In the Literature

The Hospitalist. 2010 May;2010(05):

May 1, 2010|The Hospitalist

Sameer Badlani, MD;Stacy S. Banerjee, MD;Alan J. Jung, MD;Elizabeth Marlow, MD, MPP;Valerie G. Press, MD, MPH;Milda R. Saunders, MD, MPH;Nilam J. Soni, MD Srilaxmi Tumuluri, MD;University Of Chicago

In This Edition

Literature at a Glance

A guide to this month’s studies

ICU volume and outcomes
Bicarbonate and contrast-induced nephropathy
Rate of incidental findings in chest CT angiography
Consequences of adverse-event reporting by physicians
Hip fracture comanagement
Niacin vs. ezetimibe in atherosclerosis
Effect of hospital pharmacists on readmission rates
Antibiotics in acute exacerbations of COPD

Higher Patient ICU Inflow Volumes Are Associated with Unplanned Readmissions to ICU

Clinical question: Do higher rates of unplanned ICU readmissions occur on days with high patient inflow volumes?

Background: Patients readmitted to ICUs have longer lengths of stay (LOS) and higher rates of in-hospital mortality. Previous studies suggest many ICU readmissions might be due to premature discharge, but there is little evidence evaluating the impact of patient inflow volumes on the incidence of ICU readmissions.

Study design: Retrospective, cohort study.

Setting: Large, urban, tertiary-care academic medical center in Baltimore.

Synopsis: A retrospective review of 3,233 discharges from a neurosciences critical-care unit revealed 95 unplanned readmissions to the ICU setting within 72 hours of discharge to lower level of care. The odds of one or more discharges becoming an unplanned readmission became significantly higher on days when ≥8 patients were admitted to the ICU (OR, 1.66; 95% CI, 1.03-2.68), and the odds of an unplanned readmission were almost five times higher on days when ≥10 patients were admitted, compared with days when ≤9 patients were admitted (OR, 4.99; 95% CI, 2.45-10.17).

After adjusting for patient complexity, patients discharged on days with ≥10 admissions had higher than twice the odds of becoming an unplanned readmission than patients discharged on days with ≤9 admissions (OR, 2.34; 95% CI, 1.27-4.34).

This study was limited to patients in a neurosciences critical-care unit at a single academic medical center. Further research is needed to better understand how high admission volumes lead to increased unplanned readmission rates.

Bottom line: Days with high patient inflow volumes to the ICU are associated with higher rates of unplanned readmissions to the ICU, and the rate of unplanned readmissions becomes significant once a daily threshold of eight admissions is reached.

Citation: Baker DR, Pronovost PJ, Morlock LL, Geocadin RG, Holzmueller CG. Patient flow variability and unplanned readmissions to an intensive care unit. Crit Care Med. 2009;37(11):2882-2887.

Clinical Shorts

DECLINE IN THE PERCENTAGE OF PATIENTS SEEN WITHIN RECOMMENDED TRIAGE TIMES IN U.S. EMERGENCY DEPARTMENTS

Cross-sectional study showed a decline in the triage target time by 0.8% per year on average over a period of 10 years, and the most emergent patients are the least likely to be seen within the triage target time.

Citation: Horwitz LI, Bradley EH. Percentage of US emergency department patients seen within the recommended triage time: 1997 to 2006. Arch Intern Med.2009;169(20):1857-1865.

INCREASE IN HDL LEVELS WITH THERAPY APPEARS TO BE ASSOCIATED WITH REDUCTION IN CARDIOVASCULAR EVENTS

Increase in HDL level with lipid therapy was a strong independent risk factor for reduction in cardiovascular events, and the lower the pretreatment LDL level, the greater the benefit of raising the HDL level.

Citation: Grover SA, Kaouache M, Joseph L, Barter P, Davignon J. Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels. Arch Intern Med. 2009;169(19):1775-1780.

Effectiveness of Sodium Bicarbonate in Contrast-Induced Nephropathy Prevention

Clinical question: Is IV sodium bicarbonate effective for prevention of contrast-induced nephropathy (CIN) in high-risk patients?

Background: CIN is a leading cause of acute kidney injury in the hospital setting. Some studies have suggested IV sodium bicarbonate might reduce risk for CIN; other studies challenge this conclusion.