Letter from the Editor

This month's issue discusses quick screening tools for delirium, management of patients after opioid overdose, overuse of proton-pump inhibitors, and more.

Do you know when your patients are delirious? As much as half of inpatient delirium cases are not diagnosed, according to this month's cover story. The good news is that there may be a quick, simple solution. Researchers have recently been working to cut existing delirium screening tools down to the bare necessities, allowing rapid, but still effective, bedside screening. Identifying delirium sooner could allow for earlier, more effective intervention, experts say.

Patients who overdose on opioids are obviously in need of active medical intervention. But a recent Annals of Internal Medicine study found that, if they survive the first overdose, a surprising number of these patients continue receiving opioid prescriptions, increasing their risk of another overdose. In our story, experts weigh in on prescribing for patients after an overdose and balancing the need for pain control with the risks of the drugs.

Hospitalists should also be more cautious in doling out proton-pump inhibitors (PPIs). It reviews guidelines and expert advice on appropriate use of the drugs in the hospital, and it describes projects that some hospitals have put in place to get practice in line with those recommendations. Reducing unnecessary PPI use is an example of high-value care, and our story reveals how nurses may be best positioned to lead efforts, such as removing catheters and turning off telemetry, that strive to improve the value of inpatient care. The Success Story offers another example of a high-value care initiative.

This issue also includes multiple examples of reader-submitted clinical content. There's an Expert Analysis focused on upper-extremity deep venous thrombosis, and the Brief Case section, includes a group of cases from Saint Agnes Hospital in Baltimore and an individual case from Creighton University and St. Joseph's Hospital and Medical Center in Phoenix. If you have clinical experiences or thoughts to share, please get in touch.

Stacey Butterfield
Editor-in-Chief, ACP Hospitalist