Deanne T. Kashiwagi MD, MS, FACP, SFHM, Marisha Burden MD, MBA, FACP, SFHM, Michele McGinnis MSIS, Elissa A. Kinzelman-Vesely MLIS, MA, Areeba Y. Kara MD, MS, FACP, SFHM
Background
Geographic cohorting (GCh) is a popular model of care that localizes physician teams to a single hospital unit.
Objectives
We conducted a scoping review identifying the aims, implementation strategies, study methods, and measured outcomes of GCh.
Methods
We searched the medical literature analysis and retrieval system online, Embase, and Scopus databases. Eligible citations included English language reports of interventions including GCh in adult patients. Included studies were screened for their aim, GCh implementation strategy, study method, and outcomes measured.
Results
Of 1863 identified citations, 30 met inclusion criteria, representing 27 interventions. Implementation aims varied from specific goals measured by a single metric to multiple outcomes intended to capture wide-ranging effects of GCh. A majority of studies (n = 13, 48.1%) used a pre-post cohort design. GCh was implemented in one of four ways: (1) as a stand-alone intervention, (2) bundled with accountable care unit elements, (3) bundled with care components that did not include all ACU elements, (4) GCh bundled with ACU elements and additional components (“enhanced” ACU). The measured outcomes sorted to eight different categories: patient outcomes, patient safety, patient experience, work flow, workload, clinician experience, communication/team work, and cost.
Conclusions
The current literature on GCh describes implementation as both a stand-alone intervention and bundled with other care elements. Current research has not delineated whether the degree to which GCh is implemented matters, nor what impact it has as part of a bundled care intervention. Future work would benefit from a prospective design that clarifies these questions, facilitating care models tailored to the needs of the practice ecosystem.
{"title":"Geographic cohorting of adult inpatient teams: A scoping review","authors":"Deanne T. Kashiwagi MD, MS, FACP, SFHM, Marisha Burden MD, MBA, FACP, SFHM, Michele McGinnis MSIS, Elissa A. Kinzelman-Vesely MLIS, MA, Areeba Y. Kara MD, MS, FACP, SFHM","doi":"10.1002/jhm.70096","DOIUrl":"10.1002/jhm.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Geographic cohorting (GCh) is a popular model of care that localizes physician teams to a single hospital unit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We conducted a scoping review identifying the aims, implementation strategies, study methods, and measured outcomes of GCh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the medical literature analysis and retrieval system online, Embase, and Scopus databases. Eligible citations included English language reports of interventions including GCh in adult patients. Included studies were screened for their aim, GCh implementation strategy, study method, and outcomes measured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1863 identified citations, 30 met inclusion criteria, representing 27 interventions. Implementation aims varied from specific goals measured by a single metric to multiple outcomes intended to capture wide-ranging effects of GCh. A majority of studies (<i>n</i> = 13, 48.1%) used a pre-post cohort design. GCh was implemented in one of four ways: (1) as a stand-alone intervention, (2) bundled with accountable care unit elements, (3) bundled with care components that did not include all ACU elements, (4) GCh bundled with ACU elements and additional components (“enhanced” ACU). The measured outcomes sorted to eight different categories: patient outcomes, patient safety, patient experience, work flow, workload, clinician experience, communication/team work, and cost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current literature on GCh describes implementation as both a stand-alone intervention and bundled with other care elements. Current research has not delineated whether the degree to which GCh is implemented matters, nor what impact it has as part of a bundled care intervention. Future work would benefit from a prospective design that clarifies these questions, facilitating care models tailored to the needs of the practice ecosystem.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1306-1322"},"PeriodicalIF":2.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259700","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}
<p>My mind wandered as the sermon came to a close. I was halfway through my penultimate inpatient elective of medical school and was visiting my parents for Sunday breakfast and church. It was cathartic standing with them, recharging for the long week ahead. I was still tired despite my weekend off work.</p><p>“Go see if they need your help,” my dad whispered as he nudged me out of my trance. Four congregants gathered around the altar server 10 rows ahead. They half carried him to the storage room at the back of the church. I didn't know how I could help. Even if I could, I didn't have any supplies. Not to mention I wasn't even a doctor yet. Despite this, I obliged and headed toward the commotion.</p><p>The altar server sat with the others encircling him. I introduced myself as a medical student and asked if anyone was in healthcare. There was one police officer, but the rest said “no.” They explained that “Jake,” the altar server, had an unknown chronic illness.