Streptococcus pneumoniae is a leading cause of vaccine-preventable morbidity and mortality, particularly affecting young children, older adults, and individuals with underlying medical conditions. With over 100 serotypes, it can cause a wide spectrum of illness ranging from acute otitis media and sinusitis to life-threatening manifestations such as bacteremia, pneumonia, and meningitis. Pneumococcal vaccines target a subset of these serotypes, and the introduction of the pneumococcal conjugate vaccine in 2000 led to dramatic declines in the rate of colonization, transmission, and disease incidence across all populations. Hospitalists play a crucial role in treating patients with pneumococcal disease and identifying vaccine-eligible patients.
Sonieya Nagarajah and Peter E. Wu conceptualized the manuscript and contributed to the collection of data and figures, as well as the writing of the first draft of the manuscript. All authors reviewed and revised the manuscript and approved of its final version. All authors participated in the care of this patient.
The authors declare no conflict of interest.
The authors have obtained informed, written consent.
Hepatitis C (HCV) is a chronic, prevalent disease that disproportionately affects people who use drugs in the United States. One strategy to decrease HCV prevalence is the initiation of treatment during hospitalization. Factors affecting the success of this approach are not well-characterized in the literature. Subspecialty providers in fields that treat substantial numbers of patients with HCV are well-positioned to describe factors affecting treatment provision.
To understand barriers and facilitators of inpatient hepatitis C treatment from the perspectives of subspecialty physicians in the United States.
In this qualitative research study, we interviewed 20 infectious diseases, hepatology, and addiction medicine physicians at 12 medical institutions across the United States. We analyzed interviews using a rapid matrix technique.
Four major themes emerged: (1) hospitalization can be a gateway to care for patients who otherwise might not receive HCV treatment; (2) patients are vulnerable to being lost to follow-up in the transition from inpatient to outpatient care; (3) the inpatient payment model is a barrier to widespread implementation of programs to treat HCV during hospitalization; and (4) treatment protocols and project “champions” can support inpatient HCV treatment initiatives.
Physicians view hospitalization as an opportunity for patients to start HCV treatment. However, they have concerns about patients becoming lost to follow-up after hospital discharge. Interviewees perceived that these concerns could be mitigated by implementing standardized protocols for HCV treatment with clear process ownership, as well as by dedicated funding for care navigators and systems champions. Lastly, physicians report that insurance coverage and reimbursement present major barriers to inpatient HCV treatment initiation.
Hospitalist workflows have evolved significantly, yet optimal workflows and workloads remain ill-defined. Time and motion studies (TMSs) offer insights into hospitalist activities but face methodological challenges, including variability and lack of standardization.
We aimed to systematically review TMSs of hospitalist workflows, assess trends in direct and indirect patient care, and develop a novel quality assessment tool for evaluating TMS studies.
We conducted a comprehensive search of Ovid MEDLINE (1946–October 2024), Embase (1947–October 2024), and Web of Science (1974–October 2024) in August 2023 and updated October 7, 2024. We included studies that employed observational or quantitative TMS methods focused on attending hospitalists in US general adult inpatient settings and reported the proportion of time spent in direct and indirect patient care. We assessed study quality using a quality assessment tool adapted from the Newcastle-Ottawa scale.
Seven studies met the inclusion criteria. Direct patient care accounted for a mean of 18% (range: 13%–25%) of observed time. We identified high variability in study quality, with scores ranging from 2 to 5 out of eight stars. Significant study variability precluded statistical analysis of trends, though a narrative synthesis was possible. Few studies represented diverse settings or shifts.
This review utilizes a novel quality assessment tool and highlights the need for standardized TMS methodologies to enable longitudinal comparisons and more accurate assessments of hospitalist workflows. Future studies should integrate validated tools, consider multitasking, and explore emerging metrics beyond productivity.
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