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OBJECTIVES: Gender-based disparities in salary exist in multiple fields of medicine. However, there is limited data examining gender inequities in salary in pediatric hospital medicine (PHM). Our primary objective was to assess whether gender-based salary differences exist in PHM. The secondary objective was to assess if, among women, the differences in salary varied on the basis of leadership positions or self-identified race and ethnicity. METHODS: We conducted a survey-based, cross-sectional study of pediatric hospitalists in December 2021. Our primary outcomes were base and total salary, adjusted for the reported number of average weekly work hours. We performed subanalyses by presence of a leadership position, as well as race. We used a weighted t test using inverse probability weighting to compare the outcomes between genders. RESULTS: A total of 559 eligible people responded to our survey (51.0%). After propensity score weighting, women's mean base salary was 87.7% of men's base (95% confidence interval [CI] 79.8%-96.4%, P < .01), and women's total salary was 85.6% of men's total (95% CI 73.2%-100.0%, P = .05) salary. On subgroup analysis of respondents with a leadership position, women's total salary was 80.6% of men's total salary (95% CI 68.7%-94.4%, P < .01). Although women who identified as white had base salaries that were 86.6% of white men's base salary (95% CI 78.5%-95.5%, P < .01), there was no gender-based difference noted between respondents that identified as nonwhite (88.4% [69.9%-111.7%] for base salary, 80.3% [57.2% to 112.7%]). CONCLUSIONS: Gender-based discrepancies in salary exists in PHM, which were increased among those with leadership roles. Continued work and advocacy are required to achieve salary equity within PHM.
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Hospitais Pediátricos , Salários e Benefícios , Humanos , Salários e Benefícios/estatística & dados numéricos , Feminino , Masculino , Estudos Transversais , Hospitais Pediátricos/economia , Fatores Sexuais , Adulto , Médicas/economia , Médicas/estatística & dados numéricos , Inquéritos e Questionários , Liderança , Pediatras/estatística & dados numéricos , Pediatras/economia , Médicos Hospitalares/economia , Médicos Hospitalares/estatística & dados numéricos , Sexismo/estatística & dados numéricosRESUMO
Three years after the start of the SARS-CoV-2 virus (COVID-19) pandemic, its effects continue to affect society and COVID-19 vaccination campaigns continue to be a topic of controversy and inconsistent practice. After experiencing spikes in COVID-19 cases, our University of California Davis Health Division of Hospital Medicine sought to understand the reasons underlying the low COVID-19 vaccination rates in our county and find approaches to improve the number of vaccinations among adults admitted to the inpatient setting. This quality improvement project aimed to increase COVID-19 primary and booster vaccine efforts through a multi-pronged approach of increased collaboration with specialised staff and optimisation of use of our electronic health record system.Our key interventions focused on developing a visual reminder of COVID-19 vaccine status using the functionality of our electronic medical record (EMR), standardising documentation of COVID-19 vaccine status and enhancing team-based vaccination discussions through team huddles and partnering with inpatient care coordinators. While our grassroots approach enhanced COVID-19 vaccination rates in the inpatient setting and had additional benefits such as increased collaboration among teams, system-level efforts often made a greater impact at our healthcare centre. For other institutions interested in increasing COVID-19 vaccination rates, our top three recommendations include integrating vaccination into pre-existing workflows, optimising EMR functionality and increasing vaccine accessibility in the inpatient setting.
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Vacinas contra COVID-19 , COVID-19 , Médicos Hospitalares , Melhoria de Qualidade , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Vacinas contra COVID-19/administração & dosagem , Médicos Hospitalares/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Vacinação/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , CaliforniaRESUMO
Objective The hospitalist system in the United States has been considered successful in terms of the quality of care and cost effectiveness. In Japan, however, its efficacy has not yet been extensively examined. This study examined the impact of the hospitalist system on the quality of care and healthcare economics in a Japanese population using treatment of urinary tract infection as an example. Methods We analyzed 271 patients whose most resource-consuming diagnosis at admission was urinary tract infection between April 2017 and March 2019. Propensity-matched analyses were performed to compare health care economics and the quality of care between the hospitalist system and the conventional system. Results In matched pairs, care by the hospitalist system was associated with a significantly shorter length of stay than that by the conventional system. The quality of care (oral antibiotics switch rate, rate of appropriate antibiotics change based on urine or blood culture results, detection rate of urinary tract infection etiology and the number of laboratory tests) was also considered to be favorably impacted by the hospitalist system. Although not statistically significant, hospital costs tended to be lower with the hospitalist system than with the conventional system. The mortality rate and 30-day readmission were also not significantly different between the groups. Conclusion The hospitalist system had a favorable impact on the quality of care and length of stay without increasing readmission in patients with urinary tract infection. This study is further evidence of the strong potential for the positive impact of an implemented hospitalist system in Japan.
