Background: The low published survival rate of pediatric in-hospital cardiopulmonary arrest (25-38%) 1 has led to the development of early warning systems (EWS) to identify patients at risk for deterioration. On our general pediatric unit, we implemented the published validated Children’s Hospital Early Warning System (CHEWS)2 in 04/2021. This composite scoring tool includes caregiver assessment [...]

Background: Guideline-direct medical therapy (GDMT) improves morbidity and mortality outcomes in heart failure (HF), yet disparities in prescribing patterns persist across insurance types. Previous work at our hospitals demonstrated overall increases in GDMT prescribing following two phases of targeted interventions: financial incentives and education interventions (“Post 1”) and the addition of clinical decision support systems [...]

Background: Facilitating safe transitions of care is a common concern for the discharging hospitalist. Telephone calls are the most common method of contact for post-discharge outreach. These are labor-intensive and therefore limited in scope. To better support patients after hospital discharge, we designed and implemented a 30-day automated texting program. In a pilot study, this [...]

Background: In the US, 30-day hospital readmissions remain a significant challenge, impacting patient outcomes and healthcare costs. While conventional binary classification models predict whether readmission occurs within 30 days, survival models can capture time-to-readmission dynamics and provide time-dependent risk estimates. We compared these approaches to characterize readmission patterns and guide tailored interventions. Methods: This was [...]

Background: Since 2010, 130 rural hospitals have closed, leaving only 2,250 rural hospitals remaining in the United States. Of the remaining facilities, outmigration and/or the bypassing of the local hospitals to a larger facility remains problematic and impacts a community’s access to healthcare while affecting the long-term business viability of the city. In December of [...]

Background: Hospital readmissions are frequent and can represent low-quality, high-cost care. Timely post-hospital follow-up has been described as an important element of high-quality transitions of care and readmissions prevention (1-3), yet exactly what type of follow-up is most successful is unclear. We sought to understand the relationship between timing, hospital follow-up visit provider specialty and [...]

Background: Patient After-Visit Summaries (AVSs) are critical to ensuring safe and effective hospital discharge. However, these documents are often written at reading levels that exceed many patients’ health literacy, leading to misunderstanding of care instructions and preventable post-discharge complications. Hospitalists face increasing documentation burden and limited time for discharge education. Large language models (LLMs) may [...]

Background: Mortality prediction models are increasingly being adopted in the clinical setting, both to retrospectively assess quality of care and to prospectively inform clinical practice. An open question is whether a particular hospital should employ a model trained using a diverse nationwide dataset or use a model developed primarily from local data. The Veterans Affairs [...]

Background: Administrative harm (AH), defined as negative consequences arising from administrative processes and decisions within healthcare, is pervasive in medicine, yet poorly understood and described. Methods: We sought to explore common AHs experienced by hospitalist clinicians, administrative leaders, researchers, and patient and family advisory council members that were part of two national consortiums for hospitalists [...]

Background: In Hospital Medicine, change isn’t coming—it’s already here. Transition is perhaps the only constant in this field. Whether it’s billing models, quality metrics, staffing, reimbursements, or even contracts, evolution is inevitable. A significant shift occurred when Nurse Practitioners (NP) and Physician Assistants (PAs), collectively referred to as Advanced Practice Providers (APPs), joined hospitalist groups. [...]