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CPR decision support videos can serve as a supplement to CPR preference discussions for inpatients
Clinical question: Does the use of a CPR decision support video impact patients’ code status preferences?
Background: Discussions about cardiopulmonary resuscitation are an important aspect of inpatient care but may be difficult to complete for several reasons, including poor patient understanding of the CPR process and its expected outcomes. This study sought to evaluate the impact of a CPR decision support video on patient CPR preferences.
Setting: General medicine wards at the Minneapolis Veterans Affairs from Sept. 28, 2015, to Oct. 23, 2015.
Synopsis: One hundred and nineteen patients older than 65 were randomized to receive standard care plus viewing a CPR decision support video or standard care alone. The primary outcome was patient code status preference. Patients completed a survey assessing trust in their care team.
Among the patients who viewed the video, 37% chose full code, compared with 71% of patients in the usual care arm. Patients who viewed the video were more likely to choose DNR/DNI (56%, compared with 17% in the control group). There was no significant difference in patient trust of the care team.
Study conclusions are limited by a study population consisting predominantly of white males. Though the study was randomized, it was not blinded.
Bottom line: A CPR decision support video led to a decrease in full code preference and an increase in DNR/DNI preference among hospitalized patients.
Citation: Merino AM et al. A randomized controlled trial of a CPR decision support video for patients admitted to the general medicine service. J Hosp Med. 2017;12(9):700-4.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.
Clinical question: Does the use of a CPR decision support video impact patients’ code status preferences?
Background: Discussions about cardiopulmonary resuscitation are an important aspect of inpatient care but may be difficult to complete for several reasons, including poor patient understanding of the CPR process and its expected outcomes. This study sought to evaluate the impact of a CPR decision support video on patient CPR preferences.
Setting: General medicine wards at the Minneapolis Veterans Affairs from Sept. 28, 2015, to Oct. 23, 2015.
Synopsis: One hundred and nineteen patients older than 65 were randomized to receive standard care plus viewing a CPR decision support video or standard care alone. The primary outcome was patient code status preference. Patients completed a survey assessing trust in their care team.
Among the patients who viewed the video, 37% chose full code, compared with 71% of patients in the usual care arm. Patients who viewed the video were more likely to choose DNR/DNI (56%, compared with 17% in the control group). There was no significant difference in patient trust of the care team.
Study conclusions are limited by a study population consisting predominantly of white males. Though the study was randomized, it was not blinded.
Bottom line: A CPR decision support video led to a decrease in full code preference and an increase in DNR/DNI preference among hospitalized patients.
Citation: Merino AM et al. A randomized controlled trial of a CPR decision support video for patients admitted to the general medicine service. J Hosp Med. 2017;12(9):700-4.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.
Clinical question: Does the use of a CPR decision support video impact patients’ code status preferences?
Background: Discussions about cardiopulmonary resuscitation are an important aspect of inpatient care but may be difficult to complete for several reasons, including poor patient understanding of the CPR process and its expected outcomes. This study sought to evaluate the impact of a CPR decision support video on patient CPR preferences.
Setting: General medicine wards at the Minneapolis Veterans Affairs from Sept. 28, 2015, to Oct. 23, 2015.
Synopsis: One hundred and nineteen patients older than 65 were randomized to receive standard care plus viewing a CPR decision support video or standard care alone. The primary outcome was patient code status preference. Patients completed a survey assessing trust in their care team.
Among the patients who viewed the video, 37% chose full code, compared with 71% of patients in the usual care arm. Patients who viewed the video were more likely to choose DNR/DNI (56%, compared with 17% in the control group). There was no significant difference in patient trust of the care team.
Study conclusions are limited by a study population consisting predominantly of white males. Though the study was randomized, it was not blinded.
Bottom line: A CPR decision support video led to a decrease in full code preference and an increase in DNR/DNI preference among hospitalized patients.
Citation: Merino AM et al. A randomized controlled trial of a CPR decision support video for patients admitted to the general medicine service. J Hosp Med. 2017;12(9):700-4.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.
Evidence-based care processes decrease mortality in Staphylococcus aureus bacteremia
Clinical questions: What are the trends in patient outcome for Staphylococcus aureus bacteremia (SAB)? Does the use of evidence-based care processes decrease mortality in SAB?
Background: SAB is associated with poor clinical outcomes. Prior research has demonstrated that several evidence-based interventions, namely appropriate antibiotics, echocardiography, and infectious disease consults, have been associated with improved outcomes. The use of these interventions in clinical practice and their large-scale impact on SAB mortality is not known.
Setting: Veterans Health Administration acute care hospitals in the continental United States from January 1, 2003, to Dec. 31, 2014.
