Zachary G. Jacobs MD, FHM, FACP, Michael Rothberg MD, MPH, Thomas E. MacMillan MD, MSc
Patients in the hospital frequently have multiple chronic conditions in addition to their acute illnesses. Inpatient providers may feel pressured to adjust outpatient medication regimens in response to acute variations in labs or vital signs during hospitalization, or in an attempt to optimize long-term disease control. However, this practice should generally be deferred to the outpatient setting, as the effective management of chronic conditions requires longitudinal care and should take place during periods of homeostasis. In select circumstances and for certain high-risk patients, stepwise modifications to chronic disease medications may be considered during hospitalization, but this should always be coordinated with the primary care provider.
{"title":"Point-counterpoint: Should chronic disease medications be adjusted during unrelated hospitalizations?","authors":"Zachary G. Jacobs MD, FHM, FACP, Michael Rothberg MD, MPH, Thomas E. MacMillan MD, MSc","doi":"10.1002/jhm.70143","DOIUrl":"10.1002/jhm.70143","url":null,"abstract":"<p>Patients in the hospital frequently have multiple chronic conditions in addition to their acute illnesses. Inpatient providers may feel pressured to adjust outpatient medication regimens in response to acute variations in labs or vital signs during hospitalization, or in an attempt to optimize long-term disease control. However, this practice should generally be deferred to the outpatient setting, as the effective management of chronic conditions requires longitudinal care and should take place during periods of homeostasis. In select circumstances and for certain high-risk patients, stepwise modifications to chronic disease medications may be considered during hospitalization, but this should always be coordinated with the primary care provider.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 11","pages":"1240-1244"},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph H. Joo MD, MS, MacKenzie L. Hughes PhD, Wen Hu MS, Jackie Soo ScD, Shriram Parashuram PhD, MPH, Adil Moiduddin MPP, Steven Sheingold PhD, Joshua M. Liao MD, MSc
Care coordination is integral during posthospital transitions. The Centers for Medicare & Medicaid Services (CMS) has sought to promote post-hospitalization care coordination through population-based alternative payment models (APMs) and transitional care management (TCM) services. Both can be associated with benefits, but data are lacking about their overlap. Using 2018–2019 100% Medicare claims, we compared characteristics and quantified overlap across APM and TCM groups. Of 7,034,244 beneficiaries and 11,148,266 discharges, 41.6% were APM-aligned and 14.5% involved TCM. TCM services were received in 19.7% of APM-aligned discharges; among discharges involving TCM, 56.7% occurred among APM-aligned beneficiaries. Relative to non-APM beneficiaries, APM-aligned beneficiaries receiving TCM were less likely to be from historically underserved populations, suggesting potential health disparity concerns. This early descriptive analysis offers novel evidence about TCM and APMs as major national policy investments, highlighting the need for future work on overlap and its effects on care coordination and patient outcomes.
{"title":"Overlap between transitional care management after hospital discharge and alternative payment models","authors":"Joseph H. Joo MD, MS, MacKenzie L. Hughes PhD, Wen Hu MS, Jackie Soo ScD, Shriram Parashuram PhD, MPH, Adil Moiduddin MPP, Steven Sheingold PhD, Joshua M. Liao MD, MSc","doi":"10.1002/jhm.70085","DOIUrl":"10.1002/jhm.70085","url":null,"abstract":"<p>Care coordination is integral during posthospital transitions. The Centers for Medicare & Medicaid Services (CMS) has sought to promote post-hospitalization care coordination through population-based alternative payment models (APMs) and transitional care management (TCM) services. Both can be associated with benefits, but data are lacking about their overlap. Using 2018–2019 100% Medicare claims, we compared characteristics and quantified overlap across APM and TCM groups. Of 7,034,244 beneficiaries and 11,148,266 discharges, 41.6% were APM-aligned and 14.5% involved TCM. TCM services were received in 19.7% of APM-aligned discharges; among discharges involving TCM, 56.7% occurred among APM-aligned beneficiaries. Relative to non-APM beneficiaries, APM-aligned beneficiaries receiving TCM were less likely to be from historically underserved populations, suggesting potential health disparity concerns. This early descriptive analysis offers novel evidence about TCM and APMs as major national policy investments, highlighting the need for future work on overlap and its effects on care coordination and patient outcomes.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"59-63"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacob Wagner MD, Kiril Dimitrov MD, Zachary Lauer MD, Swati Jain MBBS, Omar Jibril MD, Zach Kaltenborn MD, Aditya Kler MD, Andrew Olson MD, Justin Clark PhD, Kyle Rudser PhD, Matthew Yocum MD
Background
Lumbar puncture (LP) is frequently necessary in hospitalized patients for diagnostic and therapeutic purposes. Traditional landmark identification by palpation of the lumbar spine and pelvis can see significant failure rates. A paramedian approach is an accepted, though less frequently used technique associated with higher success rates for spinal access in anesthesia when aided by ultrasound. Similarly, point-of-care ultrasound (POCUS) of the paramedian acoustic window may help guide a paramedian LP technique.
