Academic Hospitalists Research Articles

Utilization of a National Writing Challenge to Promote Scholarly Work: A Pilot Study.

BackgroundHospitalists value mentorship and scholarly work, yet often struggle to find time and mentors amid busy clinical workloads.ObjectiveTo help catalyze writing for hospitalists nationally, we created a Writing Challenge, where we asked hospitalists to commit to the goal of writing 400 words a day, four days a week, for four weeks.MethodsProspective, programmatic evaluation with daily logs followed by a survey at the completion of the project. The four-week Writing Challenge occurred between June 7 and July 5, 2021. Email invitations to participate in the challenge were disseminated to peer networks, and the challenge was promoted using social media. Participants agreed to attempt to write 400 words per day, four days per week, for four weeks.ResultsSeventy-four individuals from 28 institutions registered for the Writing Challenge, with 36 (49%) participating in the challenge by logging their writing. Participants wrote an average of 4,372 +/- 4,324 words during the challenge. Sixty-eight percent of the participants reported that their amount of writing increased during the challenge and 50% of the participants stated they planned to publish their work, though many participants (46%) reported struggling to write each day.ConclusionsThe Writing Challenge is one way to generate increased writing and may result in increased scholarly output for academic hospitalists.

Men and Women Pursue Nonlinear Career Paths, but Impacts Differ: a Cross-Sectional Study of Academic Hospitalists.

BackgroundNonlinear career paths are increasingly common. Women in academia pursuing nonlinear career paths experience negative impacts on career trajectory. No published studies have examined how pursuit of nonlinear career paths might perpetuate gender inequities within academic hospital medicine.Objective(1) Compare the frequency of nonlinear career paths by gender among academic hospitalists; (2) assess the perceived impact of two types of nonlinear career paths—extended leave (EL) and non-traditional work arrangements (NTWA) on hospitalists’ personal lives and careers.Design, Setting, and ParticipantsCross-sectional descriptive survey study of adult hospitalist physicians in three academic centers within the USA.InterventionElectronic survey including closed- and open-ended items assessing respondent utilization of and experiences with nonlinear career paths.Main Outcomes and Measures(1) Associations between EL and demographic variables as well as gender differences in leave length and NTWA strategies using Fisher’s exact test; 2) grounded theory qualitative analysis of open-text responses.Key ResultsCompared with men, women reported taking EL more often (p = 0.035) and for longer periods (p = 0.002). Men and women reported taking NTWA at similar rates. Women reported negative impacts of EL within domains of personal life, career, well-being, and work-life integration whereas men only reported negative impacts to career. Men and women described positive impacts of NTWA across all domains.ConclusionsWomen academic hospitalists reported taking EL more often than men and experienced disproportionately more adverse impacts to personal lives and careers. Surprisingly, men reported taking NTWA to address burnout and childbirth at similar rates to women. Our findings lay the groundwork for additional exploration of cultural and policy interventions, particularly improved paid leave policies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07402-x.

Compassion fatigue in medicine: The result of an inner wear and tear

Compassion is an inner desire to alleviate the suffering of the other. Almost all of us as health care professionals had this feeling in some corner of our hearts when we chose this profession. It is no doubt a daunting task, but something within us made us feel we can help and make a difference. It is very palpable at the beginning of our careers. As a physician and an academic hospitalist, I observed medical students often having a great rapport with patients and families. Is it their enthusiasm to learn? Is it their ability to spend time with patients? Perhaps it is a combination of the joy of learning coupled with their willing hearts to open up to patients and families. Why does it change later? As we advance in our medical careers, the reality of day-to-day tasks, responsibilities, too many roles to play make a significant impact on us and perhaps slowly exhaust our resources and inner energies. It gradually erodes our interior. This leads to inner wear and tear. Our inner frustrations silently settle within ourselves and unknowingly conceal the very reason why we chose this profession. The reasons could be many, but this is one of the biggest challenges currently faced by health care.

Promotion of Academic Hospitalists: Room for Improvement

Promotion of Academic Hospitalists: Room for Improvement

Gender-Based Discrimination and Sexual Harassment Among Academic Internal Medicine Hospitalists.

