PATIENT SAFETY
A new single-center study leveraged hospitalist end-of-week transitions to better identify diagnostic errors and the possible causes behind them. Writing in Annals of Internal Medicine, researchers from Northwestern University designed an electronic questionnaire that three dozen hospitalists coming on service would fill out on day 2 of their service week, asking if their diagnoses on one or two of their new patients had changed. Those questionnaires were filled out for more than two years in 2019-21. The authors found that among more than 1,000 patients, 18% did have a diagnostic change—and that 6% had a change associated with a diagnostic error. The most common cause of error was missed information in the EHR; other types of diagnostic errors looked at included failure to order a test or consult, failure to consider a diagnosis, and a missed exam finding. The research also found that the percentage of patients with a diagnostic error was lower than described in other studies that used patient outcomes (such as ICU transfers, deaths, readmissions) as a trigger.
ED THROUGHPUT
Short-stay unit, “surgical smoothing” both reduce ED boarders
Clinical decision/observation units have been used for decades to decompress EDs—but such units are typically reserved for low-acuity patients. In a Journal of Hospital Medicine write-up, clinicians at Atlanta’s Emory University describe the short-stay unit they established in 2022, staffed 24/7 by a hospitalist-APC team, in conjunction with an already existing CDU. The authors found that non-SSU patients had a median time of 12 hours from admission order placement to the patient either leaving the ED or checking into a unit vs. only 3.4 hours for SSU patients. Given the innovation’s success and the broad range of diagnoses treated in the SSU, the authors note that they are expanding staffing to one hospitalist and two APCs. MedPage Today reported on another way to reduce ED boarding: A study that looked at fluctuations in inpatient admissions at New York hospitals found that “almost all” were due to elective admissions, with those admissions peaking at the beginning of the work week. While the authors didn’t recommend weekend surgeries, they did suggest spreading out—or “smoothing”—elective surgeries by scheduling them according to the number of inpatient or ICU beds needed and by increasing weekend discharges.
PRIVATE EQUITY
Nearly half of cardiology groups owned by investors
New data show that private equity continues to open new inroads into U.S. health care, with nearly half of all private practice cardiology groups part of a private equity portfolio. A report by MedAxiom, a subsidiary of the American College of Cardiology, noted that PE investment in cardiology groups jumped from zero in just a few years. Analysts with the organization said they’re watching to see if private equity next attempts to invest in models in which cardiologists are employed by hospitals, which the report noted is a much bigger market.
MEDICAL EDUCATION
Three-year MD program posts comparable outcomes
In a report published by Academic Medicine, authors compared outcomes from seven graduating classes of the accelerated three-year MD program at NYU Grossman School of Medicine to those of their four-year counterparts, finding similar performance across medical school and early residency. As MedPage Today coverage reported, those in the three-year program had higher pre-clerkship exam scores (84.6% vs. 83.4%). While the three-year participants had slightly lower USMLE Step 1 and 2 scores, the accelerated students scored higher on Step 3. The three-year program was designed to reduce student debt, even though NYU medical school became tuition-free shortly after the accelerated pathway was launched. Going forward, students will be able to continue training for a fourth year if they choose or they can opt to spend two more years pursuing an additional master’s degree.
DEHUMANIZING?
Why are hospital gowns so ugly?
A New York Times article tries to answer the age-old question of why hospital gowns are so ugly. A question from a reader for the publication’s fashion critic asks if the design is intentional to help the medical establishment maintain “an antiquated power dynamic.” The critic, who responded by calling the lowly hospital gown “one of the most unappealing items of clothing ever made,” hypothesized that the gowns were designed to democratize health care by making everyone look the same, giving everyone equal access to health care. But the critic noted that by making everyone look the same, the hospital gown serves as a “dehumanizing” garment that transforms people from unique individuals to merely sick people. For more on a fashion critic’s take on hospital gowns, check out the article.
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