#381 LIVE! Patient Centered Things We Do For No Reason^TM

February 13, 2023 | By Matthew Watto, MD

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Join Drs. Amin and Trubitt as they go rogue and LIVE!  from Southern Hospital Medicine to discuss Things We Do For No Reason^TM in the hospital that impact the patient experience. They cover NPO at midnight, fluid restriction, VTE chemoprophylaxis and routine vital signs via the hospital course of one poor, unfortunate soul.

Show Segments

• Intro
• NPO at midnight
• Fluid restriction
• VTE chemoprophylaxis
• Frequency of vital sign monitoring
• Outro

Things We Do For No Reason^TM Pearls

1. High risk conditions for peri-procedural aspiration include gastroparesis, gastric or  bowel obstruction, pregnancy,  and lower esophageal sphincter incompetence.
2. Low risk patients for peri-procedural aspiration can have clear liquids up to 2 hours pre-procedure and should be NPO thereafter.
3. Fluid restriction activates the RAAS pathway and thereby leads to increased sodium retention, and in turn, fluid retention.
4. Patient centered decision making should be employed when deciding to order VTE chemoprophylaxis in low risk patients. 
5. Scoring systems like the Padua score can be used to identify which patients may not warrant VTE chemoprophylaxis.

Goal

Listeners will acknowledge that there are things we do for no reason in the hospital that affect the patient experience.

Learning objectives

After listening to this episode listeners will…

1. Identify low risk patients for peri-procedural aspiration.
2. Explain the pathophysiology of the RAAS activation pathway triggered by fluid restriction.
3. Determine low risk patients for VTE chemoprophylaxis.
4. Acknowledge potential benefits to limiting overnight vital sign monitoring.

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

Amin M, Trubitt M.. “# Patient Centered Things We Do For No Reason”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date February 13, 2023.