Analysing Monday discharges to identify lost opportunities for weekend discharge.

Lower rates of hospital discharge occur on weekends compared with weekdays. The authors performed a retrospective chart review of Monday discharges from the Hospital Medicine service at an academic hospital over a 3-month period to identify reasons for delayed discharge despite medical stability. Of 202 eligible patients, 81 (40%) had documentation indicating stability for earlier discharge.

Severity of illness and the weekend mortality effect: a retrospective cohort study.

Background: Weekend admission to the hospital has been found to be associated with higher in-hospital mortality rates, but the cause for this phenomenon remains controversial. US based studies have been limited in their characterization of the weekend patient population, making it difficult to draw conclusions about the implications of this effect.

Methods: A retrospective cohort study, examining de-identified, patient level data from 2015 to 2017 at US academic medical centers submitting data to the Vizient database, comparing demographic and clinical risk profiles, as well as mortality, cost and length of stay, between weekend and weekday patient populations.

Adherence to fluid resuscitation guidelines and outcomes in patients with septic shock: Reassessing the "one-size-fits-all" approach.

Objective: The Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality.

Design: Retrospective, observational study.

Intersubject variability of risk from perchlorate in community water supplies.

This article is a brief review and summary of the estimated incremental risks (increases in hazard quotient or decreases in thyroid uptake of iodine) to pregnant women (and hence their fetuses) associated with perchlorate exposure in community water supplies (CWSs) . The analysis draws on the recent health effects review published in 2005 by the National Research Council (NRC) . We focus on the potential level of risk borne by the NRC-identified most sensitive subpopulation (pregnant women and hence their fetuses) .

Measuring clinicians' expectations prior to EHR implementation.

To measure user expectations and knowledge of the issues involved in the transition from a paper-based system to an EHR, we created an on-line questionnaire, and invited physicians from several specialties at Beth Israel Medical Center (BIMC) to respond to it. As expected, most participants had positive expectations for the EHR and its features, but respondents were more skeptical of electronic clinical decision support systems (CDSS) than we had expected. The responses of this "EHR-naïve" group of physicians underscore the importance of managing expectations with the implementation of the EHR and of the delicate balance involved in preserving physician independence when proposing a clinical decision support system.