</p><p>Despite my initial hesitation, I tried to help. Pulling on my background as an EMT and medical student, I ensured his ABCs were in check, and noticed he was unresponsive to both verbal commands and even pain. The medical ID on his apple watch confirmed his chronic illness to be epilepsy, so I started timing the episode. I instructed one of the congregants to call 911 for an ambulance immediately.</p><p>Suddenly I blanked and had no idea what to do next. Thinking of my own experience with a chronic illness as a Type 1 Diabetic, I asked myself: who would know what to do next? And then it clicked, and I decided to call his mother.</p><p>In a few moments, she was able to provide critical information that allowed us to make clinical judgements with ease. First, she told me he recently changed his anti-epileptic medications, and I silently made note of this as I considered causes of Jake's episode. Next, she stated that Jake had a rescue lorazepam, and I immediately located it in his pocket and had it readily available. As I considered whether to give Jake the rescue, I paused and asked for her advice. She said that he may not need it if he showed signs of improvement soon, but I hesitated. Would waiting prove to be the correct decision, or would my reluctance cause further consequences? I took a deep breath and thought about my own chronic illness once again. Who would I trust if I was in this situation?</p><p>Listening to Jake's mother proved to be the right course of action, as moments later Jake demonstrated symptoms of improvement on his neurological exam, sluggishly giving me a thumbs up when asked. As he regained consciousness, I talked him through the events and confided in him, “I have diabetes and was an altar server too. I would go to the backroom to check my blood sugar and treat it when it went low.” Although he couldn't respond, he offered a slight nod of understanding. In that moment, even though we didn't share the same burdens, we were brought closer by different, yet si
{"title":"Through illness, understanding","authors":"Matthew Bugada MD, Shivatej Dubbaka BS","doi":"10.1002/jhm.70095","DOIUrl":"10.1002/jhm.70095","url":null,"abstract":"<p>My mind wandered as the sermon came to a close. I was halfway through my penultimate inpatient elective of medical school and was visiting my parents for Sunday breakfast and church. It was cathartic standing with them, recharging for the long week ahead. I was still tired despite my weekend off work.</p><p>“Go see if they need your help,” my dad whispered as he nudged me out of my trance. Four congregants gathered around the altar server 10 rows ahead. They half carried him to the storage room at the back of the church. I didn't know how I could help. Even if I could, I didn't have any supplies. Not to mention I wasn't even a doctor yet. Despite this, I obliged and headed toward the commotion.</p><p>The altar server sat with the others encircling him. I introduced myself as a medical student and asked if anyone was in healthcare. There was one police officer, but the rest said “no.” They explained that “Jake,” the altar server, had an unknown chronic illness.</p><p>Despite my initial hesitation, I tried to help. Pulling on my background as an EMT and medical student, I ensured his ABCs were in check, and noticed he was unresponsive to both verbal commands and even pain. The medical ID on his apple watch confirmed his chronic illness to be epilepsy, so I started timing the episode. I instructed one of the congregants to call 911 for an ambulance immediately.</p><p>Suddenly I blanked and had no idea what to do next. Thinking of my own experience with a chronic illness as a Type 1 Diabetic, I asked myself: who would know what to do next? And then it clicked, and I decided to call his mother.</p><p>In a few moments, she was able to provide critical information that allowed us to make clinical judgements with ease. First, she told me he recently changed his anti-epileptic medications, and I silently made note of this as I considered causes of Jake's episode. Next, she stated that Jake had a rescue lorazepam, and I immediately located it in his pocket and had it readily available. As I considered whether to give Jake the rescue, I paused and asked for her advice. She said that he may not need it if he showed signs of improvement soon, but I hesitated. Would waiting prove to be the correct decision, or would my reluctance cause further consequences? I took a deep breath and thought about my own chronic illness once again. Who would I trust if I was in this situation?</p><p>Listening to Jake's mother proved to be the right course of action, as moments later Jake demonstrated symptoms of improvement on his neurological exam, sluggishly giving me a thumbs up when asked. As he regained consciousness, I talked him through the events and confided in him, “I have diabetes and was an altar server too. I would go to the backroom to check my blood sugar and treat it when it went low.” Although he couldn't respond, he offered a slight nod of understanding. In that moment, even though we didn't share the same burdens, we were brought closer by different, yet si","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1385-1386"},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251612","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}
Joséphine A. Cool MD, Cancan Zhang PhD, Julius Yang MD, Shoshana J. Herzig MD, MPH, Catherine Des Roches drPH, MSc
Background
The 21st Century Cures Act Information Blocking Rule mandates patient access to all information in their electronic medical record (EMR) without delay, cost, or special effort. Prior research into patient portal use in hospitalized adults is limited.
