Journal of hospital medicine最新文献

{"title":"Assessing the impact of workload and clinician experience on patient throughput: A multicenter study","authors":"Marisha Burden MD, MBA,&nbsp;Venkat P. Gundareddy MBBS, MPH,&nbsp;Regina Kauffman BA,&nbsp;Joseph Walker Keach MD,&nbsp;Lauren McBeth BA,&nbsp;Katie E. Raffel MD,&nbsp;John D. Rice PhD,&nbsp;Catherine Washburn MD,&nbsp;Flora Kisuule MD,&nbsp;Angela Keniston PhD, MSPH","doi":"10.1002/jhm.13555","DOIUrl":"10.1002/jhm.13555","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Various strategies have attempted to address increased patient lengths of stay (LOS), but effectiveness varies. Factors related to work design and workforce experience may also play significant roles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Utilizing data from the Discharge in the A.M. trial, we aimed to validate an electronic measure of workload (i.e., note count) and assess the relationship of workload, patient complexity, and physician years of experience to LOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective observational study at three large academic hospitals with hospital medicine physicians and patients they care for during the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measures</h3>\u0000 \u0000 <p>Workload as measured by electronic note count and physician years of experience; patient LOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From February 9, 2021 to July 31, 2021, 59 physicians completed daily surveys for 93% of 2318 scheduled shifts. We observed a moderate correlation (<i>r</i>: .56) between starting morning census and note counts but no association with LOS. We observed an effect modification between note count and the Charlson Comorbidity Index (CCI), with LOS increasing by 2.3% (95% CI: 0.3%, 4.3%; <i>p</i> = .02) and 3.9% (95% CI: 2.0%, 5.9%; <i>p</i> &lt; .0001) per patient for every 1 unit increase in note count for patients with a moderate CCI or severe CCI, respectively. Years since training was associated with a 0.7% decrease in LOS (95% CI: −1.3%, −0.1%, <i>p</i> = .03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Physician workload, as measured by note count, was associated with longer LOS with higher CCI, while more years of experience was associated with shorter LOS. Original Clinical Trial Registration: ClinicalTrials.gov number, NCT05370638.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 5","pages":"471-478"},"PeriodicalIF":2.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717867","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":"Methodological progress note: Purposeful sampling in qualitative research","authors":"Daniel Herchline MD, MSEd","doi":"10.1002/jhm.13559","DOIUrl":"10.1002/jhm.13559","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":"20 5","pages":"485-488"},"PeriodicalIF":2.4,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712258","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":"Streamlining diuresis: A quality improvement approach to implementing a sodium-based predictive diuresis protocol","authors":"Karan Rai MD, MHA,&nbsp;Hillary Landau Western MD, MBA,&nbsp;Moksha Patel MD,&nbsp;Samuel Porter MD","doi":"10.1002/jhm.13560","DOIUrl":"10.1002/jhm.13560","url":null,"abstract":"<p>Diuresis for hospitalized patients with acute decompensated heart failure is a routine clinical practice but one that remains reliant on error-prone and resource-intensive intake and output and weight measurements and is subject to wide provider variation. We sought to use quality improvement approaches to implement a data-driven predictive diuresis protocol based on natriuresis using the electronic health record to titrate dosing. Our initiative did not result in significant reductions in length of stay but did demonstrate a significant increase in the use of urine studies to guide diuresis and signals toward more aggressive diuretic dosing without an increase in adverse outcomes.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"321-326"},"PeriodicalIF":2.4,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712260","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":"Guideline concordance of electronic health record order sets for hospital-based treatment of alcohol withdrawal syndrome","authors":"Shawn M. Cohen MD,&nbsp;Nitu Kashyap MD, FAMIA,&nbsp;Tessa L. Steel MD, MPH,&nbsp;E. Jennifer Edelman MD, MHS,&nbsp;David A. Fiellin MD,&nbsp;Paul J. Joudrey MD, MPH","doi":"10.1002/jhm.13556","DOIUrl":"10.1002/jhm.13556","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Treatment of alcohol withdrawal syndrome (AWS) in hospitals is inconsistent. Electronic health record (EHR) order sets protocolize care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We examined variation in AWS order sets across hospital organizations and their concordance with AWS guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study of hospital organization user-created EHR order sets for AWS extracted from the December 2021 Epic® userweb community library. Hospital organizations with an acute care hospital and <span></span><math>\u0000 <semantics>\u0000 <mrow>\u0000 <mo>≥</mo>\u0000 </mrow>\u0000 </semantics></math>1 AWS order set were included. We