Dr. Shi Revels in the Diversity of Experiences and Opportunities in HM
Q & A with Lucy Shi, MD, UC Davis Medical Center, Sacramento, Calif. Dr. Shi felt she had too many interests and not much direction when she first started as a hospitalist. Reflecting, growing, and finding a mentor helped her refocus and she’s eager to find shared experiences with other hospitalists as a member of The Hospitalist’s editorial board. Enjoy being a hospitalist and get comfortable with your clinical practice in your first few years. Don’t compare yourself to others—spend time reflecting on what gives you energy and what motivates you. Find inspirational and supportive mentors. Appreciate t...
Source: The Hospitalist - May 3, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: Career Leadership People in HM Source Type: research

Hospitalists as Disruptors in Healthcare
Dr. Kisuule We are living in disruptive times. We are amidst national and global conflict, we survived a pandemic that changed many aspects of our lives permanently, and many of our health systems are working through financial challenges with unprecedented operating and net losses. These disruptive forces require equal and opposite forces … remember high school physics and Newton’s third law? How do we reclaim this word “disruptive” as a force for good? According to the Oxford Dictionary, disruptive is, “causing radical change in an existing industry or market through being innovative.” Healthcare disruptors a...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Career Hospital Medicine Leadership Source Type: research

Coding Corner: Dazed and Confused
An 84-year-old woman with a history of dementia was admitted for worsening confusion over the last two days. Her initial workup in the emergency department is unremarkable including a normal urinalysis, basic metabolic panel, complete blood count, and CT of the head. On day two, she is increasingly combative and requires restraints. After a discussion with her family about the risks and benefits, quetiapine is added nightly. You order an electrocardiogram to check the patient’s QT interval, magnesium level, and another basic metabolic panel. On day three, she continues to require intermittent restraints along with the ad...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine Clinical Guidelines Source Type: research

4 Things Hospitalists Can Do to Reduce Nursing Turnover
Hospitalists and hospital administrators know the greatest challenge to providing safe, high-quality healthcare day in and day out in the U.S. is adequate nurse staff. Already a problem before the pandemic, the nursing shortage continues to worsen. By 2025, less than a year from now, the U.S. will have a shortage of 200,000 to 450,000 nurses available for direct patient care, equivalent to a gap of 10% to 20%.1 There is some dispute about the existence of an overall shortage of nurses, but what is clear is that nurses are leaving direct patient care, especially medical-surgical nurses, in droves.2,3 As hospitalists, we mig...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Hospital Medicine Leadership Nursing Practice Management Source Type: research

Apixaban Reduces Risk of Stroke or Systemic Embolism in Subclinical AF
Dr. Watson Clinical question: Does oral anti-coagulation reduce stroke or systemic embolism risk in subclinical atrial fibrillation (AF)? Background: Studies have shown an increased risk of stroke and systemic embolism in subclinical AF (short, asymptomatic episodes detected by permanent pacemakers and implantable cardiac defibrillators). While oral anti-coagulation has a well-recognized role in the treatment of clinical AF, its role in subclinical AF is uncertain. Study design: Randomized controlled trial Setting: 247 clinical sites in 16 European and North American countries Synopsis: The study included 4,012 patients w...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research

High Frequency of AF Recurrence in Hospitalized Patients with New-onset AF
Dr. Watson Clinical question: What is the frequency of atrial fibrillation (AF) recurrence in patients with new-onset AF, detected while hospitalized for a noncardiac medical illness or surgery, that returns to sinus rhythm prior to discharge? Background: AF is frequently detected for the first time in patients hospitalized for a noncardiac medical illness or surgery and may be considered a provoked and transient phenomenon (rather than a paroxysmal one) in these instances. The frequency of AF recurrence and appropriate medical management in this population is unclear. Study design: Matched cohort study Setting: Three aca...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research

SGLT-2 inhibitors May Decrease Recurrent Gout Flares in Patients with Type 2 diabetes
Dr. Bernal Clinical question: Do SGLT-2 inhibitors decrease gout flares in patients with type 2 diabetes and a known history of gout? Background: Sodium–glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are known to decrease serum urate levels and the risk of incident gout. However, their role in secondary prevention of gout flares is unknown. Study design: Propensity score–matched, new-user cohort study Setting: British Columbia, Canada Synopsis: Using a group of population-based, linked, administrative databases, the population of British Columbia was studied. 15,067 patients with gout and type 2 diabetes had f...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Autoimmune Diseases In the Literature Pharmacology Rheumatology Source Type: research

