2020 Articles
Designed to Fail? the Future of Primary Care
J Gen Intern Med
Primary care is widely viewed as being in crisis despite its purported central role in addressing population issues related to healthcare cost, quality, access, and equity. Despite this pivotal role, the nature of the clinical practice today has largely emerged by default. We review the evolution of clinical practice in primary care from its genesis in small practices with paper charts and telephonic patient...
Primary care is widely viewed as being in crisis despite its purported central role in addressing population issues related to healthcare cost, quality, access, and equity. Despite this pivotal role, the nature of the clinical practice today has largely emerged by default. We review the evolution of clinical practice in primary care from its genesis in small practices with paper charts and telephonic patient...
Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: An Exploratory Qualitative Study
J Hosp Med
Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood. This paper sought to explore the lived experiences of female teaching attending physicians emphasizing strategies they use to mitigate...
Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood. This paper sought to explore the lived experiences of female teaching attending physicians emphasizing strategies they use to mitigate...
Peripherally Inserted Central Catheter Thrombosis Following placement via electrocardiography vs. traditional methods: an analysis of 42,687 patients
Am J Med
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis . Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown.
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis . Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown.
Compassionate Communication Amid the COVID-19 Pandemic
J Hosp Med
The coronavirus disease of 2019 (COVID-19) pandemic is the health crisis of our generation and will inevitably leave a lasting mark on how we practice medicine. It has already rapidly changed the way we communicate with patients, families, and colleagues. From the explosion of virtual care—which has been accelerated by need and new reimbursement policies3—to the physical barriers...
The coronavirus disease of 2019 (COVID-19) pandemic is the health crisis of our generation and will inevitably leave a lasting mark on how we practice medicine. It has already rapidly changed the way we communicate with patients, families, and colleagues. From the explosion of virtual care—which has been accelerated by need and new reimbursement policies3—to the physical barriers...
Targeting Zero Harm: A Stretch Goal That Risks Breaking the Spring
NEJM Catalyst
Despite the well-intentioned aim of eliminating all patient harm, achieving 100% success is literally impossible and in fact creates other types of harm.
Despite the well-intentioned aim of eliminating all patient harm, achieving 100% success is literally impossible and in fact creates other types of harm.
The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC
Pediatrics
Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians...
Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians...
Developing Appropriateness Criteria for Pediatric Vascular Access
Pediatrics
To describe the methodology undertaken to provide guidance on the appropriateness, as well as inappropriateness, of vascular access device selection, characteristics, and insertion technique for pediatric patients.
To describe the methodology undertaken to provide guidance on the appropriateness, as well as inappropriateness, of vascular access device selection, characteristics, and insertion technique for pediatric patients.
Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review
Pediatrics
To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).
To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).
Developing Pediatric Appropriateness Criteria for Intravenous Catheters
Pediatrics
Consider this scenario: an 8-month-old infant with osteomyelitis needs intravenous (IV) access for 3 weeks of antibiotics; what device will best ensure successful therapy and low risk of complications? Or consider this: a teenager with cystic fibrosis is hospitalized for the third time this year with an acute exacerbation. Despite multiple efforts by experienced clinicians, an IV catheter cannot be...
Consider this scenario: an 8-month-old infant with osteomyelitis needs intravenous (IV) access for 3 weeks of antibiotics; what device will best ensure successful therapy and low risk of complications? Or consider this: a teenager with cystic fibrosis is hospitalized for the third time this year with an acute exacerbation. Despite multiple efforts by experienced clinicians, an IV catheter cannot be...
Quality & safety in the literature: July 2020
Assessment of race and sex as risk factors for colonization with multidrug-resistant organisms in six nursing homes
Infect Control Hosp Epidemiol
The role of demographic characteristics, such as sex and race, as risk factors for colonization with multidrug-resistant organisms, has not been established in the nursing home setting. We demonstrate significantly higher prevalence overall in male patients, and sex differences are dependent on organism of interest and body site.
The role of demographic characteristics, such as sex and race, as risk factors for colonization with multidrug-resistant organisms, has not been established in the nursing home setting. We demonstrate significantly higher prevalence overall in male patients, and sex differences are dependent on organism of interest and body site.
Annals for Hospitalists - 16 June 2020
Transforming use of two catheters: from accessory to hazard
Lancet Infect Dis
In The Lancet Infectious Diseases, Bart J Laan and colleagues examined the effect of a tailored multifaceted intervention in medical wards in seven hospitals in the Netherlands that focused on reducing inappropriate use of two of the most commonly used medical technologies worldwide: short peripheral intravenous catheters and urinary catheters. These catheters are often inserted...
In The Lancet Infectious Diseases, Bart J Laan and colleagues examined the effect of a tailored multifaceted intervention in medical wards in seven hospitals in the Netherlands that focused on reducing inappropriate use of two of the most commonly used medical technologies worldwide: short peripheral intravenous catheters and urinary catheters. These catheters are often inserted...
Use of and Patient-Reported Complications Related to Midline Catheters and Peripherally Inserted Central Catheters
Infect Control Hosp Epidemiol
We conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central...
We conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central...
Catheter-Associated Urinary Tract Infection, Clostridioides difficile Colitis, Central Line-Associated Bloodstream Infection, and Methicillin-Resistant Staphylococcus aureus
Med Clin North Am
Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries...
Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries...
Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan
J Hosp Med
Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies.
Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies.
Is It Time to More Fully Address Teaching Religion and Spirituality in Medicine?
Ann Intern Med
About a century ago, Sir William Osler, one of the most distinguished physicians of the day, observed that “Nothing in life is more wonderful than faith…. Faith has always been an essential factor in the practice of medicine” (1). Doctors and patients shared this belief in faith, and much more...
