Journal of hospital medicine最新文献

Administrative databases are powerful tools for pediatric research but lack patient-level microbiology results. This study aimed to determine the accuracy of pathogen discharge diagnosis codes for children hospitalized with acute hematogenous musculoskeletal infections (MSKIs). Medical records for 244 children hospitalized with acute hematogenous MSKIs were manually reviewed to determine which bacterial pathogen, if any, was identified for each MSKI based on microbiology results obtained during the hospitalization. Microbiology results for each patient were then compared to their discharge diagnoses in the Pediatric Health Information System (PHIS) database to determine the accuracy of pathogen discharge codes. Discharge diagnostic codes correctly matched the microbiology results in 89.3% of encounters. Sensitivity and specificity for Staphylococcus aureus discharge diagnostic codes were 88.6% and 96.4% respectively for methicillin-susceptible S. aureus and 92.9% and 99.5% for methicillin-resistant S. aureus. Pathogen discharge codes are reliable surrogates that accurately reflect the microbiology results for children with MSKIs.

Background: Hospitalists working outside the Veterans Affairs (VA) system frequently will serve Veterans receiving care for acute conditions and/or awaiting transfer to VA facilities.

Objective: To perform a scoping review of health conditions and associated outcomes relevant to hospital medicine in US Veterans who served in active duty or reserve deployed roles after November 9, 2001.

Methods: A search of MEDLINE and Embase was performed using a combination of terms related to military service period and health conditions, yielding 5634 citations published after January 1, 2013.

Study selection and data extraction: Two reviewers performed independent screening at the title/abstract and later at the full-text levels. Conflicts at both stages were resolved through discussion. Single reviewers extracted data and synthesized results into three categories: (1) mental health and nonblast trauma, (2) neurologic outcomes, and (3) other conditions, including cardiovascular and respiratory outcomes.

Results: Of 85 included studies, 19 focused on cardiovascular, respiratory, autoimmune, and multisystem outcomes; 38 focused on mental health and nonblast trauma; and 28 focused on traumatic brain injury and neurologic outcomes. Studies showed high rates of comorbid mental health diagnoses and suicide-related behaviors relative to non-Veteran populations, as well as relatively younger incidence of cardiovascular and respiratory chronic conditions, such as atrial fibrillation.

Conclusions: Most studied health conditions among Veterans of post-9/11 conflicts have focused on areas of particular importance to the VA. However, significant gaps remain, particularly in understanding the correlation between specific exposures and clinical outcomes currently observed and to be anticipated in the future in this population.

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.

Background: Prior reviews have shown that interventions to improve inpatient handoffs are inconsistently associated with improvement in patient outcomes. This systematic review examines the effectiveness of inpatient handoff interventions on outcomes affecting patients and physicians, including objective measures when reported (PROSPERO ID: CRD42022309326).

Methods: Pubmed, Embase, and Cochrane Central Register of Controlled Trials were searched on January 13th, 2022. We included experimental or quasi-experimental studies that examined handoff communication between inpatient physicians and reported patient clinical, patient experiential, physician experiential, or cost and utilization outcomes. Studies were excluded if they examined handoffs between facilities or levels of care, or only reported subjective measures of patient safety or physician experience. Risk of bias was assessed using the ROBINS-1 and RoB-2 tools.

Results: Of the 42 included studies, six were randomized controlled trials. Most studies were conducted at academic centers (67%) and involved only residents (64%). An educational intervention was used in 52% of studies and a structural intervention was used in 43%, with 9% using both. Adverse events were significantly improved in three of 16 studies, medical errors in three of seven studies, and length of stay in three of seven studies. Four studies examined mortality, and none reported a significant improvement. Studies that used both structural and educational components reported significant improvements more frequently.

Conclusions: The literature is mixed on the impact of efforts to improve handoffs, though there are few randomized trials. Few studies reported patient experiential or cost/utilization outcomes, or involved hospitalist physicians, which represent potential areas for future research.