Gender-based discrimination and sexual harassment, both implicit and overt, have been reported in academic medicine. This study examines experiences of academic hospitalists regarding gender-based discrimination and sexual harassment. A survey was distributed to Internal Medicine hospitalists at university-based academic institutions in the United States. Questions assessed experiences regarding gender-based discrimination and sexual harassment in their interactions with patients, as well as with other healthcare providers (HCPs). Eighteen institutions participated in the survey, resulting in 336 individual responses. Female hospitalists more frequently reported inappropriate touch, sexual remarks, gestures, and suggestive looks by patients compared with male peers both over their careers (P < .001) and in the last 30 days (P < .001). Similarly, females more frequently reported being referred to with inappropriate terms of endearment (eg, "dear," "honey," "sweetheart") by patients both over their careers (P < .001) and in the last 30 days (P < .001). Almost 100% of females reported being mistaken by patients for nonphysician HCPs over their careers, compared with 29% of males (P < .001) (76% vs 10%, in the last 30 days; P < .001). Similarly, females more frequently reported sexual harassment over their careers (P < .05) and being mistaken for nonphysician HCPs by colleagues both over their careers (P < .001) and in the last 30 days (P < .001). Females rated their sense of respect both by patients (P < .001) and colleagues (P < .001) lower than males (P < .001). More females than males reported that gender negatively impacted their career opportunities (P < .001). This survey demonstrates that gender-based discrimination and sexual harassment are commonly encountered by academic hospitalists, with a significantly higher number of females reporting these experiences.

The Influence of Academic Hospitalists on Labor and Delivery Outcomes

Background: Our goal was to examine differences in maternal and neonatal outcomes following the transition from a private practice to an academic model at a community hospital. Methods: This is a retrospective cohort study of a high-volume community hospital labor and delivery unit. A private practice hospitalist group was replaced with academic hospitalists. Maternal and neonatal outcomes for patients cared for by these groups were compared. The primary outcome was a composite of maternal morbidity that included blood transfusion, anal sphincter injuries, dilation and curettage, hysterectomy, chorioamnionitis, endometritis, wound infection, intensive care unit admission, and readmission. The secondary outcomes were cesarean delivery rate and a composite of neonatal morbidity that included Apgar score ≤3 at 5 min, shoulder dystocia, birth trauma, seizure, sepsis, necrotizing enterocolitis, intraventricular hemorrhage, or mechanical ventilation. Results: 245 patients were delivered by private physicians and 447 by academic physicians over the study period. No difference in the composite maternal morbidity between private and academic hospitalist groups was identified (21 vs. 25%; aOR 1.37, 95% CI: 0.36–5.21). The academic hospitalist group had a higher cesarean delivery rate compared to the private group (25 vs. 18%; aOR 2.03, 95% CI: 1.17–3.53). There was no difference in a composite neonatal morbidity (9 vs. 8%; aOR 0.92, 95% CI: 0.052–1.63). Conclusion: Women cared for by academic hospitalists were more likely to have a cesarean delivery, but there was no difference in maternal or neonatal morbidity in patients delivered by private or academic hospitalists.

Editorial introductions

Editorial introductions

The Influence of an Academic Hospitalist Model on Neonatal Outcomes [36O

INTRODUCTION: Previous research has failed to demonstrate improved neonatal outcomes following implementation of a laborist model. Our goal was to examine if there was a difference in neonatal outcomes when labor and delivery was staffed with a private or academic hospitalist practice. METHODS: This retrospective cohort study was of a high volume community hospital labor and delivery unit. Institutional Review Board approval was obtained for this research. All deliveries by the laborist service over a six month period in 2018, three months by a private hospitalist group and three months by an academic hospitalist group, were examined. The primary outcome was a composite of neonatal morbidity that included: Apgar &lt;3 at five minutes, shoulder dystocia, birth trauma, seizure, sepsis, necrotizing enterocolitis, intraventricular hemorrhage or mechanical ventilation Differences in outcomes were examined using chi-square tests. The results were presented as relative risk (RR) with 95% confidence interval (CI). RESULTS: 245 patients were delivered by private physicians and 447 by academic physicians over the study period. There was no difference in a composite neonatal morbidity (9% vs 8%: 0.85 (0.49–1.46). NICU admissions were unchanged between the groups (8% vs 11%: 1.49 [0.85–2.62]). Transient tachypnea of the newborn (5% vs 7%: 1.30 [0.67–2.55]), hyperbilirubinemia (9% vs 14%: 1.52 [0.92–2.53]) and hypoglycemia (6% vs 10%: 1.68 [0.92–3.09]) were likewise similar. CONCLUSION: There was no difference in neonatal outcomes in patients delivered by private laborists or academic hospitalists.

