Journal of hospital medicine最新文献

{"title":"Differences in antibiotic treatment for children hospitalized with pneumonia","authors":"Jillian M. Cotter MD, MSCS,&nbsp;Mathew Hall PhD,&nbsp;Adam L. Hersh MD, PhD,&nbsp;Daniel J. Shapiro MD, MPH,&nbsp;Susan C. Lipsett MD,&nbsp;Jeffrey S. Gerber MD, PhD,&nbsp;Jonathan D. Cogen MD, MPH,&nbsp;Thomas V. Brogan MD,&nbsp;Anne J. Blaschke MD, PhD,&nbsp;Lilliam Ambroggio PhD, MPH,&nbsp;Mark I. Neuman MD, MPH","doi":"10.1002/jhm.70251","DOIUrl":"10.1002/jhm.70251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prior work has identified disparities in antibiotic use for children in the ambulatory setting, but few studies have explored antibiotic disparities in the inpatient setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We evaluated the association of both race and ethnicity and Childhood Opportunity Index (COI) with antibiotic utilization for children hospitalized with pneumonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included children hospitalized with pneumonia at one of 43 hospitals in the Pediatric Health Information System (2022–2024). We evaluated the association between race and ethnicity and COI quintiles (very low quintile representing the lowest opportunity neighborhoods) and antibiotic utilization using generalized estimating equations adjusted for confounders. Antibiotic utilization included any antibiotics and among children with antibiotics, use of broad- versus narrow-spectrum and intravenous versus oral antibiotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 49,332 children, compared with non-Hispanic White children, we found higher odds of receiving antibiotics among Asian (86% vs. 80%; odds ratio [OR]: 1.45 (95% confidence interval [CI]: 1.14, 1.84]) and non-Hispanic Black children (83% vs. 80%; OR: 1.59 [1.17, 2.15]). Hispanic children had greater odds receiving broad- rather than narrow-spectrum antibiotics (52% vs. 46%; OR: 1.30 [1.03, 1.63]). Compared with non-Hispanic White children, all other groups had greater odds of intravenous rather than oral antibiotics. Compared with children in the very high COI quintile, children in the very low COI quintile had greater odds of receiving antibiotics (86% vs. 79%; OR: 1.69 [1.12, 2.55]) and broad-spectrum antibiotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Children of some minoritized backgrounds and those residing in the lowest opportunity neighborhoods had greater odds of receiving antibiotics, broad-spectrum antibiotics, and intravenous antibiotics for pneumonia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 7","pages":"749-757"},"PeriodicalIF":1.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069430","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":"Heterogeneity and misaligned incentives in discharge transition programs: Insights from a multisite rapid qualitative study","authors":"Himali Weerahandi MD, MPH,&nbsp;Mark V. Williams MD,&nbsp;Molly A. Rosenthal MD,&nbsp;Timothy S. Anderson MD, MAS,&nbsp;Eva Angeli MD,&nbsp;Marisha Burden MD, MBA,&nbsp;Sonia Dalal MD,&nbsp;Safa Farrag MD,&nbsp;Aaron Fisher DO,&nbsp;Angela Keniston PhD, MSPH,&nbsp;Sara Westergaard MD, MPH,&nbsp;Jeffrey Schnipper MD, MPH","doi":"10.1002/jhm.70258","DOIUrl":"10.1002/jhm.70258","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transitions of care (ToC) programs are important for patient safety, but their implementation and success remain highly variable across US hospitals, particularly for patients with multimorbidity and health-related social needs (HRSNs). Hospitalists, as key decision-makers at discharge, encounter firsthand the factors that hinder the success of ToC programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore hospitalists' perspectives on successes, shortcomings, and implementation barriers in ToC programs, particularly during transitions from hospital to community settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rapid qualitative study featuring virtual focus groups with participants from the Hospital Medicine Reengineering Network (HOMERuN). Data were analyzed using a mixed inductive-deductive framework to identify key themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two individuals from 19 different organizations participated in focus groups. None of the organizations offered comprehensive ToC programs to all patients. Four major themes emerged: (1) Diagnosis-specific ToC programs are effective but contribute to care fragmentation, particularly for patients with multimorbidity; (2) postdischarge follow-up is hindered by limited appointment availability, insurance barriers, and geographic challenges; (3) ToC programs often fail to address patient preferences, HRSNs, and health literacy, and lack adequate resources and leadership support; (4) successful programs require institutional commitment, dedicated funding, interprofessional collaboration, and community engagement. Participants emphasized the need to prioritize patient-centered care over financial return on investment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current ToC programs are fragmented, undermining safe and equitable transitions. Addressing HRSNs, fostering leadership support, and prioritizing patient-centered care over short-term financial metrics are essential for improving ToC outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 7","pages":"766-776"},"PeriodicalIF":1.