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Letter from the Editor

From the September ACP Hospitalist, copyright © 2009 by the American College of Physicians

For ICU patients, when it comes to sedation, less is sometimes more. Studies have shown that critically ill patients who are given “sedation vacations” consisting of spontaneous awakening trials (SATs) and spontaneous breathing trials spend less time on the ventilator and less time in the ICU overall. But according to a March 2009 study in Critical Care , many hospitals don’t follow written policy on performing SATs, and The Journal of Critical Care recently reported that only 40% of ICUs use SATs in more than half of their patients. Why the gap between evidence and practice? Experts cited lack of time and lack of support, among other reasons, but said that hospitalists can help change that. In our cover story, Jessica Berthold explains the controversy behind SATs, why hospitals haven’t universally embraced them, and how hospitalists can get involved.

Transitions of care are well known as a danger zone where important medical information can be lost or garbled through miscommunication, and patients being transferred to skilled nursing facilities (SNFs) may be among the most vulnerable to errors. A recent survey of 199 admissions to two SNFs in Massachusetts found that medication lists on the hospital discharge summary, the patient care referral form and the SNF admission orders didn’t match up 70% of the time. One reason, experts said, may be that transfer to this care setting has been overlooked in the literature and interventions targeted to SNFs haven’t been well defined. Stacey Butterfield’s story outlines on the scope of the problem and what can be done to correct it.

This issue also features our latest Success Story, focusing on St. John’s Mercy Medical Center in St. Louis, Mo. Two years ago, hospitalists at the center became concerned because care was often being delayed while staff tried to track down the hospitalist attending for each patient. One of the St. John’s hospitalists joined forces with the IT department to create a standardized signout process through a customized Web site that tracks the patient census, lists staff contact information and allows staff to send text pages to each other. The site, which now gets 17,000 hits a month, has improved response times among staff and also offers clinical guidelines, group policies and procedures, and group announcements, among other features.

We’re always interested in learning about your successes. If you have a success story you’d like to share, or any other comments or questions, please let us know.

Sincerely,

Jennifer Kearney-Strouse

Executive Editor, ACP Hospitalist

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated