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Search results for "Pulmonology"

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  • Pulmonology
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Cases & Commentaries

The Lung Nodule That Refused To Grow

  • Spotlight Case
  • Web M&M

Alex A. Balekian, MD, MSHS, and Michael K. Gould, MD, MS; December 2012

At his first visit with a new physician, a man with a "spot" on his lung reported being followed with CT scans every 6–12 months for 8 years. In total, the patient had more than 20 CT scans.

Cases & Commentaries

Missed Pneumonia

  • Web M&M

Jeffrey M. Rohde, MD, and Scott A. Flanders, MD; November 2012

A 32-year-old man went to the emergency department with fever and pleuritic chest pain. Following an extensive work-up, he was discharged with "fever, pleural effusion, and chest wall pain", but no clear diagnosis. He returned to the ED 3 days later with worsening pain, continued fever, a new cough, and dyspnea. The patient was started on antibiotics and admitted for pneumonia with effusion.

Journal Article > Study

Reevaluation of diagnosis in adults with physician-diagnosed asthma.

Aaron SD, Vandemheen KL, FitzGerald JM, et al; Canadian Respiratory Research Network. JAMA. 2017;317:269-279.

Misdiagnosis can contribute to overuse of unnecessary medication and treatments as well as a delay in appropriate treatment, placing patients at increased risk of harm. This prospective cohort study suggests that asthma may be frequently misdiagnosed in the community setting as a result of inadequate testing for airflow limitations. In 2% of the cases analyzed, a serious underlying cardiorespiratory condition was misdiagnosed as asthma.

Newspaper/Magazine Article

Correct use of inhalers: help patients breathe easier.

ISMP Medication Safety Alert! Acute Care Edition. July 14, 2016;21:1-6.

Patients and clinicians can make medication administration mistakes when new drug delivery mechanisms are introduced. This newsletter article reviews common errors associated with the use of inhalers and offers recommendations for patients, nurses, respiratory therapists, pharmacists, and health care organizations to educate patients on the use of these medications.

Journal Article > Study

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care.

Nguyen MC, Moffatt-Bruce SD, Strosberg DS, Puttmann KT, Pan YL, Eiferman DS. Surgery. 2016;160:858-868.

The AHRQ Patient Safety Indicators (PSIs) rely on hospital administrative data to screen for patient safety problems. This study used independent physician chart review to assess the reliability of PSI 11 (postoperative respiratory failure) in identifying clinically significant patient safety events and found a positive predictive value of 38.3%. The authors argue that PSI 11 should not be used as a measure for hospital performance.

Journal Article > Commentary

A piece of my mind. Writing the wrong.

Patel JJ. JAMA. 2015;314:671-672.

Despite the potential for electronic health record (EHR) systems to improve access to patient data, unintended consequences have emerged that can hinder information seeking. To highlight how EHRs can detract from patient–physician relationships, this commentary reveals insights from a physician who failed to notice a patient's respiratory failure and distress due to over-reliance on the EHR.

Journal Article > Review

Prompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?

Weiss CH, Wunderink RG. Curr Opin Crit Care. 2013;19:448-452

This review evaluates the use of checklists coupled with forcing functions in the intensive care unit as a strategy to enhance appropriate antibiotic use.

Journal Article > Study

Does inappropriate selectivity in information use relate to diagnostic errors and patient harm? The diagnosis of patients with dyspnea.

Zwaan L, Thijs A, Wagner C, Timmermans DR. Soc Sci Med. 2013;91:32-38.

Inappropriate selectivity (failure to consider all available information or potential diagnoses) was a major contributor to diagnostic errors in patients with dyspnea.

Cases & Commentaries

Buprenorphine and the Medically Ill Patient

  • Web M&M

Elinore F. McCance-Katz, MD, PhD; October 2012

A man with a long history of opioid dependence (and smoking) went to a substance abuse program for detoxification. The patient received buprenorphine/naloxone and was found unresponsive and cyanotic a few hours later. He was diagnosed with opiate-induced respiratory distress complicated by pneumonia and chronic obstructive pulmonary disease.

Cases & Commentaries

Routine Goes Awry

  • Web M&M

Kevin C. Huoh, MD; Kristina W. Rosbe, MD; June 2011

A healthy child underwent tonsillectomy and adenoidectomy. Extubated after an uneventful surgery, within an hour the child became hypoxic and unable to breathe spontaneously, requiring reintubation.

Journal Article > Study

Time trends in pulmonary embolism in the United States: evidence of overdiagnosis.

Wiener RS, Schwartz LM, Woloshin S. Arch Intern Med. 2011;171:831-837.

Since the introduction of new diagnostic technologies in the late 1990s, pulmonary embolism diagnoses have increased, but mortality from pulmonary embolisms has not decreased. This combination of findings likely represents overdiagnosis—either due to false-positive diagnoses or detection (and treatment) of clinically insignificant clots.

Audiovisual

Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit.