Objective
To compare the probability of success before and after the implementation of a standardized training curriculum for lumbar punctures (LPs) performed by the Hospital Medicine Procedure Service (HMPS).
Methods
The HMPS at the University of Minnesota Medical Center (UMMC), a large tertiary academic medical center, implemented a standardized training for an ultrasound-assisted paramedian (USPM) approach to all bedside lumbar punctures (LPs) and then conducted a retrospective review comparing success rates between the traditional midline (ML) and USPM approaches.
Results
A total of 269 LPs were performed on hospitalized patients. Before standardization, the probability of a successful LP was 72.6% using ML approach. After standardization, using a USPM approach, the probability of a successful LP was 85.4%. The probability of a successful procedure was 13.6 (95% confidence interval: 2.8, 24.4, p = .014) percentage points higher for the USPM approach when compared to the ML approach and accounting for sex, age, BMI, and if the LP was for chemotherapy.
Conclusions
Institutions with a HMPS should consider transitioning to use of the USPM approach for bedside LPs, which is associated with a higher probability of success and reduced utilization of more resource-intensive hospital services, such as Interventional Radiology or Neuroradiology.
{"title":"Increased lumbar puncture success using a paramedian approach: A retrospective cohort study","authors":"Jacob Wagner MD, Kiril Dimitrov MD, Zachary Lauer MD, Swati Jain MBBS, Omar Jibril MD, Zach Kaltenborn MD, Aditya Kler MD, Andrew Olson MD, Justin Clark PhD, Kyle Rudser PhD, Matthew Yocum MD","doi":"10.1002/jhm.70138","DOIUrl":"10.1002/jhm.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lumbar puncture (LP) is frequently necessary in hospitalized patients for diagnostic and therapeutic purposes. Traditional landmark identification by palpation of the lumbar spine and pelvis can see significant failure rates. A paramedian approach is an accepted, though less frequently used technique associated with higher success rates for spinal access in anesthesia when aided by ultrasound. Similarly, point-of-care ultrasound (POCUS) of the paramedian acoustic window may help guide a paramedian LP technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the probability of success before and after the implementation of a standardized training curriculum for lumbar punctures (LPs) performed by the Hospital Medicine Procedure Service (HMPS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The HMPS at the University of Minnesota Medical Center (UMMC), a large tertiary academic medical center, implemented a standardized training for an ultrasound-assisted paramedian (USPM) approach to all bedside lumbar punctures (LPs) and then conducted a retrospective review comparing success rates between the traditional midline (ML) and USPM approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 269 LPs were performed on hospitalized patients. Before standardization, the probability of a successful LP was 72.6% using ML approach. After standardization, using a USPM approach, the probability of a successful LP was 85.4%. The probability of a successful procedure was 13.6 (95% confidence interval: 2.8, 24.4, <i>p</i> = .014) percentage points higher for the USPM approach when compared to the ML approach and accounting for sex, age, BMI, and if the LP was for chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Institutions with a HMPS should consider transitioning to use of the USPM approach for bedside LPs, which is associated with a higher probability of success and reduced utilization of more resource-intensive hospital services, such as Interventional Radiology or Neuroradiology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"42-48"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca Y. Linfield MD, MS, Leon S. Moskatel MD, Sean Carlton PharmD, BCPS, Fatemeh Amrollahi PhD, David Epstein MD, Amy Chang MD, PharmD, David Svec MD, MBA, Jonathan H. Chen MD, PhD, Lisa Shieh MD, PhD
We developed a Best Practice Advisory (BPA) to encourage switching from intravenous (IV) to oral (PO) formulations of antimicrobials with equal efficacy, to decrease costs and IV usage. We conducted a prospective study analyzing our BPA's effect on prescribing practices of antimicrobials in the inpatient setting of Stanford Hospital in Palo Alto, CA, over a 22-month period. Our BPA achieved a 1526/6585 (23.2%) acceptance rate and led to decreased use of IV antimicrobials, with substantial direct cost savings of at least $66,976. Future efforts will focus on expanding our BPA to non-antimicrobials given ongoing IV fluid shortages.
