Multisite analysis of patient experience scores and risk of hospital admission: a retrospective cohort study.

BACKGROUND: Routinely collected patient experience scores may inform risk of patient outcomes. The objective of the study was to evaluate the risk of hospital admission within 30-days following third-party receipt of the patient experience survey and guide interventions. METHODS: In this retrospective cohort study, we analyzed Hospital Consumer Assessment of Healthcare Providers and Systems surveys, January 2016-July 2019, from an institution's 20 hospitals in four U.S. states. Surveys were routinely sent to patients using census sampling. We analyzed surveys received ≤60 days following discharge from patients living ≤60 miles of any of the institution's hospitals. The exposures were 19 survey items. The outcome was hospital admission within 30 days after third-party receipt of the survey. We evaluated the association of favorable (top-box) vs unfavorable (non-top-box) score for survey items with risk of 30-day hospital admission in models including patient and hospitalization characteristics and reported adjusted odds ratios (aOR [95% confidence interval]). RESULTS: Among 40,162 respondents (mean age ± standard deviation: 68.1 ± 14.0 years), 49.8% were women and 4.3% had 30-day hospital admission. Patients with 30-day hospital admission, compared to those not admitted, were more likely to be discharged from a medical service line (62.9% vs 42.3%; P < 0.001) and have a higher Elixhauser index. Favorable vs unfavorable score for hospital rating was associated with lower odds of 30-day hospital admission in the overall cohort (0.88 [0.77-0.99]; P = 0.04), medical service line (0.81 [0.70-0.94]; P = 0.007), and upper tertile of Elixhauser index (0.79 [0.67-0.92]; P = 0.003). Favorable score for recommend hospital was associated with lower odds of 30-day hospital admission in the medical service line (0.83 [0.71-0.97]; P = 0.02) but for others (e.g. cleanliness of hospital environment) showed no association. CONCLUSION: In routinely collected patient experience scores, favorable hospital rating was associated with lower odds of 30-day hospital admission and may inform risk stratification and interventions. Evidence-based survey items linked to patient outcomes may also inform future surveys.

Early-Onset Neonatal Sepsis Caused by Vertical Transmission of Pasteurella multocida.

Early-onset neonatal sepsis contributes substantially to neonatal morbidity and mortality. Presenting signs and symptoms vary, and most causes are due to a limited number of common microbes. However, providers must be cognizant of unusual pathogens when treating early-onset sepsis (EOS). We report a case of a term neonate who presented with respiratory distress, lethargy, and hypoglycemia 5 hours after birth. He was treated for presumed EOS with blood culture, revealing an unusual pathogen, Pasteurella multocida . Sepsis from this pathogen is a rarely reported cause of early onset neonatal sepsis. Our report is one of few that implicate vertical transmission with molecular diagnostic confirmation of P . multocida , subspecies septica. The neonate was treated with antibiotics and supportive care and recovered without ongoing complications. Providers should maintain an index of suspicion for rare causes of neonatal EOS. For these unusual cases, precise microbial identification enables understanding to provide best clinical care and anticipation of complications.

Excipient lung disease secondary to intravenous heroin use.

We present a case of a woman who had progressive shortness of breath and wheezing with a mild restrictive pulmonary function pattern. She was initially diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of peripheral eosinophilia, bronchoalveolar lavage eosinophilia (47%) and surgical lung biopsy findings. Six months following her diagnosis, the patient returned because of persistent symptoms, and a second review of the lung biopsy revealed thrombotic lesions in the pulmonary vessels with polarisable foreign body materials, associated giant cell reactions and numerous eosinophil infiltrates, consistent with intravenous drug abuse. Further investigation showed that she had a history of intravenous heroin overdose, and the diagnosis of excipient lung disease was made. This case highlights the importance of expert pathological, radiological and clinical review of complex presentations and the need for a thorough medication and drug use history review.

The Impact of Wearable Breast Pumps on Physicians' Breastfeeding Experience and Success.

Background: Physician mothers face many barriers in their ability to meet their lactation goals. This is often due to short maternity leaves and an often busy, inflexible work schedule at the time of return to work. We aimed to characterize the effect of using wireless, wearable breast pumps in the workplace and determine if these devices may help overcome barriers to breastfeeding success for physician mothers. Methods: A cross-sectional survey was distributed to female physicians and trainees identified through the group "Doctor Mothers Interested in Lactation Knowledge (Dr. MILK)" using an anonymous, Qualtrics® survey on the group's social media site. Participants were analyzed in two groups: those who had used wearable pumps versus those who had only used traditional breast pumps. Results: Of the 542 respondents analyzed, 321 (59%) had used a wearable pump in the workplace and 221 (41%) had only used a traditional electric breast pump. Those who had used a wearable pump reported statistically significant shorter lactation breaks (p < 0.00001) and were more likely to be able to provide breast milk to their infants for their entire intended duration (p = 0.005) compared to the traditional pump group. The ability to pump as often as needed while at work (p = 0.16) and the frequency of lactation breaks throughout the day (p = 0.223) were not significantly different when comparing the two groups. Conclusions: This study demonstrates a benefit to using wearable breast pumps for women physicians as they return to work after maternity leave. Utilization of these new wearable pumps correlates with shorter lactation breaks and the ability of physician mothers to provide breast milk to their infants for their intended duration.

Examining Burnout in Interprofessional Intensive Care Unit Clinicians Using Qualitative Analysis.

BACKGROUND: Health care professionals working in intensive care units report a high degree of burnout, but this topic has not been extensively studied from an interdisciplinary perspective. OBJECTIVE: To characterize experiences of burnout among members of interprofessional intensive care unit teams and identify possible contributing factors. METHODS: This qualitative study involved interviews of registered nurses, respiratory therapists, physicians, pharmacists, and a personal care assistant working in multiple intensive care units of a single academic medical center to assess work stressors. RESULTS: Team composition was a factor in burnout, particularly when nonphysician team members felt that their opinions were not valued despite the institution's emphasis on a multidisciplinary team-based model of care. This was especially true when roles were not well defined at the outset of a code situation. Members of nearly all disciplines stated that there was not enough time in a day to complete all the required tasks. CONCLUSIONS: Multiple factors contribute to work-related stress and burnout across different professions in the intensive care unit. Improved communication and increased receptivity to diverse opinions among members of the multidisciplinary team may help reduce stress.

A 48-Year-Old Woman With Chronic Cough, Dyspnea, and Bronchiectasis.

CASE PRESENTATION: A 48-year-old woman sought a second opinion for dyspnea and chronic productive cough; she was a never smoker. Mild respiratory symptoms persisted since childhood and had progressively worsened over the previous decade. In addition, an unintentional 30-pound weight loss had occurred over several years. Six years previously, a diagnosis of hypersensitivity pneumonitis was made following right upper lobe wedge resection that revealed chronic bronchiolitis with interstitial pneumonia and non-necrotizing granulomatous inflammation. Subsequent use of prednisone elicited mild intermittent improvement. She had used feather pillows in the past without any other significant exposures. There were no reports of sinus or GI symptoms.

Post-intensive care syndrome: impact, prevention, and management.

Post-intensive care syndrome (PICS): inpatient prevention and outpatient recognition are essential http://bit.ly/2GCgz1q.