Journal of hospital medicine最新文献

Background: Secure electronic messaging is increasingly being utilized for communications in healthcare settings. While it likely increases efficiency, it has also been associated with interruptions, high message volumes, and risk of errors due to multitasking.

Objectives: We aimed to characterize patterns of secure messaging among hospitalists to understand the volume of messages, message patterns, and impact on hospitalist workload.

Methods: This was a retrospective cross-sectional study of Epic Secure Chat secure electronic messages received and sent by hospitalists from April 1 to April 30, 2023 at a large academic medical center. Number of conversations per day, number of chats sent and accessed per hour, and average minutes between when a chat was sent and accessed (lag time) were analyzed using a Pearson correlation coefficient test. Measures were plotted against patient volume and time of day.

Results: Hospitalists sent or received an average of 130 messages per day with an average of 13 messages sent or received per hour. The median lag time was 39 s. There was a statistically significant correlation between hospital medicine morning census and number of conversations per day, number of chats sent per hour, and number of chats accessed per hour, but census did not impact lag time.

Conclusion: Secure messaging volumes may be higher than previously reported, which may affect hospitalist workload and workflow and have unintended effects on interruptions, multitasking, and medical errors. Additional work should be done to better understand local messaging patterns and opportunities to optimize volume of work and distractions.

Background: Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes.

Objectives: The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence.

Methods: This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression.

Results: Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18-0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33-4.73).

Conclusions: Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence.

Background: Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition.

Objectives: To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019.

Methods: We conducted a retrospective trends study to identify use of malnutrition codes in hospitalizations in the National Inpatient Sample between 2016 and 2019. We used direct standardization by logistic regression to adjust outcomes of percutaneous gastrostomy tube placement, mechanical ventilation, and death for age, Gagne comorbidity score, and sex. We then used linear regression to test for trends over time by malnutrition type.

Results: Across all hospitalizations, codes for diagnoses of non-severe malnutrition and severe malnutrition were present in 3.7% and 4.1% of hospitalizations, respectively. Codes for any malnutrition increased over time, from 6.6% in 2016 to 8.6% in 2018 (p = .03). Codes for severe malnutrition increased from 3.3% to 4.7% (p = .01). Among hospitalizations with coded severe malnutrition diagnoses, there was a statistically significant decrease in adjusted rate of death over time (-0.54% per year, p = .03) which was not seen in hospitalizations without coded malnutrition diagnoses.

Conclusions: Use of malnutrition diagnosis codes increased significantly from 2016 to 2019. During this time, mortality among hospitalizations with a diagnosis code for severe malnutrition decreased. Though the increased prevalence of malnutrition codes may represent a change in the clinical characteristics of hospitalized patients, the decline in mortality suggests some of the increase may be due to lower threshold for coding and assignment of the diagnosis to less ill patients.

Background: Burnout and lagging academic productivity are pressing challenges in hospital medicine, leading to stagnation and attrition. Mentoring shapes professional identity formation and enhances faculty vitality and retention, but has not been optimized among academic hospitalists.

Objectives: We sought to explore how mentoring impacts academic hospitalist professional identity and to elucidate barriers to mentoring in the field.

Methods: We conducted focus groups at three academic medical centers. Informed by social-constructivist theory of identity development, we coded deidentified data and performed thematic analysis.

Results: Thirty-one academic hospitalists participated with 1 to >20 years experience. Mentoring shaped professional identity formation in six core domains: choosing academic hospital medicine, identifying and focusing on an area of interest, progressing career, navigating work-life integration, staying in academic medicine, and becoming a mentor. Distinct models included dyadic mentoring, peer mentoring, organic mentoring, and mentoring teams, each with benefits and limitations. We identified nine key mentoring actions that influenced hospitalist professional identity formation and career development. Mentoring barriers included lack of time, awareness, and access to experienced mentors, as well as poor quality mentoring and mentor-mentee malalignment. Aspects of hospitalists' professional identity also posed barriers, including ambivalence around academic identity.

Conclusions: Mentoring fosters academic thriving and retention in academic hospitalists. Access to effective mentoring remains lacking due to few senior mentors in the relatively new field of hospital medicine and reticence in academic identity, among other factors. Mentoring training, impact on underrepresented minority hospitalists, and integration into institutional culture should be considered for enhancing the career development of academic hospitalists.