There is controversy over the impact of electronic health record (EHR) systems on cost of care and safety. The authors studied the effects of an inpatient EHR system with computerized provider order entry on selected measures of cost of care and safety. Laboratory tests per week per hospitalization decreased from 13.9 to 11.4 (18%; p < 0.001). Radiology examinations per hospitalization decreased from 2.06 to 1.93 (6.3%; p < 0.009). Monthly transcription costs declined from $74,596 to $18,938 (74.6%; p < 0.001). Reams of copy paper ordered per month decreased from 1668 to 1224 (26.6%; p < 0.001). Medication errors per 1000 hospital days decreased from 17.9 to 15.4 (14.0%; p < 0.030), while near misses per 1000 hospital days increased from 9.0 to 12.5 (38.9%; p < 0.037), and the percentage of medication events that were medication errors decreased from 66.5% to 55.2% (p < 0.007). In this manuscript, we demonstrate that the implementation of an inpatient EHR with computerized provider order entry can result in rapid improvement in measures of cost of care and safety.

Peripheral arterial disease (PAD) is a common disease, and intermittent claudication (IC) is a life-changing symptom. Exercise therapy has been demonstrated to be an effective treatment for IC in a supervised setting; however, most insurance carriers do not reimburse for exercise therapy. As a result, non-supervised programs have largely replaced supervised programs, despite limited evidence of their benefit. In this retrospective study of the results of our routine care, we analyzed the outcomes of a structured 6-month home-based exercise program for IC. A total of 120 patients with PAD and IC were enrolled in a home-based exercise program. Forty-one patients fulfilled program requirements, for a 34.2% completion rate. Those who completed the program demonstrated an 86.4% improvement in their initial claudication distance and a 19.8% improvement in their absolute claudication distance. No patient factors identified those who did not complete the program versus those who completed the program and thus attained the observed benefit. We did observe that 47% of those who did not complete the program dropped-out by not keeping their follow-up appointment. Although patients who completed our program improved from baseline, it was less dramatic than reported in studies of supervised programs. The design of home-based programs should include mechanisms that maximize compliance in returning for follow-up appointments.

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The use of history and physical examination forms, combined with a brief lecture, significantly increased the percentage of highest billing codes, which increased billable income. Resident awareness of documentation requirements significantly improved.

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Clinicians should be aware of the possible association of thrombocytopenia with lansoprazole and discontinue the drug if thrombocytopenia becomes apparent.

Furazolidone may induce pulmonary hypersensitivity reactions; clinicians should be aware of this potentially serious adverse effect.