Objective
To better understand the characteristics of hospitalized adults who have an existing patient portal account and identify demographic factors associated with accessing information via the patient portal while hospitalized.
Methods
This single-center, cross-sectional observational study analyzed adult hospitalizations from April 5, 2021, to March 31, 2023, at Beth Israel Deaconess Medical Center (BIDMC). The primary outcome was the proportion of hospitalized patients who had an active BIDMC EMR account (“PatientSite”).
Results
Of the 43,588 patients included in our analytic cohort, 13,517 (31.0%) had an active PatientSite account during their hospitalization and of those, 7311 (54.0%) accessed their account while hospitalized. A total of 62% of patients who logged into their portal also accessed clinician notes. After multivariable adjustment, patients who were older, Black, male, non-English speaking, covered by Medicaid, or from out-of-state were less likely to have an active PatientSite account. Similar disparities were found in PatientSite login and accessing clinician notes, albeit smaller in magnitude than the observed disparities in having an active account.
Conclusions
This study highlights low patient portal utilization among hospitalized patients and disparities in access based on race/ethnicity, gender, age, and insurance status.
{"title":"Hospitalized patient portal access in the post-information blocking rule era","authors":"Joséphine A. Cool MD, Cancan Zhang PhD, Julius Yang MD, Shoshana J. Herzig MD, MPH, Catherine Des Roches drPH, MSc","doi":"10.1002/jhm.70093","DOIUrl":"10.1002/jhm.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The 21st Century Cures Act Information Blocking Rule mandates patient access to all information in their electronic medical record (EMR) without delay, cost, or special effort. Prior research into patient portal use in hospitalized adults is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To better understand the characteristics of hospitalized adults who have an existing patient portal account and identify demographic factors associated with accessing information via the patient portal while hospitalized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, cross-sectional observational study analyzed adult hospitalizations from April 5, 2021, to March 31, 2023, at Beth Israel Deaconess Medical Center (BIDMC). The primary outcome was the proportion of hospitalized patients who had an active BIDMC EMR account (“PatientSite”).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 43,588 patients included in our analytic cohort, 13,517 (31.0%) had an active PatientSite account during their hospitalization and of those, 7311 (54.0%) accessed their account while hospitalized. A total of 62% of patients who logged into their portal also accessed clinician notes. After multivariable adjustment, patients who were older, Black, male, non-English speaking, covered by Medicaid, or from out-of-state were less likely to have an active PatientSite account. Similar disparities were found in PatientSite login and accessing clinician notes, albeit smaller in magnitude than the observed disparities in having an active account.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights low patient portal utilization among hospitalized patients and disparities in access based on race/ethnicity, gender, age, and insurance status.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1290-1296"},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236294","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}
Trust in public health and medical practitioners has declined since COVID-19. Throughout the COVID-19 pandemic, poor communication by medical and public health professionals coincident with the rise of social media enabled unverified, often erroneous information to spread quickly and widely. Providing accurate, fact-based information is imperative to save lives and promote health. Using a robust, evidence-based approach to tracking the spread of information and partnering with trusted messengers, states can take a leadership role in combatting misinformation and safeguarding the public's health.
{"title":"Rebuilding trust in public health and medicine in a time of declining trust in science","authors":"Marianne Udow-Phillips MHSA, Joe Smyser PhD, MSPH, Natasha Bagdasarian MD, MPH","doi":"10.1002/jhm.70086","DOIUrl":"10.1002/jhm.70086","url":null,"abstract":"<p>Trust in public health and medical practitioners has declined since COVID-19. Throughout the COVID-19 pandemic, poor communication by medical and public health professionals coincident with the rise of social media enabled unverified, often erroneous information to spread quickly and widely. Providing accurate, fact-based information is imperative to save lives and promote health. Using a robust, evidence-based approach to tracking the spread of information and partnering with trusted messengers, states can take a leadership role in combatting misinformation and safeguarding the public's health.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 7","pages":"787-790"},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217955","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}
Htun Ja Mai MBBS, MPH, Ghid Kanaan MD, Sebhat Erqou MD, PhD, Vincent Salvador MD, MPH, Jacob Joseph MD, MB, Wen-Chih Wu MD, MPH, James Rudolph MD, Eduardo L. Caputo PhD, Taylor Rickard MS, Katherine Rieke PhD, MPH, Ethan M. Balk MD, MPH, Eric Jutkowitz PhD
Background
Standard inpatient management of acute decompensated heart failure (ADHF) has included restricted dietary sodium. Sodium supplementation with diuretics has been proposed as an alternative to treat ADHF in an inpatient setting.