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968153","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":"Leadership and professional development: PAUSE to sustain career flourishing","authors":"Desiree C. Burroughs-Ray MD, MPH,&nbsp;Ryan E. Nelson MD","doi":"10.1002/jhm.70313","DOIUrl":"10.1002/jhm.70313","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 7","pages":"786-787"},"PeriodicalIF":1.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647837","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":"Trust-building in pediatric hospital medicine discharge","authors":"Victor Do MD, FRCPC, MSc","doi":"10.1002/jhm.70356","DOIUrl":"10.1002/jhm.70356","url":null,"abstract":"<p>Hospital discharge is a trust-sensitive phase of care. This article reframes discharge as a longitudinal process in which families assess not only individual clinicians but also the reliability, coherence, and accountability of the healthcare system across hospitalization. Misalignment between verbal and written communication, unclear responsibility transfer, and unaddressed administrative workload can erode institutional trust, particularly for structurally marginalized families when signals of support are not sustained. Pediatric hospitalists can strengthen trust by aligning communication, responsibility, and support across care phases, anticipating postdischarge complexity, and signaling shared accountability. We propose a longitudinal, trust-oriented approach to discharge and outline strategies to operationalize this.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 7","pages":"807-811"},"PeriodicalIF":1.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966054","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":"Uncharted","authors":"Dr. Julie Eckelbarger MD","doi":"10.1002/jhm.70212","DOIUrl":"10.1002/jhm.70212","url":null,"abstract":"&lt;p&gt;I am attending on the inpatient service. I round on a patient who I admitted 3 weeks ago, who has suffered complications while in the hospital, and is still on the service when I take back over after my week off. I know her husband, her daughter, and her two granddaughters by name. Her condition improves throughout the week. On Monday, I walk in and tell her today's the day she gets to go home. The atmosphere is joyous, near festive. She and her husband cry. The family asks for a picture with me, which I happily take, and it immediately gets sent to their family group chat. They thank me for taking such good care of the patient. Their praise is effusive. I am blushing. I am pleasantly overwhelmed.&lt;/p&gt;&lt;p&gt;No one will ever know of this happy moment. There is no record. There is no way to document the profound connection we made in this patient's difficult journey to discharge.&lt;/p&gt;&lt;p&gt;I go to the next patient, a man who is dying. I have spent most of the week discussing goals of care with him, his wife, and his brothers, who I know by name. We agree on discharge home with hospice to spend his remaining days surrounded by loved ones. Arrangements are made, and he also gets to be discharged home that day. Although the mood is different from the patient prior, the family and I share a sense of relief at accepting the next steps. Within hours of his discharge, I received a patient complaint to my email inbox. The niece of this patient, who was not at the bedside and not invited by the patient to the goals of care discussions, feels that the discharge to hospice was inappropriate, and improper medical care was provided. The only acceptable solution is a curative one.&lt;/p&gt;&lt;p&gt;I respond to emails and phone calls about this patient for the next 3 weeks. I recite the events and explain the decisions made again and again. The patient advocate and I are on a first-name basis. The dissatisfaction with my actions is well-documented and will be archived permanently.&lt;/p&gt;&lt;p&gt;I isolate these emails in a folder in my inbox called “patient care.”&lt;/p&gt;&lt;p&gt;I take sign-out and prepare to go onto service again.&lt;/p&gt;&lt;p&gt;In medicine, moments that sustain us are often undocumented, while the moments that haunt us are preserved in perpetuity. We must carry the quiet victories in a ledger that no one sees while the loud misunderstandings are cc'd up the chain. There is no billing code for presence. No metric for trust. There is just the silent resolve to return to the bedside.&lt;/p&gt;&lt;p&gt;This emotional whiplash matters. Week after week, it compounds.&lt;/p&gt;&lt;p&gt;Apprehension grabbed hold of me in the lead-up to my next week on service. I felt a looming sense of anticipatory dread that the next complaint I would spend weeks defending was lurking behind each door. When the shameful email chain lasts longer than the patient encounter, it is no surprise that the short-lived positive interactions feel overshadowed. The sense that praise lives in fleeting memory while complaints live eternally in th","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 7","pages":"812-813"},"PeriodicalIF":1.