Synopsis: This study used the Veterans Affairs Informatics and Computing Infrastructure to identify 36,868 patients across 124 acute care hospitals with a first episode of SAB. Use of evidence-based care processes (specifically appropriate antibiotic use, echocardiography, and infectious disease consults) and patient mortality were recorded.
All-cause 30-day mortality decreased 25.7% in 2003 to 16.5% in 2014. Concurrently, the rate of evidence-based care processes increased from 2003 to 2014. There was lower risk-adjusted mortality when patients received all three evidence-based care processes compared to those who received none, with an odds ratio of 0.33 (95% confidence interval, 0.30-0.37); 57.3% of the decrease in mortality was attributable to use of all three evidence-based care processes.
Given the observational nature of the study, unmeasured confounders were not considered. Generalizability of the study is limited since the patients were primarily men.
Bottom line: The use of evidence-based care processes (appropriate antibiotic use, echocardiography, and infectious disease consultation) was associated with decreased SAB mortality.
Citation: Goto M et al. Association of evidence-based care processes with mortality in Staphylococcus aureus bacteremia at Veterans Health Administration hospitals, 2003-2014. JAMA Intern Med. 2017;177(10):1489-97.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.
Clinical questions: What are the trends in patient outcome for Staphylococcus aureus bacteremia (SAB)? Does the use of evidence-based care processes decrease mortality in SAB?
Background: SAB is associated with poor clinical outcomes. Prior research has demonstrated that several evidence-based interventions, namely appropriate antibiotics, echocardiography, and infectious disease consults, have been associated with improved outcomes. The use of these interventions in clinical practice and their large-scale impact on SAB mortality is not known.
Setting: Veterans Health Administration acute care hospitals in the continental United States from January 1, 2003, to Dec. 31, 2014.
Synopsis: This study used the Veterans Affairs Informatics and Computing Infrastructure to identify 36,868 patients across 124 acute care hospitals with a first episode of SAB. Use of evidence-based care processes (specifically appropriate antibiotic use, echocardiography, and infectious disease consults) and patient mortality were recorded.
All-cause 30-day mortality decreased 25.7% in 2003 to 16.5% in 2014. Concurrently, the rate of evidence-based care processes increased from 2003 to 2014. There was lower risk-adjusted mortality when patients received all three evidence-based care processes compared to those who received none, with an odds ratio of 0.33 (95% confidence interval, 0.30-0.37); 57.3% of the decrease in mortality was attributable to use of all three evidence-based care processes.
Given the observational nature of the study, unmeasured confounders were not considered. Generalizability of the study is limited since the patients were primarily men.
Bottom line: The use of evidence-based care processes (appropriate antibiotic use, echocardiography, and infectious disease consultation) was associated with decreased SAB mortality.
Citation: Goto M et al. Association of evidence-based care processes with mortality in Staphylococcus aureus bacteremia at Veterans Health Administration hospitals, 2003-2014. JAMA Intern Med. 2017;177(10):1489-97.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.
Clinical questions: What are the trends in patient outcome for Staphylococcus aureus bacteremia (SAB)? Does the use of evidence-based care processes decrease mortality in SAB?
Background: SAB is associated with poor clinical outcomes. Prior research has demonstrated that several evidence-based interventions, namely appropriate antibiotics, echocardiography, and infectious disease consults, have been associated with improved outcomes. The use of these interventions in clinical practice and their large-scale impact on SAB mortality is not known.
Setting: Veterans Health Administration acute care hospitals in the continental United States from January 1, 2003, to Dec. 31, 2014.
Synopsis: This study used the Veterans Affairs Informatics and Computing Infrastructure to identify 36,868 patients across 124 acute care hospitals with a first episode of SAB. Use of evidence-based care processes (specifically appropriate antibiotic use, echocardiography, and infectious disease consults) and patient mortality were recorded.
All-cause 30-day mortality decreased 25.7% in 2003 to 16.5% in 2014. Concurrently, the rate of evidence-based care processes increased from 2003 to 2014. There was lower risk-adjusted mortality when patients received all three evidence-based care processes compared to those who received none, with an odds ratio of 0.33 (95% confidence interval, 0.30-0.37); 57.3% of the decrease in mortality was attributable to use of all three evidence-based care processes.
Given the observational nature of the study, unmeasured confounders were not considered. Generalizability of the study is limited since the patients were primarily men.
Bottom line: The use of evidence-based care processes (appropriate antibiotic use, echocardiography, and infectious disease consultation) was associated with decreased SAB mortality.
Citation: Goto M et al. Association of evidence-based care processes with mortality in Staphylococcus aureus bacteremia at Veterans Health Administration hospitals, 2003-2014. JAMA Intern Med. 2017;177(10):1489-97.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.