Journal of hospital medicine最新文献

Society of Hospital Medicine Rapid Clinical Updates (RCUs) was developed as a tool for healthcare professionals to bridge the gap between the latest advancements and standard clinical practice. An online seminar series with nationally recognized speakers was developed with input from hospitalists and literature review. For each session, a subspecialist was paired with a hospitalist to present the latest medical research and practical implementation into clinical practice. Active audience participation was encouraged, and survey data were collected on the quality of the sessions and their impact on clinical practice. Over the past 4 years, this virtual platform has consistently been rated as high-quality and impacting clinical practice.

In the first two parts of the series, we described the sources of high prices in health care and the severe constraints faced by low-income patients when seeking to access care without incurring medical debt. In this third and final installment, we examine the origins of aggressive medical debt collection practices, their deleterious consequences for patients, and potential solutions.

Background: Workplace violence prevention programs are important for safety, but little is known about how they are perceived by clinicians or whether electronic health record (EHR) behavioral alerts are perceived as effective.

Objective: To understand perspectives on the use of EHR behavioral alerts as part of workplace violence prevention programs in hospitals.

Methods: Mixed methods study utilizing semi-structured focus groups with a structured survey. Focus group participants were members of a national hopsitalist consortium.

Results: Twenty-eight individuals from 20 different organizations participated in focus groups, with 24 (86%) completing the survey. There was broad uncertainty in best practices for inpatient workplace violence prevention. There was also wide variation in EHR behavioral alert use across multiple domains, including how and why the alerts are placed and how they are used by the end user. Finally, focus groups had mixed sentiments on the potential impacts of these alerts; among participants who responded to surveys, half (50%) noted that alerts caused deviations in care and 21% indicated they witnessed instances where behavioral alerts led to adverse patient outcomes. Most (67%) survey respondents did not think EHR behavioral alerts prevented workplace violence. The majority (88%) of respondents also reported that patient demographic factors impacted whether an alert was placed.

Limitations: The study focused on clinician experience at academic hospitals.

Conclusions and relevance: Reports of uncertainty in best practices for deploying EHR behavioral alerts, along with perceptions of variability in implementation and potential biases in alert usage, raise concerns about their effectiveness and potential for worsening disparities. Standardized, evidence-based practices that safeguard healthcare workers without compromising patient care and equity are needed.

In the setting of growing use of sodium-glucose cotransporter 2 inhibitors (SGLT2i), little is known about the prevalence and impact of euglycemic diabetic ketoacidosis (eDKA). We performed a retrospective analysis on patients with DKA in the Catholic Health Initiatives-Omaha Health system from 2018 to 2023. Among the 510 patients meeting inclusion criteria; 455 (89.2%) had traditional DKA and 55 (10.8%) had eDKA. SGLT2i use was more likely in eDKA patients (44.4% vs. 0.03%). Compared with traditional DKA, those with eDKA had a significantly longer time to diagnosis (388 vs. 166 min, p < .001) and duration of DKA (2772 vs. 2005 min, p = .007). However, intensive care unit (ICU) and hospital length of stay (LOS) were similar between both DKA groups (171 vs. 170 h; 3.43 vs. 3.37 days, respectively). The unique biochemical profile of eDKA likely delays diagnosis and treatment, ultimately leading to similar LOS despite eDKA patients having lower Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Because the proportion of eDKA is rising, hospitalists must have a heightened awareness of eDKA as SGLT2i use increases.