Journal of hospital medicine最新文献

{"title":"Hospitalized patient portal access in the post-information blocking rule era.","authors":"Joséphine A Cool, Cancan Zhang, Julius Yang, Shoshana J Herzig, Catherine Des Roches","doi":"10.1002/jhm.70093","DOIUrl":"https://doi.org/10.1002/jhm.70093","url":null,"abstract":"<p><strong>Background: </strong>The 21st Century Cures Act Information Blocking Rule mandates patient access to all information in their electronic medical record (EMR) without delay, cost, or special effort. Prior research into patient portal use in hospitalized adults is limited.</p><p><strong>Objective: </strong>To better understand the characteristics of hospitalized adults who have an existing patient portal account and identify demographic factors associated with accessing information via the patient portal while hospitalized.</p><p><strong>Methods: </strong>This single-center, cross-sectional observational study analyzed adult hospitalizations from April 5, 2021, to March 31, 2023, at Beth Israel Deaconess Medical Center (BIDMC). The primary outcome was the proportion of hospitalized patients who had an active BIDMC EMR account (\"PatientSite\").</p><p><strong>Results: </strong>Of the 43,588 patients included in our analytic cohort, 13,517 (31.0%) had an active PatientSite account during their hospitalization and of those, 7311 (54.0%) accessed their account while hospitalized. A total of 62% of patients who logged into their portal also accessed clinician notes. After multivariable adjustment, patients who were older, Black, male, non-English speaking, covered by Medicaid, or from out-of-state were less likely to have an active PatientSite account. Similar disparities were found in PatientSite login and accessing clinician notes, albeit smaller in magnitude than the observed disparities in having an active account.</p><p><strong>Conclusions: </strong>This study highlights low patient portal utilization among hospitalized patients and disparities in access based on race/ethnicity, gender, age, and insurance status.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236294","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":"Prescribed in-hospital sodium intake for decompensated heart failure: A systematic review and meta-analysis.","authors":"Htun Ja Mai, Ghid Kanaan, Sebhat Erqou, Vincent Salvador, Jacob Joseph, Wen-Chih Wu, James Rudolph, Eduardo L Caputo, Taylor Rickard, Katherine Rieke, Ethan M Balk, Eric Jutkowitz","doi":"10.1002/jhm.70091","DOIUrl":"https://doi.org/10.1002/jhm.70091","url":null,"abstract":"<p><strong>Background: </strong>Standard inpatient management of acute decompensated heart failure (ADHF) has included restricted dietary sodium. Sodium supplementation with diuretics has been proposed as an alternative to treat ADHF in an inpatient setting.</p><p><strong>Objectives: </strong>We conducted a systematic review to evaluate prescribed oral and/or intravenous sodium supplementation (with diuretics), to patients hospitalized for ADHF.</p><p><strong>Methods: </strong>We searched Medline, Embase, ClinicalTrials.gov, CINAHL, and Cochrane Database of Systematic Reviews from inception to September 24, 2024, for randomized controlled trials (RCTs), and nonrandomized comparative studies (NRCSs) reporting intermediate, clinical, or health service use outcomes for ADHF inpatients. We assessed risk of bias, and where there were at least three studies reporting results from similar analyses, we conducted meta-analyses. GRADE methodology was used to assess the strength of evidence.</p><p><strong>Results: </strong>Fourteen RCTs and two NRCSs compared supplemental sodium with furosemide to furosemide alone. Supplemental sodium with furosemide significantly decreased serum creatinine (pooled net mean difference [NMD]: -0.33 mg/dL, 95% confidence interval [CI]: [-0.50 to -0.17]), brain natriuretic peptide (pooled NMD: -62.84 pg/mL, 95% CI: [-103.61 to -22.08]), and weight (pooled NMD: -2.48 kg, 95% CI: [-4.31 to -0.66]). There were no significant differences in N-terminal pro b-type natriuretic peptide (pooled NMD: -1614 pg/mL, 95% CI: [-3582 to 353]). There was a significant decrease in length of hospital stay (pooled MD: -2.68 days, 95% CI: [-3.81 to -1.55]). Studies provided insufficient evidence on mortality and readmission outcomes, and no evidence for caloric intake or clinical congestion score.</p><p><strong>Conclusions: </strong>Sodium supplementation with diuretics may improve kidney function, promote weight loss, and shorten length of hospital stay.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201251","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":"Pediatric nurse perspectives on patient- and family-centered rounds: A qualitative study.","authors":"Jennifer Baird, Genevieve Beaird, Elizabeth K Tanner, Eileen Romano, Leah Spacciante, Sonia Garcia, Jazmin Rodriguez, Andrea Loureiro, Dorna Hairston, Kristen Emodi, Carrie Finley, April E Fegley, Jayne Rogers, Sharon Cray, Lauren Destino, Brian Good, Shilpa Patel, Nancy D Spector, Christopher P Landrigan, Alisa Khan, Erin Abu-Rish Blakeney","doi":"10.1002/jhm.70071","DOIUrl":"https://doi.org/10.1002/jhm.70071","url":null,"abstract":"<p><strong>Background: </strong>Patient- and family-centered rounding (PFCR) models are used widely in pediatric hospitals and have been associated with better communication and fewer errors. Although model fidelity and sustainability are well-documented challenges reported by physicians and families, nurse perspectives are less known.