Kevin A. Schulman MD, Wasan Kumar BS, Neera Ahuja MD
{"title":"Towards resiliency in the US healthcare supply chain","authors":"Kevin A. Schulman MD, Wasan Kumar BS, Neera Ahuja MD","doi":"10.1002/jhm.70112","DOIUrl":"10.1002/jhm.70112","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1359-1361"},"PeriodicalIF":2.3,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532008","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}
Annie Massart MD, SFHM, Mary Ann Kirkconnell Hall MPH
Sponsorship—direct action (beyond mentorship) by professionals to promote the interests of junior colleagues—catalyzes career advancement but is not always available to junior faculty. This results from the relative youth of hospital medicine as a specialty (and its small pool of senior hospitalist sponsors) and heavy clinical loads, often without protected time for academic pursuits. Our reciprocal institutional Speaker Exchange Program (SEP) is a model for junior faculty to sponsor colleagues and mentees. The SEP combines creative promotion, including freshly baked cookie boxes for conference attendees with links to our list of junior faculty talks, to supplement traditional sponsorship and faculty development strategies.
{"title":"The speaker exchange program: Cooking up sponsorship strategies to raise the professional visibility of junior faculty","authors":"Annie Massart MD, SFHM, Mary Ann Kirkconnell Hall MPH","doi":"10.1002/jhm.70118","DOIUrl":"10.1002/jhm.70118","url":null,"abstract":"<p>Sponsorship—direct action (beyond mentorship) by professionals to promote the interests of junior colleagues—catalyzes career advancement but is not always available to junior faculty. This results from the relative youth of hospital medicine as a specialty (and its small pool of senior hospitalist sponsors) and heavy clinical loads, often without protected time for academic pursuits. Our reciprocal institutional Speaker Exchange Program (SEP) is a model for junior faculty to sponsor colleagues and mentees. The SEP combines creative promotion, including freshly baked cookie boxes for conference attendees with links to our list of junior faculty talks, to supplement traditional sponsorship and faculty development strategies.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"100-104"},"PeriodicalIF":2.3,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532007","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}
Tsai-Ling Liu PhD, Timothy C. Hetherington MS, Marc Kowalkowski PhD, Marvin E. Knight MD, Jamayla Culpepper MD, MPH, Andrew McWilliams MD, MPH, Shih-Hsiung Chou PhD, McKenzie Isreal MPH, Stephanie Murphy DO
Identifying appropriate patients for hospital at Home (HaH) is challenged by the extensive inpatient population, the dynamic nature of hospitalizations, and the eligibility window for entry into the care model. This study presents the development of a rules-based algorithm (RBA) leveraging electronic health record (EHR) data to improve HaH patient identification, which is crucial for efficient HaH operations. RBA adjustments incorporated clinician feedback to align analytics resources and enhance clinical workflows. Our study highlights the importance of interdisciplinary collaboration and the potential for analytics to optimize efficiency for emerging care models.
{"title":"Collaborative development of a rules-based electronic health record algorithm for Hospital-at-Home eligibility","authors":"Tsai-Ling Liu PhD, Timothy C. Hetherington MS, Marc Kowalkowski PhD, Marvin E. Knight MD, Jamayla Culpepper MD, MPH, Andrew McWilliams MD, MPH, Shih-Hsiung Chou PhD, McKenzie Isreal MPH, Stephanie Murphy DO","doi":"10.1002/jhm.70107","DOIUrl":"10.1002/jhm.70107","url":null,"abstract":"<p>Identifying appropriate patients for hospital at Home (HaH) is challenged by the extensive inpatient population, the dynamic nature of hospitalizations, and the eligibility window for entry into the care model. This study presents the development of a rules-based algorithm (RBA) leveraging electronic health record (EHR) data to improve HaH patient identification, which is crucial for efficient HaH operations. RBA adjustments incorporated clinician feedback to align analytics resources and enhance clinical workflows. Our study highlights the importance of interdisciplinary collaboration and the potential for analytics to optimize efficiency for emerging care models.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 10","pages":"1140-1144"},"PeriodicalIF":2.3,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532004","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}
Nassr Nama MD, MSc, FAAP, Kara Picco MD, Polina Kyrychenko BHSc, Jeffrey N. Bone PhD, Julie Quet MB, BCh, BAO, Jessica L. Foulds MD, Josée Anne Gagnon MD, Chris Novak MD, FRCPC, MEd, Brigitte Parisien MD, MSc, FRCPC, Matthew Donlan MD, Ran D. Goldman MD, Anupam Sehgal MD, Ronik Kanani MD, Joanna Holland MD, Sanjay Mahant MD, Eric Coon MD, MSc, Joel S. Tieder MD, MPH, Peter J. Gill MD, DPhil, FRCPC, The Canadian BRUE Collaboration (C-BRUE-C) and the Canadian Paediatric Inpatient Research Network (PIRN)
Background
Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.
