Patient Safety & Quality
Meta-Analysis: ERAS Protocols Improve Recovery and Reduce Complications After Emergency Laparotomy – Am J Surg
18 Aug, 2024 | 19:32h | UTCStudy Design and Population: This systematic review and meta-analysis assessed the effects of Enhanced Recovery After Surgery (ERAS) protocols compared to standard care (SC) in patients undergoing emergency laparotomy. The analysis included six randomized clinical trials (RCTs) with a total of 509 patients.
Main Findings: The ERAS group showed a reduction in length of hospital stay (mean difference: -2.92 days) and quicker recovery milestones, such as time to ambulation (mean difference: -1.67 days) and first bowel opening (mean difference: -1.26 days). The ERAS protocols were also associated with lower rates of pulmonary complications (odds ratio [OR]: 0.43) and surgical site infections (OR: 0.33). Mortality rates were similar between the ERAS and SC groups.
Implications for Practice: These findings suggest that ERAS protocols may enhance recovery and reduce complications in patients undergoing emergency laparotomy. Implementation of these protocols could be beneficial in emergency surgical settings, where feasible.
Review: Prevention and Management of Device-Associated Complications in the Intensive Care Unit – The BMJ
17 Aug, 2024 | 20:04h | UTCIntroduction:
This review article, published by experts from the David Geffen School of Medicine at UCLA, focuses on the complications associated with invasive devices commonly used in the Intensive Care Unit (ICU). While these devices are essential for managing critically ill patients, they also pose significant risks, necessitating a thorough understanding of their potential complications and strategies for prevention and management.
Key Points:
1 – Central Venous Catheters (CVCs):
– CVCs are widely used in ICU patients but carry risks like vascular injury, pneumothorax, thrombosis, and infection.
– Use of real-time ultrasound guidance and careful operator technique are crucial for minimizing these risks.
– Prompt removal of unnecessary CVCs is essential to reduce the risk of complications.
2 – Arterial Catheters:
– Commonly used for hemodynamic monitoring, these catheters can lead to complications such as vascular occlusion, nerve injury, and infection.
– Ultrasound guidance is recommended to reduce the risk of complications, and catheters should be discontinued as soon as clinically feasible.
3 – Airway Devices (Endotracheal Tubes and Tracheostomies):
– Complications include laryngeal injury, tracheal stenosis, and tracheomalacia.
– Strategies to reduce these risks include minimizing intubation attempts, ensuring proper tube placement, and managing cuff pressures carefully.
4 – Extracorporeal Membrane Oxygenation (ECMO):
– ECMO is associated with significant complications, including bleeding, thromboembolic events, and neurologic injuries.
– Proper cannulation technique and vigilant monitoring are essential to mitigate these risks.
5 – Infection Control:
– Strict adherence to aseptic techniques and the use of chlorhexidine-impregnated dressings are recommended to prevent device-associated infections.
Conclusion:
This review underscores the importance of judicious use and timely removal of invasive devices in the ICU to minimize complications. Healthcare professionals must remain vigilant and employ best practices to prevent and manage these complications effectively.
Retrospective Analysis: 7% of outpatients in Massachusetts experience adverse events, predominantly drug-related – Ann Intern Med
25 May, 2024 | 19:37h | UTCThis retrospective study reviewed electronic health records from 11 outpatient sites in Massachusetts during 2018 to assess the incidence and nature of adverse events (AEs) in 3,103 patients. AEs were identified in 7.0% of the patients, translating to 8.6 events per 100 patients annually. Adverse drug events were the most frequent type of AE, constituting 63.8% of events, followed by healthcare-associated infections (14.8%) and surgical or procedural events (14.2%). The severity of these events was notable, with 17.4% being serious and 2.1% life-threatening, though none were fatal. Notably, 23.2% of these events were deemed preventable. The risk of experiencing at least one AE varied significantly by age and race, with higher rates observed among older adults and Black patients compared to other demographics. The study highlights the pressing need for targeted interventions to reduce AEs in outpatient settings.
