are associated with risk of venous thromboembolism (VTE). The relative risk of VTE between these catheter types is not well defined.
Less Lumens-Less Risk: A Pilot Intervention to Increase the Use of Single-Lumen Peripherally Inserted Central Catheters
J Hosp Med
To reduce risk of complications, existing guidelines recommend use of peripherally inserted central catheters (PICCs) with the minimal number of lumens. This recommendation, however, is difficult to implement in practice.
To reduce risk of complications, existing guidelines recommend use of peripherally inserted central catheters (PICCs) with the minimal number of lumens. This recommendation, however, is difficult to implement in practice.
Focused Ethnography of Diagnosis in Academic Medical Centers
J Hosp Med
Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings.
Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings.
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities
Infect Control Hosp Epidemiol
To estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident...
To estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident...
Peripherally Inserted Central Catheters in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals
Crit Care Med
To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward.
To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward.
A Dark Horse Diagnosis
J Hosp Med
A 73-year-old man presented to the emergency department in late winter with fevers, myalgias, fatigue, low back pain, and poor oral intake. Four days earlier, he had fallen and hit his head. His partner also noticed a few episodes of confusion in the days leading up...
A 73-year-old man presented to the emergency department in late winter with fevers, myalgias, fatigue, low back pain, and poor oral intake. Four days earlier, he had fallen and hit his head. His partner also noticed a few episodes of confusion in the days leading up...
A comprehension scale for central-line associated bloodstream infection: Results of a preliminary survey and factor analysis
PLOS One
Central line-associated bloodstream infections (CLABSI) are associated with significant morbidity and mortality. This condition is therefore the focus of quality initiatives, which primarily use audit and feedback to improve performance. However, feedback of quality data inconsistently affects clinician behavior.
Central line-associated bloodstream infections (CLABSI) are associated with significant morbidity and mortality. This condition is therefore the focus of quality initiatives, which primarily use audit and feedback to improve performance. However, feedback of quality data inconsistently affects clinician behavior.
Indwelling Urethral versus Suprapubic Catheters in Nursing Home Residents: Determining the Safest Option for Long-Term Use
J Hosp Infect
Long-term infectious complications associated with type of indwelling urinary catheter are unknown. Aim: To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug resistant organism (MDRO) colonization between nursing home (NH) residents with indwelling urethral and suprapubic catheters.
Long-term infectious complications associated with type of indwelling urinary catheter are unknown. Aim: To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug resistant organism (MDRO) colonization between nursing home (NH) residents with indwelling urethral and suprapubic catheters.
Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA appropriateness method
BMJ Qual Saf [Open Access]
Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use.
Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use.
Choosing the Right Central Venous Catheter for Parenteral Nutrition
Am J Gastroenterol
The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology...
The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology...
Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity - a systematic review and meta-analysis
Infect Control Hosp Epidemiol
The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities...
The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities...
Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies
BMJ Qual Saf [Open Access]
Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains.
Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains.
Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad
BMJ Qual Saf
Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests...
Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests...
Indwelling Urethral versus Suprapubic Catheters in Nursing Home Residents: Determining the Safest Option for Long-Term Use
J Hosp Infect
Long-term infectious complications associated with type of indwelling urinary catheter are unknown. To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug resistant organism (MDRO) colonization between nursing home (NH) residents...
Long-term infectious complications associated with type of indwelling urinary catheter are unknown. To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug resistant organism (MDRO) colonization between nursing home (NH) residents...
Mind the Overlap: How System Problems Contribute to Cognitive Failure and Diagnostic Errors
Diagnosis
Traditionally, research has examined systems- and cognitive-based sources of diagnostic error as individual entities. However, half of all errors have origins in both domains. We conducted a focused ethnography of inpatient physicians at two academic institutions...
Traditionally, research has examined systems- and cognitive-based sources of diagnostic error as individual entities. However, half of all errors have origins in both domains. We conducted a focused ethnography of inpatient physicians at two academic institutions...
Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centers in the USA
BMJ Open
Several large studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment and clinical outcomes. Whether physician attire can affect the patient experience—and how this influences satisfaction—is unknown.
Several large studies have shown that improving the patient experience is associated with higher reported patient satisfaction, increased adherence to treatment and clinical outcomes. Whether physician attire can affect the patient experience—and how this influences satisfaction—is unknown.
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative
BMJ Qual Saf
Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data...
Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data...
Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization
Clin Infect Dis
Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of...
Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of...
Assessing a National Collaborative Program Focused on Catheter-Associated Urinary Tract Infection Prevention in a Veterans Health Administration (VHA) Nursing Home Cohort
Infect Control Hosp Epidemiol
Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.
Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. We assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes, which are part of an integrated system.
A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill
Intensive Care Med
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU.
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU.
Economic Evaluation of a Catheter‐Associated Urinary Tract Infection Prevention Program in Nursing Homes
J Am Geriatr Soc
To assess the economic effect and cost effectiveness of a targeted catheter‐associated urinary tract infection (CAUTI) prevention intervention in the nursing home (NH) setting.
To assess the economic effect and cost effectiveness of a targeted catheter‐associated urinary tract infection (CAUTI) prevention intervention in the nursing home (NH) setting.
Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population
Clin Infect Dis
The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post–acute populations.
The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post–acute populations.
Focused ethnography of diagnosis in academic medical centers
J Hosp Med
Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings.
Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings.
Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care
BMJ Qual Saf
In his book on the psychology of persuasion, Robert Cialdini noted: “as the stimuli saturating our lives continue to grow more intricate and variable, we will have to depend increasingly on our shortcuts to handle them all”.1 Such cognitive shortcuts, or heuristics...
In his book on the psychology of persuasion, Robert Cialdini noted: “as the stimuli saturating our lives continue to grow more intricate and variable, we will have to depend increasingly on our shortcuts to handle them all”.1 Such cognitive shortcuts, or heuristics...
The Epidemiology of Hospital-Acquired Urinary Tract-Related Bloodstream Infection in Veterans
Am J Infect Control
Hospital-acquired urinary tract-related bloodstream infections are rare but often lethal. Recent epidemiology of this condition among the United States veteran population is poorly described.
Hospital-acquired urinary tract-related bloodstream infections are rare but often lethal. Recent epidemiology of this condition among the United States veteran population is poorly described.
Perception of Resources Spent on Defensive Medicine and History of Being Sued Among Hospitalists: Results from a National Survey
J Hosp Med
The United States spends substantially more per capita for healthcare than any other nation. Defensive medicine is 1 source of such spending, but its extent is unclear.
The United States spends substantially more per capita for healthcare than any other nation. Defensive medicine is 1 source of such spending, but its extent is unclear.
Pilot randomised controlled trial to improve hand hygiene through mindful moments
BMJ Qual Saf
To evaluate the effectiveness of a brief mindfulness intervention on hand hygiene performance and mindful attention for inpatient physician teams. A pilot, pre-test/post-test randomised controlled mixed methods trial.
To evaluate the effectiveness of a brief mindfulness intervention on hand hygiene performance and mindful attention for inpatient physician teams. A pilot, pre-test/post-test randomised controlled mixed methods trial.
Patterns and Predictors of Short-Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study
J Hosp Med
The guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated duration of use is ≤5 days. However, short-term PICC use is common in hospitals. We sought to identify patient, provider, and device characteristics...
The guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated duration of use is ≤5 days. However, short-term PICC use is common in hospitals. We sought to identify patient, provider, and device characteristics...
Risk of Venous Thromboembolism Following Peripherally Inserted Central Catheter Exchange: an Analysis of 23,000 Hospitalized Patients
Am J Med
Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known.
Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known.
Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures
Infect Control Hosp Epidemiol
Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have...
Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have...
Factors Associated With the Implementation of a Nurse Staffing Directive
J Nurs Adm
In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing. We aimed to describe experiences and factors related to SM implementation.
In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing. We aimed to describe experiences and factors related to SM implementation.