Journal of hospital medicine最新文献

Assessing the impact of workload and clinician experience on patient throughput: A multicenter study.

Journal of hospital medicine Pub Date : 2024-11-26 DOI: 10.1002/jhm.13555

Marisha Burden, Venkat P Gundareddy, Regina Kauffman, Joseph Walker Keach, Lauren McBeth, Katie E Raffel, John D Rice, Catherine Washburn, Flora Kisuule, Angela Keniston

{"title":"Assessing the impact of workload and clinician experience on patient throughput: A multicenter study.","authors":"Marisha Burden, Venkat P Gundareddy, Regina Kauffman, Joseph Walker Keach, Lauren McBeth, Katie E Raffel, John D Rice, Catherine Washburn, Flora Kisuule, Angela Keniston","doi":"10.1002/jhm.13555","DOIUrl":"https://doi.org/10.1002/jhm.13555","url":null,"abstract":"Background: 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.Objective: 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.Methods: Retrospective observational study at three large academic hospitals with hospital medicine physicians and patients they care for during the study.Measures: Workload as measured by electronic note count and physician years of experience; patient LOS.Results: From February 9, 2021 to July 31, 2021, 59 physicians completed daily surveys for 93% of 2318 scheduled shifts. We observed a moderate correlation (r: .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%; p = .02) and 3.9% (95% CI: 2.0%, 5.9%; p < .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%, p = .03).Conclusion: 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.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Methodological progress note: Purposeful sampling in qualitative research. 方法论进展说明：定性研究中的有目的抽样。

Journal of hospital medicine Pub Date : 2024-11-24 DOI: 10.1002/jhm.13559

Daniel Herchline

引用次数: 0

Streamlining diuresis: A quality improvement approach to implementing a sodium-based predictive diuresis protocol. 简化利尿：实施基于钠的预测性利尿方案的质量改进方法。

Journal of hospital medicine Pub Date : 2024-11-24 DOI: 10.1002/jhm.13560

Karan Rai, Hillary Landau Western, Moksha Patel, Samuel Porter

引用次数: 0

Guideline concordance of electronic health record order sets for hospital-based treatment of alcohol withdrawal syndrome. 医院治疗酒精戒断综合征的电子病历订单集指南一致性。

Journal of hospital medicine Pub Date : 2024-11-24 DOI: 10.1002/jhm.13556

Shawn M Cohen, Nitu Kashyap, Tessa L Steel, E Jennifer Edelman, David A Fiellin, Paul J Joudrey

{"title":"Guideline concordance of electronic health record order sets for hospital-based treatment of alcohol withdrawal syndrome.","authors":"Shawn M Cohen, Nitu Kashyap, Tessa L Steel, E Jennifer Edelman, David A Fiellin, Paul J Joudrey","doi":"10.1002/jhm.13556","DOIUrl":"https://doi.org/10.1002/jhm.13556","url":null,"abstract":"Background: Treatment of alcohol withdrawal syndrome (AWS) in hospitals is inconsistent. Electronic health record (EHR) order sets protocolize care.Objective: We examined variation in AWS order sets across hospital organizations and their concordance with AWS guidelines.Methods: 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 <math> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> <annotation>$ge $</annotation></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).Results: 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.Conclusions: 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.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From rounds to retweets: A digital media fellowship perspective. 从回合到转发：数字媒体研究员的视角。

Journal of hospital medicine Pub Date : 2024-11-20 DOI: 10.1002/jhm.13557

Catherine Glatz, Maha Suileman, Joseph S Thomas, Patricia Tran, Samir S Shah, Charlie M Wray

引用次数: 0

Tempering expectations for hospital price transparency rules as a solution to health care cost growth. 降低对医院价格透明规则作为医疗成本增长解决方案的期望值。

Journal of hospital medicine Pub Date : 2024-11-17 DOI: 10.1002/jhm.13558

Michal Horný, Paul R Shafer

引用次数: 0

Overcoming barriers to care for Alcohol Use Disorder: Pathways for change. 克服酒精使用障碍的护理障碍：变革之路。

Journal of hospital medicine Pub Date : 2024-11-14 DOI: 10.1002/jhm.13554

Anthony H Ecker, Michael A Cucciare, Jan A Lindsay