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Supplemental Digital Content is Available in the Text. Severe sepsis and septic shock cause significant morbidity and mortality with health care costs approximating $17 billion annually. The Surviving Sepsis Campaign 2012 recommended time-sensitive care bundles to improve outcomes for patients with sepsis. At our community teaching hospital, a review of sepsis management for patients admitted to a medical intensive care unit (ICU) between December 2015 and March 2016 found 70.8% compliance with timing of lactate draw, 65.3% compliance for blood cultures, and 51.4% compliance with antibiotic administration recommendations. Thus, a quality improvement initiative to improve detection and time to bundle completion for ICU-level patients was designed. Previous studies suggest that utilization of sepsis alert systems and sepsis response teams in the emergency department setting is associated with improved compliance with recommended sepsis bundles and improved hospital mortality. Therefore, a "sepsis alert" protocol was implemented that used both an electronic alert and an overhead team alert that mobilized nursing, pharmacy, phlebotomy, and a senior internal medicine resident to bedside. In addition, a template to document sepsis diagnosis and bundle adherence was created. After implementation, we noted improvement in appropriately timed serum lactate, 88.6% versus 70.8% (p =.008) with no significant improvements in blood cultures, antibiotic administration, or mortality. [ABSTRACT FROM AUTHOR]

Hospitalists frequently consult medical subspecialists in the management of inpatients. Given the potential impact on health resource utilization, it is important to understand the working relationship between these groups.~Background~Background~A cross-sectional survey of hospitalists, n = 655, and subspecialists across Ohio (nephrologists and endocrinologists), n = 293, was conducted to investigate perceptions and communication about reasons, timing, and impact of hospital consultations.~Methods~Methods~Survey response rate was 13.3%. Hospitalists were more likely to report subspecialty request to serve as admitting physician with subsequent consultation 63.2% versus 26.7%, p < .001. Hospitalists with a daily workload ¿15 patients per day were more likely to report that this impeded their ability to manage details of patient care versus hospitalists with <15 patients per day, 53.2% versus 24.1%, p = .02, and resulted in subspecialty consultation for problems manageable by the hospitalist, 38.3% versus 6.9%, p = .003. Hospitalists were less likely than subspecialists to report major impact from consultation 50.0% versus 81.0%, p = .001 and they were more likely to report direct communication for urgent consults 97.3% versus 48.8%, p < .001.~Results~Results~Future work should be aimed at addressing hospitalist workload, improving communication, and ensuring appropriate need and timing of consultation.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic. An electronic reminder was prospectively implemented into our electronic medical record (EMR) with the goal of improving screening rates. After 1 year, a retrospective chart review was conducted. Comparisons of the pre- and post-electronic reminder intervention data were made using chi-square tests and odds ratios (OR). The purposeful AAA screening rate improved 27.8% during the intervention, 40.3% (95% confidence interval [CI]: 28.6-52.0%) versus 12.5% (95% CI: 3.1-21.9%), p = .002, suggesting patients were more likely to be screened as a result of the electronic reminder, OR = 4.73 (95% CI: 1.77-12.65). This improvement translates to a large effect size, Cohen's d = 0.86 (95% CI: 0.31-1.40). Electronic reminders are a simple EMR addition that can provide evidence-based education while improving adherence rates with preventive health screening measures.~Unassigned [ABSTRACT FROM AUTHOR]

Objective: To determine the reaction of neurology practitioners to the Food and Drug Administration (FDA) alert concerning suicidality (suicidal ideation or behavior) and antiepileptic drugs., Methods: We designed a 21-question survey asking about the participants' approach to suicidality and depression in patients with epilepsy (PWE), and their reaction to the FDA alert and its impact on their clinical practices. Participants (n = 780) were invited via e-mail to respond to a Zoomerang survey. Two reminders were sent to increase the response., Results: The survey was completed by 175 participants (22%). Most were epilepsy specialists practicing in academic settings. Almost 62% did not use any scale to routinely screen for depression in PWE. For those who used a scale, the Beck Depression Inventory was the most used one. About 42% did not feel comfortable initiating treatment for depression. Although 98% warn about behavioral side effects when starting antiepileptic drugs, only 44% warn specifically about suicidal ideations or behavior. More than half were not aware of patients who attempted to commit suicide or who had committed suicide. The mean scores for the FDA alert clarity, appropriateness, and impact on clinical practice (on a scale from 1 to 10) were low, at 5.3, 4.1, and 3.6. Almost 46% did not feel the alert is going to change their practice., Conclusion: The Food and Drug Administration alert did not get a favorable score from the surveyed responders. Participants actively alert patients about behavioral side effects of antiepileptic drugs, but are not specific about suicide.