Background: Frailty is a clinical syndrome characterized by vulnerability to stressors resulting from a loss of physiological reserve across multiple systems. Frailty is a common condition in older adults and is associated with disability, morbidity, increased healthcare utilization, and mortality. Frailty assessments derive from two major frameworks: the frailty phenotype and the deficit accumulation model. [...]

Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014 and December 31, [...]

Background: Communication between referring Veterans Health Administration (VHA) facilities and home health care agencies in the community is imperative for comprehensive care for Veterans. However, to date little is known about communication during care transitions from VHA facilities to home health care. The purpose of the present study is to conduct a preliminary exploratory survey [...]

Background: High-quality medication reconciliation is key to reducing medication errors during care transitions. This concept is of paramount importance to Veterans living in rural areas due to less access to clinical pharmacy services. We adapted MARQUIS (Multicenter Medication Reconciliation Quality Improvement Study), in which hospitalists mentored teams in implementation of best practices for inpatient medication [...]

Background: Communication between team members is fundamental to providing high quality care to hospitalized patients (1). Breakdowns in communication lead to compromised patient safety, delays in care, and poor utilization of resources (2). Our Veterans Affairs (VA) hospital has about 200 inpatient beds, primarily staffed by resident physician teams. Bedside nurses use the admission order [...]

Background: Rural areas are disproportionately affected by physician shortages, and small rural hospitals in particular struggle to staff acute medicine services 24/7. Telehospitalist models are emerging as an alternative to provide inpatient medicine services in rural settings. In a 2018 needs assessment of rural Veterans Health Administration (VHA) hospitals, 60% percent reported being short on [...]

Background: Burnout among hospital medicine physicians has been reported to be 50-60%, with prevalence likely increasing during the COVID-19 pandemic (1-3). Prior studies suggest burnout may be lower in the Veterans Administration (VA) compared to non-VA healthcare settings (4, 5). However, specific data examining burnout in VA Hospital Medicine (HM) physicians are lacking. To address [...]