Category Archives: Inpatient care

Jul 16 2013
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Improving Care for Some of the Sickest Patients at Small, Community Hospitals

Deverick J. Anderson, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation Physician Faculty Scholars program and an associate professor of medicine at Duke University School of Medicine. He recently led a study, published in the July issue of Infection Control and Hospital Epidemiology, that finds small, community hospitals have higher rates of ventilator-associated pneumonia than larger hospitals, even though they use ventilators less frequently.

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Human Capital Blog: Why did you decide to look at this particular topic?

Deverick Anderson: Our group is very interested in infectious diseases and hospital epidemiology in community hospitals. Despite the fact that more than half of the health care provided in the United States is provided in this setting, data are rarely, if ever, published from small, community hospitals.

HCB: What did your study look at?

Anderson: We analyzed prospectively collected surveillance data on ventilator-associated pneumonia (VAP) from 31 community hospitals over a five year period (2007-2011).

HCB: What did you find? 

Anderson: As expected, VAP led to significant morbidity and mortality. The most common cause of VAP was methicillin-resistant Staphylococcus aureus, or MRSA.  Most surprisingly, however, we noted that the incidence of VAP was inversely associated with hospital size. In other words, the smallest community hospitals in our network (with less than 30,000 patient-days per year) had the highest rates of VAP.

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Feb 25 2013
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Upcoming Webinar: Nurse-Led Delirium Prevention

Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI) grantees Michele Balas, PhD, and William Burke, MD, will present their research on a nurse-led plan to manage delirium in critically ill adults in a webinar on February 28, from 3-4 p.m. EST.

The main goal of the interdisciplinary project was to implement, analyze and disseminate an evidence-based, nurse-led, interprofessional, multi-component program focused on improving the care and outcomes of critically ill adults. The study focused on applying a program of delirium screening, prevention and treatment developed at Vanderbilt University.

This webinar is part of INQRI’s “Translating Research into Practice” series.

Register for the webinar.
Learn more about Balas and Burke’s research.

Aug 13 2012
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In Aurora, A Massacre Becomes a Miracle, and Then Patients Help Doctors Heal

Comilla Sasson, MD, MS, is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado.  Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010.

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I wasn’t even supposed to work that night. I had finished a long day of meetings, and found out at 6:30 pm that my colleague, who had called in sick twice in 40 years, had influenza and he knew it was best not to expose Emergency Department (ED) patients to it.  After he called, I remember thinking, “Well, I can just power through until 8 am. Nothing too bad happens on Thursday nights.”

The night began as many other nights do in our ED. Twenty-five of our 50 beds were taken up by inpatients who were waiting for hospital beds to open up.  The ED was completely full, with another 10 patients in the waiting room. “Another one of those nights,” I groaned to myself.  We were already on “divert” status, meaning that ambulances would bypass our hospital and go to others in town. This should be a relatively easy night, right?

Until we received the call over the dispatch radio at approximately 12:30 am: Shooting at a theater in Aurora. Hopefully the paramedics remembered we were already at capacity and took the patients elsewhere.  Nine minutes later, we received a frantic phone call from one of the policemen on scene: Multiple shooting victims and Aurora Police Department just received permission to transport patients to hospitals in the backs of police cars instead of waiting for ambulances.  That’s when we realized this was not a gang fight with one or two victims, this was something different. 

The first police car showed up at 1:06 am. We raced out to the ambulance bay and started removing patients from the back of the car. The police car looked like a crime scene, with blood splattered throughout. As we were pulling the first two victims out of the car, another police car showed up. And another. And another. In total, we received nine police cars and one ambulance within 45 minutes.  Looking out into our ambulance bay with police lights flashing, I realized, this is not like any other shooting I have been involved in. This is radically different.

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