Wm. Claiborne Dunagan

Antimicrobial misuse in patients with positive blood cultures

PURPOSE Inappropriate antimicrobial use was examined among a randomly and prospectively selected cohort of patients with at least one positive result of blood cultures. This misuse was then analyzed with respect to hospital charges and length of stay (LOS). PATIENTS AND METHODS The study consisted of 70 patients (average age, 58.5 years) who had not undergone bone marrow transplantation. Patient charts were reviewed daily for the following information: clinical signs and symptoms of infection, pertinent laboratory data, culture results, detailed data on each antimicrobial in every antimicrobial regimen and their appropriateness, hospital charges, LOS, diagnostic and procedure codes, and discharge status. Three severity of illness variables were generated. Inappropriate antimicrobial use was described according to one of 12 categories. RESULTS The percent of antimicrobial misuse, defined as the proportion of days of administration of antimicrobials on which one or more antimicrobials were judged inappropriate, was found to be 22.3%. After adjustment for severity of illness and diagnosis, this average inappropriateness correlated with 4.2 additional hospitalization days and

Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system.

5,368 additional hospital charges. CONCLUSION Our results cannot distinguish among several possible reasons for these associations, including direct causality (e.g., toxicity and prolonged hospitalization for antimicrobial use) and indirect links such as inappropriate utilization of other resources and influences of severity of illness on antimicrobial use not accounted for in our equations. Nevertheless, the magnitude of the association gives import to the desirability of further studies.

The Cost of Serious Fall-Related Injuries at Three Midwestern Hospitals

OBJECTIVE Preventing hospital falls and injuries requires knowledge of fall and injury circumstances. Our objectives were to determine whether reported fall circumstances differ among hospitals and to identify predictors of fall-related injury. DESIGN Retrospective cohort study. Adverse event data on falls were compared according to hospital characteristics. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for risk factors for fall-related injury. SETTING Nine hospitals in a Midwestern healthcare system. PATIENTS Inpatients who fell during 2001-2003. RESULTS The 9 hospitals reported 8,974 falls that occurred in patient care areas, involving 7,082 patients; 7,082 falls were included in our analysis. Assisted falls (which accounted for 13.3% of falls in the academic hospital and 9.8% of falls in the nonacademic hospitals; P<.001) and serious fall-related injuries (which accounted for 3.7% of fall-related injuries in the academic hospital and 2.2% of fall-related injuries in the nonacademic hospitals; P<.001) differed by hospital type. In multivariate analysis for the academic hospital, increased age (aOR, 1.006 [95% CI, 1.000-1.012]), falls in locations other than patient rooms (aOR, 1.53 [95% CI, 1.03-2.27]), and unassisted falls (aOR, 1.70 [95% CI, 1.23-2.36]) were associated with increased injury risk. Altered mental status was associated with a decreased injury risk (aOR, 0.72 [95% CI, 0.58-0.89]). In multivariate analysis for the nonacademic hospitals, increased age (aOR, 1.007 [95% CI, 1.002-1.013]), falls in the bathroom (aOR, 1.46 [95% CI, 1.06-2.01]), and unassisted falls (aOR, 1.83 [95% CI, 1.37-2.43]) were associated with injury. Female sex (aOR, 0.83 [95% CI, 0.71-0.97]) was associated with a decreased risk of injury. CONCLUSION Some fall characteristics differed by hospital type. Further research is necessary to determine whether differences reflect true differences or merely differences in reporting practices. Fall prevention programs should target falls involving older patients, unassisted falls, and falls that occur in the patients bathroom and in patient care areas outside of the patients room to reduce injuries.

Patient satisfaction: focusing on "excellent".

BACKGROUND Consequences of fall-related injuries can be both physically and financially costly, yet without current data, hospitals cannot completely determine the financial cost. As part of the analysis for an initiative to minimize falls with injury, the cost and length of stay attributable to serious fall injury were estimated at three hospitals in a Midwestern health care system METHODS In a retrospective case-control study, 57 hospital inpatients discharged between January 1, 2004, and October 16, 2006, who sustained a serious fall-related injury (fracture, subdural hematoma, any injury resulting in surgical intervention, or death) were identified through the incident reporting system and matched to nonfaller inpatient controls by hospital, age within five years, year of discharge, and diagnosis-related group (DRG). RESULTS Multivariate analyses indicated that operational costs for fallers with serious injury, as compared with controls, were

Evaluation of Rooms with Negative Pressure Ventilation Used for Respiratory Isolation in Seven Midwestern Hospitals

13,316 more (p < .01; 95% confidence interval [CI],

Clinical validation of the AHRQ postoperative venous thromboembolism patient safety indicator.

1,395-

Screening of physicians for tuberculosis.

35,561) and that fallers stayed 6.3 days longer than nonfallers (p < .001; 95% CI, 2.4-14.9). Univariate analyses indicated they were also significantly more likely to have diabetes with organ damage, moderate to severe renal disease, and a higher mean score on the Charlson Comorbidity Index. In optimal bipartite matching (OBM) analyses, fallers with serious injury cost

Inpatients' willingness to recommend: a multilevel analysis.

13,806 more (p < .001; 95% CI,

Neisseria elongata subsp. elongata, as a cause of human endocarditis

5,808-

Decision Analysis for Metric Selection on a Clinical Quality Scorecard

29,450) and stayed 6.9 days longer (p < .001; 95% CI, 2.8-14.9). CONCLUSIONS Hospital inpatients who sustained a serious fall-related injury had higher total operational costs and longer lengths of stay than nonfallers. Despite possible limitations regarding the cost allocation methods, the analysis included data from three different hospitals, and supplemental multivariate analyses adjusting for academic hospital status did not meaningfully affect the results.