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Prediction tool for mortality after respiratory compromise
Background: Scoring systems exist to predict outcomes following cardiac arrest. There is currently no reliable model to predict outcome of patients who have survived acute respiratory compromise (ARC).
Study Design: A retrospective cohort study.
Setting: Get with the Guidelines Resuscitation (GWTG-R) is an online medical registry that tracks ARC data from more than 300 hospitals.
Synopsis: Using the GWTG-R database of ARC, researchers identified 13,193 cases of ARC to study the variables affecting prognosis. They randomized the group into derivation (75% of patients) and validation (25% of patients) cohorts and used c-statistics to create the prognostic scoring system. The greatest predictors of in-hospital mortality were age greater than 80 years, hypotension in the four hours preceding the ARC event, and the need for intubation.
This scoring system did not take into account any comorbidities (such as organ failure) that occurred shortly after the ARC event, although these likely affect mortality.
Bottom Line: Predicting in-hospital mortality for survivors of ARC events may help clinical prognostication. Such tools could also facilitate comparisons between hospitals and guide quality improvement projects.
Citation: Moskowitz A, Anderson LW, Karlsson M, et. al. Predicting in-hospital mortality for initial survivors of acute respiratory compromise (ARC) events: Development and validation of the ARC score. Resuscitation. 2017 Jun;115:5-10.
Dr. Suman is clinical instructor of medicine in the University of Kentucky division of hospital medicine.
Background: Scoring systems exist to predict outcomes following cardiac arrest. There is currently no reliable model to predict outcome of patients who have survived acute respiratory compromise (ARC).
Study Design: A retrospective cohort study.
Setting: Get with the Guidelines Resuscitation (GWTG-R) is an online medical registry that tracks ARC data from more than 300 hospitals.
Synopsis: Using the GWTG-R database of ARC, researchers identified 13,193 cases of ARC to study the variables affecting prognosis. They randomized the group into derivation (75% of patients) and validation (25% of patients) cohorts and used c-statistics to create the prognostic scoring system. The greatest predictors of in-hospital mortality were age greater than 80 years, hypotension in the four hours preceding the ARC event, and the need for intubation.
This scoring system did not take into account any comorbidities (such as organ failure) that occurred shortly after the ARC event, although these likely affect mortality.
Bottom Line: Predicting in-hospital mortality for survivors of ARC events may help clinical prognostication. Such tools could also facilitate comparisons between hospitals and guide quality improvement projects.
Citation: Moskowitz A, Anderson LW, Karlsson M, et. al. Predicting in-hospital mortality for initial survivors of acute respiratory compromise (ARC) events: Development and validation of the ARC score. Resuscitation. 2017 Jun;115:5-10.
Dr. Suman is clinical instructor of medicine in the University of Kentucky division of hospital medicine.
Background: Scoring systems exist to predict outcomes following cardiac arrest. There is currently no reliable model to predict outcome of patients who have survived acute respiratory compromise (ARC).
Study Design: A retrospective cohort study.
Setting: Get with the Guidelines Resuscitation (GWTG-R) is an online medical registry that tracks ARC data from more than 300 hospitals.
Synopsis: Using the GWTG-R database of ARC, researchers identified 13,193 cases of ARC to study the variables affecting prognosis. They randomized the group into derivation (75% of patients) and validation (25% of patients) cohorts and used c-statistics to create the prognostic scoring system. The greatest predictors of in-hospital mortality were age greater than 80 years, hypotension in the four hours preceding the ARC event, and the need for intubation.
This scoring system did not take into account any comorbidities (such as organ failure) that occurred shortly after the ARC event, although these likely affect mortality.
Bottom Line: Predicting in-hospital mortality for survivors of ARC events may help clinical prognostication. Such tools could also facilitate comparisons between hospitals and guide quality improvement projects.
Citation: Moskowitz A, Anderson LW, Karlsson M, et. al. Predicting in-hospital mortality for initial survivors of acute respiratory compromise (ARC) events: Development and validation of the ARC score. Resuscitation. 2017 Jun;115:5-10.
Dr. Suman is clinical instructor of medicine in the University of Kentucky division of hospital medicine.
