Journal of hospital medicine最新文献

Background: Academic hospitalists have major roles in medical education, clinical care, and other academic medical center missions. Their professional identity development has implications for vitality, burnout, retention, and patient safety.

Objective: To characterize academic internal medicine hospitalist professional identity and its development.

Methods: Ten focus group interviews were conducted with 31 hospitalists in early-, mid-, and late-career stages at three academic medical centers. Data were analyzed using thematic analysis.

Results: Academic hospitalist identity development was characterized by (1) constant core clinician identity, (2) navigating interfaces between different spheres of knowledge, influence, and activity (patients, systems, learners, and multiple medical and psychosocial issues), (3) expanding identities in the "extension zone" outside of patient care, (4) variable and ambiguous academic identity, (5) ongoing negotiation between extrinsic factors (resources, relationships, and validation), intrinsic factors (personal identities and professional values), and identity development, (6) diverse career trajectories, and (7) professional identity driving career decision-making.

Conclusions: In contrast to a "deficit" view of generalists lacking focus on a specific disease or organ system, academic internal medicine hospitalist professional identity encompasses distinct roles and skills. While hospitalists individualize their activities outside the context of patient care, the core clinician identity remains a beacon guiding these activities. Hospitalists' varied and ambiguous concepts of what it means to be academic may contribute to lagging academic progress. Organizations should support hospitalists' unique professional identities, seek clarity around what it means to be academic, and foster ongoing professional identity development.

Healthcare workers face a disproportionately high risk of workplace violence compared to other industries, and disruptive patient behavior causes significant distress for care teams. To address this, we developed a structured, multidisciplinary response to unsafe inpatient behavior, that allows care teams to focus on patient care and maintain therapeutic relationships, while nonclinical administrators enforce hospital rules. In the event of recurrent violence, our framework also provides guidance for administrative discharge-the discharge of an adult inpatient from the hospital before medical readiness-which is available as a last resort to maintain a safe working and healing environment.

New policies require hospitals to identify and address patients' health-related social needs (HRSN) yet provide minimal guidance on how screening should be conducted. This observational study occurred at a large academic hospital serving a diverse population. Hospital and research staff independently screened newly admitted medical patients for six HRSNs using an instrument designed by a quality improvement team. We calculated κ statistics to assess HRSN agreement between hospital and research staff. Analysis of 413 patients revealed fair to moderate agreement between hospital and research staff screenings (κ = 0.25-0.54). Hospital staff identified fewer patients with needs related to medication affordability, housing, food, transportation, and mental health, but identified a higher proportion with needs related to the usual source of care. Hospital staff underestimate the proportion of patients with HRSN, potentially excluding patients from referral to social services.

Background: Prior work has identified disparities in antibiotic use for children in the ambulatory setting, but few studies have explored antibiotic disparities in the inpatient setting.

Objectives: We evaluated the association of both race and ethnicity and Childhood Opportunity Index (COI) with antibiotic utilization for children hospitalized with pneumonia.

Methods: This cross-sectional study included children hospitalized with pneumonia at one of 43 hospitals in the Pediatric Health Information System (2022-2024). We evaluated the association between race and ethnicity and COI quintiles (very low quintile representing the lowest opportunity neighborhoods) and antibiotic utilization using generalized estimating equations adjusted for confounders. Antibiotic utilization included any antibiotics and among children with antibiotics, use of broad- versus narrow-spectrum and intravenous versus oral antibiotics.

Results: Among 49,332 children, compared with non-Hispanic White children, we found higher odds of receiving antibiotics among Asian (86% vs. 80%; odds ratio [OR]: 1.45 (95% confidence interval [CI]: 1.14, 1.84]) and non-Hispanic Black children (83% vs. 80%; OR: 1.59 [1.17, 2.15]). Hispanic children had greater odds receiving broad- rather than narrow-spectrum antibiotics (52% vs. 46%; OR: 1.30 [1.03, 1.63]). Compared with non-Hispanic White children, all other groups had greater odds of intravenous rather than oral antibiotics. Compared with children in the very high COI quintile, children in the very low COI quintile had greater odds of receiving antibiotics (86% vs. 79%; OR: 1.69 [1.12, 2.55]) and broad-spectrum antibiotics.

Conclusion: Children of some minoritized backgrounds and those residing in the lowest opportunity neighborhoods had greater odds of receiving antibiotics, broad-spectrum antibiotics, and intravenous antibiotics for pneumonia.

Background: Hospitalized patients are typically inactive, though evidence highlights the effectiveness of mobility-enhancing interventions in improving health outcomes. Technology-assisted approaches are increasingly used to encourage patient movement.

Objectives: This scoping review examines technology-assisted initiatives designed to promote physical activity in hospitalized adults and explores implementation strategies used to facilitate these initiatives.

Methods: The Arksey and O'Malley's 2005 framework was used. Studies were identified through searches of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane trials. Bibliographies of included studies were searched. Characteristics of technology-assisted interventions and implementation strategies used were extracted, categorized, and analyzed for frequency.

Results: Thirty papers representing 28 unique initiatives were identified from 6049 articles. The technology used were wearable step or activity counters (20), exergames (6), mobile ambulation reminders (3), and applications for in-bed exercises (1). Five implementation strategies reported from three studies were coded using the Expert Recommendations for Implementing Change: identifying and preparing champions, facilitating relay of clinical data, conducting educational meetings, developing and distributing educational materials. Eight behavior change techniques were reported: encouragement, collaborative goal setting, increasing daily goals, progress tracking, visual data display, patient education, environmental modification and physical therapist support.

Conclusion: The implementation of technology-assisted mobility interventions in hospitals to enhance patient mobility is emerging. Applying implementation and behavioral science frameworks may enhance effectiveness. Future studies are required to evaluate implementation strategy outcomes and to examine patient and clinician experiences to inform intervention adaptation and to facilitate integration into routine clinical hospital ward/unit practice.