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: 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: Effective communication between health-care providers, patients and their families is a key aspect of the discussion surrounding a patient’s goals of care.  One crucial part of this process is reaching a shared understanding of how the patient views their own quality of life.   The objective of this study was to characterize factors patients and [...]

Background: Shared decision-making (SDM) has been shown to be an important tool for improving patient engagement and health care outcomes. Despite the demonstrated value of SDM across disciplines, little is known about how to increase SDM in general inpatient settings. We sought to evaluate the effectiveness of an educational bundle on inpatient resident teams’ abilities [...]

Case Presentation: A previously healthy 19 year-old college student presented after coughing up a live worm (Figure 1). The night prior, he had developed a cough and right-sided chest “cramping.” Although he reported respiratory and constitutional symptoms from his concurrent COVID-19 infection, he stated that the cough was atypical and was associated with a sensation [...]

Background: Hospitalists frequently lead family meetings with patients and family members. Shared decision making employed during family meetings is believed to foster mutual understanding of its participants, including understanding of prognosis. However, this assumption has not been empirically assessed. Methods: We performed a secondary analysis of data from a trial of a decision support tool [...]

Case Presentation: An 89-year-old man with coronary artery disease, hypertension, and osteoarthritis presented with acute-onset severe posterior neck pain, with no viral prodrome. The patient reported experiencing generalized weakness and associated headache, but denied any fevers, chills, cough, myalgia, joint pain, ulcers or rashes. Additionally, he did not report any photophobia, phonophobia, changes in vision, [...]

Background: Clinicians face substantial challenges in limiting life-prolonging interventions (e.g., ICU admission, life-sustaining treatments, invasive procedures) near the end of life, even when they judge these interventions to be non-beneficial [1-3]. The objective of our study was to empirically derive a descriptive framework of decision-making approaches used by clinicians to limit (i.e., withhold or withdraw) [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, and are associated with withholding treatments outside of the cardiac arrest setting. [...]

Background: As medical complexity of pediatric patients rises, inpatient family care conferences (FCCs) are increasingly utilized to discuss treatment decisions and goals of care with families and multiple care team members. Studies have shown that emotional connections with providers at a FCC increase family satisfaction with these conferences. Proposals for structuring FCCs suggest involvement of [...]