Journal of hospital medicine最新文献

{"title":"Using Labs Wisely: A collaboration between Choosing Wisely Canada and over 150 Canadian hospitals.","authors":"Thomas Bodley, Bilal Shakir, Gillian Hurwitz, Adina Weinerman, Lisha Lo, Saranya Arnoldo, Chloe Chow, Janet Simons, Wendy Levinson","doi":"10.1002/jhm.70477","DOIUrl":"https://doi.org/10.1002/jhm.70477","url":null,"abstract":"<p><strong>Background: </strong>Many in-hospital laboratory tests are unnecessary. Unnecessary testing is associated with patient harm, fiscal inefficiency, and environmental waste.</p><p><strong>Objectives: </strong>In 2021, Choosing Wisely Canada launched the Using Labs Wisely (ULW) hospital collaborative to (1) build national expertise on reducing unnecessary testing, (2) share testing data, and (3) spread quality improvement (QI) initiatives. This process evaluation describes the development, implementation, and program engagement.</p><p><strong>Methods: </strong>ULW hospitals participate in web-based education/networking, national benchmarking via comparative reports, and QI initiatives. Hospital engagement was measured by enrollment, data submission, and presentations of QI progress. Comparative reports include inpatient testing volumes normalized to bed-days between hospitals (peer) and within hospitals (self) over time. Overall engagement and interventions used in QI programs are summarized.</p><p><strong>Results: </strong>From January 2021 to February 2026, 157 hospitals from 6 provinces joined ULW, including 91 (58%) academic, 64 (41%) community, and 2 (1%) pediatric. 91 (58%) submitted testing data. Eight low-value test indicators include: coagulation profiles, aspartate aminotransferase (AST), urea, creatinine-kinase MB isoenzyme, serum or red blood cell folate, vitamin B12, erythrocyte sedimentation rate, and urine cultures. 67 (43%) hospitals presented during 39 collaborative project status updates. Urea, AST, and coagulation testing were the most intervened on. Most interventions (57/73, 78%) use multimodal strategies including education, audit and feedback, order set modification, and test ordering rules.</p><p><strong>Conclusions: </strong>ULW is a national QI collaborative to reduce low-value hospital laboratory testing. Keys to engagement include robust national representation, leveraging data, and facilitating spread of successful QI initiatives.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120855","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}

{"title":"Editorial on: \"Association between point-of-care ultrasonography use and requests for formal imaging studies in hospital-based internal medicine: A retrospective cohort study\".","authors":"Sheila Swartz, Devin Madenberg","doi":"10.1002/jhm.70501","DOIUrl":"https://doi.org/10.1002/jhm.70501","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120902","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}

{"title":"Intensive care unit utilization following the elimination of intermediate care.","authors":"Muhammad Bilal, Jason A Stamm, John K McIlwaine, Idorenyin F Udoeyo, Andrea L Berger, Howard L Corwin","doi":"10.1002/jhm.70502","DOIUrl":"https://doi.org/10.1002/jhm.70502","url":null,"abstract":"<p><strong>Background: </strong>Many hospitals have established intermediate care units (IMCU) to improve intensive care unit (ICU) utilization. There is little data on how eliminating an existing IMCU affects ICU utilization and the characteristics of ICU patients.</p><p><strong>Objective: </strong>Effect of IMCU elimination on ICU utilization and characteristics of patients admitted to the ICU.</p><p><strong>Methods: </strong>Retrospective observational before-after study. ICU utilization and characteristics of patients admitted to the ICU were evaluated.</p><p><strong>Results: </strong>Following IMCU elimination ICU utilization significantly increased. ICU admissions increased from 14.2% to 20.5% of hospital admissions, p < .001, monthly ICU admissions increased 42% while total ICU and hospital days increased 32% and 30%, respectively. Pre-elimination IMCU to ICU transfers comprised 6.7% of ICU admissions. Post elimination emergency department (ED) to ICU admissions increased (31.0% vs. 23.6%) as did ward to ICU admissions (41.3% vs. 37.6%). Low-risk monitoring ICU admissions increased 23% to 33%. There was no increase in ICU readmissions or time from ED to ICU or hospital admission. For ICU patients, propensity-adjusted odds ratio (OR) indicated lower ICU and hospital mortality following IMCU elimination, OR 0.82 (0.71, 0.96) and OR 0.83 (0.73, 0.95), respectively. Interrupted Time Series analysis demonstrated that IMCU elimination did not significantly affect secular trends in ICU or hospital mortality.</p><p><strong>Conclusion: </strong>Eliminating IMCU increased ICU utilization and affected the characteristics of ICU admissions. Despite increased utilization, the outcomes of patients admitted to the ICU did not worsen. Further study is warranted on the clinical outcomes of patients previously admitted to IMCU and hospital outcomes following IMCU elimination.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120872","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}

