Journal of hospital medicine最新文献

Overwhelming inpatient capacity at referral hospitals undermines both regional healthcare networks and patient outcomes. To address increasing capacity constraints, Intermountain Health implemented a Load Balancing Protocol to redirect stable, lower-acuity admissions from our overburdened quaternary hospital to three community hospitals. By aligning patient acuity with optimal care settings, our strategy preserves advanced care capacity and enhances safe, equitable, and efficient care. In 4 years, our protocol diverted 5112 bed-days from the quaternary hospital and has undergone several iterative improvements. In this article, we describe the barriers and keys to innovation that contribute to the success of this Load Balancing Protocol.

Access to infectious diseases physicians has been increasingly difficult, as many infectious diseases fellowship programs have unfilled positions. This has coincided with increasing numbers of internal medicine residents pursuing hospitalist medicine. A small community hospital system merged its infectious diseases practice into a hospitalist group. The group has been able to maintain continuous coverage. Although the majority of physicians enjoyed the work-life balance of being an ID-hospitalist, the majority preferred to do ID without hospital medicine.

We evaluated whether peripheral intravenous catheter (PIV) utilization and complications (i.e., infiltration/extravasation) differed between children hospitalized with pneumonia who received initial oral versus intravenous antibiotics. In a retrospective cohort study of children hospitalized with pneumonia at four affiliated sites within a single hospital system from 2014 to 2020, we evaluated PIV outcomes and compared them using bivariable analyses and multivariable regression models. Among 1035 children, 65% received initial oral antibiotics and 59% had PIVs. PIVs were placed in 38% of children with oral antibiotics and 99% with IV antibiotics. Infiltration/extravasation occurred in 1% of children with oral antibiotics and 9% with IV antibiotics. Among children with PIVs, those with oral antibiotics had lower odds of infiltration/extravasation (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.17-0.9). Given the pain and anxiety of PIVs for children and the morbidity associated with infiltrations/extravasations, initial oral antibiotics provide an opportunity to improve patient and family experiences and minimize PIV-related harms.

The evidence base supporting the effectiveness of shorter antibiotic courses for a variety of common infections has grown substantially, yet many implementation barriers remain. We examine recent data evaluating shorter antibiotic courses for bacteremia, community-acquired pneumonia, ventilator-associated pneumonia, and complicated urinary tract infections/pyelonephritis.

Background and objectives: Children with medical complexity (CMC) have chronic health conditions often associated with functional limitations. CMC comprise 1%-5% of the pediatric population. In Canada, their care accounts for one-third of pediatric health spending. We aim to describe the most costly and prevalent conditions leading to hospitalization in CMC in Ontario, Canada.

Methods: Population-based, cross-sectional study from a universally funded system utilizing health administrative databases. Children (<18 years old) with valid provincial healthcare coverage admitted to a hospital from 2014 to 2019 were included. CMC was defined using validated algorithms. Encounters were classified into clinical conditions using the Pediatric Clinical Classification System. Outcomes included condition-specific prevalence, cost, and cost rank estimated using a costing algorithm in Canadian dollars.

Results: There were 627,314 pediatric hospitalizations, costing $4.28 billion. Of these, 141,653 (23%) hospitalizations were for CMC, costing $2.25 billion (52%). Among encounters for CMC, 84,280 (60%) were for children with medical technology. One-third of hospitalizations in CMC were in community hospitals. Nearly half (1.30 million, 46%) of days in hospital were in CMC, along with 60% of intensive care unit (ICU) days (667,497 days). Low birth weight ($555.4 million), prematurity ($70.0 million), and respiratory distress of the newborn ($46.6 million) were the costliest conditions. Low birth weight (88 per 1000 encounters), chemotherapy (42 per 1000 encounters), and pneumonia (29 per 1000 encounters) were the most prevalent conditions.

Conclusions: Understanding the most costly and prevalent inpatient conditions in CMC will help to prioritize more targeted research questions and interventions to improve healthcare utilization and patient outcomes.

Despite a rising demand for geriatricians, fewer than 1% of physicians have achieved board certification in the subspecialty. Most geriatrics fellowship programs offer a traditional 1-year, full-time training model, which is often financially and logistically challenging for residency graduates who wish to pursue hospitalist careers. To address this challenge, we developed an innovative 2-year combined Geriatric Medicine Fellowship-Hospitalist track using an Accreditation Council For Graduate Medical Education- and American Board of Internal Medicine-approved interrupted training model. We describe the novel structure and implementation approach, offering a replicable framework for academic institutions seeking to strengthen their geriatrics workforce development and facilitate an age-friendly health system.