Background: In 2016, there were more than 50,000 hospitalists working in the United States. The Society of Hospital Medicine (SHM) published ‘The Core Competencies in Hospital Medicine’ as a blueprint to standardize expectations of practicing hospitalists and to inform continuing medical education (CME) programs. We conducted a qualitative study to discover elements judged to be [...]

Background: Physician burnout impacts job satisfaction and turnover with significant financial and operational costs in addition to the negative impact on patient care. Organizations are increasingly focused on methods to improve physician resilience. Our study aims to explore the impact of difficult patient encounters on hospitalist resilience to inform future individual and organizational efforts to [...]

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: Pain remains a major concern for medically hospitalized adults, and pain treatment is a focus of hospital quality reporting and improvement efforts. Pharmacologic treatment during hospitalization for acute pain and cancer pain rest on some evidence, but as many as 1 in 3 adult medical inpatients suffer from chronic pain. Little is known about [...]

Background: Frequently hospitalized patients face unique challenges in navigating health care systems. Although practice-, hospital-, and accountable care organization-level programs to address the needs of these patients exist, interventions have had mixed results, with only some demonstrating reduction in hospitalizations or costs. To best serve frequently hospitalized patients and improve future interventions, clinicians, leaders, and [...]

Background: Patients with sickle cell disease (SCD) experience painful and life threatening vaso-occlusive episodes (VOE) that cause frequent hospitalizations, account for >80% of their >$1 million lifetime healthcare costs, and can be fatal. Yet, there is a dearth of evidence addressing inpatient VOE care leading to a stark absence of evidence-informed guidelines. As a first [...]

Background: National guidelines recommend hospitals implement standardized approaches to handoffs, and recent quantitative research has indicated that standardized approaches such as the I-PASS tool can lead to sustained improvements in patient safety and provider communication in a diverse array of settings.1 Our hospital medicine group piloted a formal written handoffs process based on the I-PASS [...]

Background: Hospitalized older adults are increasingly referred to skilled nursing facilities (SNFs) for post-acute care following hospitalization. However, whether hospitalized older adults are enabled to make high-quality decisions about different post-acute care options is unclear. This is important because a high-quality decision aligned with patient values and expectations may lead to a better match of [...]

Background: Hospital admissions are the majority contributor to the cost in caring for diabetes, accounting for about 40% of the costs. As most hospital reimbursements are based upon diagnosis-related groups, hospitals have strong financial incentives for quicker discharges to control length of stay and costs. This can limit the time available to develop a comprehensive [...]

Background: Virtual Hospitalist (VH) care models are emerging in hospital medicine to address workforce shortages and improve patient access. VH programs are any programs where the hospitalist and patient are located at different sites, but the patient requires an acute level of care. This can include arrangements where: 1) the patient is located in a [...]