The IV antibiotic tigecycline received a label change and warning from the FDA, given the drug has been associated with higher mortality than similar broad spectrum antibiotics. Although a mechanism for the higher mortality has not been elucidated, the FDA is recommending the use of alternative antibiotics, rather than tigecycline, in hospitalized patients wtih serious infections (FDA site)

The CDC has announced an expected 160 million doses of influenza vaccine this year, to be available by the end of September. The single vaccine will incorporate all 3 influenza viruses (including the 2009 H1N1) and will be universally recommended to all adult patients and all healthcare workers (CDC website)

In this systematic review of bedside assessments for delirium in hospitalized patients, the CAM had the best diagnostic accuracy of all tests reviewed, with a positive likelihood ratio of 10 and negative likelihood ratio of 0.2 (abstract).

In this retrospective analysis of 5777 hospitalized patients, ESR and CRP “agreed” (both elevated or both normal) in 67% of patients. Of the 33% disagreements, chart review found the majority of disagreements were an elevated ESR and normal CRP, where the CRP more accurately reflected the patient’s condition (resolving inflammatory condition or false positive ESR). In suspected inflammatory conditions, CRP is a more accurate measure in hospitalized patients, with fewer false negatives or positives than ESR (abstract)

This paper described the role and process of a hospitalist managing patients admitted but boarding in the ED of a large tertiary care hospital. In hospitals with high occupancy rates, ED boarders are a common and vulnerable patient population, the care of which is often fragmented and unpredictable. This program is intriguing and may be feasible for large hospital medicine programs to implement (abstract)

In this large retrospective analysis, every 10% increase in the ”fragmentation” of care (% of care given by a hospitalist that was not the patient’s primary hospitalist) increased the LOS by 0.39 days. Although it is easy to agree that care fragmentation is undesirable, we need to figure out ways to balance career longevity with care continuity to optimize care quality and efficiency (abstract)

In this time-motion study of hospitalists, only 17% of the day was spent in direct patient care, 25% communicating, and 34% with medical documentation. In addition, 16% of the time was spent doing more than 1 activity (multi-tasking). Those with higher patient loads spent the same amount of time in direct patient care, but spent less time communicating and documenting (abstract). Presumably streamlining communication and documentation processes may allow us to see more patients, or spend more time with our current ones.

In this large retrospective analysis of an ICU, the amount of blood transfused significantly decreased from 1997 to 2007. The percent of patients transfused decreased from 31% to 18%, the mean hemoglobin level before transfusion decreased from 7.9 to 7.3, and the mean number of transfusions decreased from 4.3 to 3.0. ICU transfusion practices have become more restrictive in accordance with clinical guideline recommendations (abstract)

In this trial of 200 hip fracture patients, they were randomized to IV iron or standard treatment. The iron group had lower rates of blood transfusions (41% vs 33%), which was significantly lower in the subgroup of patients with intra-capsular fractures (46% vs 14%). There were no significant differences in LOS or mortality. IV iron peri-operatively may reduce transfusion need in patients with hip fractures (abstract)

This evaluation of University of Michigan Health System’s liability claims and cost before and after they implemented a program of full disclosure of medical errors (with patient compensation). They found decreases in the rate of liability claims and decreases in the costs (of total liability, patient compensation, and other legal costs). Not only is full medical error disclosure the appropriate thing to do, it may also be financially advantageous (abstract).