ABSTRACT
Purpose: As health care progresses toward pay for performance reimbursement models and focus is placed on the patient as a consumer, health care systems must adapt by initiating new programs and services. This institution responded by implementing a "Meds 2 Beds" program integrating clinical services with dispensing and medication delivery during transitions of care. This study evaluates outcomes relevant to patients, health care providers, pharmacists, and administrators. Methods: This observational chart review evaluated the effectiveness of a "Meds 2 Beds" program from May 1, 2014, through December 1, 2015. Patients who participated in this program were matched 1:1 with controls who did not. The primary outcome was 30-day hospital readmission. Secondary outcomes included 30-day emergency department (ED) visits, patient satisfaction, and financial impact. Results: In this sample, 185 "Meds 2 Beds" patients were matched to 185 controls. Thirty day readmission occurred in 16 (8.7%) "Meds 2 Beds" cases and 19 (10.3%) controls (P = .71). Rates of 30-day ED visits were nonsignificantly reduced in cases (22 [11.9%] vs 33 [18.1%]; odds ratio = 0.62, P = .11) and occurred significantly later (11 vs 7 days, P = .03). Conclusions: This study showcases a creative medication delivery and discharge counseling program. The program provides financial benefit to the institution creating a direct revenue stream from prescription dispensing while highlighting a potential for reduced readmissions and ED visits (although a statistically significant difference was not demonstrated in this analysis). A similar model can be adopted by other health care institutions to improve the quality of patient care.
ABSTRACT
Background: Pleiotropic anti-inflammatory and immunomodulatory effects of statins have been associated with improved outcomes in the critically ill population. Objective: To evaluate the implications of prior statin use on the duration of vasopressor therapy in the setting of septic shock. Methods: This was a retrospective, multicenter study of adult patients who were diagnosed with septic shock. Patients were included if they were treated with any vasopressor for greater than 6 hours from the time of admission. The primary outcome was to compare the duration of vasopressor therapy in patients with septic shock with and without previous statin exposure. Results: A total of 88 statin-exposed cases and 205 unexposed controls were included in the analysis. Despite 92% of statin-exposed patients being reinitiated on therapy within 24 hours, the duration of vasopressors did not differ between groups (44 hours, statin group vs 53 hours, control group, P = .51). There were also no mortality differences between the statin group and the controls (40% vs 47%, P = .27). Conclusions: Long-term statin exposure does not impact the duration of vasopressor therapy in septic shock. The lack of differences in clinical outcomes supports the concept that sepsis involves pro- and anti-inflammatory pathways as well as other nonimmunologic pathways. Results lend further credence to the recent conceptualization of sepsis, with complications leading to organ dysfunction caused not primarily due to inflammatory responses but by a dysregulated response to infection.
ABSTRACT
Probiotics are living microorganisms which have demonstrated many benefits in prevention, mitigation, and treatment of various disease states in critically ill populations. These diseases include antibiotic-associated diarrhea, Clostridium difficile diarrhea, ventilator-associated pneumonia, clearance of vancomycin-resistant enterococci from the GI tract, pancreatitis, liver transplant, major abdominal surgery, and trauma. However, their use has been severely limited due to a variety of factors including a general naïveté within the physician community, lack of regulation, and safety concerns. This article focuses on uses for probiotics in prevention and treatment, addresses current concerns regarding their use as well as proposing a protocol for safe use of probiotics in the critically ill patient.
