Although nutrition is one of the most basic human needs, it's often overlooked in the hospital. Studies have shown that, on average, enteral feeding meets only 50% of patients' nutritional requirements, and it's not uncommon for substantial caloric deficits to accumulate in the first week after hospital admission, experts say. In our cover story, Stacey Butterfield reviews new guidelines on nutrition support therapy from the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, including a controversial provision on starting parenteral feeding, and talks to leaders in the field for advice on keeping your patients adequately fed.
The primary care shortage is well known, but there's another shortage that may soon be impacting hospitalist practices: general surgeons. Over the past 25 years, the number of general surgeons per capita has decreased by more than 25%, and more surgeons have begun working in a locum tenens capacity. The result? Hospitalists are more likely to find themselves caring for patients of surgeons who are here today and gone tomorrow. But that doesn't mean that patient care will be adversely affected, experts say. Take a look at this trend as well as tips on working with temporary surgeons at your facility.
This issue also features a Q&A with two doctors, a trauma surgeon and a hospitalist, who've come up with a novel method of managing trauma admissions at their hospital. Swedish Medical Center in Denver, Colo., uses an algorithm to determine if trauma patients would benefit from medical rather than surgical management. For the cases that qualify, hospitalists take the lead. A recent pre-post study found that rates of mortality, complications and placement to rehab were similar in patients who were managed with the service and those who were not, although the service did slightly increase length of stay. Click here to learn more about this innovative program.
Finally, in our latest Expert Analysis, Lawrence E. Stam, ACP Member, looks at when hospitalists should seek a nephrology consult in patients with renal failure. If you have suggestions for clinical topics you'd like to see explored in this section, or any other comments or questions, please let us know. As always, we look forward to hearing from you.
Executive Editor, ACP Hospitalist