Journal of hospital medicine最新文献

{"title":"Evaluating the impact of patient-staff interactions on sleep opportunities using the electronic health record.","authors":"Sullafa Kadura, Lisa Pink, Diego R Mazzotti, Kathleen Fear","doi":"10.1002/jhm.13568","DOIUrl":"10.1002/jhm.13568","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized patients often experience disrupted sleep due to nighttime patient-staff interactions (PSIs). This study evaluates how PSIs impact sleep opportunities in neurology inpatients using electronic health record (EHR) data and introduces surrogate measures of sleep such as longest uninterrupted sleep opportunity (LUSO) and interruptive episodes.</p><p><strong>Objective: </strong>To develop a methodology leveraging time-stamped EHR data to quantify and visualize the impact of PSIs on inpatient sleep opportunities.</p><p><strong>Methods: </strong>We analyzed 3305 patient nights in an inpatient neurology unit, categorizing PSIs into six types: vital signs, neurological checks, medication administration, bedside diagnostic testing, off-unit diagnostic testing, and bed changes. We calculated LUSO and interruptive episodes and used a linear mixed model to assess the relationship between PSIs and LUSO.</p><p><strong>Results: </strong>PSIs occurred in 92% of patient nights, averaging 2.81 interruptive episodes and 4.06 h of LUSO per night. Vital signs and medication administrations were the most frequent PSIs. Neurological checks and off-unit diagnostic testing were associated with the largest reductions in LUSO (approximately 40 min), followed by bed changes (-33.79 min).</p><p><strong>Conclusion: </strong>This study demonstrates the utility of LUSO and interruptive episodes as EHR-based measures to link PSIs to sleep opportunities. While vital signs and medications were the most frequent PSIs, neurological checks and off-unit testing were associated with the largest impact on reducing LUSO. The predominance of single-PSI interruptive episodes underscores that the bundling of PSIs is not occurring. These findings highlight that PSIs impact sleep opportunities in distinct ways, supporting the use of this methodology to evaluate and address EHR-linked disruptions to patient sleep.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782205","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":"Identifying opportunities to reduce imaging overuse in hospitalized children.","authors":"Sanyukta Desai, Jennifer Treasure, Troy Richardson, Matt Hall, Samir S Shah, Joanna E Thomson","doi":"10.1002/jhm.13562","DOIUrl":"https://doi.org/10.1002/jhm.13562","url":null,"abstract":"<p><strong>Background: </strong>Radiologic imaging is routinely performed to aid in diagnosis for hospitalized children. Identifying and reducing variability in imaging practices can improve care while reducing harms and costs.</p><p><strong>Objectives: </strong>To identify common inpatient pediatric conditions with high prevalence of imaging and variation in imaging practices and imaging-related costs across hospitals.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of children 0-18 years old admitted to 50 children's hospitals in the Pediatric Health Information Systems database between 2017 and 2019. We excluded patients with complex chronic conditions, pregnancy, newborn, or neonatal intensive care charges, and those who died or who were discharged to hospice or rehabilitation facilities. Conditions with at least 2500 discharges and in which ≥30% of patients received imaging were included. Outcomes included imaging frequency, standardized imaging-related costs (including all modalities across all encounters), and hospital-level variation in imaging costs using the intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>Of the 56 included conditions, imaging was most frequently conducted in patients with pectus excavatum (97.8%), scoliosis (96.2%), and intestinal obstruction (96%). Fracture ($21.4 million), trauma ($15.7 million), and appendicitis ($8.6 million) had the highest total imaging-related costs. Conditions with the highest geometric mean standardized imaging costs were nervous system disorders ($507), osteomyelitis ($494), vesicoureteral reflux/hydronephrosis ($468). Scoliosis (ICC = 0.49) and preseptal cellulitis (ICC = 0.48) had the highest variation in imaging-related costs.</p><p><strong>Conclusion: </strong>To reduce imaging overuse in hospitalized children, conditions with frequent imaging, high imaging-related costs, and high hospital-level variation in imaging practices should serve as priorities for future evidence generation, guideline development, and/or improvement initiatives.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775932","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":"Employing EHR usage data to improve care requires clinician engagement and trust.","authors":"Adam Rule, Robert El-Kareh","doi":"10.1002/jhm.13565","DOIUrl":"https://doi.org/10.1002/jhm.13565","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752692","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":"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":"<p><strong>Background: </strong>Treatment of alcohol withdrawal syndrome (AWS) in hospitals is inconsistent. Electronic health record (EHR) order sets protocolize care.</p><p><strong>Objective: </strong>We examined variation in AWS order sets across hospital organizations and their concordance with AWS guidelines.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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><p><strong>Conclusions: </strong>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>","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}

{"title":"From rounds to retweets: A digital media fellowship perspective.","authors":"Catherine Glatz, Maha Suileman, Joseph S Thomas, Patricia Tran, Samir S Shah, Charlie M Wray","doi":"10.1002/jhm.13557","DOIUrl":"https://doi.org/10.1002/jhm.13557","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","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, Paul R Shafer","doi":"10.1002/jhm.13558","DOIUrl":"10.1002/jhm.13558","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive load in hospital medicine: Implications for teachers, learners, and programs.","authors":"Erica M Levine, Andrew P J Olson, Temple Ratcliffe, Elexis McBee","doi":"10.1002/jhm.13552","DOIUrl":"https://doi.org/10.1002/jhm.13552","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635237","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":"Compliance with price transparency rules in United States (US) pediatric hospitals.","authors":"Emily Reimer, Matthew C Scanlon, Amalia Jereczek, Andrea R Maxwell","doi":"10.1002/jhm.13546","DOIUrl":"https://doi.org/10.1002/jhm.13546","url":null,"abstract":"<p><p>This study describes United States (US) pediatric hospitals' compliance with the Centers for Medicare and Medicaid price transparency rule. The price transparency rule was intended to make healthcare costs more transparent for patients and families to aid in informed decisions and help avoid unexpected charges. The price transparency rule consists of two parts: (1) a standard charge file, and (2) \"shoppable services.\" Using hospital websites accessed through the Children's Hospital Association during January and February 2023, we found that only 48.7% of US pediatric hospitals were fully compliant with all required components despite implementation of this rule nearly 3 years ago.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515394","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":"Things We Do for No Reason™: Routine use of \"denies\" and other stigmatizing language in medical documentation.","authors":"Julia B Caton, Anita Vanka, Rebecca Dougherty","doi":"10.1002/jhm.13527","DOIUrl":"https://doi.org/10.1002/jhm.13527","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484220","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":"The art of sponsorship: Priming talent for success in academic medicine.","authors":"Samir S Shah, Nancy D Spector","doi":"10.1002/jhm.13517","DOIUrl":"https://doi.org/10.1002/jhm.13517","url":null,"abstract":"","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335286","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}