Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed and PsycINFO for published, peer-reviewed articles in English (1990English ( -2016 using search terms designed to capture studies that tested the performance of depression screening tools in inpatient settings and studies that examined associations between depression detected during hospitalization and clinical or utilization outcomes. Two investigators reviewed each full-text article and extracted data. The prevalence of depression ranged from 5% to 60%, with a median of 33%, among hospitalized patients. Several screening tools identified showed high sensitivity and specificity, even when self-administered by patients or when abbreviated versions were administered by individuals without formal training. With regard to outcomes, studies from several individual hospitals found depression to be associated with poorer functional outcomes, worse physical health, and returns to the hospital after discharge. These findings suggest that depression screening may be feasible in the inpatient setting, and that more research is warranted to determine whether screening for and treating depression during hospitalization can improve patient outcomes.

Background: Pain is common among hospitalized patients. Inpatient opioid prescribing is not without risk. Acute pain management guidelines could inform safe opioid prescribing in the hospital and limit associated unintended consequences. Purpose: To evaluate the quality and content of existing guidelines for acute, non-cancer pain management. Data Sources: The National Guideline Clearinghouse, MEDLINE via PubMed, websites of relevant specialty societies and other organizations, and selected international search engines. Study Selection: Guidelines published between January 2010 to August 2017 addressing acute, non-cancer pain management among adults were considered. Guidelines focused on chronic pain, specific diseases, and non-hospital setting were excluded. Data Extraction: Quality assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Data Synthesis: Four guidelines met selection criteria. Most recommendations were based on expert consensus. Guidelines recommended restricting opioids to severe pain or pain that has not responded to non-opioid therapy, using the lowest effective dose of short-acting opioids for the shortest duration possible, and co-prescribing opioids with non-opioid analgesics. Guidelines generally recommended checking the prescription drug monitoring program when prescribing opioids, developing goals for patient recovery, and educating patients regarding risks and side effects of opioid therapy. Additional recommendations included using an opioid dose conversion guide, avoidance of co-administration of parenteral and oral opioids, and using caution when co-prescribing opioids with other central nervous system depressants. Conclusions: Guidelines, based largely on expert opinion, recommend judicious opioid prescribing for severe, acute pain. Future work should assess the implications of these recommendations on hospital-based pain management.

BackgroundHospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain.ObjectiveTo systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals.MethodsA search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine’s Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study.ResultsFifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI −$288 000 to $392 000), relative to usual care.ConclusionsQI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.