measured the proportion of guideline-concordant care practices within four categories: (1) laboratory assessment, (2) risk assessment for severe AWS and associated management changes, (3) symptom assessment and treatment of AWS, and identification and management of complications and (4) screening, diagnosis, and treatment of unhealthy alcohol use and AUD including medications for alcohol use disorder (MAUD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-five organizations with 289 order sets were included. The proportion of organizations with guideline-concordant laboratory assessments included testing of electrolytes (83%), hepatic function (75%), substance use (83%), and screening for infections (33%). Guidance for assessing risk of severe AWS (34%) and indications for care escalation (63%) used inconsistent definitions. Use of guideline-concordant medications for AWS (99%) and AWS symptom scores (91%) were nearly universal. MAUD was included by two organizations (2%). A common templated order set was used by 26% of organizations in EHR order sets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We observed frequent organizational inclusion of guideline-concordant medications and symptom scores but rare and/or poorly defined guidance for evaluating risk of severe AWS, escalation of care, and MAUD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 6","pages":"550-561"},"PeriodicalIF":2.4,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712250","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":"From rounds to retweets: A digital media fellowship perspective","authors":"Catherine Glatz MD,&nbsp;Maha Sulieman MD,&nbsp;Joseph S. Thomas MD,&nbsp;Patricia Tran MD, MS,&nbsp;Samir S. Shah MD, MSCE,&nbsp;Charlie M. Wray DO, MS","doi":"10.1002/jhm.13557","DOIUrl":"10.1002/jhm.13557","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":"20 6","pages":"637-641"},"PeriodicalIF":2.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678078","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":"Tempering expectations for hospital price transparency rules as a solution to health care cost growth","authors":"Michal Horný MSc, PhD,&nbsp;Paul R. Shafer PhD","doi":"10.1002/jhm.13558","DOIUrl":"10.1002/jhm.13558","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 6","pages":"649-650"},"PeriodicalIF":2.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645300","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":"Overcoming barriers to care for Alcohol Use Disorder: Pathways for change","authors":"Anthony H. Ecker PhD,&nbsp;Michael A. Cucciare PhD,&nbsp;Jan A. Lindsay PhD","doi":"10.1002/jhm.13554","DOIUrl":"10.1002/jhm.13554","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":"20 5","pages":"528-529"},"PeriodicalIF":2.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635256","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":"Hospital at Home: Time to define the home-based care continuum and establish standards for research","authors":"Richard D. Rothman MD,&nbsp;Jessica A. Hohman MD, MSc, MSc,&nbsp;Michael J. Maniaci MD","doi":"10.1002/jhm.13551","DOIUrl":"10.1002/jhm.13551","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"420-421"},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635245","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":"The Journal of Hospital Medicine turns 20","authors":"Samir S. Shah MD, MSCE, MHM,&nbsp;The Journal of Hospital Medicine Editorial Leadership Team","doi":"10.1002/jhm.13548","DOIUrl":"10.1002/jhm.13548","url":null,"abstract":"&lt;p&gt;We are honored to lead the &lt;i&gt;Journal of Hospital Medicine&lt;/i&gt; into its 20th year, continuing our commitment to publishing high-quality research and commentary that advance the field, influence policy, and improve patient care. Enhancing clinical knowledge also remains integral to our mission, hence the many forums to which our readers can avail themselves, including &lt;i&gt;Clinical Progress Notes, Clinical Guideline Highlights for the Hospitalist, Things We Do for No Reason™, Clinical Care Conundrums&lt;/i&gt;, and, most recently, &lt;i&gt;Visual Vignettes&lt;/i&gt;, a column focused on physical diagnosis.&lt;/p&gt;&lt;p&gt;We have also adapted to and shaped new ways of consuming medical information as we build a community around the journal. Our redesigned website and active engagement by our expanded digital media team on a variety of platforms, including LinkedIn, X (formerly Twitter), Instagram, and Threads, allow readers to engage with us in ways that best meet their needs. Moreover, our pioneering editorial and digital media fellowship programs play a key role in developing academic leaders. Notably, our commitment extends beyond research and education to embracing the dynamic ways healthcare intersects with society. Thus, we have published research and perspectives on vulnerable populations, such as Veterans, LGBTQ+ individuals, the elderly, children, and incarcerated individuals, and perspectives on voting rights, climate change, reproductive rights, and gun violence, issues that inevitably affect our patients and colleagues.