Hospitals acute care

Occurring 2-4 d after acute care hospital admission... 

TBW depletion (often referred to as dehydration ) is typically a more gradual, chronic problem compared to ECF depletion. Because TBW depletion represents a loss of hypotonic fluid (proportionally more water is lost than sodium) from all body compartments, a primary disturbance of osmolality is usually seen. The signs and symptoms of TBW depletion include CNS disturbances (mental status changes, seizures, and coma), excessive thirst, dry mucous membranes, decreased skin turgor, elevated serum sodium, increased plasma osmolality, concentrated urine, and acute weight loss. Common causes of TBW depletion include insufficient oral intake, excessive insensible losses, diabetes insipidus, excessive osmotic diuresis, and impaired renal concentrating mechanisms. Long-term care residents are frequently admitted to the acute care hospital with TBW depletion secondary to lack of adequate oral intake, often with concurrent excessive insensible losses. 

Raehl, C.L., Bond, C.A., and Pitterle, M.E., Ambulatory pharmacy services affiliated with acute care hospitals. Pharmacotherapy, 13(6) 618-625 (1993). 

Many elderly persons, whether demented or cognitively intact, have medical conditions that disrupt sleep. Untreated insomnia and daytime sleepiness have been associated with nursing home placement and mortality. Medically ill older adults admitted to acute care hospitals are particularly vulnerable to sleep disruptions, which appear to be created as much by the various treatments and procedures, unfamiliar routines, and environmental conditions, as by the pain, anxiety, and discomfort associated with their underlying medical condition. Medical conditions especially likely to disrupt sleep are congestive heart failure, chronic obstructive pulmonary disease, Parkinson s disease, gastroesophageal reflux disease, arthritis, and nocturia. 

Action Provide definitive medical care to victims who become seriously ill or injured as a result of a major disaster or emergency. For this purpose, NDMS has established and maintains a nationwide network of voluntarily precommitted, nonfederal, acute care hospital beds in the largest U.S. metropolitan areas. 

Atkinson AJ Jr, Nadzam DM, Schaff RL. An indicator-based program for improving medication use in acute care hospitals. Clin Pharmacol Ther 1991 50 125-8. 

In addition to the smallpox response teams, ACIP and HICPAC have recommended that every acute-care hospital identify and vaccinate a team of health care workers who might provide direct care for the first smallpox patients requiring admission or who might manage suspected case patients in emergency departments. When possible, to reduce the potential for adverse reactions to the vaccine, designated health care workers should be those who previously received smallpox vaccinations. 

Hawaii Yes Licensed acute care hospitals Restricted to modifying drug regimen Administer drugs by injection allowed... 

It is also notable that the numbers of hospitals in urban and rural settings are shrinking. In 1993, there were 3012 urban hospitals and 2249 rural, whereas in 1998, there were 2816 urban and 2199 rural hospitals (13). The numbers of public acute care hospitals decreased from 1390 in 1993 to 1260 in 1997 (8). Closure of hospitals and simultaneous reductions in hospital beds has occurred in inner city areas where care is provided for large numbers of indigent patients. Such closures are related to the high costs of care, which are not concomitantly reimbursed by state and federal sources... 

The typical work settings for clinical pharmacists in a health system include acute care hospital, ambulatory clinic, outpatient pharmacy, home care pharmacy, and community pharmacy. 

Acute care hospital in the patient care area(s). 

Sattar et al. discussed the impact of changing social trends on infectious diseases in industrial nations [1]. These investigators observed that in the last 20 years, as healthcare costs have risen, acute-care hospital admissions have decreased dramatically. During this time period, the number of days per hospital stay decreased from 12 to 5 days. Consequently, the number of patients in home care and thus the potential for infectious disease spread in the home have increased. 

Michel, R, Quenon, J.L., de Sarasqueta, A.M. and Scemama, O. (2004) Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. British Medical Journal, 32B(7433), 199. 

Turunen, H., Partanen, P, Mantynen, R., Kvist, T., Miettinen, M. and Vehvilainen-Julkunen, K. 2011. Management Support for Patient Safety A Three Year Follow Up Study for Hospital Staff in Four Finnish Acute Care Hospitals. 10th ENDA Congress, 5-8 October 2011, Rome. 

Frankel et al. (2008) Executive Walk Rounds Two years Two acute care hospitals Safety Attitudes Questionnaire Hospital A increased from 62% to 77% Hospital B increased from 46% to 56%... 

It appears that the modern patient safety movement started in 1991 with the publication of the results of the Harvard Medical Practice Study in the New England Journal of Medicine [2-4], In the study, the medical records of 30,000 patients hospitalized in acute care hospitals in New York State in 1984 were examined. In 1996, the American Medical Association announced the formation of the National Patient Safety Foundation [2], In 1999, the National Academy of Sciences Institute of Medicine released its report entitled "To Err Is Human Building a Safer Health System" [5]. The report stated that medical errors are causing 44,000-98,000 preventable deaths annually in the United States. In 2001, the United States Congress appropriated 50 million per year for patient safety research to the Agency for Healthcare Research and Quality (AHRQ) [2],... 

Bonis, P. A., Pickens, G. T., Rind, D. M, Foster, D. A, Associationof a Clinical Knowledge Support System with Improved Patient Safety, Reduced Complications and Shorter Length of Stay among Medicare Beneficiaries in Acute Care Hospitals in the United States, International Journal of Medical Informatics, Vol. 77, No. 11, 2003, pp. 745-753. 

Studdert, Brennan, and Thomas, 2000 2.9% AE rate from 15,000 medical records randomly drawn in 1992 from acute care hospitals 2% of AEs were considered serious death occurred 0.3% of the time, and permanent disability occurred in 1.3% of injuries... 

Janssen RS, St Louis ME, Satten GA, et al. (1992) HIV infection among patients in US acute care hospitals. Strategies for the counseling and testing of hospital patients. N Engl J Med 327 445-452... 

In the New England region of the USA, Rossingnol et al. [26] reviewed data on adult bum patients admitted to any of the240 of a possible 256 acute-care hospitals. Between the years of 1978 and 1979,485 (30 %) of these bums were work related, and there were 91 chemical skin injuries [26]. 

Munoz-Price LS, Hota B, Sterner A, Weinstein RA. Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009 30(11) 1031-5. 

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