Differences in Postpartum Contraceptive Use in Patients Delivered by Academic Versus Private Hospitalists [09J

INTRODUCTION: Research has shown that women discharged postpartum without a contraception plan are significantly more likely to have a suboptimal interpregnancy interval. There is a lack of evidence examining the differences in postpartum contraception rates in patients treated by an academic hospitalist versus a private hospitalist. METHODS: A retrospective cohort study was completed examining women who delivered at a community hospital under the care of the hospitalist service surrounding a transition from a private to academic hospitalist service. Institutional Review Board approval was obtained. Records were collected for deliveries during six months in 2018. The primary outcome was postpartum women discharged without a contraceptive plan. Data was compared using a chi-square test. Relative risks with 95% confidence intervals were calculated. RESULTS: 245 patients were delivered by a private physician and 447 patients were delivered by an academic physician. Patients delivered by an academic physician chose not to receive any contraception less often than patients delivered by a private physician (24% vs 32%: relative risk [RR] 0.67, 95% confidence interval [CI] [0.47-0.95]). Those delivered by an academic physician chose to receive long-acting reversible contraception more often than those delivered by a private physician (11% vs 1%: RR 9.48 [CI 2.92-30.79]). There was no difference in receiving a bilateral tubal ligation (1% vs 2%: RR 0.82 [CI 0.23-2.93]) or user-dependent contraception between the two groups (64% vs 65%: RR 0.96 [CI 0.69-1.33]). CONCLUSION: Postpartum patients receiving care from an academic laborist were more likely to have a contraception plan at discharge and to desire long-acting reversible contraception.

Beyond Discharge Summaries: Communication Preferences in Care Transitions Between Hospitalists and Primary Care Providers Using Electronic Medical Records.

Ineffective transitions of care continue to be a source of risk for patients. Although there has been widespread implementation of electronic medical record (EMR) systems, little is currently known about hospitalists' and primary care providers' (PCPs) direct communication preferences at discharge using messaging capabilities in a shared EMR system. We examined how hospitalists and PCPs with a shared EMR prefer to directly communicate at the time of hospital discharge by identifying preferred modes, information prioritization, challenges, facilitators, and proposed solutions. A sequential, explanatory mixed methods study with surveys and semi-structured interviews. Thirty-eight academic hospitalists and 63 PCPs working in outpatient clinics in a single safety net hospital system with a shared EMR. Descriptive statistics were used to analyze survey responses. Interviews were analyzed using immersion/crystallization and a mixture of inductive and deductive thematic analysis. PCPs preferred direct communication at discharge through a message within the EMR while hospitalists preferred a message within the EMR and email. Qualitative results identified key themes related to patient care and direct communication: value of direct communication, safety, social determinants of health, and clinical judgment. Both groups prioritized direct communication for high-risk medications, pending and follow-up studies, and high-risk patients that hospitalists were concerned about. Overall, both hospitalists and PCPs reported that ensuring patient safety, flagging patients with social challenges, and expressing concerns about patients based on clinical judgment were key communication priorities. Hospitalists and primary care providers report considerable overlap in preferences for direct communication at the time of hospital discharge through a shared EMR. Specifically, both groups reported similar concerns regarding patient safety and continuity during transitions. Direct messaging within the EMR could enable "closed loop" communication that helps ensure safe transitions of care for high-risk patients.

Overnight cross-coverage on hospital medicine services: perceived workload based on patient census, pager volumes, and patient acuity

ABSTRACT Objective Little is understood about what contributes to perceived workload for those providing overnight coverage to hospitalized patients overnight, which limits the ability to modify these factors or to proactively identify appropriate staffing levels. The objective of this study is to understand the major contributors to perceived overnight cross-coverage workload. Methods Cross-covering advanced practice providers (APPs) in a large academic hospitalist group completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) at the end of each night shift. Other shift characteristics were collected, including patient load, assigned action items, watcher/unstable patients, newly admitted patients, number of units covered, total pages, peak pager density, rapid response team (RRT) activations, and intensive care unit (ICU) transfers. Results For 14 APP participants, who completed 271 post-shift surveys, the mean (SD) patient load was 49.9 (6.4) patients per night, and providers received a mean (SD) of 40.8 (13.7) total pages per shift. Mean (SD) NASA-TLX score was 35.1 (19.0). In multivariate modeling, total pages, action items, and any RRT or ICU transfer were associated with significant increases in the mean NASA-TLX score, with estimated effect sizes of 0.5, 0.8, and 14.3, respectively, per 1-unit increase in each shift characteristic. The greatest cumulative contributor to perceived workload was total number of pages, followed by the presence of any RRT activation/ICU transfer, with estimated effect sizes of 20.4 and 14.9, respectively. Conclusions Total number of pages was the greatest contributor to perceived workload. This study suggests that quality improvement initiatives designed to improve pager communication may considerably improve provider-perceived workload.

