September 2009

Spontaneous awakening trials: How to increase adherence in the ICU

Research is one thing, and practice quite another. It’s been nine years since a New England Journal of Medicine study showed ICU patients recover more quickly when their sedation medication is routinely stopped. It’s been over a year and a half since a Lancet study found that combining this practice, called spontaneous awakening trials, with spontaneous breathing trials further decreased patients’ time on mechanical ventilation and in the ICU. Yet a sizable number of hospitals still don’t do it.

Lost in transition

Medication discrepancies between hospitals and skilled nursing facilities are common. Learn why and what you can do about it.

Treatment on the fly: Mobile units help hospitals boost surge capacity

Portable “MASH-likeâ€ï¿½ hospital units are helping communities across the country improve their ability to respond to disasters and other events requiring extra capacity.

Q&A: Lowering hospital readmissions by improving care transitions

The Hospital to Home program targets changes by 2012.

Hospitalist Web site streamlines signouts, helps communication

At St. John’s Mercy Medical Center in St. Louis, Mo., a hospitalist-developed Web site makes it easy to identify and contact each patient’s attending physician.

Unmasking the patient's hidden agenda

A patient’s reply of “so-soâ€ï¿½ regarding her depression leads a doctor to dig deeper.

A devotion to patients that springs from gratitude

For Suren Pathman, MD, doctoring is all about service.

Letter from the Editor

Studies have shown that critically ill patients who are given “sedation vacationsâ€ï¿½ consisting of spontaneous awakening trials (SATs) and spontaneous breathing trials spend less time on the ventilator and less time in the ICU overall. But many hospitals don’t follow written policy on performing SATs, and a large proportion don’t use SATs in the majority of their patients.

Newman's Notions | FREE
Most ACP Hospitalist content is available exclusively to ACP Members. This article is free to the public.

A tick's tale

People have always been fascinated by medical comedies, medical dramas and medical reality shows. One of the most interesting of the current crop has to be “House, M.D.â€ï¿½â€”not because it is the most believable, but because it is by far the most inaccurate.

Too much information

A medical student recounts her experience as a patient.

Accurate coding for transfer to post-discharge facilities

Accurate ICD-9-CM codes for diagnoses and procedures performed during a hospital stay will only partially determine payment. Discharge status codes must be given equal attention.

MKSAP: Sedation and ventilation

The following cases and commentary, which address sedation and ventilation, are excerpted from ACP’s Medical Knowledge Self-Assessment Program (MKSAP14).

Propofol, ventilators, infusion sets recalled

Propofol, ventilators, infusion sets recalled.

Journal watch: recent studies of note

Recent studies about pressure stocking use after stroke, hospital-acquired pneumonia, and other topics.

In the News

Guidelines on catheter-related infections, and more.