Objectives
We conducted a systematic review to evaluate prescribed oral and/or intravenous sodium supplementation (with diuretics), to patients hospitalized for ADHF.
Methods
We searched Medline, Embase, ClinicalTrials.gov, CINAHL, and Cochrane Database of Systematic Reviews from inception to September 24, 2024, for randomized controlled trials (RCTs), and nonrandomized comparative studies (NRCSs) reporting intermediate, clinical, or health service use outcomes for ADHF inpatients. We assessed risk of bias, and where there were at least three studies reporting results from similar analyses, we conducted meta-analyses. GRADE methodology was used to assess the strength of evidence.
Results
Fourteen RCTs and two NRCSs compared supplemental sodium with furosemide to furosemide alone. Supplemental sodium with furosemide significantly decreased serum creatinine (pooled net mean difference [NMD]: −0.33 mg/dL, 95% confidence interval [CI]: [−0.50 to −0.17]), brain natriuretic peptide (pooled NMD: −62.84 pg/mL, 95% CI: [−103.61 to −22.08]), and weight (pooled NMD: −2.48 kg, 95% CI: [−4.31 to −0.66]). There were no significant differences in N-terminal pro b-type natriuretic peptide (pooled NMD: −1614 pg/mL, 95% CI: [−3582 to 353]). There was a significant decrease in length of hospital stay (pooled MD: −2.68 days, 95% CI: [−3.81 to −1.55]). Studies provided insufficient evidence on mortality and readmission outcomes, and no evidence for caloric intake or clinical congestion score.
Conclusions
Sodium supplementation with diuretics may improve kidney function, promote weight loss, and shorten length of hospital stay.
{"title":"Prescribed in-hospital sodium intake for decompensated heart failure: A systematic review and meta-analysis","authors":"Htun Ja Mai MBBS, MPH, Ghid Kanaan MD, Sebhat Erqou MD, PhD, Vincent Salvador MD, MPH, Jacob Joseph MD, MB, Wen-Chih Wu MD, MPH, James Rudolph MD, Eduardo L. Caputo PhD, Taylor Rickard MS, Katherine Rieke PhD, MPH, Ethan M. Balk MD, MPH, Eric Jutkowitz PhD","doi":"10.1002/jhm.70091","DOIUrl":"10.1002/jhm.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Standard inpatient management of acute decompensated heart failure (ADHF) has included restricted dietary sodium. Sodium supplementation with diuretics has been proposed as an alternative to treat ADHF in an inpatient setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We conducted a systematic review to evaluate prescribed oral and/or intravenous sodium supplementation (with diuretics), to patients hospitalized for ADHF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched Medline, Embase, ClinicalTrials.gov, CINAHL, and Cochrane Database of Systematic Reviews from inception to September 24, 2024, for randomized controlled trials (RCTs), and nonrandomized comparative studies (NRCSs) reporting intermediate, clinical, or health service use outcomes for ADHF inpatients. We assessed risk of bias, and where there were at least three studies reporting results from similar analyses, we conducted meta-analyses. GRADE methodology was used to assess the strength of evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen RCTs and two NRCSs compared supplemental sodium with furosemide to furosemide alone. Supplemental sodium with furosemide significantly decreased serum creatinine (pooled net mean difference [NMD]: −0.33 mg/dL, 95% confidence interval [CI]: [−0.50 to −0.17]), brain natriuretic peptide (pooled NMD: −62.84 pg/mL, 95% CI: [−103.61 to −22.08]), and weight (pooled NMD: −2.48 kg, 95% CI: [−4.31 to −0.66]). There were no significant differences in N-terminal pro b-type natriuretic peptide (pooled NMD: −1614 pg/mL, 95% CI: [−3582 to 353]). There was a significant decrease in length of hospital stay (pooled MD: −2.68 days, 95% CI: [−3.81 to −1.55]). Studies provided insufficient evidence on mortality and readmission outcomes, and no evidence for caloric intake or clinical congestion score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sodium supplementation with diuretics may improve kidney function, promote weight loss, and shorten length of hospital stay.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 11","pages":"1193-1201"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201251","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}
Jennifer Baird PhD, MPH, MSW, RN, Genevieve Beaird PhD, RNC-OB, CNE, Elizabeth K. Tanner PhD, RN, FAAN, Eileen Romano RN, Leah Spacciante MN, RN, Sonia Garcia RN, BSN, CPN, Jazmin Rodriguez RN, Andrea Loureiro RN, BSN, CPN, Dorna Hairston PhD, RN, NEA-BC, NPD-BC, Kristen Emodi DNP, APRN-NP, PNP-AC/PC, Carrie Finley RN, April E. Fegley BA, Jayne Rogers MSN, RN, Sharon Cray BBA, Lauren Destino MD, Brian Good MB, BCh, BAO, Shilpa Patel MD, Nancy D. Spector MD, Christopher P. Landrigan MD, MPH, Alisa Khan MD, MPH, Erin Abu-Rish Blakeney PhD, RN
Background
Patient- and family-centered rounding (PFCR) models are used widely in pediatric hospitals and have been associated with better communication and fewer errors. Although model fidelity and sustainability are well-documented challenges reported by physicians and families, nurse perspectives are less known.