{"title":"The impact of a best practice advisory for shifting to oral medications: A quality improvement project","authors":"Rebecca Y. Linfield MD, MS, Leon S. Moskatel MD, Sean Carlton PharmD, BCPS, Fatemeh Amrollahi PhD, David Epstein MD, Amy Chang MD, PharmD, David Svec MD, MBA, Jonathan H. Chen MD, PhD, Lisa Shieh MD, PhD","doi":"10.1002/jhm.70127","DOIUrl":"10.1002/jhm.70127","url":null,"abstract":"<p>We developed a Best Practice Advisory (BPA) to encourage switching from intravenous (IV) to oral (PO) formulations of antimicrobials with equal efficacy, to decrease costs and IV usage. We conducted a prospective study analyzing our BPA's effect on prescribing practices of antimicrobials in the inpatient setting of Stanford Hospital in Palo Alto, CA, over a 22-month period. Our BPA achieved a 1526/6585 (23.2%) acceptance rate and led to decreased use of IV antimicrobials, with substantial direct cost savings of at least $66,976. Future efforts will focus on expanding our BPA to non-antimicrobials given ongoing IV fluid shortages.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1377-1382"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shana A. Burrowes PhD, Kayla C. Jones MA, Christopher J. Williams MS, Caitlin M. Neri MD, MPH, Elizabeth S. Klings MD, Scarlett L. Bellamy ScD, Allan J. Walkey MD, MSc, Mari-Lynn Drainoni PhD, MEd, Robyn T. Cohen MD, MPH
Background
In 2017 Boston Medical Center's (BMC) general pediatric inpatient unit implemented bi-level positive airway pressure (BiPAP) as supportive noninvasive ventilation for acute chest syndrome prevention (SNAP) to prevent adverse respiratory outcomes among medically stable, hospitalized patients with sickle cell disease. Barriers and facilitators to SNAP implementation at BMC differ from those in other settings.
Objective
To examine contextual determinants of SNAP implementation across different settings.
Methods
We conducted semi-structured interviews with inpatient clinicians at three sites (Site 1: extensive implementation, Site 2: limited implementation, Site 3: not implemented) about factors that would affect SNAP implementation. Interviews and analysis were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.
Results
We interviewed 29 healthcare workers (physicians, nurses, physician assistants, child life specialists, respiratory therapists and psychologists). Five major themes emerged: (1) Communication between staff, particularly between the night and day shift, is critical for BiPAP initiation and success. (2) Nurses are key to successful SNAP implementation. (3) SNAP implementation requires multidisciplinary support, including integration of respiratory therapists and child life. (4) Individual unit level size, culture and workflow influence implementation (5) Hospital resources and leadership support are important for SNAP implementation.
Conclusions
Successful SNAP implementation across different contexts will require optimized communication between healthcare team members and the integration of respiratory therapy and child life early in the process of BiPAP initiation. Adapting to the unique features of each institution will be critical.
