American College of Chest Physicians, Oct. 24-28

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CHEST 2015

The annual meeting of the American College of Chest Physicians was held from Oct. 24 to 28 in Montreal and attracted approximately 6,000 participants from around the world, including specialists and heath care professionals involved in the prevention, diagnosis, and treatment of chest diseases. The conference featured presentations focusing on clinical updates in chest medicine, including advances in pulmonary, critical care, and sleep medicine.

As part of a practice improvement project, Pavan Irukulla, M.D., of Maimonides Medical Center in Brooklyn, N.Y., and colleagues evaluated a three-step intervention aimed at decreasing urinary catheterization rates. The approach involved educating staff, having criteria for utilization of urinary catheters, and implementation of bladder scans.

"We were able to decrease utilization rates by 77 percent. With decreases in utilization rates we were also able to decrease catheter associated urinary tract infections," Irukulla said. "Our study was a practice improvement project which was mostly a retrospective study; therefore, it would be worthwhile if a randomized study can be performed."

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As part of an initiative to improve patient care, Aruna Jahoor, M.D., of Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine in Temple, and colleagues performed a retrospective chart review of patients with severe sepsis from January 2010 to December 2013. The investigators sought to determine whether certain variables affected mortality, particularly how long the patients were staying in the emergency department prior to intensive care unit (ICU) admission.

"My initial hypothesis was that the longer patients waited in the emergency department, the higher the mortality. However, when we analyzed the data we actually found that patients who spent more than six hours in the emergency department prior to ICU admission had lower in-hospital and 28-day mortality rates," Jahoor said. "When we further analyzed the data, however, we found that the patients with a shorter stay had higher initial lactate levels, which indicated sicker patients with a higher mortality rate. When we looked at the lactate levels, we found that for every increase in one unit of lactate, our patients had a 17 percent increase in mortality. Patients who spent less than six hours in the emergency department had an in-hospital mortality rate of 32.1 percent. Those who stayed more than six hours had a mortality rate of 17.2 percent. We found similar results for the 28-day mortality rates."

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Carmine Simone, M.D., of the Toronto East General Hospital, and colleagues found that providing patients with text message reminders leading up to their surgery increases the likelihood that they will follow instructions and keep their appointments. In addition, the investigators found that having patients track their progress after discharge from hospital allows them to report complications earlier and avoid visiting the emergency department.

"Web-based education modules enable patients to better gauge their symptoms and make more informed decisions about calling the surgeon's office or proceeding to the emergency department. We found a significant reduction in the number of emergency department visits and cancelled procedures after implementing the mobile device reminders and post-discharge daily log," Simone said. "Patients are relying more and more on mobile technology to monitor their health and communicate with their caregivers. Physicians can use this technology to better educate and ultimately empower patients with reliable information that will positively impact their recovery from surgery. We will try to develop mobile applications to allow patients to participate in their postoperative care before discharge (i.e., while in hospital). This will ensure patients are aware of the expectations for successful recovery but also to ensure quality care for all surgical patients."

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