Letter from the Editor

This month's issue includes articles on managing the census, watching for malnutrition in obese patients, and combating alarm fatigue.

The conditions of a census surge are familiar to most hospitalist services. Some surges in the census can be predictable, such as those associated with flu season, but others can occur with absolutely no warning. No matter the cause, though, hospitals need to have a way to handle these sudden increases, or decreases, in the numbers of patients they see without overwhelming physicians or having a negative effect on patient care. In our cover story for this issue, Janet Colwell talks to hospitalists at different institutions to find out what plans they have in place to manage census surges, which ideas have worked and which haven't, and which solutions effectively balance costs and safety.

Alarm fatigue is another perennial problem in hospitals, to the point that it has been named a National Patient Safety Goal by The Joint Commission, which is requiring the establishment of policies to manage alarms by January 2016. Alarms can be helpful and necessary in some instances, but there's no doubt that their pervasiveness has also decreased their overall usefulness. Our article looks at ways to identify problem alarms and other methods of alleviating alarm fatigue, including eliminating duplicate alarms, removing warning alarms but maintaining crisis alarms, and basing potential solutions on your own hospital's specific data and situation.

When an obese patient is hospitalized, malnutrition may not be a physician's first concern. But research has shown that overlooking poor nutrition in obese patients can lead to worse outcomes. Clinicians should be alert to, and screen for, pre-existing malnutrition in obese patients, especially those who have had gastric bypass surgery or who have otherwise lost 10% or more of their body weight in the past 6 months, according to experts. In addition, physicians should keep an eye out for the possibility of obese patients developing malnutrition while hospitalized, for the same reasons that nonobese patients do: protein wasting, NPO status, or general lack of appetite. Read our story to learn more.

Finally, this month's Expert Analysis focuses on what hospitalists need to know about cardiopulmonary stress tests. The authors argue that such testing is underused in hospitalized patients even though it can provide a comprehensive picture of oxygen delivery and use, gas exchange efficiency, and any breathing abnormalities, among other variables.

How is your hospital handling alarm fatigue? Let us know.

Stacey Butterfield
Editor-in-Chief, ACP Hospitalist