By the book: Optimizing patient care
Cutting-edge care requires keeping up with constantly changing information.
Some of the most common conditions that hospitalists encounter in clinical practice are also those for which optimal care is a constantly moving target. With new literature and updated guidelines emerging at a rapid pace—sometimes a few times a year—keeping up can be a daunting endeavor.
These common conditions that hospitalists encounter in clinical practice most often involve lung pathologies, including pneumonia, chronic obstructive pulmonary disease (COPD), and asthma.
“While it is difficult to say, our estimate would be that 20%-30% of admissions involve some sort of respiratory condition,” said Joanna Bonsall, MD, PhD, SFHM, associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia. “It can be overwhelming to stay on top of the latest evidence for care of these conditions.”
Dr. Bonsall and Daniel Dressler, MD, MSc, MHM, FACP, professor of medicine and director of Internal Medicine Teaching Services at Emory University Hospital, will lead an interactive session, “You Leave Me Breathless: Optimal Care for Pneumonias, COPD and Asthma Exacerbations, and More,” 11:30 a.m.-12:20 p.m. on Tuesday.
During the session, using a case-based format, audience members will actively participate to decide on the best next steps in patients presenting with various types of pneumonia as well as exacerbations of COPD and asthma. Faculty will interactively discuss and provide best and newest literature evidence and guidelines to support the optimal evaluation and management of patients presenting with these common pulmonary conditions.
Updating of guidelines is variable based on the organization(s) producing the guidelines, which can add another degree of difficulty trying to track them. Although some are updated annually, other updates are less frequent and some are more, according to Drs. Bonsall and Dressler.
“For example, pneumonia guidelines are not updated very frequently: More than 10 years passed between the IDSA (Infectious Diseases Society of America) and ATS’s (American Thoracic Society) pneumonia guidelines updates. However, international COPD guidelines (e.g., GOLD Guidelines) and international Asthma Guidelines (e.g., GINA Guidelines) are updated annually or sometimes twice per year,” both commented. “Therefore, it’s important to stay on top of new study evidence that can guide care (in the absence of updated guidelines), which may emerge throughout each year; and stay on top of frequently updated guidelines that change yearly based on newly published evidence.”
Drs. Bonsall and Dressler recommend taking full advantage of update alerts offered through societies, including the Society of Hospital Medicine, as well as other “push” resources, such as the New England Journal of Medicine Journal Watch, especially for frequently updated guidelines (COPD and asthma).
“These are often the best resources to find most of the updated evidence,” they said. “Point-of-care references can also be helpful when you're caring for particular patients with respiratory conditions.”
Keeping up to date on guidelines and recommendations ultimately results in the best care for patients and can shape outcomes. One example of this involves the recent recommendation that adults with asthma use inhaled corticosteroids as part of acute relief asthma control—either combined inhaled corticosteroid with long-acting beta agonist (ICS-LABA) or taking ICS when using a short-acting beta agonist (such as albuterol) is used, Dr. Dressler said.
“We now have great evidence that this approach is superior to using albuterol alone for acute relief of asthma, but practices seem to be lagging for this guideline-recommended approach,” he said.
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