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Understanding Hospital Delirium And Some Tips To Prevent It

No matter how sick my grandmother got or what her doctors said, she refused to go to the hospital because she thought it was a dangerous place. To some degree, she was right. Although hospitals can be places of healing, hospital stays can have serious downsides, too.

One that has been getting a lot of attention lately is the development of delirium in people who are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. It’s the most common complication of hospitalization among older people.

We wrote about treating and preventing hospital delirium earlier this year in the Harvard Women’s Health Watch. In the New York Times “The New Old Age” blog, author Susan Seliger vividly describes her 85-year-old mother’s rapid descent into hospital delirium, and tips for preventing it.

Although delirium often recedes, it may have long-lasting aftereffects. Read more »

*This blog post was originally published at Harvard Health Blog*

CMS “Never Events” Incentivize Physicians To Avoid Caring For High Risk Patients

In 2008, the Centers for Medicare and Medicaid Services (CMS) announced it would no longer pay for the treatment of “never events,” i.e., certain medical conditions in hospitalized patients which the Feds deem to be universally avoidable under all circumstances. These conditions included:

* Decubitus ulcers
* Two kinds of catheter-associated infections
* Air embolism
* Mediastinitis after coronary bypass surgery
* Transfusing patients with the wrong blood type
* Leaving objects inside surgery patients
* In-hospital falls

Then, having been delighted with the results of its original list (or dismayed that healthcare costs continued to skyrocket despite its original list) CMS subsequently proposed declaring several new conditions as “never events,” including: Read more »

*This blog post was originally published at The Covert Rationing Blog*

Are The Quality Metrics For Neurologists Reasonable?

Quality and safety metrics that will specifically affect neurologists/neurohospitalists are coming in the next few years, and neurohospitalists need to be involved in the discussion of what those metrics are, warned S. Andrew Josephson of USCF during a neurohospitalists session at the Stroke 2010 conference yesterday.

He urged the audience to consider the current metric of “time to antibiotics administration for pneumonia,” which seems like a reasonable quality metric on the surface. To get compliance rates up, many hospitals give antibiotics to anyone with a little sputum, a cough, a fever, etc., as soon as he/she arrives at the ED. Thus, resistance rates have risen along with administration rates, because people are getting the drugs when they have things like bronchitis, not just pneumonia. Read more »

*This blog post was originally published at ACP Hospitalist*

Cognitive Impairment Often Goes Undocumented In Hospital Charts

A recent JHM study found that hospital staff often don’t recognize cognitive impairment in patients age 65 and older. This was especially true for patients on the younger end of the spectrum, and those with more comorbidity.

Of the 424 patients (43%) in the study who were cognitively impaired, 61% weren’t recognized as such by ICD-9 coding. Interestingly, there was no significant difference between patients with documented and undocumented cognitive impairment as far as mortality, length of stay, home discharge, readmission rates, incidence of delirium, or receipt of anticholinergics. One troubling finding: a significant number of patients with cognitive impairment received anticholinergic medication, even though it’s not recommended for patients with any type of CI. Read more »

*This blog post was originally published at ACP Hospitalist*

The Ultimate Criterion For A Hospital “Never Event”

As many of you know, I’ve been pretty upset about the “never events” policy put forward by CMS. That’s because they took a theoretically reasonable punitive rule (Medicare will not pay hospitals for patient care related to gross medical errors, aka “never events,” like wrong-side surgery) and made it far too general (never events include delirium, falls, and any infection – even a cold). It is absolutely impossible to prevent these sorts of things 100% of the time. So how should “never events” be defined?

The Happy Hospitalist nails it:

Can the never event happen at home? If the answer is yes, it cannot be a never event. It is a natural event. Even the criminal events that nobody can foresee are considered never events. Tell me how a hospital can prevent a random crazy family member or hospital guest from going berserk and assaulting an employee or patient. It’s impossible to predict or prevent.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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How To Be A Successful Patient: Young Doctors Offer Some Advice

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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