Objectives
Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.
Methods
This multicenter observational cohort (2017–2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.
Results
Of 758 infants (92% higher-risk), we noted variation in admission rates (32%–76%, p < .001), ICU admissions (0%–20%, p < .001), median LOS (0.8–2.0 days, p < .001), ECG (24%–78%, p < .001), EEG (8%–29%, p = .001), and anti-reflux medication (0%–21%, p < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%–8%, p = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8–33.0, p = .03), empiric antibiotics (15.8 h, 95% CI: 4.7–26.9, p = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8–23.2, p < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.
Conclusions
Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.
{"title":"Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study","authors":"Nassr Nama MD, MSc, FAAP, Kara Picco MD, Polina Kyrychenko BHSc, Jeffrey N. Bone PhD, Julie Quet MB, BCh, BAO, Jessica L. Foulds MD, Josée Anne Gagnon MD, Chris Novak MD, FRCPC, MEd, Brigitte Parisien MD, MSc, FRCPC, Matthew Donlan MD, Ran D. Goldman MD, Anupam Sehgal MD, Ronik Kanani MD, Joanna Holland MD, Sanjay Mahant MD, Eric Coon MD, MSc, Joel S. Tieder MD, MPH, Peter J. Gill MD, DPhil, FRCPC, The Canadian BRUE Collaboration (C-BRUE-C) and the Canadian Paediatric Inpatient Research Network (PIRN)","doi":"10.1002/jhm.70094","DOIUrl":"10.1002/jhm.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter observational cohort (2017–2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 758 infants (92% higher-risk), we noted variation in admission rates (32%–76%, <i>p</i> < .001), ICU admissions (0%–20%, <i>p</i> < .001), median LOS (0.8–2.0 days, <i>p</i> < .001), ECG (24%–78%, <i>p</i> < .001), EEG (8%–29%, <i>p</i> = .001), and anti-reflux medication (0%–21%, <i>p</i> < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%–8%, <i>p</i> = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8–33.0, <i>p</i> = .03), empiric antibiotics (15.8 h, 95% CI: 4.7–26.9, <i>p</i> = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8–23.2, <i>p</i> < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1297-1305"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510073","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}
Adults continue to be admitted to children's hospitals for a variety of reasons. But should they? Transfer from the pediatric to adult hospital setting is the standard of high-quality care for any young adult. Adult hospitalists are equipped to care for these patients. Transferring these patients to the adult model of care may not be as seamless as we would hope for. Pediatric to adult healtcare transition helps promote equitable care and addresses the growing scarcity of pediatric beds. Providers working in pediatric settings caring for adolescents and young adults must work help their patients succeed in executing and completing timely transfer into adult hospital models of care, collaborating with others and building supports for transition along the way.
{"title":"Point-counterpoint: Adult patients in children's hospitals","authors":"Meg Groom MD, Ruchi Doshi MD, Rachel Peterson MD, Ashley Jenkins MD","doi":"10.1002/jhm.70113","DOIUrl":"10.1002/jhm.70113","url":null,"abstract":"<p>Adults continue to be admitted to children's hospitals for a variety of reasons. But should they? Transfer from the pediatric to adult hospital setting is the standard of high-quality care for any young adult. Adult hospitalists are equipped to care for these patients. Transferring these patients to the adult model of care may not be as seamless as we would hope for. Pediatric to adult healtcare transition helps promote equitable care and addresses the growing scarcity of pediatric beds. Providers working in pediatric settings caring for adolescents and young adults must work help their patients succeed in executing and completing timely transfer into adult hospital models of care, collaborating with others and building supports for transition along the way.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 10","pages":"1130-1135"},"PeriodicalIF":2.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499957","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}
{"title":"A missed opportunity? Hospitalization as a window for hepatitis C virus treatment initiation","authors":"Justin Berk MD, MPH, MBA, Leah Harvey MD","doi":"10.1002/jhm.70115","DOIUrl":"10.1002/jhm.70115","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1375-1376"},"PeriodicalIF":2.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499956","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}
Maylyn Martinez MD, MSc, William F. Parker MD, MS, PhD
<p>Hospitalization is an important precipitant of disability. Adults who are hospitalized are 60% more likely to develop long-term disability than those who are not<span><sup>1</sup></span> and hospital-acquired disability (HAD) occurs in approximately one-third of all hospitalized patients.<span><sup>2</sup></span> Many patients who experience HAD require discharge to a skilled nursing facility for rehabilitation, 13% being institutionalized for the first time in their lives.<span><sup>3</sup></span> Many patients who develop HAD will have permanent disability<span><sup>4</sup></span> requiring long-term assistance with activities of daily living (ADL)<span><sup>4</sup></span> and increased use of community resources.<span><sup>5, 6</sup></span> Studies have repeatedly shown that physical therapy (PT) is a key component of the treatment and prevention of HAD and mobility loss.<span><sup>7-9</sup></span> Compared to patients who have fewer than three PT sessions during hospitalization, those who receive three to four sessions have 20% more functional improvement and are 4% more likely to discharge to home instead of a nursing facility. For those receiving more than seven sessions, function improves by 78% and likelihood of discharge home by 22%.