Journal of hospital medicine最新文献

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.

Beginning in March 2023, we integrated a clinical pharmacist into our interprofessional addiction medicine consult service (ACS) to improve care at our hospital and expand substance use disorder best practices regionally. Here, we share experiences from our first 18 months, describing the ACS pharmacist role and highlighting advances at the level of pharmacy care, the hospital, and the region. The ACS pharmacist enriched ACS care quality; built and implemented order sets and workflows; educated the interdisciplinary workforce; and provided training and technical assistance across regional hospitals. Healthcare leaders should consider integrating ACS pharmacists to advance and spread hospital-based addiction care.

Globally, respiratory syncytial virus (RSV) is responsible for more than 3.6 million hospitalizations and 100,000 deaths every year. Since 2023, three immunizations have been approved for clinical use, each targeting a different patient population. These newly available RSV immunizations are poised to prevent hospitalizations, reduce costs for healthcare systems, and save lives. This review will discuss the evidence behind these immunization strategies and examine their potential to blunt the global impact from RSV.