Questioning Things We Routinely Do: A Lines and PPI drips

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Great Post — Could Patient Centred Outcomes Research — based on real time analytics on data harnessed from the patients within the system — help stop such practices ?

JAMA Internal Medicine Blog

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A medicine trainee’s daily life is filled not just with rounds, the calling of consults, and care coordination, but also with smaller tasks, never formally taught in the medical school curriculum, that take on a rote, almost liturgical quality. Potassium repletion, ordering daily labs, making patients NPO–all are faithfully transmitted from one trainee generation to the next. Annoying as these can be to everyone–the patient most of all, but also the trainee and the nurse–most survive because they “make sense” and seem harmless. (Not always true, of course, at least not as often as believed.) In last week’s online issue of JAMA IM, then, there may be some relief for all from these daily errands: arterial catheters (“A lines”) in the ICU and proton pump inhibitor (PPI) drips for the patient with a GI bleed.

In the first article, Gershengorn and colleagues retrospectively examined patients in 139 ICUs in the US and compared mortality among those who received an A line and propensity matched controls who…

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