Questions such as this are often a signal to the patient that the clinical encounter has come to an end. Yet, there are rarely any questions brought up by the patient. That does not necessarily mean that they understand or are equipped to participate in their healthcare. In fact, surveys show that over one-third of patients have poor health literacy and up to nearly 90% of patients do not have the health literacy that is needed to be able to navigate the complexities of our healthcare system. (1)
There are also opportunities for ground-level employees and stakeholders to participate in QI. Kaizen is a LEAN approach that focuses on “Continuous Improvement” in small daily changes which support larger institutional initiatives.
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An 18-year-old female with a history of epilepsy presents via emergency medical services. She has been having generalized tonic-clonic activity for the past 5-minutes. Her sister who lives with her tells you she hasn’t taken her seizure medications for the past two weeks as she has been out of them. She has an abortive medication, but sister was unsure how to administer it, so no medication has been given.
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When considering oxygen delivery devices, it is essential to consider the needs of the patient and any contraindications to those modalities. While there are many styles of oxygen delivery modalities, they function differently. For example, some oxygen modalities can provide low flow oxygen amounts due to their dependence on patients on minute ventilation, such as the nasal cannula and the simple face mask. Other oxygen modalities provide fixed amounts of oxygen regardless of the patient’s minute ventilation, thus making them easily titratable. These are the Venturi face mask and the high flow nasal cannula. This blog will walk you through the various oxygen modalities available to provide supplemental oxygen for the patients.
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A two-month-old infant presents to the emergency department with the chief complaint of fussiness for the past two hours. On examination the infant is fussy, but you aren’t able to determine an obvious source of the fussiness. You are unsure of what to do next, but then remember a helpful mnemonic for the differential of a fussy infant: IT CRIES.
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Walk into any ICU on any given day and there will be a patient who is suffering from sepsis. Arguably, the most common diagnosis that the ICU physician encounters and a diagnosis that requires rapid recognition and treatment. ICU physicians have been trained to follow surviving sepsis guidelines which have gone through updates over the years since their first launch in 2002. We now have the 2021 updates, and I would like to go over some of those most important updates with you. Hopefully this will be informative and save you from having to read a 60 page document.
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Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and is estimated to cost 49 billion dollars annually for treatment and missed work in America.¹ Since COPD is common, preventable, and treatable, this blog post will discuss the outpatient management of stable COPD and recent updates to the guidelines.
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Previous blog posts have touched on reasons for Quality Improvement (QI) in healthcare as well as introductions to technical approaches such as Six Sigma that have been proven by industries to facilitate positive change. Technical approaches like Six Sigma rely on buy-in from upper management stakeholders as well as professionals with experience in statistics.
There are also opportunities for ground-level employees and stakeholders to participate in QI. Kaizen is a LEAN approach that focuses on “Continuous Improvement” in small daily changes which support larger institutional initiatives.
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A 5-year-old male presents after being bit on the arm by the family dog. He was playing with the dog and when he went to take the toy away from the dog and the dog bit him on the left arm just prior to arrival. Patient has a 2 cm wound to his left arm. Bleeding is controlled. Family is anxious about whether he will need stitches.
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There is currently a worldwide pandemic (besides COVID!) that deserves an equal amount of attention. Obesity has been increasing in prevalence throughout the world for several decades and the care of these patients is becoming increasingly complex. In 2005, it was estimated that obesity costs the US $147-210 billion per year and this likely has only increased.¹
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We frequently think of children as having the ability to bounce back from stressful situations. However, evidence shows that prolonged stress and trauma can interrupt healthy development and put children at risk for lifelong health complications.
