Stress ulcer prophylaxis for non-critically ill patients on a teaching service.
BACKGROUND
Doctors frequently give non-critically ill patients unjustified stress ulcer prophylaxis (SUP). It is unknown if this practice also occurs during residency training.


OBJECTIVE
To evaluate the pattern of SUP given to non-critically ill medical patients on the teaching service of an internal medicine residency programme.


METHODS
This was a retrospective cohort study of non-critically ill adults admitted to the internal medicine teaching service of a community hospital from August 2003 to July 2004. We assessed receipt of SUP, association of SUP with risk factors for stress ulcer bleeding; appropriateness of SUP according to evidence-based criteria; and incidence of stress ulcer bleeding.


RESULTS
Of the 774 patient records reviewed, 545 were included in the study. The average age was 55.4 years. Patients were more likely to receive SUP if they had more risk factors for stress ulcer bleeding (P < 0.001). Overall, 54.9% (299 of 545) of patients received SUP. Of these 299 patients, at least 58.5% did not warrant SUP, depending on the criteria used. Of the entire cohort of 545 non-critically ill patients, 32.1% to 54.9% received unjustified SUP, depending on the criteria applied. There were no cases of stress ulcer bleeding.


CONCLUSIONS
Many non-critically ill patients on the teaching service received unjustified SUP, suggesting the need for institutional protocols and educational interventions to promote evidence-based practice during residency training.
Hwang
Kevin O
KO
Joint Primary Care Fellowship, Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA. kevin.o.hwang@uth.tmc.edu
Kolarov
Sanja
S
Cheng
Lee
L
Griffith
Rebecca A
RA
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*