Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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As a newly recognized subspecialty, understanding programmatic models for pediatric hospital medicine (PHM) programs is vital to lay the groundwork for a sustainable field. Although variability has been described within university-based PHM programs, there remains no national benchmark for community-based PHM programs. ⋯ Forty-three out of 70 (63%) site leaders perceived their programs as sustainable, with no significant difference by employer structure. Future studies should further explore root causes for workload discrepancies between community and academic employed programs along with establishing potential standards for PHM program development.
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Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
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Observational Study
Potentially Inappropriate Use of Intravenous Opioids in Hospitalized Patients.
Physicians have the potential to decrease opioid misuse through appropriate prescribing practices. We examined the frequency of potentially inappropriate intravenous (IV) opioid use (where oral use would have been more appropriate) in patients hospitalized at a tertiary medical center. ⋯ Of the 200 patients studied, 31% were administered potentially inappropriate IV opioids at least once during their hospitalization, and 33% of all IV doses administered were potentially inappropriate. Given the numerous advantages of oral over IV opioids, this study suggests significant potential for improving prescribing practices to decrease risk of addiction, costs, and complications, ultimately improving the value of care provided.
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Venous thromboembolism (VTE) is a serious medical condition that results in preventable morbidity and mortality. ⋯ Multiple factors act as barriers to patients receiving VTE chemoprophylaxis. These barriers are often modifiable targets for quality improvement. There is a need to focus on behavior changes that will remove or minimize barriers and equip nurses to ensure administration of VTE chemoprophylaxis by engaging patients in their care.
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Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue. ⋯ Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG's broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.