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The To Err Is Human report, published in 2000, was a landmark paper that spoke of the need for quality healthcare in America. There are organizations who were laying the foundations for improvements in healthcare even prior to this paper. In the 1980s, a project called the National Demonstration Project in Quality Improvement in Health Care enlisted help from industry leaders such as AT&T, Ford, and IBM to help healthcare organizations use industry-standard processes to improve quality and reduce costs in healthcare. This project had significant successes with over half of organizations achieving important outcomes such as reducing length of stay, fewer postoperative infections, and reducing waiting times in Emergency Departments. This project eventually became the Institute for Healthcare Improvement (IHI). They have established activities across Africa, Asia, Europe, and North America to become a leading international not-for-profit organization dedicated to improving healthcare. (1)
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18-year-old female presents to the emergency department (ED) with concern for facial flushing, difficulty breathing, and vomiting. She was at a party with some of her friends when she developed flushing and difficulty breathing after eating a cookie. Friends thought she may be having a panic attack, so took her outside where she had several episodes of emesis. Symptoms did not improve, so she was brought to the ED for evaluation.
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In this blog post we’ll be going over how to manage diabetes mellitus type II in the inpatient setting when diabetes is not the reason for admission.
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A 72-year-old female with history of OSA, recent tibula & fibular fracture s/p ORIF presents to the hospital with shortness of breath and was found to have bilateral submassive pulmonary embolisms and underwent EKOS thrombolysis and was discharged with Eliquis.
She returns to the hospital within 24 hours after a slip from bed with a left ankle dislocation. In the OR she had a cardiac arrest with return of spontaneous circulation. In the ICU, she was given systemic alteplase for worsening right heart strain and started on a heparin drip. As a result, obstructive shock greatly improved. Transthoracic echocardiogram demonstrated mod-severe global right ventricular hypokinesis and flattened septum with EF of 40%. She was eventually extubated and was discharged home.
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Immunizations have made a significant impact on the health of our patients by decreasing the rate of vaccine preventable illnesses. However, increasing numbers of people are expressing concerns about vaccine safety, vaccine side effects, and the necessity of vaccines in general. For some, like pediatricians, discussing the importance of vaccination and addressing vaccine hesitancy has become a well-versed part of patient education. With the COVID-19 pandemic, conversations about vaccines are now something that providers in every specialty should consider incorporating into their patient encounters.
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A previous blog post referenced the To Err is Human report that was published in 2000. This report was the inciting force behind improving healthcare quality in the United States. As payers and regulators become the stakeholders in the cost and outcomes of healthcare, healthcare systems must now approach quality improvement (QI) through many different experiences. These approaches may focus on reducing waste, making workflows more accommodating to employees, workplace standards of organization, or reducing the variability and results of practice and procedures.
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Sally is a 3-year-old female who presents after a head injury. She was at home jumping from the couch to the coffee table when she fell and struck the front of her head on the ground. The couch is about 1.5 feet off the ground. She cried initially but is now calm. She did not pass out and there was no vomiting. Her mom is very worried about the possibility of bleeding and is asking you if imaging is needed. What do you tell her?
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Gastrointestinal bleeding is a commonly encountered problem in the inpatient setting. Current treatment guidelines recommend maintaining a mean arterial pressure (MAP) greater than 65 mmHg, similar to other medical patients. An abundance of trauma surgery literature has provided guidance for uncompressible bleeding sites due to trauma by appropriately adjusting MAP goals based on the clinical picture and allowing hypotension in various settings, termed permissive hypotension. So, should this be carried over to the GI bleed setting since it is also uncompressible and has it been looked at before? That’s what we are here to find out.
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We all know decompensated cirrhotic patients can be critically ill, with a myriad of associated syndromes. Despite this, only on two occasions were syndromes defined by a consensus. In 1978, a conference organized in Sassari, Italy was convened to define and propose diagnostic criteria for hepatorenal syndrome (HRS). After another decade, the 13th International Conference of Gastroenterology in Rome, Italy called for modification of the original criteria.
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Summer is officially here and full of fun and games…until it isn’t! Biking, skateboarding, rollerblading, and a variety of other outdoor activities peak this time of year when school is out of session and the weather becomes warm. Kids will inevitably fall, tumble, and bump their heads…all part of learning and development. In fact, even the most experienced rider is at risk for a fall! Without a helmet these summertime fun activities pose serious danger for traumatic brain injury which can lead to permanent disability, coma, or even death.
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