<span><sup>10</sup></span> There is a growing large body of evidence that supports these findings. While patients admitted to the hospital with irreversible pre-existing functional impairments or total functional independence can benefit from simple nursing interventions or independent ambulation, we know that those with new functional impairments or at high risk for HAD will have better functional and discharge outcomes with more in-hospital physical rehabilitation.</p><p>The American Physical Therapy Association reported that in 2022, there were 5.2% fewer therapists than needed to meet demand, and that number would grow to 14.7% by 2037. Unfortunately, despite the enormous benefits of physical and occupational therapy (OT) for certain patients, these staffing shortages and the absence of mandated staffing ratios for therapists severely limits their supply in hospitals. Because of clear associations with care quality and patient safety, the Center for Medicare and Medicaid Services (CMS) mandates that hospitals have adequate numbers of licensed registered and vocational nurses but, even for them, does not mandate specific staffing ratios. Instead, factors including patient acuity, admission numbers, and staff expertise and skills are used to make nurse staffing decisions on a unit-to-unit basis.<span><sup>11, 12</sup></span> For physical and occupational therapists working in the acute care setting, there is no legislation for staffing, let alone mandates for specific staffing ratios. Little is known about the basis for therapy staffing decisions or what role hospital leadership expects them to fill, but studies show that, based on the referrals they receive, therapists feel they are frequently mistaken
{"title":"Ethical allocation of physical and occupational therapy in acute care","authors":"Maylyn Martinez MD, MSc, William F. Parker MD, MS, PhD","doi":"10.1002/jhm.70111","DOIUrl":"10.1002/jhm.70111","url":null,"abstract":"<p>Hospitalization is an important precipitant of disability. Adults who are hospitalized are 60% more likely to develop long-term disability than those who are not<span><sup>1</sup></span> and hospital-acquired disability (HAD) occurs in approximately one-third of all hospitalized patients.<span><sup>2</sup></span> Many patients who experience HAD require discharge to a skilled nursing facility for rehabilitation, 13% being institutionalized for the first time in their lives.<span><sup>3</sup></span> Many patients who develop HAD will have permanent disability<span><sup>4</sup></span> requiring long-term assistance with activities of daily living (ADL)<span><sup>4</sup></span> and increased use of community resources.<span><sup>5, 6</sup></span> Studies have repeatedly shown that physical therapy (PT) is a key component of the treatment and prevention of HAD and mobility loss.<span><sup>7-9</sup></span> Compared to patients who have fewer than three PT sessions during hospitalization, those who receive three to four sessions have 20% more functional improvement and are 4% more likely to discharge to home instead of a nursing facility. For those receiving more than seven sessions, function improves by 78% and likelihood of discharge home by 22%.<span><sup>10</sup></span> There is a growing large body of evidence that supports these findings. While patients admitted to the hospital with irreversible pre-existing functional impairments or total functional independence can benefit from simple nursing interventions or independent ambulation, we know that those with new functional impairments or at high risk for HAD will have better functional and discharge outcomes with more in-hospital physical rehabilitation.</p><p>The American Physical Therapy Association reported that in 2022, there were 5.2% fewer therapists than needed to meet demand, and that number would grow to 14.7% by 2037. Unfortunately, despite the enormous benefits of physical and occupational therapy (OT) for certain patients, these staffing shortages and the absence of mandated staffing ratios for therapists severely limits their supply in hospitals. Because of clear associations with care quality and patient safety, the Center for Medicare and Medicaid Services (CMS) mandates that hospitals have adequate numbers of licensed registered and vocational nurses but, even for them, does not mandate specific staffing ratios. Instead, factors including patient acuity, admission numbers, and staff expertise and skills are used to make nurse staffing decisions on a unit-to-unit basis.<span><sup>11, 12</sup></span> For physical and occupational therapists working in the acute care setting, there is no legislation for staffing, let alone mandates for specific staffing ratios. Little is known about the basis for therapy staffing decisions or what role hospital leadership expects them to fill, but studies show that, based on the referrals they receive, therapists feel they are frequently mistaken ","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1355-1358"},"PeriodicalIF":2.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478280","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}
Jeffrey L. Schnipper MD, MPH, Sunil Kripalani MD, MSc
{"title":"The future of hospital medicine research: Three next steps","authors":"Jeffrey L. Schnipper MD, MPH, Sunil Kripalani MD, MSc","doi":"10.1002/jhm.70103","DOIUrl":"10.1002/jhm.70103","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 11","pages":"1249-1250"},"PeriodicalIF":2.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334682","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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