Journal of hospital medicine最新文献

The Center for Medicare and Medicaid Services Patient Safety Structural Measure is an attestation-based public reporting measure encouraging hospitals to establish comprehensive patient safety programs, measure, and report their outcomes. Hospitalist practice is uniquely situated to benefit from and advance this policy: in particular, the emphasis on transparency and patient and family engagement. A clinical practice of talking openly with patients and families about harm requires clinical teams and leaders to systematically identify, report, analyze, improve, and heal. We describe this new policy, its limitations, and potential influences on hospital care.

Despite a decline in hepatitis A virus (HAV) incidence following vaccine introduction, HAV remains a public health concern in the United States. Recent multi-state outbreaks have demonstrated that HAV can re-emerge and highlight inequities in vaccine coverage or access, outbreak response, and in those with social or health risk factors. Continued investment in prevention, particularly vaccination and surveillance, is essential to prevent resurgence. Hospitalization offers a critical opportunity to address these gaps and provide equitable protection for at-risk populations.

Beginning in 2021, we developed and implemented the SQuID (subcutaneous insulin in diabetic ketoacidosis [DKA]) protocol for low to moderate severity (LTM) DKA, treating these patients on a single inpatient Hospitalist-run observation floor and demonstrating reductions in emergency department (ED) length of stay of over 3 h compared with LTM DKA patients treated in the ED with intravenous (IV) insulin and subsequently admitted to the medical floor. We expanded bed eligibility to a second Hospitalist-only floor from March 2023 to March 2024. We demonstrated equivalent safety and effectiveness of SQuID in LTM DKA compared with treatment on IV insulin, reducing intensive care unit (ICU) utilization for LTM DKA by over 33%, and maintaining high clinician acceptability ratings. Here we discuss lessons learned, keyinsights and pitfalls for the implementation of this innovation.

Background: Onboarding physicians into a new organization occurs frequently in Hospital Medicine, but variations in structure and content lead to challenges in optimizing effective onboarding processes.

Objective: To capture current onboarding practices in Hospital Medicine groups by surveying academic institutions across the United States to highlight similarities, differences, and opportunities.

Methods: A cross-sectional survey distributed through REDCap over a 3-month period to hospitalist division directors through the Hospital Medicine Reengineering Network (HOMERuN). Survey questions were drafted and refined initially through the Medical Education Affinity Group in HOMERuN. Quantitative data were analyzed using IBM SPSS Statistics (Version 29). Descriptive statistics were calculated for demographic variables. Chi-square tests were conducted to explore relationships between variables.

Results: Out of 68 institutions surveyed, 30 (44%) responded, most of the institutions' new hires transitioned directly from residency or fellowship programs without prior experience practicing as hospitalists. More than half (53%) of institutions conclude their onboarding program before the start of work for new hires. The majority of hospitals shared common topics in onboarding, such as clinical workflow, billing and documentation, logistics and geography, electronic health record, hospital policies, admission and discharge processes, sign-out, and cross-coverage.

Conclusion: Variations exist in our nation's Hospital Medicine onboarding programs, but common practice is found in content topics. Understanding these practices, as delineated in our study, is the first step toward collaborations to create standardized strategies in hospitalist onboarding to strengthen this important practice in the field.

Background: While interhospital patient transfers are common, most existing literature centers on transfers to academic medical centers (AMCs) and tertiary/quaternary care hospitals for a higher level of care. With the growing trend of healthcare system consolidation and formation of regional affiliations, many systems now coordinate admissions and capacity on a broader system-wide scale. As a result, some AMCs have developed programs to facilitate outbound transfer to regional affiliate hospitals. This shift prompted our study.

Objectives: Our study aims to understand the current landscape of outbound transfer programs and to identify key facilitators and barriers to successful implementation, resultant operational successes, and future aspirations.

Methods: We conducted semi-structured qualitative interviews with AMCs across the United States that have an affiliation with another institution. Affiliation is defined as "an agreement to collaborate on an initiative or to provide a specific service together. This may involve local, regional or national partners." Data were analyzed using inductive and deductive methods in Nvivo software.

Results: We conducted interviews with 12 AMCs from all four major United States regions ranging from 550 to 1700 beds. We identified five key themes from the study and included: (1) transfer activity, (2) barriers to implementation, (3) facilitators to implementation, (4) successes, and (5) aspirations.

Conclusion: This study highlights the vital role of patient transfer programs in ensuring high-quality care and managing capacity within AMCs and healthcare systems. Successful implementation depends on addressing inefficiencies, fostering collaboration, and promoting equitable care. Prioritizing these factors can improve patient outcomes and alleviate capacity constraints, enabling timely access to necessary care.