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Eligibility For Posthospitalization Venous Thromboembolism Prophylaxis In Hospitalized Patients With Covid-19: A Retrospective Cohort Study, Valerie M. Vaughn, David Ratz, Elizabeth S. Mclaughlin, Jennifer K. Horowitz, Scott A. Flanders, Elizabeth A. Middleton, Paul J. Grant, Scott Kaatz, Geoffrey D. Barnes

Hospital Medicine Articles

Background: A recent randomized trial, the MICHELLE trial, demonstrated improved posthospital outcomes with a 35-day course of prophylactic rivaroxaban for patients hospitalized with COVID-19 at high risk of venous thromboembolism. We explored how often these findings may apply to an unselected clinical population of patients hospitalized with COVID-19.

Methods and Results: Using a 35-hospital retrospective cohort of patients hospitalized between March 7, 2020, and January 23, 2021, with COVID-19 (MI-COVID19 database), we quantified the percentage of hospitalized patients with COVID-19 who would be eligible for rivaroxaban at discharge per MICHELLE trial criteria and report clinical event rates. The main clinical …

Derivation And External Validation Of A Simple Risk Score To Predict In-Hospital Mortality In Patients Hospitalized For Covid-19: A Multicenter Retrospective Cohort Study, Charlotte Z. Mann, Chelsea Abshire, Monica Yost, Scott Kaatz, Lakshmi Swaminathan, Scott A. Flanders, Hallie C. Prescott, Johann A. Gagnon-Bartsch

Hospital Medicine Articles

ABSTRACT: As severe acute respiratory syndrome coronavirus 2 continues to spread, easy-to-use risk models that predict hospital mortality can assist in clinical decision making and triage. We aimed to develop a risk score model for in-hospital mortality in patients hospitalized with 2019 novel coronavirus (COVID-19) that was robust across hospitals and used clinical factors that are readily available and measured standardly across hospitals. In this retrospective observational study, we developed a risk score model using data collected by trained abstractors for patients in 20 diverse hospitals across the state of Michigan (Mi-COVID19) who were discharged between March 5, 2020 and …

Trends In Venous Thromboembolism Anticoagulation In Patients Hospitalized With Covid-19, Valerie M. Vaughn, Monica Yost, Chelsea Abshire, Scott A. Flanders, David Paje, Paul Grant, Scott Kaatz, Tae Kim, Geoffrey D. Barnes

Hospital Medicine Articles

Importance: Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality.

Objective: To characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality.

Design, Setting, and Participants: This cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients …

Barriers And Facilitators To Reducing Frequent Laboratory Testing For Patients Who Are Stable On Warfarin: A Mixed Methods Study Of De-Implementation In Five Anticoagulation Clinics., Geoffrey D. Barnes, Sevan Misirliyan, Scott Kaatz, Elizabeth A. Jackson, Brian Haymart, Eva Kline-Rogers, Jay Kozlowski, Gregory D. Krol, James B. Froehlich, Anne Sales

Hospital Medicine Articles

BACKGROUND: Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). De-implementation efforts aim to reduce the use of low-value clinical practices. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative.

METHODS: Using a mixed-methods approach, …

The Comparison Of Physician To Computer Interpreted Electrocardiograms On St-Elevation Myocardial Infarction Door-To-Balloon Times, Sagger Mawri, Alexander Michaels, Joseph J. Gibbs, Sunay Shah, Sunil Rao, Aaron Kugelmass, Natesh Lingam, Muhammad Arida, Gordon Jacobsen, Ian Rowlandson, Karthik Iyer, Akshay Khandelwal, James Mccord

Hospital Medicine Articles

OBJECTIVE: The purpose of the project was to study the impact that immediate physician electrocardiogram (ECG) interpretation would have on door-to-balloon times in ST-elevation myocardial infarction (STEMI) as compared with computer-interpreted ECGs.

METHODS: This was a retrospective cohort study of 340 consecutive patients from September 2003 to December 2009 with STEMI who underwent emergent cardiac catheterization and percutaneous coronary intervention. Patients were stratified into 2 groups based on the computer-interpreted ECG interpretation: those with acute myocardial infarction identified by the computer interpretation and those not identified as acute myocardial infarction. Patients (n = 173) from September 2003 to June 2006 …