Difficult decisions

Learn about dilemmas related to feeding tubes in advanced dementia and ICU admission in this month's issue.

This issue focuses on some difficult decisions that hospitalists face. Our cover story addresses the decision to place a feeding tube in a patient with advanced dementia. The evidence base and physician preference generally say no, yet many patients receive the devices anyway. The article looks at the factors that complicate this decision and gathers advice from experts on how hospitalists can provide optimal, thoughtful care for these vulnerable patients and their families.

This month's other tricky decision is which patients should be admitted to the ICU. We've been trying to help you solve this one for years (see “Too many or too few: Who belongs in the ICU?” in the February 2013 ACP Hospitalist), and unfortunately, the experts say there's still no definitive answer even in the works. As the story explains, some critical care researchers have given up the idea that triage decision making can ever be standardized. The good news is they also don't believe that the lack of protocols is necessarily a barrier to providing high-value, high-quality ICU care. A related Test Yourself has questions from MKSAP 18 focused on intensive care.

Our readers have contributed a lot to this issue. We have an Expert Analysis offering advice on the diagnosis and treatment of subsegmental pulmonary embolism and a Perspectives piece covering what every hospitalist should know about the Emergency Medical Treatment and Labor Act. As always, we welcome your submissions at acphospitalist@acponline.org. Just be sure not to type them on the magical computer described in this month's Newman's Notions.

Stacey Butterfield