{"title":"Supportive noninvasive ventilation for acute chest syndrome prevention in hospitalized children with sickle cell disease: Determinants of implementation","authors":"Shana A. Burrowes PhD, Kayla C. Jones MA, Christopher J. Williams MS, Caitlin M. Neri MD, MPH, Elizabeth S. Klings MD, Scarlett L. Bellamy ScD, Allan J. Walkey MD, MSc, Mari-Lynn Drainoni PhD, MEd, Robyn T. Cohen MD, MPH","doi":"10.1002/jhm.70137","DOIUrl":"10.1002/jhm.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In 2017 Boston Medical Center's (BMC) general pediatric inpatient unit implemented bi-level positive airway pressure (BiPAP) as supportive noninvasive ventilation for acute chest syndrome prevention (SNAP) to prevent adverse respiratory outcomes among medically stable, hospitalized patients with sickle cell disease. Barriers and facilitators to SNAP implementation at BMC differ from those in other settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine contextual determinants of SNAP implementation across different settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with inpatient clinicians at three sites (Site 1: extensive implementation, Site 2: limited implementation, Site 3: not implemented) about factors that would affect SNAP implementation. Interviews and analysis were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 29 healthcare workers (physicians, nurses, physician assistants, child life specialists, respiratory therapists and psychologists). Five major themes emerged: (1) Communication between staff, particularly between the night and day shift, is critical for BiPAP initiation and success. (2) Nurses are key to successful SNAP implementation. (3) SNAP implementation requires multidisciplinary support, including integration of respiratory therapists and child life. (4) Individual unit level size, culture and workflow influence implementation (5) Hospital resources and leadership support are important for SNAP implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successful SNAP implementation across different contexts will require optimized communication between healthcare team members and the integration of respiratory therapy and child life early in the process of BiPAP initiation. Adapting to the unique features of each institution will be critical.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"152-163"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Physiological monitor alarms are critical for detecting abnormalities but often cause alarm fatigue due to excessive, nonactionable events. This issue is pronounced in the pediatric setting, where movements and crying increase the alarm frequency. The long-term feasibility of countermeasures to reduce alarm fatigue remains underexplored.
Objectives
To evaluate the long-term outcomes of alarm countermeasures implemented through a quality improvement initiative.
Methods
From January 2016 to February 2024, two intervention phases were implemented in nine wards of a tertiary pediatric center, with each phase being followed by a nonintervention period. The first intervention involved monthly data assessment, daily electrode replacement, and discussions about monitoring discontinuation criteria. The second intervention introduced patient-specific alarm thresholds and reminders to reconsider monitoring settings. Alarms were categorized as Advisory, Warning or Crisis. The primary outcome was daily alarm frequency per patient (ppd). A negative binomial regression was used for interrupted time series analysis.
Results
Overall, 46,302,740 alarms in 65,720 patients were analyzed. The alarm frequency declined from approximately 143 ppd to 99 ppd during the first intervention phase but rose to 124 ppd in the subsequent nonintervention phase. In the second intervention phase, the frequency declined to 86 ppd, the lowest value recorded, but rebounded to 165 ppd, the highest level, during the nonintervention phase. Advisory and Warning alarms showed a similar trend while Crisis alarms decreased consistently in the last phase.
Conclusions
The interventions were associated with reduction in the alarm frequency but were unsustainable. Long-term success requires integrating countermeasures into a durable framework.