Peer Observations: Enhancing Bedside Clinical Teaching Behaviors.

BackgroundMedical training relies on direct observations and formative feedback. After residency graduation, opportunities to receive feedback on clinical teaching diminish. Although feedback through learner evaluations is common, these evaluations can be untimely, non-specific, and potentially biased. On the other hand, peer feedback in a small group setting or lecture format has been shown to be beneficial to teaching behaviors, however, little is known if peer observation using a standardized tool followed by feedback results in improved teaching behaviors. Therefore, the objective of this study was to examine if feedback after peer observation results in improved inpatient teaching behaviors.MethodsThis study was conducted at a tertiary care hospital. Academic hospitalists in the Division of Hospital Medicine developed a standardized 28-item peer observation tool based on the Stanford Faculty Development Program to observe their peers during bedside teaching rounds and provide timely feedback after observation. The tool focused on five teaching domains (learning climate, control of session, promotion of understanding and retention, evaluation, and feedback) relevant to the inpatient teaching environment. Teaching hospitalists were observed at the beginning of a two-week teaching rotation, given feedback, and then observed at the end of the rotation. Furthermore, we utilized a post-observation survey to assess the teaching and observing hospitalists’ comfort with observation and the usefulness of the feedback. We used mixed linear models with crossed design to account for correlations between the observations. Models were adjusted for gender, age, and years of experience. We tested the internal validity of the instrument with Cronbach’s alpha.ResultsSeventy (range: one to four observations per faculty) observations were performed involving 27 teaching attendings. A high proportion of teachers were comfortable with the observation (79%) and found the feedback helpful (92%), and useful for their own teaching (88%). Mean scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach’s alpha of 0.81 showing high internal validity.ConclusionsPeer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors. The success of this approach resulted in the expansion of peer observation to other Divisions within the Department of Internal Medicine at our Institution.

The new era of academic hospitalist in Japan.

Types of original research of peer-reviewed publications by hospitalists.

Hospitalists as Triagists: Description of the Triagist Role across Academic Medical Centers

From the hospitalist perspective, triaging involves the evaluation of a patient for potential admission to an inpatient service. Although traditionally done by residents, many academic hospitalist groups have assumed the responsibility for triaging. We conducted a cross-sectional survey of 235 adult hospitalists at 10 academic medical centers (AMCs) to describe the similarities and differences in the triagist role and assess the activities and skills associated with the role. Eight AMCs have a defined triagist role; at the others, hospitalists supervise residents/advanced practice providers. The triagist role is generally filled by a faculty physician and shared by all hospitalists.We found significant variability in verbal communication practices (P = .02) and electronic communication practices (P < .0001) between the triagist and the current provider (eg, emergency department, clinic provider), and in the percentage of patients evaluated in person (P < .0001). Communication skills, personal efficiency, and systems knowledge are dominant themes of attributes of an effective triagist.

Predictors of 30-day hospital readmission: The direct comparison of number of discharge medications to the HOSPITAL score and LACE index

Effective hospital readmission risk prediction tools exist, but do not identify actionable items that could be modified to reduce the risk of readmission. Polypharmacy has attracted attention as a potentially modifiable risk factor for readmission, showing promise in a retrospective study. Polypharmacy is a very complex issue, reflecting comorbidities and healthcare resource utilisation patterns. This investigation compares the predictive ability of polypharmacy alone to the validated HOSPITAL score and LACE index readmission risk assessment tools for all adult admissions to an academic hospitalist service at a moderate sized university-affiliated hospital in the American Midwest over a 2-year period. These results indicate that the number of discharge medications alone is not a useful tool in identifying patients at high risk of hospital readmission within 30 days of discharge. Further research is needed to explore the impact of polypharmacy as a risk predictor for hospital readmission.

Frequency of Ethical Issues on a Hospitalist Teaching Service at an Urban, Tertiary Care Center.