&lt;/p&gt;&lt;p&gt;Healthcare, by its nature, intersects with policy and legislation. Decisions made by lawmakers—whether at the federal or state level—have a tangible effect on patient health. For example, changes to child labor laws in some states place some of our most vulnerable populations at risk of exploitation.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Permissive gun laws in one state are associated not only with higher within state gun-related suicides and homicides but also with other states' firearm-related deaths.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Decisions surrounding women's healthcare, including abortion access, contraception, and reproductive rights, are being made in statehouses across the country.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The consequences of these decisions are not abstract: we see them in the lives of real people—in children and adolescents, like the more than 1200 killed in gun-related violence in 2024, and in women who experienced life-threatening septic abortions due to delayed care in restrictive states.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As healthcare providers, we are caregivers and advocates for our patients first and foremost. As a journal, our responsibility is to acknowledge and inform our readers about broader societal issues, including those shaped by political discourse, that directly influence our patients' health. The decisions those of us in healthcare make—from how to console grieving parents, counsel a pregnant woman whose fetus has chromosomal abno","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"5-7"},"PeriodicalIF":2.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635262","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":"Our futile charades","authors":"Ella Eisinger BS","doi":"10.1002/jhm.13553","DOIUrl":"10.1002/jhm.13553","url":null,"abstract":"&lt;p&gt;&lt;i&gt;Let's go down on the midaz, up on the fent&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;&lt;i&gt;First peel off the vaso, then pull back on the levo&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Dial down the FiO2, titrate the PEEP&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;There is so much titrating and tinkering in the ICU that at some point the patient is rendered seemingly passive, a recipient weathering the pressor escalations and opioid boluses until they meet the observational and objective parameters of comfort and clinical stability.&lt;/p&gt;&lt;p&gt;I think that it is because of this subliminally perceived passivity that I am so taken aback when an intubated patient breaks through the fog of sedation and begins pointing at my watch and at his mouth. Residents and I gather around his bed as the room is suddenly transformed into an enormous episode of charades in which we feverishly guess at what he is trying to say.&lt;/p&gt;&lt;p&gt;“It's 4:16 in the afternoon on July 22, 2024,” we say repeatedly alongside, “yes, we want to try and take that tube out soon.”&lt;/p&gt;&lt;p&gt;He scowls in exasperation, giving us a much-deserved eye roll.&lt;/p&gt;&lt;p&gt;We try to explain that there are a few more conditions we need to optimize before he can be extubated—that he has fluid in his lungs and a new pneumonia that we are now treating, that we had tried extubation once already and wanted to offer him the best second chance possible. But he keeps pointing at his mouth and throwing his hands up in the air, his composure adopting a new flavor of attitude and rightful frustration.&lt;/p&gt;&lt;p&gt;“Oh, we know,” we sympathize. “We really want that tube out, too.”&lt;/p&gt;&lt;p&gt;He throws his hands up in the air one more time, pleading for divine intervention to knock some sense into our heads.&lt;/p&gt;&lt;p&gt;As I meanwhile find wonder in the emotions now alighting a face that had been rendered expressionless for days, my attending puts an end to our futile charades. She holds out a piece of paper with a grid of letters and guides a pointing tool into his hand, bridging the chasm between patient and provider.&lt;/p&gt;&lt;p&gt;His hand tremulously crawls across the sheet. W-A-T-E-R.&lt;/p&gt;&lt;p&gt;Our room falls silent, our reassurances of the imminence of extubation melting to the ground.&lt;/p&gt;&lt;p&gt;By my final week of my first month in the ICU as a trainee, I had come to understand how the agency of a critically ill patient is temporarily contained in favor of that same agency's long-term preservation. Holding beneficence in the highest esteem, we ask patients to ascribe to our lab draws, treatments, and procedures; more often than not, consent is provided by surrogate decision makers in lieu of the patients themselves. And so it can provoke a sense of discomfort when a patient rouses from the sedation spell and begins to soulfully inhabit the body that until then had been rolled, stuck, and proceduralized. I wanted them to agree with the care they had been receiving, to continue along with the gameplan that we had so meticulously outlined through hours upon hours of rounds, albeit absent their direct participation. I found that any reluctan","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"327-328"},"PeriodicalIF":2.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635252","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}