Considerable attention has been devoted to the effect of social support on patient outcomes after acute myocardial infarction (AMI). However, little is known about the relation between patient living arrangements and outcomes. Thus, we used data from PREMIER, a registry of patients hospitalized with AMI at 19 US centers between 2003-04, to assess the association of living alone with post-AMI outcomes. Outcome measures included 4-year mortality, 1-year readmission, and 1-year health status, using the Seattle Angina Questionnaire (SAQ) and Short Form-12 physical health component (SF-12 PCS) scales. Patients who lived alone had higher crude 4-year mortality (21.8% vs. 14.5%, P<0.001), but comparable rates of 1-year readmission (41.6% vs. 38.3%, p=0.79). Living alone was associated with lower unadjusted quality of life (mean SAQ −2.40 (95% confidence interval [CI] −4.44, −0.35), p=0.02), but had no impact on SF-12 PCS (−0.45 (95% CI −1.65, 0.76), p=0.47) compared with patients who did not live alone. After multivariable adjustment, patients who lived alone had a comparable risk of mortality (hazard ratio [HR] 1.35, 95% CI: 0.94-1.93) and readmission (HR 0.99, 95% CI: 0.76-1.28) as patients who lived with others. Mean quality of life scores remained lower among patients who lived alone (SAQ −2.91 (95% CI −5.56, −0.26), p=0.03). Living alone may be associated with poorer angina-related quality of life one year post-MI, but is not associated with mortality, readmission, or other health status measures after adjusting for other patient and treatment characteristics.
Background
Hospitalists are key providers of care to medical inpatients, and sign-out is an integral part of providing safe, high quality inpatient care. There is little known about hospitalist-to-hospitalist sign-out.
Objective
To evaluate the quality of hospitalist/physician-extender sign-outs by assessing how well the sign-out prepares the night team for overnight events and to determine attributes of effective sign-out.
Design
Analysis of a written-only sign-out protocol on a non-teaching hospitalist service using prospective data collected by attending physician survey during overnight shifts.
Setting
Yale-New Haven Hospital (YNHH), a 966-bed, urban, academic medical center in New Haven, CT with approximately 13,700 hospitalist discharges annually.
Results
We recorded 124 inquiries about 96 patients during 6 days of data collection in 2012. Hospitalists referenced the sign-out for 89 (74%) inquiries, and the sign-out was considered sufficient in isolation to respond to 27 (30%) of these inquiries. Hospitalists physically saw the patient for 14 (12%) of inquiries. Nurses were the originator for most inquiries (102 [82%]). The most common inquiry topics were medications (55 [45%]), plan of care (26 [21%]) and clinical changes (26 [21%]). Ninety-five (77%) of inquiries were considered to be “somewhat” or “very” clinically important by the hospitalist.
Conclusions
Overall, we found that attending hospitalists rely heavily on written sign-out to address overnight inquiries, but that those sign-outs are not reliably effective. Future work to better understand the roles of written and verbal components in sign-out is needed to help improve the safety of overnight care.
Comprehensive measures to benchmark or track safety performance do not yet exist. The authors aimed to develop and validate a process to identify comprehensive, clinically meaningful sets of safety measures that would draw on the clinical experiences and perceptions of active practitioners. They pilot tested this process for safety measure development for 2 hospital departments (ie, intensive care units and general surgery services) by holding 7 brainstorming sessions with physicians and nurses in major academic and community teaching hospitals in Boston, Massachusetts, and Baltimore, Maryland. Participants identified lists of patient harms that they considered to be among the 20 most frequent and the 20 most severe in their respective units. The authors generated a master list of patient harms, which participants then ranked by both frequency and severity via E-mail voting. This process produced safety measures with inherent credibility with clinicians on the front lines of care.
Background-Sign-out is the process (written, verbal, or both) by which one clinical team transmits information about patients to another team. Poor quality sign-outs are associated with adverse events and delayed treatment. How different specialties approach written sign-outs is unknown.
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