Background: In a time when rural hospitals across the United States are closing for various reasons and local residents are left with limited access to healthcare, our academic medical center successfully built one of the few new rural facilities in the country and opened it in January 2023. The new hospital is a seventeen bed [...]

Background: The availability of beds within healthcare systems has been stressed during each wave of the COVID-19 pandemic. Healthcare systems with tertiary hospitals have had increasing patient volumes and face limitations of specialized urgent (e.g., ECMO) and routine (e.g., Percutaneous Coronary Intervention) functions during critical inpatient surge volumes. Reserving the limited capacity at a tertiary [...]

Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. Demand for healthcare value has driven renewed attention to HaH, including from the Centers for Medicare and Medicaid Services. The COVID-19 pandemic has only magnified consideration of alternative sites of care. Where studied, HaH models have had desirable [...]

Background: A small number of patients account for a disproportionate number of hospital readmissions. The Complex High Admission Management Program (CHAMP) is designed to improve care and reduce hospitalizations for frequently readmitted patients. Non-randomized studies of CHAMP found reductions in readmission but may be subject to regression to the mean. We conducted a randomized trial [...]

Background: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. Our study aimed to identify the major changes in inpatient pediatric healthcare delivery and potential learnings from these changes. Methods: We conducted semi-structured interviews for this qualitative study. We purposefully sampled hospitals [...]

Background: In 2013, the American Academy of Pediatrics’ position statement, “Guiding Principles for Pediatric Hospital Medicine (PHM) Programs,” emphasized the importance of professional development for each PHM physician. However, little is published about PHM physicians’ perspectives on professional development. The objectives of this study were to explore pediatric hospitalists’ perceptions of professional development needs, desired [...]

Background: Hospitalization is costly, associated with the potential for adverse medical events and may have deleterious health effects.  Hospitalist physicians are uniquely positioned to help patients avoid unnecessary hospitalizations.  Our attending-only hospitalist practice in a tertiary academic center admits approximately 350 patients monthly, the majority of which are referred through the emergency department (ED).  Our [...]

Background: Due to the importance of rest for inpatients, the American Academy of Nursing recommends preserving patient sleep by reducing unnecessary nocturnal care as part of their Choosing Wisely® campaign. Prior sleep-promotion interventions often fail due to lack of sustained staff behavior change. We designed and implemented SIESTA, which combined staff education with the behavioral economics [...]

Background: Coordination of inpatient and outpatient care is an important challenge in improving population health but evidence examining the effectiveness of existing care coordination programs is mixed. The Comprehensive Care Physician (CCP) Program at the University of Chicago provides patients at increased risk of hospitalization the opportunity to receive inpatient and outpatient care from the [...]

Background: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care. In this study, we aim to better understand which patients may (or may not) benefit from IHT by evaluating the impact of IHT on clinically important patient outcomes among a variety of patient diagnoses. Methods: We performed [...]