Background: The number of individuals with dementia in the U.S., currently estimated at 5.3 million, is projected to triple by 2050. For patients with cognitive impairment, the unfamiliar and stressful hospital environment often requires constant observation (CO) to ensure patient safety. The use of constant observation (CO) in the hospital setting, while originating in patients [...]

Background: Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. Furthermore, the number of geriatric healthcare providers dedicated to the care of hospitalized vulnerable older adults is currently insufficient. Purpose: Our objective was to create an [...]

Background: Transient elevations of blood pressure are common in hospitalized older adults and may lead inpatient clinicians to intensify inpatient antihypertensive therapy and discharge patients on these intensified regimens. Intensification of outpatient regimens during hospitalization can easily become over-treatment once patients return home, increasing patients’ risk of adverse drug events including syncope and falls. Thus, [...]

Background: The Saturday Neighborhood Health Clinic (SNHC) is a volunteer physician and medical student-staffed clinic that provides episodic care for uninsured St. Louis residents and connects them with long term primary care providers. An estimated 20% of mentally ill adults remain uninsured. Furthermore, compared to the insured, depressed uninsured patients are only half as likely [...]

Background: Hospital Medicine continues to grow as a specialty and hospital medicine programs are rapidly expanding to meet this demand. One of the challenges of a rapidly growing program is how to onboard our new hires in a way that ensures their satisfaction and at the same time preserves engagement in a rapidly growing group. Purpose: The aim [...]

Background: Among Society of Hospital Medicine (SHM) members, 40% are women, and most of them are assistant professors, which suggests that a significant proportion of hospitalists are women of childbearing age. The United States lags behind most other countries regarding support for working mothers and parental leave, but there is limited data to describe the [...]

Background: While understanding the cognitive contributions to diagnosis has become important, few studies have aimed to understand physician diagnostic reasoning in real-time. Using a case-based approach, we sought to: (a) characterize differences in diagnostic reasoning among hospitalists; and (b) identify factors associated with diagnostic accuracy. Methods: A total of 10 hospital medicine attending physicians from [...]

Background: Patient & Family Advisory Councils (PFACs) are groups of patients, family members and caregivers who meet regularly to share their experiences of healthcare or perspectives on a specific topic. Over 50% of acute care hospitals have PFACs. PFACs can also provide an opportunity to engage its members in research and quality improvement (QI) efforts, [...]

Background: Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to [...]

Background: Sepsis, which is life-threatening organ dysfunction occurring in response to systemic infection, is a frequently fatal syndrome for which early recognition and treatment are paramount. While there are some reports that female and black patients with sepsis experience greater delays in time to antibiotics, there is an overall paucity of published data on whether [...]