Journal of hospital medicine最新文献

Background: Rising emergency department (ED) boarding times have become a public health crisis. It is unclear whether certain racial and ethnic groups are disproportionately affected.

Objective: To identify racial and ethnic inequities in ED boarding time and explore which factors may contribute to prolonged boarding times.

Design, setting, and participants: Retrospective cohort study of 38,766 adults (≥18 years) admitted to internal medicine services from EDs at two Boston hospitals (March 2018-February 2024).

Measurements: Race and ethnicity categorized as non-Hispanic White (White), non-Hispanic Black (Black), Hispanic, and non-Hispanic "Other" (including Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, or unspecified).

Primary outcome: prolonged ED boarding (≥4 h from admission order to inpatient transfer). Multivariable logistic regression assessed associations; additional analyses evaluated health insurance as a mediator.

Results: Among 38,766 patients (53.1% female), 59.9% were White, 20.3% Black, 14.4% Hispanic, and 5.4% "Other" race and ethnicity. Prolonged ED boarding occurred in 32.1%. In adjusted models, Black patients had 9% higher odds (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.15; p = .004) and "Other" racial and ethnic patients had 16% higher odds (OR, 1.16; 95% CI, 1.05-1.27; p = .003) compared to White patients of prolonged ED boarding; no significant difference was observed for Hispanic patients (OR, 0.98; 95% CI, 0.92-1.04; p = .51). Adjusting for insurance attenuated racial disparities in ED boarding. Medicaid insurance was consistently associated with increased odds of prolonged boarding across racial and ethnic groups, particularly among Hispanic (OR, 1.86; 95% CI, 1.63-2.12; p ≤ .001) and Black (OR, 1.78; 95% CI, 1.59-1.99; p < .001) patients. Medicare was associated with lower odds of prolonged boarding across all groups.

Limitations: Two-site study.

Conclusions: Black and other marginalized racial and ethnic patients were more likely to experience prolonged ED boarding, and differential health insurance access may contribute to this inequity. As boarding rises nationally, targeted interventions are needed to reduce disparities.

Background: The incarcerated population in the United States is underserved and aging rapidly; there is a dearth of information regarding their health, including hospital care. Epidemiological information is crucial to guide policymakers' planning. This analysis provides comparison data on the admissions of incarcerated and nonincarcerated patients.

Objectives: Identify differences in inpatient care between incarcerated and nonincarcerated patients by comparing 10 years of data at an academic medical center that serves as the largest single provider of hospital care for the state's Department of Corrections.

Methods: Ten-year cohort study comparing all admissions of incarcerated males (n = 4525) to a matched cohort of nonincarcerated (n = 13,575) at an academic medical center serving as the largest provider of hospital care for the state's Department of Corrections. We included patients ≥18 years old and admitted to the hospital while in custody of the Department of Corrections between January 1, 2010, and December 31, 2019. Primary outcomes were patient characteristics, including demographics and comorbidities, and hospitalization characteristics, including length of stay and diagnosis.

Results: Compared with the nonincarcerated cohort, the incarcerated patients were more likely to be Black (33.4% vs. 6.6%, p < 0.05), Hispanic/Latine (6.1% vs. 2.1%, p < 0.001), admitted to a general medicine service (33.4% vs. 22.6%, p < 0.01), and less likely to be admitted to neurological/psychiatric services (5.2% vs. 9.1%, p < 0.01). The incarcerated cohort had a higher mean Charlson Comorbidity Index (3.83 vs. 3.65, p < 0.001), with statistically significant differences observed among patients aged 40-59.

Conclusion: In this cohort study, there were differences in patient and hospitalization characteristics between incarcerated and nonincarcerated patients that may have clinical implications. Policymakers and researchers must work toward improving both the health and health care of this marginalized population.

Background: Health literacy-informed and language-concordant written materials can promote caregiver understanding of care plans although are not commonly used in inpatient rounds.

Objectives: We sought to develop and evaluate a health literacy-informed, multilingual electronic real-time summary of rounds for hospitalized patients (the Rounds eSummary).

Methods: A multidisciplinary team developed the Rounds eSummary using health literacy, communication, and language equity best practices and multiple rounds of piloting. To generate the eSummary, clinicians completed a link with closed-ended options for various rounds components (e.g., illness severity, plan), caregiver's preferred language, and contact information. This generated an electronic PDF rounds summary (15 possible languages) emailed or texted to the family. We used descriptive statistics to analyze eSummaries (n = 437) created from October 25, 2024 to February 1, 2025. Separately, for a purposive sample of English eSummaries (n = 12) that represented different diagnoses and plans, two independent raters examined reading grade level (average of five formulas), understandability, and actionability (Patient Education Materials Assessment Tool for Printable Materials).

Results: Rounds eSummaries were generated in eight languages across three sites; the most common languages were English (89%), Spanish (6.2%), and Portuguese (1.8%). Plans commonly included medicines (42%), nutrition (30%), and oxygen (24%). More than half (61%) were accessed at least once by the patient/caregiver; of the eSummaries accessed, the average engagement time was 29.1 s (standard deviation 25.2). The average reading grade level was 6.8 (standard deviation 0.6, range 5.8-7.8). Overall understandability and actionability scores were 87% and 60%, respectively.

Conclusion: We designed a usable Rounds eSummary that addressed language and health literacy barriers.

Trial registration: ClinicalTrials.gov identifier: NCT05591066.

Hospitalists care for patients with acute pain who have an opioid use disorder and require pain management. Hospitalists may withhold opioids for acute pain due to a variety of reasons. However, adequate pain management in patients with opioid use disorder, including with opioids, is the standard of care. This piece explains how to best manage acute pain in hospitalized patients with opioid use disorder with supportive evidence and discharge planning considerations.

Hospitalists rarely sit when communicating with patients at the bedside. As an important component of etiquette-based medicine, hospitalists should strive to get to eye level when communicating with patients. Sitting, when compared to standing at the bedside, improves physician-patient communication and does not lead to any additional time spent in the patient's room.