About a century ago, Sir William Osler, one of the most distinguished physicians of the day, observed that “Nothing in life is more wonderful than faith…. Faith has always been an essential factor in the practice of medicine” (1). Doctors and patients shared this belief in faith, and much more...
A Jaw-Dropping Diagnosis
J Hosp Med
Five Questions Every Mentee Should Have an Answer To
J Hosp Med
When we began forming a mentor-mentee relationship in academic medicine a decade ago, it became clear that both structure and expertise was necessary for success. Structure—in the form of expectations that outlined who was responsible for what, how often we should meet, and how best to communicate—made explicit that which is usually implicit...
When we began forming a mentor-mentee relationship in academic medicine a decade ago, it became clear that both structure and expertise was necessary for success. Structure—in the form of expectations that outlined who was responsible for what, how often we should meet, and how best to communicate—made explicit that which is usually implicit...
Preventing healthcare-associated infection in Switzerland: Results of a national survey
Infect Control Hosp Epidemiol
We assessed infection prevention in Swiss hospitals via a national survey focusing on infection prevention practices prior to a large national infection prevention initiative. Of the 59 hospitals that responded (77%), 98% had infection prevention teams and 40% very good or excellent leadership support. However, a minority of hospitals used recommended infection prevention practices...
We assessed infection prevention in Swiss hospitals via a national survey focusing on infection prevention practices prior to a large national infection prevention initiative. Of the 59 hospitals that responded (77%), 98% had infection prevention teams and 40% very good or excellent leadership support. However, a minority of hospitals used recommended infection prevention practices...
Making MAGIC: how to improve the use of peripherally inserted central catheters
BMJ Qual Saf
At this very moment, somewhere in the world, an intravenous catheter is being placed in a hospitalised patient.
At this very moment, somewhere in the world, an intravenous catheter is being placed in a hospitalised patient.
How Should U.S. Hospitals Prepare for Coronavirus Disease 2019 (COVID-19)?
Ann Intern Med
Coronavirus disease 2019 (COVID-19) is on the verge of being declared a pandemic. As of 7 March 2020, a total of 423 cases and 19 deaths, including several non–travel-related cases, areas of sustained community transmission, and a nursing home outbreak, have been reported. Best-case estimates suggest that COVID-19 will stress bed capacity, equipment, and health care personnel in U.S. hospitals in ways not previously experienced.
Coronavirus disease 2019 (COVID-19) is on the verge of being declared a pandemic. As of 7 March 2020, a total of 423 cases and 19 deaths, including several non–travel-related cases, areas of sustained community transmission, and a nursing home outbreak, have been reported. Best-case estimates suggest that COVID-19 will stress bed capacity, equipment, and health care personnel in U.S. hospitals in ways not previously experienced.
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates
BMJ Qual Saf
Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs). The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates.
Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs). The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates.
Leadership & Professional Development: Make a Friend Before You Need One
J Hosp Med
To succeed in a hospital, leaders need a generous supply of social and political capital. House officers learn this very quickly, especially when they are relying on other members of the healthcare team to obtain tests and studies for their patients and calling for specialty consultations. To be successful and efficient, building relationships and trust is key. Such capital, unfortunately, takes time to develop.
To succeed in a hospital, leaders need a generous supply of social and political capital. House officers learn this very quickly, especially when they are relying on other members of the healthcare team to obtain tests and studies for their patients and calling for specialty consultations. To be successful and efficient, building relationships and trust is key. Such capital, unfortunately, takes time to develop.
Annals for Hospitalists - 19 May 2020
Mindful Mentorship
Healthcare
Mentorship – a dynamic relationship between a protégé and an incumbent aimed at the reciprocal development of both – is foundational to academic success. Although mentors play varying roles in the evolution of mentees, some have greater impact and influence than others. What distinguishes these “uber” mentors from their counterparts?
Mentorship – a dynamic relationship between a protégé and an incumbent aimed at the reciprocal development of both – is foundational to academic success. Although mentors play varying roles in the evolution of mentees, some have greater impact and influence than others. What distinguishes these “uber” mentors from their counterparts?
Antibiotic Stewardship Teams and Clostridioides difficile Practices in United States Hospitals: A National Survey in The Joint Commission Antibiotic Stewardship Standard Era
Infect Control Hosp Epidemiol
Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US...
Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US...
Trends in Health Care-Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017
JAMA Net Open
Health care-associated infection (HAI) is associated with substantial harm. To reduce HAI, the largest integrated health care system in the United States-the Veterans Health Administration-was an early adopter of infection prevention policies and initiatives. Whether these efforts translated into increased use of practices to prevent HAI in Veterans Affairs (VA) hospitals is unknown.
Health care-associated infection (HAI) is associated with substantial harm. To reduce HAI, the largest integrated health care system in the United States-the Veterans Health Administration-was an early adopter of infection prevention policies and initiatives. Whether these efforts translated into increased use of practices to prevent HAI in Veterans Affairs (VA) hospitals is unknown.
Infection Prevention Practices in the Netherlands: Results From a National Survey
Antimicrob Resist Infect Control
To examine the extent to which acute care hospitals in the Netherlands have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI).
To examine the extent to which acute care hospitals in the Netherlands have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI).
Psychological Safety and Infection Prevention Practices: Results From a National Survey
Am J Infect Control
Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals.
Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals.
Using Democratic Deliberation to Engage Veterans in Complex Policy Making for the Veterans Health Administration
Fed Pract
A democratic deliberation panel of veterans providing insight into veteran perspectives on resource allocation and the Veterans Choice Act showed the importance and feasibility of engaging veterans in the policy-making process.
A democratic deliberation panel of veterans providing insight into veteran perspectives on resource allocation and the Veterans Choice Act showed the importance and feasibility of engaging veterans in the policy-making process.