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310454","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":"Gender differences in secure chat and electronic health records use among hospital-based physicians","authors":"Micaela Witte MD,&nbsp;Catherine McDermott MD, MEd,&nbsp;Kathryn L. Levy MD,&nbsp;Kimberly Nelsen MSN, RN,&nbsp;Sachita Shrestha MPH,&nbsp;Shuo Tian PhD,&nbsp;David Paje MD, MPH,&nbsp;Virginia Sheffield MD","doi":"10.1002/jhm.70236","DOIUrl":"10.1002/jhm.70236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Digital messaging within electronic health records (EHRs) is central to inpatient communication. While intended to enhance efficiency, these tools may contribute to unequal digital workloads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate gender-based differences in EHR and secure messaging use among hospital-based physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective observational study at a single academic tertiary care hospital using EHR metadata from July 2023 to June 2024. Participants included a total of 205 internal medicine and medicine–pediatrics physicians (108 senior residents, 97 faculty) serving as primary clinicians on hospitalist shifts. Measures included daily number of messages sent/received, time spent in EHR and secure chat, and hours worked, stratified by gender and role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physicians worked a median of 9.4 h/day, spending 40.7% of their time in the EHR and 6.3% in secure chat. Women and men work similar hours (9.5 vs. 9.3, <i>p</i> = .40) but women spent more time in the EHR (248 vs. 222 min/day; <i>p</i> &lt; .001) and secure chat (38 vs. 34 min, <i>p</i> &lt; .001) and exchanged more daily messages (62 vs. 53 sent; 56 vs. 48 received, both <i>p</i> &lt; .001). Patterns were consistent across residents and faculty. Among faculty, gender differences persisted after a new scheduling model, which reduced overall work hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women physicians engaged more in digital communication than men, despite similar hours worked, and these differences persisted after a workflow change. These findings underscore the need for equity-informed strategies that both mitigate excess burden and recognize the potential value of proactive communication in hospital settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 7","pages":"715-723"},"PeriodicalIF":1.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551982","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 consequence of saying “no”: Triage and moral injury in inter-hospital transfers","authors":"Benjamin Vipler MD, MEd, FACP,&nbsp;Courtney Enix MD,&nbsp;Khooshbu Dayton MD,&nbsp;Amy Yu MD","doi":"10.1002/jhm.70310","DOIUrl":"10.1002/jhm.70310","url":null,"abstract":"<p>Moral injury in healthcare is not limited to face-to-face care; the virtual healthcare space has significant potential for emotional distress stemming from challenging triage decisions. This perspective article is written from the vantage of hospitalists practicing virtual hospital medicine and administrative triage as part of a transfer center for a large academic health system. In this article, the authors highlight reasons behind how moral injury occurs in the virtual healthcare space including instances where capacity concerns require triage of resources leading to delays in patient care. Solutions proposed to minimize moral injury for transfer center clinicians include education around triage and virtual hospital medicine systems, establishing interhospital transfer standards of care, examining innovative strategies to address capacity constraints, and creating a system that diffuses the responsibility of transfer decisions so that one individual does not bare the sole weight of each morally consequential decision.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 6","pages":"677-680"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583403","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":"Clinical guideline highlights for the hospitalist: Recommendations for pneumonia in hospitalized children with neurologic impairment","authors":"Elizabeth L. Nichols MD,&nbsp;J. Andrew Watson MD","doi":"10.1002/jhm.70317","DOIUrl":"10.1002/jhm.70317","url":null,"abstract":"<p>Children with neurologic impairment (CNI) represent a large, diverse group of patients with underlying congenital and acquired neuromuscular and neurodevelopmental disabilities.<span>¹</span> CNI are at increased risk for developing pneumonia due to limited ability to handle oropharyngeal secretions and gastric contents.<span>^{1, 2}</span> These impairments increase susceptibility to both community-acquired and aspiration-related pathogens and augment risk of severe illness, with complications including hospitalization, respiratory failure, sepsis, and mortality.<span>^1-4</span> Given their heterogeneity, CNI are largely excluded from pediatric evidence-based guidelines for pneumonia.<span>⁵</span> This leads clinicians to make management decisions based on institutional practices and narrative evidence.<span>⁶</span> In this recently published paper, a panel of experts reviewed existing literature to develop recommendations for the hospitalist caring for CNI hospitalized with pneumonia.<span>⁷</span></p><p>Per current AAP clinical practice guidelines, recommendations were rated based on the strength of available evidence (Grade A, B, C, D, or X), denoted as letters in superscripts below.</p><p>The authors declare no conflict of interest.