Berenholtz SM, Pham JC, Thompson DA, et al. Infect Control Hosp Epidemiol. 2011;32:305-314. 

The landmark Keystone ICU project, a statewide quality improvement initiative that used interventions grounded in safety culture and human factors engineering to improve safety in the intensive care unit, stands as one of the seminal achievements of the patient safety field. The success of the Keystone ICU project at reducing central line–associated bloodstream infections has been widely publicized, and this study reports a similar success in reducing rates of ventilator-associated pneumonia. As with the prior results, this article emphasizes that the success of the study was attributable to the multifaceted quality improvement approach used and the cultural change it engendered in participating ICUs.

Journal Article > Study

The value of adding a verbal report to written handoffs on early readmission following prolonged respiratory failure.

Hess DR, Tokarczyk A, O’Malley M, Gavaghan S, Sullivan J, Schmidt U. Chest. 2010;138:1475-1479.

Teamwork and communication failures are a continued threat to patient safety. Intensive care units (ICU) have demonstrated the impact of different strategies to address these failures and improve patient outcomes. This study, targeting patients with prolonged respiratory failure, involved adding a verbal telephone report to an existing written one during transfer from the ICU. While the strengthened handoff process was associated with a trend toward reduced readmissions, its most impressive impact was on the total cost of care per patient, which fell significantly. Investigators estimated that nearly $185,000 was saved per 100 discharges, arguing that their intervention represents an improvement in the value of care (quality divided by cost) for this population. An accompanying editorial [see link below] discusses the implications of these findings and the broader role of poor communication in medical errors.

Journal Article > Study

Improving reliability of clinical care practices for ventilated patients in the context of a patient safety improvement initiative.

Pinto A, Burnett S, Benn J, et al. J Eval Clin Pract. 2011;17:180-187.

This qualitative study examined the process of implementing a standardized checklist of safety interventions for patients receiving mechanical ventilation.

Journal Article > Study

Detection of postoperative respiratory failure: how predictive is the Agency for Healthcare Research and Quality's Patient Safety Indicator?

Utter GH, Cuny J, Sama P, et al. J Am Coll Surg. 2010;211:347-354.e1-29.

The AHRQ Patient Safety Indicator for postoperative respiratory failure accurately identified cases of clinically diagnosed respiratory failure, with a false-positive rate of approximately 17%.

Journal Article > Study

Clinical and economic outcomes attributable to health care–associated sepsis and pneumonia.

Eber MR, Laxminarayan R, Perencevich EN, Malani A. Arch Intern Med. 2010;170:347-353.

Health care–associated infections are common and the subject of wide-scale prevention programs, despite concerns about their use as a quality metric. This study used a national database to examine the clinical and economic costs attributed to the development of health care–associated sepsis and pneumonia. Analyzing nearly 600,000 cases, investigators found 2.3 million hospitalization days, $8.1 billion in in-hospital costs, and 48,000 preventable deaths attributed to health care–associated sepsis and pneumonia. They also reported at least 40% higher length of stay and costs in patients with these complications who underwent invasive procedures compared to those who did not. Despite limitations in utilizing administrative data to draw clinical details, the findings are notable. A related commentary [see link below] discusses reducing preventable harm in the context of this study's findings, calling for greater investments in the science of health care quality and safety.

Journal Article > Study

Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia?

Johnson V, Mangram A, Mitchell C, Lorenzo M, Howard D, Dunn E. Am Surg. 2009;75:1171-1174.

This study demonstrated that implementation of multidisciplinary rounds reduced the incidence of ventilator-associated pneumonia in a trauma unit.

Journal Article > Commentary

Poor medication history plus slow symptom onset delays a diagnosis.

Wilkin T, Hale LS, Claiborne RA. JAAPA. October 2009;22:39-41.

This case report presents complete documentation of home medications as a strategy to prevent delay in diagnosis due to unrecognized medication adverse effects.

Book/Report

Hospital Performance Report.

Trenton, NJ: New Jersey Department of Health and Senior Services; March 2012.

Detailing results of an error reporting initiative in New Jersey, this annual report explains how consumers can use this information and provides tips for safety when obtaining health care. A supplement highlights findings related to patient safety indicators.

Journal Article > Study

Dropping the baton during the handoff from emergency department to primary care: pediatric asthma continuity errors.

Hsiao AL, Shiffman RN. Jt Comm J Qual Patient Saf. 2009;35:467-474.

Discontinuity between providers is a well-documented source of errors, as prior research has documented safety problems arising from handoffs and signouts in the hospital and at the time of hospital discharge. The need for accurate information transfer between providers is no less important for patients seen in the emergency department (ED), but this study found that most pediatricians were unaware that their asthma patients had required an ED visit. This occurred despite the existence of a structured system for communication between the ED and primary care physicians. Many patients also failed to follow up in clinic as instructed, perhaps corroborating prior research showing that many ED patients do not fully comprehend discharge instructions. This study adds another facet to the problem of patient safety in chronic disease management.

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