Journal of hospital medicine最新文献

{"title":"The lost humanity of listening deeply","authors":"Jeffrey P. Yaeger MD, MPH,&nbsp;Katherine R. Baker MD","doi":"10.1002/jhm.70152","DOIUrl":"10.1002/jhm.70152","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"445-446"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Securing benefits of crisis-driven innovations","authors":"Marina Dantas MD, MSCR,&nbsp;Jessica L. Markham MD, MSc","doi":"10.1002/jhm.70180","DOIUrl":"10.1002/jhm.70180","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"447-448"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing healthcare violence as systemic failure","authors":"Minal R. Patel PhD, MPH,&nbsp;Patrick M. Carter MD,&nbsp;Marc A. Zimmerman PhD","doi":"10.1002/jhm.70276","DOIUrl":"10.1002/jhm.70276","url":null,"abstract":"<p>Healthcare workers face escalating violence despite significant security investments, suggesting current approaches miss fundamental causes. We argue that most healthcare violence stems not from individual pathology but from systemic failures—financial barriers, insurance denials, access delays, and administrative complexity—that create volatile patient–provider interactions. Healthcare workers become targets for anger about institutional dysfunctions they cannot control. Current prevention strategies emphasizing individual risk assessment and physical security fail to address these root causes. We propose a research agenda examining connections between system failures and violence, potentially identifying upstream interventions that complement existing security measures while targeting the healthcare dysfunctions driving this epidemic.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"442-444"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality assessment of artificial intelligence-generated versus human-written hospital summaries evaluating detail, usefulness, and continuity of care","authors":"Douglas Challener MD, MS,&nbsp;Shant Ayanian MD,&nbsp;Alexander Ryu MD,&nbsp;John O'Horo MD, MPH,&nbsp;Heather Heaton MD, MS","doi":"10.1002/jhm.70163","DOIUrl":"10.1002/jhm.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital discharge summaries are critical for ensuring continuity of care, but their quality often varies. Large language models (LLMs) have the potential to standardize and enhance the efficiency of this documentation process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the quality of hospital discharge summaries created by an LLM-based hospital course drafting tool created by Epic Systems compared with human-written summaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective study at a single tertiary-care institution in 2024. The cohort included 100 adult hospitalizations lasting &gt;72 h across medical and surgical dismissing services. No interventions were performed. Summaries (LLM-generated vs. human-written) were independently reviewed using a standardized rubric covering nine domains (e.g., comprehensiveness, clarity, relevance). Scores were normalized and compared. Readability was assessed using Flesch Reading Ease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LLM-generated summaries outperformed human-written summaries across all criteria (<i>p</i> &lt; .05), with the greatest difference observed in comprehensiveness (LLM median 0.62 vs. human −0.23). Human-written summaries from surgical services scored lower than those from medical services, but LLM performance was consistent across both. Human summaries had higher Flesch Reading Ease scores (33.11 vs. 26.2; <i>p</i> &lt; .05), reflecting simpler language.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LLM-generated summaries demonstrated superior quality, consistency, and clinical utility compared with human-written summaries, highlighting their potential to improve documentation efficiency and standardization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"375-379"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ready enough","authors":"Samir S. Shah MD, MSCE, MHM","doi":"10.1002/jhm.70154","DOIUrl":"10.1002/jhm.70154","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"359-360"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lone wolves of the night—Do I belong?","authors":"Amelita Woodruff MD,&nbsp;Avni Shah MD","doi":"10.1002/jhm.70229","DOIUrl":"10.1002/jhm.70229","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"407-408"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency, cost, and variation in inpatient diagnostic imaging use in children′s hospitals","authors":"Megan E. Collins MD, MPH, MHPE,&nbsp;John R. Stephens MD,&nbsp;Matt Hall PhD,&nbsp;Matthew J. Molloy MD, MPH,&nbsp;Elisha McCoy MD,&nbsp;Irma T. Ugalde MD, MBE,&nbsp;Michael J. Steiner MD, MPH,&nbsp;Jillian M. Cotter MD, MSCS,&nbsp;Samantha A. House DO, MPH,&nbsp;Michael J. Tchou MD, MSc,&nbsp;Jessica L. Markham MD, MSc","doi":"10.1002/jhm.70183","DOIUrl":"10.1002/jhm.70183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diagnostic imaging studies are frequently utilized when caring for pediatric patients. The most prevalent and costly imaging studies among hospitalized children are unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Identify imaging studies with highest frequency, cost, rates of repetition, and hospital variation among hospitalized children, including patients with intensive care (ICU) stays and complex chronic conditions (CCCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of patients hospitalized from January 1, 2021 to December 31, 2022 across 45 children′s hospitals in the Pediatric Health Information System. We identified diagnostic imaging studies for inpatient and observation encounters using billing codes grouped by body system and modality. We measured imaging frequency, costs, and variation across hospitals, overall and for ICU stays and children with CCCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1,523,343 encounters; 59.1% had imaging, with $2.03 billion in imaging costs. The most frequently obtained and repeated imaging included chest X-ray (CXR), abdominal X-ray, and cardiovascular (CV) ultrasound/echocardiography. The imaging studies with highest cumulative cost were cardiovascular ultrasound, CXR, and neuro/head MRI. ICU