Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department.

Introduction Intensivist involvement for patients with sepsis is associated with decreased complications and mortality, and lower hospital resource utilization, but few studies have evaluated outcomes for patients exposed to electronic intensive care unit (eICU) telemedicine sepsis management in the emergency department (ED). In this study, we assess whether eICU cart exposure in the ED improved compliance with components of the 2010 Surviving Sepsis Campaign bundles, length of stay (LOS), disposition and hospital costs. Methods An institutional review board-approved, retrospective cohort study was completed on patients with confirmed sepsis who presented to our ED from July 2010 through February 2013. Results Of 711 patient ED encounters, 314 cases met criteria for analysis (95 exposed and 219 non-exposed). Patient cohorts had similar demographics and comorbid International Classification of Diseases, Ninth Edition (ICD-9) diagnoses. The exposed cohort received antibiotics more quickly (122.3 minutes ±83.3 versus 163.4 minutes ±204.4, p = 0.043) and were more likely to have lactic acid levels drawn within six hours (98.9% vs. 90%, p = 0.019). The exposed cohort had a shortened ED LOS (in days) 0.08 ± 0.28 versus 0.16 ± 0.37, p = 0.036. Hospital LOS, disposition and death were similar in both cohorts. Total hospital costs for the exposed cohort were lower and less variable (US$19,713 ± 16,550 vs. US$24,364 ± 25068), but this was not significant ( p = 0.274). Discussion Our findings suggest that in individuals with confirmed sepsis, ED exposure to a telemedicine-based eICU cart impacted adherence to aspects of the Surviving Sepsis Campaign recommended bundle, but did not impact overall survival and medical costs.

Incidence of hemorrhage among anticoagulated patients receiving antiplatelet therapy after percutaneous coronary intervention.

This study aimed to compare major hemorrhage rates among patients receiving warfarin, acetylsalicylic acid (ASA), and clopidogrel to those receiving ASA and clopidogrel following percutaneous coronary intervention with stent implantation. This retrospective cohort study identified patients with stents implanted between September 1, 2003 and December 31, 2006. Patients treated with warfarin, ASA, and clopidogrel within 30 days of hospital discharge (Triple Therapy group) were matched by age, sex, and stent type to patients treated with ASA and clopidogrel (Dual Therapy group). Outcomes included the incidence rates of major hemorrhage and major adverse coronary events (MACE) within 12 months of stent implantation. There were 175 and 339 patients in the Triple Therapy and Dual Therapy groups, respectively. There were 25 (14.3%) and 10 (3.0%) major hemorrhages in the Triple Therapy and Dual Therapy groups, respectively (OR 9.0; 95% CI, 3.1-26.1). Patients in the Triple Therapy group had a greater likelihood of MACE compared to patients in the Dual Therapy group (OR 2.0; 95% CI 1.1-3.8). Post-stent treatment with warfarin, ASA, and clopidogrel was associated with a substantially greater likelihood of major hemorrhage than treatment with ASA and clopidogrel alone.

Web sites and pediatric residency training programs in the United States.

The purpose of this study was to describe the use of Web sites by pediatric residency programs in the United States, the information provided on those Web sites, and the degree of user-friendliness in navigating the Web sites. Most residency programs (137/197) listed a Web address; 96% (131) of these sites were accessible and were analyzed. Most programs (98/131) provided information for 11 to 20 content items, 11 programs described less than 10 content items, and the remaining 22 programs listed 21 to 42 content items on their Web sites. Most Web sites (87%) were categorized into the user-friendly level. Extremely user-friendly Web sites also provided information on significantly more content items. Although 95% and 96% of positions were filled through match in programs with user-friendly Web sites and programs with extremely user-friendly Web sites, respectively, these were not statistically different from the programs with less user-friendly Web sites, where only 88% of positions were filled through the match. The majority of pediatric residency training programs have Web sites. Most of these Web sites were user-friendly and provided a variety of information sought by applicants.