Journal of hospital medicine最新文献

Many patients are unable to identify members of their hospital care team and experience confusion regarding some medical terminology used during hospitalization, including descriptions of the structure of their inpatient care team. This cross-sectional study sought to (1) examine inpatients' understanding of the role of a hospitalist and (2) assess inpatients' familiarity with other medical terminology commonly used in the hospital. We surveyed 172 patients admitted to the hospital medicine service at two academic medical centers. We found that almost half (47%) of respondents were unfamiliar with the term and/or role of a hospitalist, while the remaining patients had varied understanding of the role. Several other medical terms were frequently misunderstood (such as "NPO," "PA," and "Attending"). Ongoing efforts are needed to improve communication to ensure that hospitalized patients understand the hospitalist's role and the medical terms shared with them.

Background: Hospital at Home (HaH) programs are used throughout the United States and are beneficial in both providing patients care in environments most comfortable to them and freeing up inpatient beds. Better informing patients about HaH programs, while promoting shared decision-making (SDM), should be prioritized by health systems. SDM apps may promote increased patient agency and understanding of complex HaH care decisions. We previously developed, usability tested, and refined a HaH SDM app.

Objectives: To evaluate the utility of SDM apps in assisting pneumonia patients with HaH admission.

Methods: Usability surveys (N = 16) and semistructured interviews with patients (N = 9) and nurse navigators (N = 3) were utilized to evaluate our app in assisting pneumonia patients as they contemplated HaH admission. Recruitment occurred at three hospitals in the southeastern United States. Surveys were analyzed consistent with their validated measures, while interviews were analyzed using inductive coding methodologies.

Results: Patients supported receiving HaH information via an app, with many noting that presenting content via multiple modalities (e.g., videos, pictures, text) was helpful and that the app assisted their care decision. App-guided inquiries into patients' care preferences helped patients visualize their priorities and promoted feelings of agency, while providing important information to care teams. Participants found visuals effective at conveying program details, for example, HaH's in-home setup, which may assist with health literacy challenges. Potential barriers included the need to expand app accessibility for vision impaired and non-English speaking patients.

Conclusions: SDM apps may better inform patients' HaH care decisions, allowing patients self-directed access to information and engagement with visual content, which may address challenges related to health literacy and navigating complex, time-sensitive decisions.

Introduction: Few rural hospital medicine programs include workforce development training that provides social and professional support for interdisciplinary teams. Even fewer include training that creates supportive learning environments that result in higher staff satisfaction, lower burnout, and reduced turnover. The Acute Inpatient Medicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) aims to create supportive learning environments in Veterans Health Administration (VA) rural hospital medicine teams.

Methods: AIM-HI is a type II hybrid implementation study utilizing a convergent mixed methods approach to evaluate the Relational Playbook, a workforce development intervention, and three implementation strategies: behavioral nudges, learning and leadership collaboratives, and leadership coaching. AIM-HI implementation will occur in waves, enrolling additional hospitals every 12 months. In the first wave, AIM-HI will be implemented at three tertiary VA hospitals that treat at least 1000 rural Veterans annually and have an active inpatient hospital medicine program. The primary outcomes in year 1 will be the acceptability, appropriateness, and feasibility of AIM-HI assessed through participant surveys and interviews. In subsequent years, trends in the learning environment, job satisfaction, burnout, and turnover scores will be assessed using a linear mixed-effect model.

Discussion: The anticipated impact of AIM-HI is to evaluate the utility of the implementation strategies and assess trends in Playbook intervention outcomes. The Playbook has strong face validity; however, before large-scale adoption across the VA enterprise, it is essential to establish the acceptability, appropriateness, and feasibility of the Playbook and implementation strategies, as well as to gather data on AIM-HI effectiveness.

Background: Hospitalists in British Columbia care for a large percentage of hospitalized patients across 21 acute care facilities.

Objective: We aimed to characterize the demographic and work attributes of the workforce and to understand levels of burnout and the relationship between workload and job satisfaction.

Methods: We conducted a cross-sectional survey of individuals participating in hospitalist programs in BC.

Results: Almost all individuals (96%) were involved in the care of patients with COVID-19 in 2021, the height of the pandemic. High rates of burnout were demonstrated among hospitalists, with a large number of providers planning to significantly reduce or stop their involvement in acute care. Regression analysis identified workload as an important factor associated with burnout. Older physicians, those who had been practising for longer, and those with moderate to high number of shifts were more likely to consider reducing their involvement with their programs.

Conclusions: High levels of burnout are associated with a desire to reduce work involvement among BC hospitalists. Health system leaders need to consider factors contributing to burnout as a key aspect of broader health human resource planning efforts.