Little is known about the daily ethical conflicts encountered by hospitalists that do not prompt a formal clinical ethics consultation. We describe the frequencies of ethical issues identified during daily rounds on hospitalist teaching services at a metropolitan, tertiary-care, teaching hospital. Data were collected from September 2017 through May 2018 by two attending hospitalists from the ethics committee who were embedded on rounds. A total of 270 patients were evaluated and 113 ethical issues were identified in 77 of those patients. These issues most frequently involved discussions about goals of care, treatment refusals, decision-making capacity, discharge planning, cardiopulmonary resuscitation status, and pain management. Only five formal consults were brought to the Hospital Ethics Committee for these 270 patients. Our data are the first prospective description of ethical issues arising on academic hospitalist teaching services and are an important step in the development of a targeted ethics curriculum for hospitalists.

You Can't Have It All: The Experience of Academic Hospitalists During Pregnancy, Parental Leave, and Return to Work.

The United States lags behind most other countries regarding the support for working mothers and parental leave. Data are limited to describe the experience of female hospital medicine physicians during pregnancy, parental leave, and their return to work in academic hospital medicine. We conducted a qualitative descriptive study including interviews with 10 female academic hospitalists chosen from institutions across the country that are represented in Society of Hospital Medicine (SHM) Committees. Interview guides were based on the following domains: experience in pregnancy, parental leave, and return to work. Interviews were recorded, transcribed verbatim, and analyzed using a general inductive approach to theme analysis using the ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany). Women in hospital medicine experience the following six common challenges in their experience as new parents, each of which has the potential to impact their career trajectory, wellness, and are associated with areas for institutional improvement: (1) access to paid parental leave, (2) physical challenges, (3) breastfeeding, (4) career opportunities, (5) colleague responses, and (6) empathy in patient care.

Physician Perceptions of Advanced Practice Providers on Hospitalist Teams

Abstract Little is known about physician perceptions of nurse practitioners (NPs) and physician assistants (PAs) on hospitalist teams and the factors that impact their perceptions. Academic physician hospitalists were surveyed to better understand those factors, focusing on NP/PA experience, training, and physician experience with NPs/PAs. Perceptions by hospitalist physicians of NPs/PAs were strongly positive. Notable findings include the perceived positive impacts of NPs/PAs on clinical care provided, practice efficiency, and physician satisfaction. Most respondents prefer working with NPs and PAs with multiple years of clinical experience, particularly those who have participated in training beyond NP/PA graduate programs of study.

Limiting Newborn Antibiotic Exposure through Refined Sepsis Screening

Purpose/Objective: The Kaiser Neonatal Early-Onset Sepsis Calculator (KNESC) is a screening tool for early-onset sepsis in newborns with gestational age ≥ 35 weeks. Substantial research supports KNESC as an effective screening tool and as a tool to limit newborn antibiotic exposure. Due to the supportive research, our academic pediatric hospitalist group completed a stepwise transition from following the CDC GBS Prevention Guidelines to implementation of the KNESC in our newborn nursery, as a quality improvement project. …

Academic Hospitalist Programs and the Impact on Resident Education [3C

INTRODUCTION: Hospitalist programs have increased in prevalence since their introduction in the mid-1990s, doubling over a 5-year period from 114 to 240. While the laborist model increases patient safety and decreases physician fatigue and burnout in general, its impact on resident education is unknown. The purpose of the study was to determine the number of hospitalist programs within an academic setting and to exam the perceived impact of the program on postgraduate training in obstetrics and gynecology. METHODS: A validated survey was sent to program directors at all 242 U.S. Obstetrics and Gynecology training programs using an anonymous online survey instrument. The survey included 9 questions and took approximately 3-5 minutes to complete. The email was distributed three times: initial email with follow up emails at one and six months. Groups of interest were compared by chi-square test. RESULTS: 242 OB/Gyn residency training programs were surveyed. There were 98 respondents for a response rate of 36%. Twenty-eight percent of programs had a hospitalist program. Of these programs, the majority perceived the presence of laborists to have a positive impact on resident education (n=30, 90%) and did not perceive a reduction in the number of patients or procedures available to the residents (n=26, 96.3%). In addition, resident feedback in these programs indicated a hospitalist program was beneficial to their education (n=19, 70%). CONCLUSION: The implementation of a hospitalist program in the setting of postgraduate training in Obstetrics and Gynecology does not negatively impact resident education and is perceived by program leadership and trainees as beneficial.