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 6","pages":"657-659"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635519","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":"Prior GLP-1 agonist use is not associated with adverse inpatient critical care outcomes: A propensity-matched analysis","authors":"Albert K. Park MD,&nbsp;Jason Hom MD,&nbsp;Javier Lorenzo MD,&nbsp;Vidya Rao MD,&nbsp;Gavin Hui MD, PhD,&nbsp;Matthew Vickers FRACGP, MBBS,&nbsp;Neera Ahuja MD, FACP, SFHM","doi":"10.1002/jhm.70228","DOIUrl":"10.1002/jhm.70228","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Glucagon-like peptide-1 (GLP-1) agonists are increasingly prescribed for obesity and type 2 diabetes. GLP-1 agonists influence body composition through effects on both fat mass and fat-free mass. Given that critically ill patients experience severe protein catabolism and commonly develop intensive care unit (ICU)-acquired weakness, questions arise about outcomes when metabolic demands are high during critical illness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to examine the relationship between prior GLP-1 agonist use and critical care outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using Stanford Health Care data from January 2015 to July 2024. Adults aged 18–89 years admitted to intensive care with body mass index (BMI) 20–60 kg/m² were included. Of 15,191 eligible ICU patients, 468 (3.1%) received GLP-1 agonist prescriptions within 12 months before hospitalization. Using high-dimensional propensity score matching with lasso regression, we created 452 matched pairs and compared in-hospital mortality, hospital length of stay, and ICU length of stay between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were well-balanced. The matched GLP-1 agonist and comparison groups showed similar in-hospital mortality (5.1% vs. 4.9%, odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.58 to 1.91, <i>p</i> = .88), mean hospital length of stay (13.7 ± 21.3 vs. 13.4 ± 18.1 days, mean difference [MD]: 0.38, 95% CI: −2.21 to 3.05, <i>p</i> = .77), and ICU length of stay (5.9 ± 9.0 vs. 5.4 ± 6.6 days, MD: 0.51, 95% CI: –0.52 to 1.50, <i>p</i> = .33).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this first study examining the relationship between prior GLP-1 agonist use and critical care outcomes, we found no significant associations with in-hospital mortality, hospital length of stay, or ICU length of stay.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 6","pages":"605-611"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598480","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":"Improving sleep on the inpatient general, non-stroke neurology service: A quasi-experimental interventional trial","authors":"Noor F. Shaik MD, PhD,&nbsp;Lydia Denison MD,&nbsp;G. M. Anya Venezia MD,&nbsp;Lovisa Ljungberg MD,&nbsp;Alexa Lebrón-Cruz BA,&nbsp;David Resnick MSEd, MPH,&nbsp;Colleen Peachey MSN, RN,&nbsp;Carolyn Ziemba RN,&nbsp;Michael Buckley MHA, MSW,&nbsp;Michael Karamardian MD, MBA,&nbsp;Patrick Z. Liu DPhil,&nbsp;Alan Napole BA,&nbsp;Jennifer Hong BA,&nbsp;Ruoheng Zeng BA,&nbsp;Connie Yu BA,&nbsp;Andrew Chan,&nbsp;Charles Bae MD, MHC,&nbsp;Laura Stein MD, MSEd,&nbsp;Colin A. Ellis MD,&nbsp;Denise J. Xu MD","doi":"10.1002/jhm.70223","DOIUrl":"10.1002/jhm.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospitalized patients often experience poor sleep, which is associated with worse health outcomes, increased rates of delirium, and readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To improve overnight sleep for clinically stable general neurology patients at a single academic center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a quasi-experimental pre-post clinical trial of two sleep-protective interventions: (1) a sleep-friendly order set that reduced overnight interruptions by discontinuing vital sign checks/neurological examinations and retiming medications/blood draws; and (2) a “sleep menu” of comfort items. The primary outcome measure was sleep duration. Secondary outcomes were awakenings and patient responses to the Richards-Campbell Sleep Questionnaire. Safety outcomes were rates of delirium, ICU transfers, and 30-day readmissions. We compared the groups using linear mixed-effects models to account for repeated measures (multiple nights per participant).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed data from 66 pre-intervention participants (238 nights) and 61 post-intervention participants (244 nights). The interventions did not increase sleep duration (pre-intervention median 5.5 h [interquartile range (IQR) 4.0,6.6], post-intervention median 5.4 h [4.1, 6.7], <i>p</i> = .84). There was marginal improvement in nightly awakenings (pre-intervention 2 [1, 4], post-intervention 2 [1, 3], <i>p</i> = .04). There were no significant differences in subjective sleep measures or safety outcomes. Targeted care team interruptions all significantly decreased post-intervention, though staff intrusions remained a common patient-reported barrier to sleep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fragmented and reduced sleep was common in our general neurology population. Although our interventions did not improve sleep outcomes—apart from a modest drop in nocturnal awakenings—there was a significant decrease in care team interruptions. Poor inpatient sleep is multifactorial, and meaningful change likely requires comprehensive interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 6","pages":"612-619"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151582","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}