Objective
Our objective was to identify benefits for nurses and describe barriers and facilitators to nurse involvement in a PFCR model.
Methods
We used a qualitative descriptive approach to conduct and analyze focus group data. Focus group participants were nurses from sites participating in the Patient- and Family-centered (PFC) I-PASS Safer Communication on Rounds Every Time (SCORE) study, a hybrid effectiveness implementation study of a PFCR model at 21 US pediatric hospitals.
Results
Twenty-nine nurses from 14 study sites participated in four focus groups. We identified multiple benefits, barriers, and facilitators of nurse participation in PFC I-PASS rounds. Benefits included better communication, time savings and efficiency, conveying that nursing is a contributing part of the team. Barriers included competing demands of nurses’ workload, lack of fidelity during rounds, and uncertainty about whether nurses are welcome by other care team members. Facilitators key to supporting nurse participation and engagement in rounds included clear nursing role in rounds, predictable rounding schedule and format, attending physicians fostering a welcoming environment, and strategies for when a nurse is not available.
Conclusions
Nurses report many benefits of PFC I-PASS rounds. Increasing and sustaining nurse participation in PFC I-PASS requires specific, nurse-informed implementation strategies targeting both structural and interprofessional aspects of rounds.
{"title":"Pediatric nurse perspectives on patient- and family-centered rounds: A qualitative study","authors":"Jennifer Baird PhD, MPH, MSW, RN, Genevieve Beaird PhD, RNC-OB, CNE, Elizabeth K. Tanner PhD, RN, FAAN, Eileen Romano RN, Leah Spacciante MN, RN, Sonia Garcia RN, BSN, CPN, Jazmin Rodriguez RN, Andrea Loureiro RN, BSN, CPN, Dorna Hairston PhD, RN, NEA-BC, NPD-BC, Kristen Emodi DNP, APRN-NP, PNP-AC/PC, Carrie Finley RN, April E. Fegley BA, Jayne Rogers MSN, RN, Sharon Cray BBA, Lauren Destino MD, Brian Good MB, BCh, BAO, Shilpa Patel MD, Nancy D. Spector MD, Christopher P. Landrigan MD, MPH, Alisa Khan MD, MPH, Erin Abu-Rish Blakeney PhD, RN","doi":"10.1002/jhm.70071","DOIUrl":"10.1002/jhm.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patient- and family-centered rounding (PFCR) models are used widely in pediatric hospitals and have been associated with better communication and fewer errors. Although model fidelity and sustainability are well-documented challenges reported by physicians and families, nurse perspectives are less known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to identify benefits for nurses and describe barriers and facilitators to nurse involvement in a PFCR model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a qualitative descriptive approach to conduct and analyze focus group data. Focus group participants were nurses from sites participating in the Patient- and Family-centered (PFC) I-PASS Safer Communication on Rounds Every Time (SCORE) study, a hybrid effectiveness implementation study of a PFCR model at 21 US pediatric hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine nurses from 14 study sites participated in four focus groups. We identified multiple benefits, barriers, and facilitators of nurse participation in PFC I-PASS rounds. Benefits included better communication, time savings and efficiency, conveying that nursing is a contributing part of the team. Barriers included competing demands of nurses’ workload, lack of fidelity during rounds, and uncertainty about whether nurses are welcome by other care team members. Facilitators key to supporting nurse participation and engagement in rounds included clear nursing role in rounds, predictable rounding schedule and format, attending physicians fostering a welcoming environment, and strategies for when a nurse is not available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nurses report many benefits of PFC I-PASS rounds. Increasing and sustaining nurse participation in PFC I-PASS requires specific, nurse-informed implementation strategies targeting both structural and interprofessional aspects of rounds.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 11","pages":"1166-1173"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201250","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}
Michelle Knees DO, Sarah J. Flynn MD, MPhil, Esther Y. Hsiang MD, MBA, Alan A. Kubey MD, FACP
