Miss Lily's List: Nursing

• Hospitals are not hotels, and although hospital patients may in some ways be informed consumers, they’re predominantly sick, needy people, depending on us, the nurses and doctors, to get them through a very tough physical time. They do not come to us for vacation, but because they need the specialized, often painful help that only we can provide. Sadly, sometimes we cannot give them the kind of help they need.
• If the Centers for Medicare and Medicaid Services is to evaluate the patient experience and link the results to reimbursement, it needs to incorporate questions that address the complete and expected hospital experience. It’s fair and even valuable to compare hospitals on the basis of how well they maintain standards of patient engagement. But a survey focused on “satisfaction” elides the true nature of the work that hospitals do. In order to heal, we must first hurt.

• In hospitalized, hemodynamically stable patients, at what hemoglobin concentration should a decision to transfuse RBCs be  considered?

• In adult and pediatric intensive care unit patients, transfusion should be considered at hemoglobin concentrations of 7 g/dL  or less. 

     

  In postoperative surgical patients, transfusion should be considered at a hemoglobin concentration of 8 g/dL or less or for  symptoms (chest pain, orthostatic hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure). 

     
• The restrictive strategy in this trial permitted transfusion if the postoperative hemoglobin concentration was less than  8 g/dL or if the patient had symptoms, defined as chest pain believed to be cardiac in origin, orthostatic hypotension or  ta

  chycardia unresponsive to fluid challenge, or symptoms of congestive heart failure. The

  panel believed that these recommendations  would probably apply to most postsurgical and medical patients, with the exception of tho

  se with the acute coronary syndrome.  We also r

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  end restrictive transfusion in patients receiving predeposit, autologous RBCs.

• In hospitalized, hemodynamically stable patients with preexisting cardiovascular disease, at what hemoglobin concentration  should a decision to transfuse RBCs be considered? 

     

     
• Transfusion should be considered at a hemoglobin concentration of 8 g/dL or less or for symptoms (chest pain, orthostatic  hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure).
• In hospitalized, hemodynamically stable patients, should transfusion be guided by symptoms rather than hemoglobin concentration?
• The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration.

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