Letter from the editor

Overprescribing of antibiotics is often cited as a chief culprit behind the rising threat of “superbug” infections, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. So it was a bit disheartening to learn that prescriptions for common antibiotics at many hospitals have actually gone up in recent years. The study, published in the Nov. 10, 2008 Archives of Internal Medicine, found that 63.5% of almost 800,000 adults discharged from 35 hospitals in 2006 received an antibacterial drug, a significant increase over 2002 levels. Further, the increase was driven by an upsurge in prescriptions for vancomycin, a trend which feeds the rise of a vancomycin-resistant strain of MRSA.

Fortunately, some hospitals are heeding the call to action. In our cover story, Susan Fitzgerald explores so-called “antimicrobial stewardship teams,” multidisciplinary groups charged with spreading the word about judicious use of antibiotics. The challenge, said one infectious disease expert, is getting physicians to consider the implications of each individual prescription and “think globally” about resistance.

Another challenge for hospitalists is dealing with the needs of an increasingly elderly patient population. Two articles in this issue focus on how to identify common potential problems at admission and help reduce patients' risk of further injury after discharge. In one, writer Dee Simmons, RN, talks to geriatric specialists about how to help prevent delirium in elderly patients who appear confused upon admission. And writer Jan Bowers explores what hospitalists can do to help prevent post-discharge fractures, which can be precipitated by hospitalization, according to a recent study. Reviewing an elderly patient's medication list for problems that could contribute to confusion or loss of balance is among eight simple steps recommended by one expert to prevent post-discharge falls.

This issue also marks the debut of our new “<a href=“coding.htm”>Coding Corner” columnist, Deborah Hale, a certified coding specialist with more than 20 years experience providing utilization management, coding, billing and clinical documentation improvement consultation for hospitals throughout the U.S. In her inaugural column, Ms. Hale explains the implications of CMS’ recent conversion to Medicare Severity Refined Diagnostic-Related Group payments, or MS-DRGs. The new methodology highlights the importance of making accurate secondary diagnoses in patients with common conditions, such as chronic heart failure. Read the column for tips on optimizing your reimbursements by ensuring accurate documentation of primary and secondary diagnoses.

We look forward to hearing your comments and suggestions for the new coding column, or any of our other features and departments. Look for all of our content online or email us.

Janet Colwell
Executive Editor, ACP Hospitalist