Secure messaging platforms were designed to optimize healthcare communication by providing asynchronous, bidirectional, Health Insurance Portability and Accountability Act-compliant text messaging options. Proponents argue that these platforms streamline workflows, foster coordination across multidisciplinary teams, and improve patient safety. However, critics highlight their potential to disrupt workflows through overwhelming message volumes and task interruptions, increased risk for miscommunication, and possible detrimental impacts on patient care. While secure messaging shows promise for modernizing hospital communication, it requires institutional guidelines and thoughtful use to mitigate inefficiencies and risks.
{"title":"Is secure messaging an effective tool for inpatient communication?","authors":"Michelle Knees DO, Sarah J. Flynn MD, MPhil, Esther Y. Hsiang MD, MBA, Alan A. Kubey MD, FACP","doi":"10.1002/jhm.70090","DOIUrl":"10.1002/jhm.70090","url":null,"abstract":"<p>Secure messaging platforms were designed to optimize healthcare communication by providing asynchronous, bidirectional, Health Insurance Portability and Accountability Act-compliant text messaging options. Proponents argue that these platforms streamline workflows, foster coordination across multidisciplinary teams, and improve patient safety. However, critics highlight their potential to disrupt workflows through overwhelming message volumes and task interruptions, increased risk for miscommunication, and possible detrimental impacts on patient care. While secure messaging shows promise for modernizing hospital communication, it requires institutional guidelines and thoughtful use to mitigate inefficiencies and risks.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"1022-1027"},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176172","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}
<p>As has been widely reported, major cuts to the Medicaid program are on the table in federal budget negotiations.<span><sup>1</sup></span> While details are still forthcoming, among the proposals most discussed are changes in the structure of federal financing and restrictions on state financing mechanisms often used to pay hospitals. Medicaid is a core source of payment for hospital-based services, particularly for children, and changes in federal and state financing may have significant fallout for hospital services that could ultimately negatively affect children's health. While many people understand that funding cuts are on the table, fewer comprehend the mechanisms and details of how these cuts may be enacted; understanding these details can help connect the dots between federal debate and access to children's health care services.</p><p>Medicaid provides health insurance for nearly 80 million people, including 38 million children.<span><sup>2</sup></span> The program finances 19% of all US hospital expenditures<span><sup>3</sup></span> but plays a larger role in children's hospital care. Medicaid covers over 4 in 10 births (and nearly half of births in rural areas),<span><sup>4</sup></span> pays for over half of non-infant pediatric hospitalizations in the United States,<span><sup>5</sup></span> and accounts for more than half (54.3%) of gross revenue to children's hospitals.<span><sup>6</sup></span> Medicaid also finances ancillary and outpatient services related to hospital care for children (such as laboratory services, rehab services, or care coordination services), preventive and routine pediatric care, and community-based services to support children with special health care needs.<span><sup>7</sup></span></p><p>Medicaid hospital payments are a mix of federal and state dollars. Within federal requirements, state have discretion in setting methods and rates for Medicaid hospital payment, including whether services are provided under fee-for-service or managed care arrangements. The federal government then matches state Medicaid spending on an open-ended basis, with the share paid by the federal government ranging from 50% to 77% (federal shares are higher in lower-income states).<span><sup>8</sup></span> States can finance their share of Medicaid through general revenues or other sources such as provider taxes, in which states use revenue from fees on health care providers to finance their share of Medicaid costs.</p><p>In addition to base payments for hospital services paid through claims, states make Medicaid supplemental payments to hospitals. Medicaid supplemental payments are generally lump sum payments not tied to specific encounters, and they take various forms including disproportionate share hospital payments, upper payment limit payments, and uncompensated care pools. State use of supplemental payments is governed by federal regulations that essentially cap expenditures (specific rules vary by type of payment). While base
{"title":"Next steps: Implications of proposed changes in federal Medicaid financing on hospital services for children","authors":"Rachel Garfield PhD, MHS","doi":"10.1002/jhm.70087","DOIUrl":"10.1002/jhm.70087","url":null,"abstract":"<p>As has been widely reported, major cuts to the Medicaid program are on the table in federal budget negotiations.<span><sup>1</sup></span> While details are still forthcoming, among the proposals most discussed are changes in the structure of federal financing and restrictions on state financing mechanisms often used to pay hospitals. Medicaid is a core source of payment for hospital-based services, particularly for children, and changes in federal and state financing may have significant fallout for hospital services that could ultimately negatively affect children's health. While many people understand that funding cuts are on the table, fewer comprehend the mechanisms and details of how these cuts may be enacted; understanding these details can help connect the dots between federal debate and access to children's health care services.</p><p>Medicaid provides health insurance for nearly 80 million people, including 38 million children.<span><sup>2</sup></span> The program finances 19% of all US hospital expenditures<span><sup>3</sup></span> but plays a larger role in children's hospital care. Medicaid covers over 4 in 10 births (and nearly half of births in rural areas),<span><sup>4</sup></span> pays for over half of non-infant pediatric hospitalizations in the United States,<span><sup>5</sup></span> and accounts for more than half (54.3%) of gross revenue to children's hospitals.<span><sup>6</sup></span> Medicaid also finances ancillary and outpatient services related to hospital care for children (such as laboratory services, rehab services, or care coordination services), preventive and routine pediatric care, and community-based services to support children with special health care needs.<span><sup>7</sup></span></p><p>Medicaid hospital payments are a mix of federal and state dollars. Within federal requirements, state have discretion in setting methods and rates for Medicaid hospital payment, including whether services are provided under fee-for-service or managed care arrangements. The federal government then matches state Medicaid spending on an open-ended basis, with the share paid by the federal government ranging from 50% to 77% (federal shares are higher in lower-income states).<span><sup>8</sup></span> States can finance their share of Medicaid through general revenues or other sources such as provider taxes, in which states use revenue from fees on health care providers to finance their share of Medicaid costs.</p><p>In addition to base payments for hospital services paid through claims, states make Medicaid supplemental payments to hospitals. Medicaid supplemental payments are generally lump sum payments not tied to specific encounters, and they take various forms including disproportionate share hospital payments, upper payment limit payments, and uncompensated care pools. State use of supplemental payments is governed by federal regulations that essentially cap expenditures (specific rules vary by type of payment). While base ","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 11","pages":"1231-1233"},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181001","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}
Seonkyeong Yang MS, PhD, Anders Westanmo PharmD, Mark Bounthavong PharmD, PhD, Ronald Shorr MD, Haesuk Park PhD, Weihsuan Lo-Ciganic PhD, Muna Canales MD, MS
As-needed blood pressure (BP) medication used to treat asymptomatic BP elevations in the hospital may be harmful. However, its association with hospitalization costs remains unknown. We conducted a retrospective cohort study with target trial emulation and propensity-score matching to compare the total and subtype hospitalization costs for those who received as-needed BP medication (YES) versus not (NO) during a Veterans Affairs hospital stay between October 1, 2015 and September 30, 2020. After matching (n = 25,455 per group), the as-needed YES group had a longer length of stay compared to the NO group. Hospitalizations in the YES group were associated with higher total and subtype hospitalization costs compared to the NO group. Similarly, individuals in the YES group had higher daily total hospital costs compared to the NO group, driven primarily by increased nursing and surgery costs. Our findings suggest that the expenditure implications of as-needed BP medication use merit further investigation.
