Top 10 issues in hospital medicine for 2008

As mentioned before, I have been rather surprised that the arbitrary lists of "top healthcare blogs" are dominated by diet blogs while some clinical ones blogs authored by practicing physicians do not get the ranking deserved by their usefulness. One such essential clinical blog is Dr. RW Notes.

Here are the top 10 issues in hospital medicine for 2008 according to Dr. R.W. Donell, a hospitalist in Arkansas. Selected short excerpts accompany each link:

1. State of the hospitalist movement

"The security of our niche is based not on any measurable value, but on the mass exodus of traditional practitioners from the hospital."

2. Patient safety and the culture of blame

"Just as the quality movement has led to a culture of shame, the safety movement has exacerbated a culture of blame. That’s pretty ironic given that the seminal document of the patient safety movement, IOM’s To Err is Human, viewed the culture of blame as counterproductive and sought to mitigate it."

3. Confusing performance with quality.

"Quality improvement is a misnomer. "Quality improvement" implies that patients will have better outcomes. Yet, few studies exist that show that improving performance measures really improves outcomes. As Dr. Robert Wachter said in his blog just the other day, performance is driven by shame and embarrassment."

4. Emergency room handoffs.

"Poor communication and handoff errors are driven by administrative pressure on ERs to reduce their wait times and improve “throughput.”

5. What do we know about glycemic control in hospitalized patients?

"Little more than observational studies, pathyphysiologic rationale and common sense."

6. Weaning from ventilators is obsolete

"The new thinking is that most patients should not be weaned. Rather, on any given day they are either ready for extubation or they are not."

7. Emerging problems in the treatment of MRSA

"We live with the fear that suddenly, one day, we will wake up to find vancomycin resistant Staphylococcus aureus (VRSA)."

8. Resistant gram negative infections

"Extended spectrum beta lactamases (ESBLs) and carbapenemases along with other resistance mechanisms may result in resistance to all commonly prescribed antibiotics, necessitating consideration of alternatives such as tygecycline or the older and largely abandoned class of polymyxins."

9. Palliative care

"This is something the entire hospitalist service, not a just special team, should be doing."

10. How should hospitalists respond to the pseudoscientific invasion?

"Suppose an integrative medicine consult service is introduced at your hospital with plans to offer Therapeutic Touch, Reiki, acupuncture and Tai Chi. The CEO asks for your support. What do you do?"

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