Estimating hospital costs of catheter‐associated urinary tract infection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100140/1/jhm2079.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/100140/2/jhm2079-sup-0002-suppinfo.pd

What effect does an educational intervention have on interns' confidence and knowledge regarding acute dyspnea management?

BACKGROUND Though acute dyspnea is commonly encountered in hospitalized patients, interns often receive only informal instruction in managing such patients. We hypothesized that formal instruction would improve interns' knowledge and confidence in managing patients with acute dyspnea. METHODS Twenty-six internal medicine interns were randomized to receive either standard education or standard education plus the educational intervention. The educational intervention included two small-group, case-based discussions on acute dyspnea management. All participants completed pre- and post-intervention surveys over four months that assessed their knowledge and confidence in managing patients with acute dyspnea. RESULTS Of the 16 interns in the intervention group, 14 attended one of the two small-group sessions while seven attended both sessions. Mean confidence increased by 21.2% in the intervention group and 14.4% in the control group. The trend over time for both groups was significant ( P < .001); the effect of the intervention was not ( P = .19). Mean knowledge scores increased 7.6% in the intervention group and 5.5% in the control group. Again, the trend over time for both groups was significant ( P < .01), but the effect of the intervention was not ( P = .65). A per-protocol analysis revealed a trend toward significance with mean scores increasing 15.6% ( P = .067). CONCLUSIONS Our trial found that intern confidence and knowledge about acute dyspnea management increased significantly over time; however, no significant differences between the intervention and control groups were seen. The complete intervention was not administered to the majority of the intervention group, thereby skewing results to the null. The per-protocol analysis suggests attendance at educational sessions may improve knowledge. Future interventions should use a more sensitive testing instrument, a larger sample, and a more powerful intervention. Journal of Hospital Medicine 2006;1:339–343. © 2006 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55916/1/134_ftp.pd

Clostridium difficile infection in the United States: A national study assessing preventive practices used and perceptions of practice evidence

We surveyed 571 US hospitals about practices used to prevent Clostridium difficile infection (CDI). Most hospitals reported regularly using key CDI prevention practices, and perceived their strength of evidence as high. The largest discrepancy between regular use and perceived evidence strength occurred with antimicrobial stewardship programs.Infect. Control Hosp. Epidemiol. 2015;36(8):969–971</jats:p

Do physicians examine patients in contact isolation less frequently? A brief report

Background: Patients who are hospitalized and infected with multi drug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to gown and glove before patient examination. Contact isolation with active culture surveillance appears beneficial in preventing the spread of drug-resistant infections; however, contact isolation may impede the ability to examine patients as a result of the additional effort required to gown and glove. We assessed whether patients who are hospitalized and placed under contact precautions are examined less often by second- and third-year medical residents (ie, senior medical residents), and attending physicians during morning rounds. Method: We conducted a prospective cohort study on the inpatient medical services at 2 university-affiliated medical centers. We directly observed senior medical residents and attending physicians during morning rounds, and recorded the contact precaution status of the patient and whether they were examined by either physician. Results: Of a total of 139 patients, 31 (22%) were in contact isolation. Senior medical residents examined 26 of 31 patients (84%) in contact isolation versus 94 of 108 patients (87%) not in contact isolation (relative risk, 0.96; 95% confidence interval, 0.81-1.14; P = .58). In comparison, attending physicians examined 11 of 31 patients (35%) in contact isolation versus 79 of 108 patients (73%) not in contact isolation (relative risk, 0.49; 95% confidence interval, 0.30-0.79; P \u3c .001). Discussion: Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation

Do physicians examine patients in contact isolation less frequently? A brief report

Background: Patients who are hospitalized and infected with multi drug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to gown and glove before patient examination. Contact isolation with active culture surveillance appears beneficial in preventing the spread of drug-resistant infections; however, contact isolation may impede the ability to examine patients as a result of the additional effort required to gown and glove. We assessed whether patients who are hospitalized and placed under contact precautions are examined less often by second- and third-year medical residents (ie, senior medical residents), and attending physicians during morning rounds. Method: We conducted a prospective cohort study on the inpatient medical services at 2 university-affiliated medical centers. We directly observed senior medical residents and attending physicians during morning rounds, and recorded the contact precaution status of the patient and whether they were examined by either physician. Results: Of a total of 139 patients, 31 (22%) were in contact isolation. Senior medical residents examined 26 of 31 patients (84%) in contact isolation versus 94 of 108 patients (87%) not in contact isolation (relative risk, 0.96; 95% confidence interval, 0.81-1.14; P = .58). In comparison, attending physicians examined 11 of 31 patients (35%) in contact isolation versus 79 of 108 patients (73%) not in contact isolation (relative risk, 0.49; 95% confidence interval, 0.30-0.79; P \u3c .001). Discussion: Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation

Hospitalist Staffing and Patient Satisfaction in the National Medicare Population

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96722/1/jhm2001.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/96722/2/jhm2001-sup-0001-suppinfo.pd

Unique Factors Rural Veterans’ Affairs Hospitals Face When Implementing Health Care‐Associated Infection Prevention Initiatives

Purpose Health care‐associated infection (HAI) is costly to hospitals and potentially life‐threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans’ Affairs (VA) hospitals and the unique factors they face in implementing these practices. Methods This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. Findings We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Conclusions Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI‐related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102110/1/jrh12024.pd

Hospitalist Experiences, Practice, Opinions, and knowledge regarding peripherally inserted central catheters: Results of a national survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101780/1/jhm2095.pd

Urinary Catheters: What Type Do Men and Their Nurses Prefer?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111067/1/j.1532-5415.1999.tb01567.x.pd

Informal Caregiving Time and Costs for Urinary Incontinence in Older Individuals in the United States

To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals. DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443). SETTING: Community-dwelling older people. PARTICIPANTS: National population-based sample of community-dwelling older people. MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads. RESULTS: Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours ( P < .001). Women in these groups received 5.9, 7.6, and 10.7 hours ( P < .001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and$4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and$2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care. CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66038/1/j.1532-5415.2002.50170.x.pd