{"title":"Hospitalization costs associated with as-needed blood pressure medication use in the Veterans Healthcare System","authors":"Seonkyeong Yang MS, PhD, Anders Westanmo PharmD, Mark Bounthavong PharmD, PhD, Ronald Shorr MD, Haesuk Park PhD, Weihsuan Lo-Ciganic PhD, Muna Canales MD, MS","doi":"10.1002/jhm.70089","DOIUrl":"10.1002/jhm.70089","url":null,"abstract":"<p>As-needed blood pressure (BP) medication used to treat asymptomatic BP elevations in the hospital may be harmful. However, its association with hospitalization costs remains unknown. We conducted a retrospective cohort study with target trial emulation and propensity-score matching to compare the total and subtype hospitalization costs for those who received as-needed BP medication (YES) versus not (NO) during a Veterans Affairs hospital stay between October 1, 2015 and September 30, 2020. After matching (<i>n</i> = 25,455 per group), the as-needed YES group had a longer length of stay compared to the NO group. Hospitalizations in the YES group were associated with higher total and subtype hospitalization costs compared to the NO group. Similarly, individuals in the YES group had higher daily total hospital costs compared to the NO group, driven primarily by increased nursing and surgery costs. Our findings suggest that the expenditure implications of as-needed BP medication use merit further investigation.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"64-69"},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175686","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}
Amy Yu MD, Lauren McBeth, Claire Westcott PA-C, Stephanie Mueller MD, MPH, Mustafa Ozkaynak PhD, MS, Brooke Dorsey Holliman PhD, Anna Maw MD, MS, Jacinda Nicklas MD, MPH, Christine D. Jones MD, MS
Background
Complex and inefficient information and task organization contribute to high cognitive load for clinicians in interhospital transfer (IHT) care. High cognitive load can lead to medical errors and clinician stress.
Objective
Our study aims to highlight areas of high cognitive load experienced by hospital medicine physicians and advanced practice providers who care for IHT patients.
Methods
Descriptive qualitative study using 1-h semi-structured interviews with hospital medicine clinicians at an academic medical center. We conducted thematic analysis using a combined inductive and deductive coding approach until saturation was achieved.
Results
We interviewed 30 hospital medicine clinicians including 17 physicians (57%) and 13 advanced practice providers (43%) with 1–18 years of experience (mean 5.7 years). Participants identified multiple contributors to cognitive load for clinicians involved in IHTs. Some of these contributors, such as case complexity and time constraints, were fixed, while others, such as task switching, information synthesis burdens, and poor relational trust were seen as potentially modifiable. Participants suggested that (1) creating a single IHT workflow to minimize distractions, (2) streamlining information presentation to optimize information synthesis, and (3) facilitating trust building between healthcare team members as potential solutions to reducing cognitive load.
Conclusions
Physicians and advanced practice providers at an academic medical center experienced increased cognitive load in IHTs when faced with frequent task switching, inefficient delivery of clinical information, and variable levels of trust between healthcare team members. Addressing cognitive load experienced by clinicians in IHTs may lead to safer IHT care and lower risk of clinician burnout.
{"title":"Overloaded: How task switching, information synthesis, and poor relational trust make interhospital transfers challenging","authors":"Amy Yu MD, Lauren McBeth, Claire Westcott PA-C, Stephanie Mueller MD, MPH, Mustafa Ozkaynak PhD, MS, Brooke Dorsey Holliman PhD, Anna Maw MD, MS, Jacinda Nicklas MD, MPH, Christine D. Jones MD, MS","doi":"10.1002/jhm.70084","DOIUrl":"10.1002/jhm.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Complex and inefficient information and task organization contribute to high cognitive load for clinicians in interhospital transfer (IHT) care. High cognitive load can lead to medical errors and clinician stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our study aims to highlight areas of high cognitive load experienced by hospital medicine physicians and advanced practice providers who care for IHT patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive qualitative study using 1-h semi-structured interviews with hospital medicine clinicians at an academic medical center. We conducted thematic analysis using a combined inductive and deductive coding approach until saturation was achieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 30 hospital medicine clinicians including 17 physicians (57%) and 13 advanced practice providers (43%) with 1–18 years of experience (mean 5.7 years). Participants identified multiple contributors to cognitive load for clinicians involved in IHTs. Some of these contributors, such as case complexity and time constraints, were fixed, while others, such as task switching, information synthesis burdens, and poor relational trust were seen as potentially modifiable. Participants suggested that (1) creating a single IHT workflow to minimize distractions, (2) streamlining information presentation to optimize information synthesis, and (3) facilitating trust building between healthcare team members as potential solutions to reducing cognitive load.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Physicians and advanced practice providers at an academic medical center experienced increased cognitive load in IHTs when faced with frequent task switching, inefficient delivery of clinical information, and variable levels of trust between healthcare team members. Addressing cognitive load experienced by clinicians in IHTs may lead to safer IHT care and lower risk of clinician burnout.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1282-1289"},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176110","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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