{"title":"Multidimensional neighborhood social drivers of health and pediatric hospital readmission risk.","authors":"Britanny Winckler, Cadence Pinkerton, Annie Qu, Louis Ehwerhemuepha","doi":"10.1002/jhm.70504","DOIUrl":"https://doi.org/10.1002/jhm.70504","url":null,"abstract":"<p><strong>Background: </strong>Social drivers of health (SDoH) are associated with pediatric hospital readmissions, but the contribution of neighborhood-level measures remains unclear.</p><p><strong>Objective: </strong>Evaluate associations between neighborhood-level SDoH, including the Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Agency for Healthcare Research and Quality (AHRQ) SDoH variables, and pediatric readmission.</p><p><strong>Patients and methods: </strong>This single-center retrospective study included 39,930 encounters of patients aged 1 month to 18 years from February 2019 through December 2023. Encounters were linked to census tract-level SDoH data. Principal component analysis (PCA) was used to reduce AHRQ SDoH variables to 10 components. Logistic regression evaluated associations with 7-day and 30-day unplanned readmissions.</p><p><strong>Results: </strong>The median age at encounter was 6.7 years (interquartile range, 2.0-12.1 years); 54.7% of patients were Hispanic, and 62.5% had public insurance. Unplanned readmissions occurred in 3.8% of encounters within 7 days and 8.6% within 30 days. Neither COI nor SVI was associated with either readmission outcome in unadjusted or adjusted analyses (all p > .05). PCA-derived neighborhood constructs identified associations not captured by conventional indices. Military-Associated Community Environment was independently associated with both 7-day and 30-day readmissions, and multiple neighborhood dimensions modified associations between clinical factors and readmission risk.</p><p><strong>Conclusions: </strong>Conventional neighborhood-level indices were not associated with pediatric readmission risk. However, PCA revealed multidimensional neighborhood characteristics associated with readmissions, primarily through interactions with specific clinical conditions. These findings suggest that neighborhood context influences pediatric readmission by modifying disease-specific clinical vulnerability rather than through uniform effects across all patients.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120829","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}

{"title":"Hospitalist perspectives and practices in treating hospitalized patients with alcohol withdrawal syndrome in the era of phenobarbital re-emergence.","authors":"James C Willey, Julia E Szymczak, Andrew D Auerbach, Jeffrey L Schnipper, Sunil Kripalani, Troy E Madsen, Evan Done, Michael A Incze, Valerie M Vaughn, James D Harrison","doi":"10.1002/jhm.70499","DOIUrl":"10.1002/jhm.70499","url":null,"abstract":"<p><p>Medication treatment for moderate to severe alcohol withdrawal syndrome (AWS) is evolving, particularly with renewed phenobarbital use. However, little research has examined how hospitalists manage AWS. We conducted a multiple-methods study involving hospitalists from a national US Hospital Medicine research network. Thirty-three hospitalists from 27 tertiary hospitals completed surveys and participated in seven focus groups on August 8, 2025. Benzodiazepines remained the most common treatment, but phenobarbital use was reported in 67% of emergency departments and 44% of inpatient medical units. Four themes emerged: hospitalists are adaptable in responding to changing practices and drug shortages; a lack of consensus on AWS treatment practices leads to a \"wild west approach\" to therapy selection; hospitalists prioritize care-delivery outcomes when selecting medications; and patients are minimally involved in shared decision-making. Participants strongly supported additional research to guide evidence-based AWS care. These findings highlight uncertainty and the need for standardized, patient-centered approaches to AWS management.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hospitalist-led short-stay rehabilitation unit reduced inpatient discharge delays.","authors":"Kavon Javaherian, Nathan Baskin, Charlie M Wray","doi":"10.1002/jhm.70509","DOIUrl":"https://doi.org/10.1002/jhm.70509","url":null,"abstract":"<p><p>Hospitalized patients requiring post-acute rehabilitation often remain in acute care while awaiting skilled nursing facility placement. In July 2023, the San Francisco VA Health Care System opened a hospitalist-led short-stay rehabilitation unit within its Community Living Center, called the Lotus. Mean referral-to-discharge time, excluding referral hold periods, decreased from 6.89 days in fiscal year (FY) 2023 to 4.58 days in FY2024 and 3.35 days in FY2025. The Lotus became the lowest-delay post-acute care destination and the facility's most frequently used individual rehabilitation destination. This model suggests hospitalist integration into post-acute care may improve hospital throughput without expanding post-acute bed capacity.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120905","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}