Semaglutide in Patients with HFpEF and Obesity
This study enrolled adult patients with obesity (BMI ≥30 kg/m2), HFpEF (left ventricular ejection fraction ≥45%; and New York Heart Association functional class II, III, or IV), a Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) of less than 90 points, a six-minute walk distance of at least 100 m; and clinical or laboratory evidence of volume-overloaded HF. About 500 participants, median age of 69, were randomized to receive semaglutide 2.4 mg subcutaneously weekly, versus placebo for 52 weeks. In patients randomized to receive semaglutide, there was an improvement in self-reported HF symptoms...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Pharmacology Source Type: research

Frailty Assessment and Perioperative Adverse Cardiovascular Events After Noncardiac Surgery
Dr. Chandler Clinical question: Can a frailty assessment tool be used to identify patients at higher risk for major adverse cardiac events (MACE) prior to noncardiac surgery? Background: Studies have outlined the risk of increasing frailty on overall health outcomes and hospitalizations and as a possible risk factor for complications after noncardiac surgery.  The association between frailty scores and perioperative MACE is limited.  Study design: Retrospective cohort study Setting: Administrative data of patients aged ≥45 hospitalized for noncardiac surgeries between 2004 and 2014 in the U.S. Synopsis: Using the Nati...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research

Black Patients More Likely to Experience Security Emergency Responses
Colby Feeney, MD, FHM Clinical question: Do race and ethnicity predict the use of security emergency responses (SER) in a non-psychiatric inpatient setting? Background: Studies have demonstrated increased restraint use in certain racial groups in the emergency department (ED) and inpatient psychiatry settings. While there is also literature to suggest increased use of security for nonwhite patients, there is little known about the association between race and ethnicity identification and the use of SERs and restraints in the non-psychiatric inpatient setting. Study design: Retrospective cohort study Setting: Single tertia...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Advocacy Diversity in Medicine In the Literature Source Type: research

Piperacillin-tazobactam Doesn ’ t Increase Risk of AKI Compared to Cefepime
This study randomized 2,511 patients who were ordered an antipseudomonal antibiotic in the emergency department (ED) or intensive care unit (ICU) to receive cefepime or piperacillin-tazobactam. The primary outcome was stage 3 AKI (using the Kidney Disease: Improving Global Outcomes [KDIGO] definition) or death by day 14, and there was no significant difference in this outcome between the two groups (OR, 0.95, 95% CI, 0.8 to 1.13). Coadministration rates of vancomycin were practically equivalent between both groups. The study also prespecified a secondary outcome of neurological dysfunction; patients receiving cefepime had ...
Source: The Hospitalist - May 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Neurology Pharmacology Source Type: research

Shared Experiences Make Us Stronger Together
Dr. Kris Rehm, outgoing SHM president, and Dr. Rachel Thompson, immediate past president, continued The Prez Room series of discussions with members. As I reflect on our time this year, I want to highlight a few experiences and moments that embody why I’m so grateful to have served as president of our society—some of which, I hope, you’ve shared with me. Since last year’s SHM Converge in Austin, Texas, the SHM staff and Board of Directors have worked to advance the mission, vision, and goals that we shared last year. This has provided us with a clear focus on areas where we should remain engaged and others where w...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Leadership Source Type: research

Coding Corner: A Critical Opportunity
A 17-year-old with a history of major depressive disorder who is new to the hospitalist service is being transferred out of the pediatric intensive care unit (PICU) after an intentional Benadryl overdose in a suicide attempt. You review her labs from this morning showing that her electrolytes are normal. You review her pregnancy test and urine drug screen which are both negative. You review the nursing note from this morning which states she is alert, oriented, and calm and her parents are at the bedside. You interpret her electrocardiogram (EKG) tracing and calculate her QTc to be back to normal at 420. She remains active...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine Clinical Guidelines Coding Source Type: research

Torsemide or Furosemide After Discharge in Patients Hospitalized with HF
Clinical question: Is there a mortality difference in patients discharged on torsemide versus furosemide after heart failure hospitalization? Background: Torsemide has been thought to be superior to furosemide in patients with congestive heart failure (CHF), but no high-quality, randomized, controlled, trial data were available comparing different loop diuretics in patients with CHF and looking at all-cause mortality until the TRANSFORM-HF trial. Study design: Open-label, pragmatic, randomized, controlled trial Setting: 60 U.S. hospitals Synopsis: 2,859 patients with a median age of 65 years randomized to torsemide (1,431)...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research