Reference (link to abstract – $ for full-text):
Cluster-Randomized Trial: No reduction in hospitalization rates with EHR-based algorithm in chronic kidney disease patients
30 Apr, 2024 | 13:16h | UTCThis study evaluates the effectiveness of a personalized EHR-based algorithm combined with practice facilitators to reduce hospitalization rates among patients with chronic kidney disease, type 2 diabetes, and hypertension. Conducted as an open-label, cluster-randomized trial across 141 primary care clinics, 11,182 patients were divided into two groups: the intervention group (5,690 patients) and the usual-care group (5,492 patients). After one year, the hospitalization rate was slightly lower in the intervention group (20.7%) compared to the usual-care group (21.1%), but this difference was not statistically significant (p=0.58). Secondary outcomes, including emergency department visits, readmissions, cardiovascular events, dialysis, and death rates were similar between the groups, except for a slightly higher rate of acute kidney injury in the intervention group. The study concludes that the EHR-based intervention did not significantly decrease hospitalizations at one year.
Commentary on X:
Original Article: Pragmatic Trial of Hospitalization Rate in Chronic Kidney Disease (ICD-Pieces trial) https://t.co/aJ0Ao0uf90 #Nephrology pic.twitter.com/l4xc54Buxy
— NEJM (@NEJM) April 8, 2024
Reference (link to abstract – $ for full-text):
Meta-Analysis: Effectiveness of therapist-guided remote vs. in-person cognitive behavioral therapy
20 Mar, 2024 | 19:32h | UTCStudy Design and Population: This systematic review and meta-analysis investigated the efficacy of therapist-guided remote cognitive behavioral therapy (CBT) compared to traditional in-person CBT. The authors conducted a comprehensive search across several databases, including MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials, up to July 4, 2023. A total of 54 randomized controlled trials (RCTs) were included, encompassing 5463 adult patients presenting with various clinical conditions. The study meticulously assessed the risk of bias and extracted data using a standardized approach, and outcomes were analyzed using a random-effects model.
Main Findings: The primary analysis focused on patient-important outcomes, comparing the effectiveness of remote and in-person CBT across diverse conditions such as anxiety and related disorders, depressive symptoms, insomnia, chronic pain or fatigue syndromes, body image or eating disorders, tinnitus, alcohol use disorder, and mood and anxiety disorders. The meta-analysis, based on moderate-certainty evidence, found little to no difference in effectiveness between remote and in-person CBT (standardized mean difference [SMD] −0.02, 95% confidence interval −0.12 to 0.07), suggesting that both delivery methods are comparably effective across a range of disorders.
Implications for Practice: The findings indicate that therapist-guided remote CBT is nearly as effective as in-person CBT for treating a variety of mental health and somatic disorders. This supports the potential for remote CBT to significantly increase access to evidence-based care, especially in settings where in-person therapy is not feasible or is limited by geographic, economic, or social barriers. Future research should explore optimizing remote CBT delivery methods to further enhance accessibility and efficacy.
Reference: Zandieh, S. et al (2024). Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ, 196(10), E327-E340. [Link]
Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes
11 Aug, 2023 | 15:41h | UTCEffects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)
Commentaries:
When it comes to blood pressure cuffs, size matters – MedicalResearch.com
One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN
Related:
Commentary on Twitter
Using a regular blood pressure (BP) cuff regardless of individual’s arm size resulted in 3.6 mmHg lower systolic BP when a regular cuff was one size too-large, and 4.8 and 19.5 mmHg higher when a regular cuff was one and two sizes too small. https://t.co/ZKnGfWc9fy
— JAMA Internal Medicine (@JAMAInternalMed) August 7, 2023
Study | The high financial and human cost of quality metric reporting in hospitals
11 Aug, 2023 | 15:36h | UTCThe Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)
Author Interview: The Costs of Quality Reporting – JAMA
Commentaries:
The Cost of “Quality” – Emergency Medicine Literature of Note
How John Hopkins spent $5m and 108,478 hours on quality reporting in one year – HealthLeaders
The cost of quality metric reporting – Becker’s Hospital Review
Study | Uncovering the potential overuse of laboratory tests by combining cost, abnormal result proportion, and physician variation
11 Aug, 2023 | 15:34h | UTC
