Patient safety hospital discharge

We have proved the safety of discharging patients diagnosed with plague from the hospital after treatment and one negative test instead of three. This allows closing the epidemic foci 4 days earlier, and it already is regulated by the new Ministry of Health standard. 

ExTRACT-TIMI 25 is a 21,000-patient trial evaluating enoxaparin versus UFH in STEMI patients receiving fibrinol54ic therapy (Fig. 7.4) (38a). Importantly, it will provide information on the efficacy and safety of reduced doses of enoxaparin in the elderly. Patients in ExTRACT-TIMI 25 may be treated with approved regimens of streptokinase, t-PA, reteplase (r-PA), or TNK within 6 hours of the onset of symptoms. They are randomized to either standard weight-adjusted therapy with UFH [bolus 60 U/kg (maximum 4000 U) followed by an initial infusion of 12 U/kg/h (maximum 1000 U/h)] for at least 48 hours or to enoxaparin. For patients under 75 years, the enoxaparin regimen consists of an intravenous bolus of 30 mg followed by subcutaneous injections of 1.0 mg/kg every 12 hours. Patients 75 years or older do not receive the initial intravenous bolus and receive only 75% of the maintenance subcutaneous doses (0.75 mg/kg every 12 hours). Treatment with enoxaparin continues until hospital discharge or day 8,... 

Since the publication of patient information sheets encouraging participation in safety practices, a small number of studies have assessed patients willingness to speak up and otherwise check on hospital procedures. We will consider three representative studies focusing respectively on consumers (i.e. people not in hospital), recently discharged patients and patients in hospital. 

Cocaine use may account for up to 25% of acute myocardial infarctions among patients aged 18-45 years. The safety of a 12-hour observation period in a chest pain unit followed by discharge in individuals with cocaine-associated chest discomfort who are at low risk of cardiovascular events has been evaluated in 302 consecutive patients aged 18 years or older (66% men, 70% black, 84% tobacco users) who developed chest pain within 1 week of cocaine use or who tested positive for cocaine (59). Cocaine use was self-reported by 247 of the 302 subjects and rest had urine positive for cocaine 203 had used crack cocaine, 51 reported snorting, and 10 had used it intravenously. Of the 247 who reported cocaine use, 237 (96%) said they had used it in the week before presentation and 169 (68%) within 24 hours before presentation. Follow-up information was obtained for 300 subjects. There were no deaths from cardiovascular causes. Four patients had a non-fatal myocardial infarction during the 30-day period all four had continued to use cocaine. Of the 42 who were directly admitted to hospital, 20 had acute coronary syndrome. The authors suggested that in... 

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