{"title":"Sustainability of bundled approaches to alarm fatigue: Lessons from a long-term quality improvement study","authors":"Shogo Akahoshi MD, Shun Nagasawa MD, Kentaro Fukuda MD, Kazuki Iio MD, Nanako Kawata MD, Hidehiro Minegishi MD, Mana Sakatani MD, Akiko Kinumaki MD, Masako Tomotsune BSN, Yoshihiko Morikawa MD, Hiroshi Hataya MD","doi":"10.1002/jhm.70129","DOIUrl":"10.1002/jhm.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Physiological monitor alarms are critical for detecting abnormalities but often cause alarm fatigue due to excessive, nonactionable events. This issue is pronounced in the pediatric setting, where movements and crying increase the alarm frequency. The long-term feasibility of countermeasures to reduce alarm fatigue remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the long-term outcomes of alarm countermeasures implemented through a quality improvement initiative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 2016 to February 2024, two intervention phases were implemented in nine wards of a tertiary pediatric center, with each phase being followed by a nonintervention period. The first intervention involved monthly data assessment, daily electrode replacement, and discussions about monitoring discontinuation criteria. The second intervention introduced patient-specific alarm thresholds and reminders to reconsider monitoring settings. Alarms were categorized as Advisory, Warning or Crisis. The primary outcome was daily alarm frequency per patient (ppd). A negative binomial regression was used for interrupted time series analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 46,302,740 alarms in 65,720 patients were analyzed. The alarm frequency declined from approximately 143 ppd to 99 ppd during the first intervention phase but rose to 124 ppd in the subsequent nonintervention phase. In the second intervention phase, the frequency declined to 86 ppd, the lowest value recorded, but rebounded to 165 ppd, the highest level, during the nonintervention phase. Advisory and Warning alarms showed a similar trend while Crisis alarms decreased consistently in the last phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The interventions were associated with reduction in the alarm frequency but were unsustainable. Long-term success requires integrating countermeasures into a durable framework.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"34-41"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valerie J. Lang MD, MHPE, Kimberly Fluet PhD, Kimberly Bloom-Feshbach MD, Maria Klimenko MD
Background
Academic hospitalists have major roles in medical education, clinical care, and other academic medical center missions. Their professional identity development has implications for vitality, burnout, retention, and patient safety.
Objective
To characterize academic internal medicine hospitalist professional identity and its development.
Methods
Ten focus group interviews were conducted with 31 hospitalists in early-, mid-, and late-career stages at three academic medical centers. Data were analyzed using thematic analysis.
Results
Academic hospitalist identity development was characterized by (1) constant core clinician identity, (2) navigating interfaces between different spheres of knowledge, influence, and activity (patients, systems, learners, and multiple medical and psychosocial issues), (3) expanding identities in the “extension zone” outside of patient care, (4) variable and ambiguous academic identity, (5) ongoing negotiation between extrinsic factors (resources, relationships, and validation), intrinsic factors (personal identities and professional values), and identity development, (6) diverse career trajectories, and (7) professional identity driving career decision-making.
Conclusions
In contrast to a “deficit” view of generalists lacking focus on a specific disease or organ system, academic internal medicine hospitalist professional identity encompasses distinct roles and skills. While hospitalists individualize their activities outside the context of patient care, the core clinician identity remains a beacon guiding these activities. Hospitalists’ varied and ambiguous concepts of what it means to be academic may contribute to lagging academic progress. Organizations should support hospitalists’ unique professional identities, seek clarity around what it means to be academic, and foster ongoing professional identity development.
{"title":"Academic internal medicine hospitalist professional identity development","authors":"Valerie J. Lang MD, MHPE, Kimberly Fluet PhD, Kimberly Bloom-Feshbach MD, Maria Klimenko MD","doi":"10.1002/jhm.70132","DOIUrl":"10.1002/jhm.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Academic hospitalists have major roles in medical education, clinical care, and other academic medical center missions. Their professional identity development has implications for vitality, burnout, retention, and patient safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To characterize academic internal medicine hospitalist professional identity and its development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten focus group interviews were conducted with 31 hospitalists in early-, mid-, and late-career stages at three academic medical centers. Data were analyzed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Academic hospitalist identity development was characterized by (1) constant core clinician identity, (2) navigating interfaces between different spheres of knowledge, influence, and activity (patients, systems, learners, and multiple medical and psychosocial issues), (3) expanding identities in the “extension zone” outside of patient care, (4) variable and ambiguous academic identity, (5) ongoing negotiation between extrinsic factors (resources, relationships, and validation), intrinsic factors (personal identities and professional values), and identity development, (6) diverse career trajectories, and (7) professional identity driving career decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In contrast to a “deficit” view of generalists lacking focus on a specific disease or organ system, academic internal medicine hospitalist professional identity encompasses distinct roles and skills. While hospitalists individualize their activities outside the context of patient care, the core clinician identity remains a beacon guiding these activities. Hospitalists’ varied and ambiguous concepts of what it means to be academic may contribute to lagging academic progress. Organizations should support hospitalists’ unique professional identities, seek clarity around what it means to be academic, and foster ongoing professional identity development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"125-132"},"PeriodicalIF":2.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas A. Bosch MD, MSc, Anica C. Law MD, MS, Nareg H. Roubinian MD, S. Reza Jafarzadeh DVM, MPVM, PhD, Allan J. Walkey MD, MSc
Background
Transfusion of packed red blood cells (pRBCs) below a hemoglobin concentration of 7.0 g/dL is common, but it is unclear if the timing of transfusion during hospitalization modifies transfusion effectiveness. We sought to determine if effects of pRBC transfusion are heterogenous based on time from hospital admission.