</p><p><strong>Objective: </strong>Our objective was to identify benefits for nurses and describe barriers and facilitators to nurse involvement in a PFCR model.</p><p><strong>Methods: </strong>We used a qualitative descriptive approach to conduct and analyze focus group data. Focus group participants were nurses from sites participating in the Patient- and Family-centered (PFC) I-PASS Safer Communication on Rounds Every Time (SCORE) study, a hybrid effectiveness implementation study of a PFCR model at 21 US pediatric hospitals.</p><p><strong>Results: </strong>Twenty-nine nurses from 14 study sites participated in four focus groups. We identified multiple benefits, barriers, and facilitators of nurse participation in PFC I-PASS rounds. Benefits included better communication, time savings and efficiency, conveying that nursing is a contributing part of the team. Barriers included competing demands of nurses' workload, lack of fidelity during rounds, and uncertainty about whether nurses are welcome by other care team members. Facilitators key to supporting nurse participation and engagement in rounds included clear nursing role in rounds, predictable rounding schedule and format, attending physicians fostering a welcoming environment, and strategies for when a nurse is not available.</p><p><strong>Conclusions: </strong>Nurses report many benefits of PFC I-PASS rounds. Increasing and sustaining nurse participation in PFC I-PASS requires specific, nurse-informed implementation strategies targeting both structural and interprofessional aspects of rounds.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201250","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":"Is secure messaging an effective tool for inpatient communication?","authors":"Michelle Knees, Sarah J Flynn, Esther Y Hsiang, Alan A Kubey","doi":"10.1002/jhm.70090","DOIUrl":"https://doi.org/10.1002/jhm.70090","url":null,"abstract":"<p><p>Secure messaging platforms were designed to optimize healthcare communication by providing asynchronous, bidirectional, Health Insurance Portability and Accountability Act-compliant text messaging options. Proponents argue that these platforms streamline workflows, foster coordination across multidisciplinary teams, and improve patient safety. However, critics highlight their potential to disrupt workflows through overwhelming message volumes and task interruptions, increased risk for miscommunication, and possible detrimental impacts on patient care. While secure messaging shows promise for modernizing hospital communication, it requires institutional guidelines and thoughtful use to mitigate inefficiencies and risks.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176172","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":"Hospitalization costs associated with as-needed blood pressure medication use in the Veterans Healthcare System.","authors":"Seonkyeong Yang, Anders Westanmo, Mark Bounthavong, Ronald Shorr, Haesuk Park, Weihsuan Lo-Ciganic, Muna Canales","doi":"10.1002/jhm.70089","DOIUrl":"https://doi.org/10.1002/jhm.70089","url":null,"abstract":"<p><p>As-needed blood pressure (BP) medication used to treat asymptomatic BP elevations in the hospital may be harmful. However, its association with hospitalization costs remains unknown. We conducted a retrospective cohort study with target trial emulation and propensity-score matching to compare the total and subtype hospitalization costs for those who received as-needed BP medication (YES) versus not (NO) during a Veterans Affairs hospital stay between October 1, 2015 and September 30, 2020. After matching (n = 25,455 per group), the as-needed YES group had a longer length of stay compared to the NO group. Hospitalizations in the YES group were associated with higher total and subtype hospitalization costs compared to the NO group. Similarly, individuals in the YES group had higher daily total hospital costs compared to the NO group, driven primarily by increased nursing and surgery costs. Our findings suggest that the expenditure implications of as-needed BP medication use merit further investigation.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175686","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":"Next steps: Implications of proposed changes in federal Medicaid financing on hospital services for children.","authors":"Rachel Garfield","doi":"10.1002/jhm.70087","DOIUrl":"https://doi.org/10.1002/jhm.70087","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181001","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":"Overloaded: How task switching, information synthesis, and poor relational trust make interhospital transfers challenging.","authors":"Amy Yu, Lauren McBeth, Claire Westcott, Stephanie Mueller, Mustafa Ozkaynak, Brooke Dorsey Holliman, Anna Maw, Jacinda Nicklas, Christine D Jones","doi":"10.1002/jhm.70084","DOIUrl":"https://doi.org/10.1002/jhm.70084","url":null,"abstract":"<p><strong>Background: </strong>Complex and inefficient information and task organization contribute to high cognitive load for clinicians in interhospital transfer (IHT) care. High cognitive load can lead to medical errors and clinician stress.