{"title":"Osteitis fibrosa cystica.","authors":"Adela M Greeley, Tyler B Larsen","doi":"10.1002/jhm.70474","DOIUrl":"10.1002/jhm.70474","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":"1206-1207"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908416","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}

{"title":"Community-level variation in diagnostic testing in infants hospitalized for poor weight gain.","authors":"Courtney Sump, Margaret Ridge, Chen Chen, Bin Huang, Henry T Puls, Andrew F Beck, Joanna Thomson","doi":"10.1002/jhm.70505","DOIUrl":"https://doi.org/10.1002/jhm.70505","url":null,"abstract":"<p><strong>Background: </strong>Infants with poor weight gain (PWG) are frequently hospitalized for evaluation and management. Diagnostic testing during hospitalization varies and may reflect practice variation and bias.</p><p><strong>Objective: </strong>To determine if diagnostic testing among infants hospitalized for PWG differed by community characteristics, as measured by the childhood opportunity index (COI).</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of children, ages 2 weeks-11 months, hospitalized with PWG at 43 children's hospitals in the Pediatric Health Information Systems database between 2017 and 2022. COI, measured at the zip-code level, was categorized into nationally normed quintiles. Logistic regression models estimated adjusted associations between COI and diagnostic testing, accounting for confounders defined a priori and clustering by hospital.</p><p><strong>Results: </strong>Compared to infants from very high COI communities, those from very low COI communities were more likely to receive screening tests like CBC (64.2% vs. 54.2%, adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.10, 1.35). In contrast, infants from very low COI communities were less likely to have diagnostic testing directed toward investigation of potentially specific medical etiologies, including upper gastrointestinal series (10.3% vs. 12.8%, aOR 0.67, 95% CI 0.56, 0.81). However, they were more likely to receive urine toxicology screening (1.5% vs. 0.6%, aOR 2.4, 95% CI 1.39, 4.14), suggestive of suspected neglect.</p><p><strong>Conclusions: </strong>This national study demonstrates community-level variation in the diagnostic evaluation of infants hospitalized for PWG. While differences in psychosocial factors and healthcare access may contribute, these findings underscore the need to address potential bias in the care of infants with PWG.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120834","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}

{"title":"Hospitalist-driven penicillin allergy delabeling at a quaternary care academic medical center.","authors":"Anita N Moudgal, Tara Ward, Neal Chandnani, Eric Grimm, Misha Huang, Sarah Scarpato, Sandra Spencer, Michael J Tchou, Anjeli Kalra","doi":"10.1002/jhm.70309","DOIUrl":"10.1002/jhm.70309","url":null,"abstract":"<p><p>A penicillin allergy label is not benign and significantly impacts patient care. Penicillin allergy delabeling can be conducted in an efficient, cost-effective, and safe manner by proceeding directly to oral challenge. Through a quality improvement initiative, we developed and implemented a protocol for hospitalist clinicians to delabel penicillin allergies among low-risk hospitalized patients. Risk stratification was determined by PEN-FAST, a validated screening tool. The primary outcome was the total number of patients that underwent delabeling within 1 year. We exceeded our goal of delabeling more than 5% of patients in 1 year with no major adverse events.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":"1200-1205"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517738","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}

{"title":"Reply to: \"Letter to the Editor regarding 'A randomized trial of I-SLEEP: A patient education and empowerment intervention on inpatient sleep duration and medical sleep disruptions'\".","authors":"Aashna Sunderrajan, John Cursio, Noah Mason, Maxx Byron, Maylyn Martinez, Nicola Orlov, Kristen L Knutson, Babak Mokhlesi, Valerie G Press, David O Meltzer, Vineet M Arora","doi":"10.1002/jhm.70406","DOIUrl":"10.1002/jhm.70406","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":"1198-1199"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611486","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}