Methods
Multicenter retrospective cohort study including hospitals in the Premier Inc. AI Healthcare Database between 2016 and 2022. Hospital encounters for adults with at least one hemoglobin concentration measured between hospital Days 1–7 were included. For each day, the lowest hemoglobin concentration was identified; patient-days were then separated into seven analytic cohorts based on the day in which a hemoglobin concentration was recorded (index day). We used regression discontinuity to quantify the effect of index day pRBC transfusion versus no transfusion on an outcome of hospital mortality or discharge to hospice (risk difference [RD]) at a hemoglobin concentration threshold of 7.0 g/dL in each cohort.
Results
A total of 2,293,021 index days across 997,277 inpatient encounters were included. The association between pRBC transfusion and hospital mortality or discharge to hospice differed based on days from admission, shifting from benefit on Day 1 (RD: −2.9 [95% CI: −5.9, −0.04] %) to harm on index Days 6 and 7 (Day 6, RD: 3.3 [95% CI: 0.4, 6.1] %; Day 7, RD: 4.1 [95% CI: 0.8, 7.3] %, p-interaction < .0001).
Conclusions
Transfusion during hospitalization was associated with benefit early in hospitalization and harm at later time points.
{"title":"Variation in effectiveness of blood transfusion by hospital day: A multicenter retrospective study","authors":"Nicholas A. Bosch MD, MSc, Anica C. Law MD, MS, Nareg H. Roubinian MD, S. Reza Jafarzadeh DVM, MPVM, PhD, Allan J. Walkey MD, MSc","doi":"10.1002/jhm.70133","DOIUrl":"10.1002/jhm.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transfusion of packed red blood cells (pRBCs) below a hemoglobin concentration of 7.0 g/dL is common, but it is unclear if the timing of transfusion during hospitalization modifies transfusion effectiveness. We sought to determine if effects of pRBC transfusion are heterogenous based on time from hospital admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicenter retrospective cohort study including hospitals in the Premier Inc. AI Healthcare Database between 2016 and 2022. Hospital encounters for adults with at least one hemoglobin concentration measured between hospital Days 1–7 were included. For each day, the lowest hemoglobin concentration was identified; patient-days were then separated into seven analytic cohorts based on the day in which a hemoglobin concentration was recorded (index day). We used regression discontinuity to quantify the effect of index day pRBC transfusion versus no transfusion on an outcome of hospital mortality or discharge to hospice (risk difference [RD]) at a hemoglobin concentration threshold of 7.0 g/dL in each cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2,293,021 index days across 997,277 inpatient encounters were included. The association between pRBC transfusion and hospital mortality or discharge to hospice differed based on days from admission, shifting from benefit on Day 1 (RD: −2.9 [95% CI: −5.9, −0.04] %) to harm on index Days 6 and 7 (Day 6, RD: 3.3 [95% CI: 0.4, 6.1] %; Day 7, RD: 4.1 [95% CI: 0.8, 7.3] %, <i>p</i>-interaction < .0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Transfusion during hospitalization was associated with benefit early in hospitalization and harm at later time points.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"133-141"},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Osnard MD, MS, MPH, Gregory W. Ruhnke MD, MS, MPH
{"title":"A costly gap in safety: Ending the practice of as-needed antihypertensive therapy","authors":"Michael Osnard MD, MS, MPH, Gregory W. Ruhnke MD, MS, MPH","doi":"10.1002/jhm.70135","DOIUrl":"10.1002/jhm.70135","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"98-99"},"PeriodicalIF":2.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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