Perspective | An AI-enhanced electronic health record could boost primary care productivity
9 Aug, 2023 | 15:36h | UTCAn AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity – JAMA (free for a limited period)
M-A | Nearly 37% of elderly outpatients are at risk due to potentially inappropriate medication use
8 Aug, 2023 | 13:37h | UTC
M-A | Approximately 25 min/day of walking can boost function and cut adverse events in acutely hospitalized elders
8 Aug, 2023 | 13:35h | UTC
M-A | Significant QOL and mental health improvements in caregivers via targeted interventions
3 Aug, 2023 | 13:28h | UTC
Position Paper | Prioritizing deprescribing in fall prevention strategies
28 Jul, 2023 | 14:12h | UTCOriginal Guideline: World guidelines for falls prevention and management for older adults: a global initiative – Age and Ageing
Giving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach
26 Jul, 2023 | 13:20h | UTCGiving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach – Intensive Care Medicine (free for a limited period)
Commentary on Twitter
? Giving voice to critically ill patients! ⬇️ visual abstract including 15 concerns expressed by conscious patients at high risk of dying in #ICU to
➡️improve communication/support
➡️better meet needs
➡️support research on EoL & quality of dying/death
?️ https://t.co/pQK5B77eCW pic.twitter.com/BCRDkmD7SG— Intensive Care Medicine (@yourICM) July 24, 2023
Research Findings | US annual serious harms from misdiagnosis estimated at 795K in recent study
25 Jul, 2023 | 13:57h | UTCBurden of serious harms from diagnostic error in the USA – BMJ Quality & Safety (link to abstract – $ for full-text)
News Release: Report Highlights Public Health Impact of Serious Harms From Diagnostic Error in U.S. – Johns Hopkins Medicine
Commentaries:
Misdiagnoses cost the U.S. 800,000 deaths and serious disabilities every year, study finds – STAT
Review | Research on prescribing cascades
24 Jul, 2023 | 12:53h | UTCResearch on prescribing cascades: a scoping review – Frontiers in Pharmacology
Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide
19 Jul, 2023 | 14:33h | UTC
Survey Study | ChatGPT’s performance in simulated patient-provider interactions
19 Jul, 2023 | 14:28h | UTCPutting ChatGPT’s Medical Advice to the (Turing) Test: Survey Study – JMIR Medical Education
Related: ChatGPT’s responses to patient questions rated higher for quality and empathy than physicians
Systematic Review | An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice
19 Jul, 2023 | 14:23h | UTC
Review | Infection prevention and control in the medical imaging environment
18 Jul, 2023 | 13:31h | UTC
What are effective strategies to reduce low-value care? An analysis of 121 randomized deimplementation studies
17 Jul, 2023 | 13:55h | UTC
Retrospective Analysis | Inconsistencies in pediatric drug dosing found in over half of prehospital emergency drug administrations
17 Jul, 2023 | 13:50h | UTCCommentaries:
Children and Drug Dosing Variations When in Transit to the Hospital – AAP Journals Blog
Variation Seen in Dosing of Meds at Prehospital Pediatric Encounters – HealthDay
Review | A health systems approach to critical care delivery in low-resource settings
17 Jul, 2023 | 13:29h | UTC
Commentary on Twitter (thread – click for more)
1/ @yourICM's highlights:
?OPEN ACCESS~ Health systems approach to #CriticalCare delivery in low-resource settings? https://t.co/W7d3q7UP1D
?OPEN ACCESS~ #ICU #Sepsis-associated #AKI? https://t.co/gLCXjcH2ah
?Myocarditis: a primer for intensivists? https://t.co/UUga5lYX0q pic.twitter.com/tB8am5zEny— ESICM (@ESICM) July 14, 2023
Consensus Paper | Implementing strategies to prevent infections in acute-care settings
14 Jul, 2023 | 13:03h | UTCNews Release: New guidance for infection prevention in acute care settings – Society for Healthcare Epidemiology of America
Related:
Practice Recommendation | Strategies to prevent MRSA transmission and infection in hospitals
Consensus Paper | Strategies to prevent surgical site infections in acute-care hospitals
Consensus Paper | Strategies to prevent Clostridioides difficile infections in acute-care hospitals
Quality Improvement Study | Improved asymptomatic bacteriuria management by reduction of unnecessary urine culture requests
14 Jul, 2023 | 12:54h | UTCRelated:
Study: Hospital Intervention Resulted in a 45% Reduction in the Urine Cultures Ordered
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
IDSA Guideline for the Management of Asymptomatic Bacteriuria
Commentary on Twitter
???Powerful message from our new study in @JAMAInternalMed: diagnostic stewardship (better use of diagnostic tests) was responsible for ALL the⬇️in unnecessary antibiotic use for ASB. ➕results??nudge to action. Time to??upstream to improve care! https://t.co/yO4UpA6ZKK pic.twitter.com/hXZGvNmVJP
— Valerie Vaughn (@ValerieVaughnMD) July 11, 2023