VIP services linked to unnecessary care
Clinical Question: Does “very important person” (VIP) status impact physician decision making and lead to unnecessary care?
Background: In many centers, VIP patients avail VIP services, which involve extra services beyond the standard of care. No prior studies assess the impact of such VIP services on these patients.
Setting: Centers associated with the Hospital Medicine Reengineering Network (HOMERuN).
Synopsis: Of the 160 hospitalists across eight sites, 45% felt that VIP services were present at their hospital. These patients often had personal ties with the hospital. The majority of hospitalists (78%) felt VIP patients received similar medical care, compared with non-VIP patients. However, 63% felt pressured by VIP patients or families to order unnecessary tests. Moreover, 36% perceived pressure from hospital administration to comply with VIP patient wishes. Most hospitalists (56%) reported being more likely to comply with requests from VIP patients than from other patients.
The survey questions were not validated, so the responses might not reflect actual perceptions of hospitalists. These results are purely qualitative, so the burden of unnecessary care cannot be quantified.
Bottom Line: Most hospitalists perceive VIP services to lead to pressure to deliver unnecessary care.
Citation: Allen-Dicker J, Auerbach A, Herzig SJ. Perceived Safety and Value of Inpatient “Very Important Person” Services. J Hosp Med. 2017 Mar;12(3):177-179.
Dr. Suman is clinical instructor of medicine in the University of Kentucky division of hospital medicine.
Clinical Question: Does “very important person” (VIP) status impact physician decision making and lead to unnecessary care?
Background: In many centers, VIP patients avail VIP services, which involve extra services beyond the standard of care. No prior studies assess the impact of such VIP services on these patients.
Setting: Centers associated with the Hospital Medicine Reengineering Network (HOMERuN).
Synopsis: Of the 160 hospitalists across eight sites, 45% felt that VIP services were present at their hospital. These patients often had personal ties with the hospital. The majority of hospitalists (78%) felt VIP patients received similar medical care, compared with non-VIP patients. However, 63% felt pressured by VIP patients or families to order unnecessary tests. Moreover, 36% perceived pressure from hospital administration to comply with VIP patient wishes. Most hospitalists (56%) reported being more likely to comply with requests from VIP patients than from other patients.
The survey questions were not validated, so the responses might not reflect actual perceptions of hospitalists. These results are purely qualitative, so the burden of unnecessary care cannot be quantified.
Bottom Line: Most hospitalists perceive VIP services to lead to pressure to deliver unnecessary care.
Citation: Allen-Dicker J, Auerbach A, Herzig SJ. Perceived Safety and Value of Inpatient “Very Important Person” Services. J Hosp Med. 2017 Mar;12(3):177-179.
Dr. Suman is clinical instructor of medicine in the University of Kentucky division of hospital medicine.
Clinical Question: Does “very important person” (VIP) status impact physician decision making and lead to unnecessary care?
Background: In many centers, VIP patients avail VIP services, which involve extra services beyond the standard of care. No prior studies assess the impact of such VIP services on these patients.
Setting: Centers associated with the Hospital Medicine Reengineering Network (HOMERuN).
Synopsis: Of the 160 hospitalists across eight sites, 45% felt that VIP services were present at their hospital. These patients often had personal ties with the hospital. The majority of hospitalists (78%) felt VIP patients received similar medical care, compared with non-VIP patients. However, 63% felt pressured by VIP patients or families to order unnecessary tests. Moreover, 36% perceived pressure from hospital administration to comply with VIP patient wishes. Most hospitalists (56%) reported being more likely to comply with requests from VIP patients than from other patients.
The survey questions were not validated, so the responses might not reflect actual perceptions of hospitalists. These results are purely qualitative, so the burden of unnecessary care cannot be quantified.
Bottom Line: Most hospitalists perceive VIP services to lead to pressure to deliver unnecessary care.
Citation: Allen-Dicker J, Auerbach A, Herzig SJ. Perceived Safety and Value of Inpatient “Very Important Person” Services. J Hosp Med. 2017 Mar;12(3):177-179.
Dr. Suman is clinical instructor of medicine in the University of Kentucky division of hospital medicine.