</p><p><strong>Objective: </strong>Our study aims to highlight areas of high cognitive load experienced by hospital medicine physicians and advanced practice providers who care for IHT patients.</p><p><strong>Methods: </strong>Descriptive qualitative study using 1-h semi-structured interviews with hospital medicine clinicians at an academic medical center. We conducted thematic analysis using a combined inductive and deductive coding approach until saturation was achieved.</p><p><strong>Results: </strong>We interviewed 30 hospital medicine clinicians including 17 physicians (57%) and 13 advanced practice providers (43%) with 1-18 years of experience (mean 5.7 years). Participants identified multiple contributors to cognitive load for clinicians involved in IHTs. Some of these contributors, such as case complexity and time constraints, were fixed, while others, such as task switching, information synthesis burdens, and poor relational trust were seen as potentially modifiable. Participants suggested that (1) creating a single IHT workflow to minimize distractions, (2) streamlining information presentation to optimize information synthesis, and (3) facilitating trust building between healthcare team members as potential solutions to reducing cognitive load.</p><p><strong>Conclusions: </strong>Physicians and advanced practice providers at an academic medical center experienced increased cognitive load in IHTs when faced with frequent task switching, inefficient delivery of clinical information, and variable levels of trust between healthcare team members. Addressing cognitive load experienced by clinicians in IHTs may lead to safer IHT care and lower risk of clinician burnout.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176110","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":"Clinical progress note: Phenobarbital in the treatment of alcohol withdrawal syndrome.","authors":"Thad E Abrams, Matthew V Ronan","doi":"10.1002/jhm.70088","DOIUrl":"https://doi.org/10.1002/jhm.70088","url":null,"abstract":"<p><p>Alcohol withdrawal syndrome (AWS) is a common condition experienced by hospitalized patients. Practice patterns have evolved over time to include the use of phenobarbital, a barbiturate, as an adjunct to benzodiazepines or as an alternative monotherapy. The American Society of Addiction Medicine (ASAM) has recommended the use of phenobarbital in the management of AWS in certain clinical contexts. The current evidence base for the use of phenobarbital in AWS remains limited, though sufficient to demonstrate safety and efficacy as an alternative to benzodiazepines.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180493","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":"Clinical guideline highlight: Pediatric refractory constipation.","authors":"Katherine Krause, Elizabeth Mertens","doi":"10.1002/jhm.70072","DOIUrl":"https://doi.org/10.1002/jhm.70072","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183361","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":"Re-envisioning interhospital transfer: A qualitative study exploring alternatives to transfer.","authors":"Stephanie K Mueller, James D Harrison, Amy Yu, Caitlin Kelly, Luci K Leykum","doi":"10.1002/jhm.70083","DOIUrl":"https://doi.org/10.1002/jhm.70083","url":null,"abstract":"<p><strong>Background: </strong>Interhospital transfer (IHT, the transfer of patients between acute care hospitals) is often undertaken to provide patients with specialized care. However, mounting hospital capacity pressures suggest a need for re-envisioning IHT with consideration of alternatives to transfer in select patients.</p><p><strong>Methods: </strong>We conducted a qualitative focus group study with key informants involved in IHT, including patient/family representatives, accepting and transferring clinicians, and hospital leadership. We used case examples of distinct IHT scenarios and a semi-structured focus group guide to explore aspects of the IHT process and potential alternative modalities of care. Data were analyzed using thematic analysis, with data coded into sub-themes and higher order themes until thematic saturation was achieved.</p><p><strong>Results: </strong>We conducted a total of 7 focus groups, involving 6 patient/family representatives, 12 accepting clinicians, 9 transferring clinicians, and 12 hospital leadership from 13 geographically diverse hospitals. Within the higher order theme of \"clinically appropriate alternatives to transfer,\" we identified several sub-themes, including transferring hospital support, ambulatory alternatives, and patient and organizational risks and benefits. Within the higher order theme of \"feasibility and barriers to identified alternatives\" we identified three sub-themes, including clinician unease about expansion of clinical scope, lack of healthcare infrastructure to support tele-health care, and limited outpatient capacity.</p><p><strong>Discussion: </strong>In this qualitative study of key informants involved in IHT, we identified several viable alternatives to IHT and revealed potential barriers that could impede their widespread implementation. These insights provide optimal targets for advancing efforts to develop and operationalize new care models, re-envisioning IHT management.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183412","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}