Asunto(s)
Corea/patología , Discinesias/patología , Hiperglucemia/patología , Malformaciones Arteriovenosas Intracraneales/patología , Anciano , Ganglios Basales/irrigación sanguínea , Enfermedad Cerebrovascular de los Ganglios Basales/patología , Glucemia/metabolismo , Circulación Cerebrovascular/fisiología , Corea/complicaciones , Discinesias/complicaciones , Femenino , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Humanos , Hiperglucemia/complicaciones , Malformaciones Arteriovenosas Intracraneales/complicaciones , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Numeric pagers are commonly used communication devices in healthcare, but cannot convey important information such as the reason for or urgency of the page. Alphanumeric pagers can display both numbers and text, and may address some of these communication problems. OBJECTIVE: Our primary aim was to implement an alphanumeric paging system. DESIGN: Continuous quality improvement study using rapid-cycle change methods. SETTING: General Internal Medicine (GIM) inpatient wards at 1 tertiary care academic teaching hospital. PARTICIPANTS: All residents, attending physicians, nurses, and allied health staff working on the general medicine (GM) wards. MEASUREMENTS: We measured: (1) the proportion of pages sent as text pages, (2) the source of the pages, (3) the content of the text pages, (4) the pages that disrupted scheduled education activities, and (5) satisfaction with the alphanumeric paging system. RESULTS: After implementation, 52% of pages sent from physicians or the GM wards were sent as text pages (P < 0.001). 93% of pages between physicians were text pages, compared to 27% of pages from the GM wards to physicians (P < 0.001). The most common reason for text paging among physicians was to arrange work or teaching rounds (33%). The most common reason for text paging from the GM wards was to request a patient assessment or for notification of a patient's clinical status (25%). There was a 29% reduction in disruptive pages sent during scheduled educational rounds (P < 0.001). CONCLUSIONS: We successfully implemented an alphanumeric paging system that reduced disruptive pages on a GM inpatient service.
Asunto(s)
Centros Médicos Académicos/normas , Sistemas de Comunicación en Hospital/normas , Hospitales de Enseñanza/normas , Pacientes Internos , Cuerpo Médico de Hospitales/normas , Centros Médicos Académicos/métodos , Centros Médicos Académicos/tendencias , Actitud del Personal de Salud , Sistemas de Comunicación en Hospital/tendencias , Hospitales de Enseñanza/métodos , Hospitales de Enseñanza/tendencias , Humanos , Internado y Residencia/métodos , Internado y Residencia/normas , Internado y Residencia/tendencias , Cuerpo Médico de Hospitales/tendenciasRESUMEN
OBJECTIVE: To evaluate a bedside clinical prediction rule for detecting moderate or severe aortic stenosis. DESIGN: Cross-sectional study with independent comparison to a diagnostic reference standard, doppler echocardiography. SETTING: Urban university hospital. PARTICIPANTS: Consecutive hospital inpatients (n = 124) who had been referred for echocardiography. MEASUREMENTS AND MAIN RESULTS: Participants were examined by a third-year general internal medicine resident and a staff general internist. We hypothesized in advance that absence of a murmur over the right clavicle would rule out aortic stenosis, while the presence of three or four associated findings (slow carotid artery upstroke, reduced carotid artery volume, maximal murmur intensity at the second right intercostal space, and reduced intensity of the second heart sound) would rule in aortic stenosis. Study physicians were unaware of echocardiographic findings. The outcome was echocardiographic moderate or severe aortic stenosis, defined as a valve area of 1.2 cm2 or less, or a peak instantaneous gradient of 25 mm Hg or greater. Absence of a murmur over the right clavicle ruled out aortic stenosis (likelihood ratio [LR] 0.10; 95% confidence interval [CI] 0.01, 0.44). The presence of three or four associated findings ruled in aortic stenosis (LR 40; 95% CI 6.6, 240). If a murmur was present over the right clavicle, but no more than two associated findings were present, then the examination was indeterminate (LR 1.8; 95% CI 0.93, 2.9). CONCLUSION: A clinical prediction rule, using simple bedside maneuvers, accurately ruled in and ruled out aortic stenosis.