encounters were 15.1% of total encounters, but accounted for 44.6% of imaging costs; CCC encounters were 39.6% of the total but accounted for 74.2% of costs. Interhospital variation was low among the most frequent and costly imaging modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among a cohort of hospitalized children, CXR and CV ultrasounds were among the most prevalent, costly, and frequently repeated imaging studies. Encounters with ICU stays and for patients with CCCs incurred disproportionate imaging costs. Our results serve as a starting point for identifying imaging overuse and developing achievable benchmarks of care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"380-390"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shortage as a catalyst for high-value care: Evaluation of a blood culture stewardship intervention driven by supply chain disruption","authors":"Camille Ezran MD, MS,&nbsp;Elizabeth Herrle MD,&nbsp;Christina F. Yen MD,&nbsp;Nicholas J. Mercuro PharmD,&nbsp;Daniel J. Diekema MD,&nbsp;Lesley B. Gordon MD, MS","doi":"10.1002/jhm.70158","DOIUrl":"10.1002/jhm.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinicians often repeat blood cultures in hospitalized, bacteremic patients in excess. Unnecessary cultures have negative impacts, including increased length of hospitalization and environmental waste.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of diagnostic stewardship interventions on repeat blood culture ordering in bacteremic patients during the BD Bactec blood culture bottle shortage in 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a quasi-experimental study including a pre, post, and sustainment phase of adult patients hospitalized with a bloodstream infection at the MaineHealth healthcare system from March to November 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine hundred and forty patients met inclusion criteria. Stewardship interventions reduced repeat blood cultures in patients with Gram-negative rod and Streptococcal bacteremia from 52% to 25% (<i>p</i> &lt; .001), which increased to 47% in the sustainment phase. When repeat cultures were warranted (e.g., <i>Staphylococcus aureus</i>), the interval between cultures increased from 1.7 to 2.0 days (<i>p</i> = .002); during the sustainment phase it decreased to 1.9 days. We estimate that 1968 cultures would be averted yearly if the interventions were sustained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>During a culture bottle shortage, diagnostic stewardship interventions significantly decreased the proportion of unnecessary repeat cultures, thereby improving adherence to evidence-based care and reducing cost and environmental impact. After the shortage ended, the gains in stewardship were partially lost. This suggests that beyond improving education, interventions aimed at impressing upon providers the severity of the shortage itself impacted behavior. Future efforts should identify how positive behavior changes can be extended beyond acute crises to promote high-value, environmentally responsible healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"368-374"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large language model-based identification of venous thromboembolism diagnostic delays","authors":"Verity Schaye MD, MHPE,&nbsp;Daniel J. Sartori MD,&nbsp;Lexi Signoriello PhD,&nbsp;Kiran Malhotra MD,&nbsp;Benedict Guzman MS,&nbsp;Bijal Rajput MD,&nbsp;Ilan Reinstein MS,&nbsp;Jesse Burk-Rafel MD, MRes","doi":"10.1002/jhm.70194","DOIUrl":"10.1002/jhm.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delayed diagnosis of venous thromboembolism (VTE) is prevalent among hospitalized patients, yet case identification is challenging and feedback limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop a large language model (LLM)-based electronic-trigger to identify VTE diagnostic delays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All admissions to internal medicine (IM) residents at NYU Langone Health between January 2022 and December 2023 (<i>n</i> = 20,843) were included. Using an open-source LLM, prompts were validated to detect (1) residents considering VTE in admission notes and (2) VTE confirmation in five types of imaging reports (<i>n</i> = 100 for each prompt validation set). The validated prompts were applied to determine discordance between admission note differential omitting VTE and imaging report confirming VTE. Two hospitalists reviewed discordant cases using a validated tool to identify diagnostic delays. Hospitalizations were labeled as diagnostic delays, in-hospital complication, or false-positive. Based on in-hospital complication and false-positive patterns, exclusion criteria were implemented. Positive predictive value (PPV) and negative predictive value (NPV) were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The LLM prompts correctly classified admission notes and VTE imaging studies with high accuracy (range 98%–100%, <i>n</i> = 699 VTE cases identified). Of the 137 diagnostic delays the LLM-based electronic-trigger identified, 31 were true-positives, 60 in-hospital complications, and 46 false-positives. 4.4% of all VTE hospitalizations had a diagnostic delay. With the exclusion criteria, the PPV was 48% (95% confidence interval [CI], 35%–62%) and NPV was 95% (95% CI, 87%–98%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed the first LLM-based electronic-trigger to identify VTE diagnostic delays, with higher performance than existing non-LLM electronic-triggers. LLM-based approaches can facilitate diagnostic performance feedback and are scalable to other conditions and institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":"391-401"},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: In response: “The core competencies in hospital medicine: Procedures 2025 update”","authors":"Satyen Nichani MD, FACP, SFHM,&nbsp;Megan E. Brooks MD, MPH, FACP, SFHM,&nbsp;Christine Bryson DO, FACP, SFHM,&nbsp;Nick Fitterman MD, MACP, SFHM,&nbsp;Meltiady Issa MD, MBA, FACP, SFHM,&nbsp;Michael Lukela MD, FACP, FAAP, SFHM,&nbsp;Nick Marzano MEd,&nbsp;Kelly Sopko MD, SFHM,&nbsp;Joseph R. Sweigart MD","doi":"10.1002/jhm.70161","DOIUrl":"10.1002/jhm.70161","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}