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Médicos Hospitalares , Infecções Urinárias , Humanos , Médicos Hospitalares/economia , Médicos Hospitalares/normas , Médicos Hospitalares/estatística & dados numéricos , Hospitalização , Tempo de Internação , Readmissão do Paciente , Estudos Retrospectivos , Eficiência Organizacional , Japão/epidemiologia , Infecções Urinárias/economia , Infecções Urinárias/epidemiologia , Infecções Urinárias/terapia , Pontuação de Propensão , Atenção à Saúde/economia , Atenção à Saúde/normas , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricosRESUMO
Importance: Despite the growing number of physicians who reduce clinical time owing to research, administrative work, and family responsibilities, the quality of care provided by these physicians remains unclear. Objective: To examine the association between the number of days worked clinically per year by physicians and patient mortality. Design, Setting, and Participants: This cross-sectional analysis was completed on a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were admitted to the hospital with an emergency medical condition and treated by a hospitalist in 2011 through 2016. Because hospitalists typically work in shifts, hospitalists' patients are plausibly quasirandomized to hospitalists based on the hospitalists' work schedules (natural experiment). The associations between hospitalists' number of days worked clinically per year and 30-day patient mortality and readmission rates were examined, adjusting for patient and physician characteristics and hospital fixed effects (effectively comparing physicians within the same hospital). Data analysis was conducted from July 1, 2020, to July 2, 2021. Exposures: Physicians' number of days worked clinically per year. Main Outcomes and Measures: The primary outcome was 30-day patient mortality, and the secondary outcome was 30-day patient readmission. Results: Among 392â¯797 hospitalizations of patients treated by 19â¯170 hospitalists (7482 female [39.0%], 11â¯688 male [61.0%]; mean [SD] age, 41.1 [8.8] years), patients treated by physicians with more days worked clinically exhibited lower mortality. Adjusted 30-day mortality rates were 10.5% (reference), 10.0% (adjusted risk difference [aRD], -0.5%; 95% CI, -0.8% to -0.2%; P = .002), 9.5% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001), and 9.6% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001) for physicians in the first (bottom), second, third, and fourth (top) quartile of days worked clinically, respectively. Readmission rates were not associated with the numbers of days a physician worked clinically (adjusted 30-day readmissions for physicians in the bottom quartile of days worked clinically per year vs those in the top quartile, 15.3% vs 15.2%; aRD, -0.1%; 95% CI, -0.5% to 0.3%; P = .61). Conclusions and Relevance: In this cross-sectional study, hospitalized Medicare patients treated by physicians who worked more clinical days had lower 30-day mortality. Given that physicians with reduced clinical time must often balance clinical and nonclinical obligations, improved support by institutions may be necessary to maintain the clinical performance of these physicians.
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Mortalidade Hospitalar , Médicos Hospitalares , Padrões de Prática Médica , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Correlação de Dados , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Médicos Hospitalares/organização & administração , Médicos Hospitalares/estatística & dados numéricos , Médicos Hospitalares/provisão & distribuição , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
ABSTRACT: Health care employees are the front liners whom are directly involved in the management of COVID-19 at high risk of developing psychological distress and other mental health illness. We aim to assess the burden of depression during this pandemic on health care employees treating COVID-19 in Saudi Arabia. We also will shed the light on the best solutions of how to encounter depression.A cross-sectional, hospital-based survey conducted via a region-stratified, 2-stage cluster sample was conducted for 554 participants in >15 hospitals from April 29, 2020, to June 30, 2020. Depression is measured using the established PHQ9 score system. We grade PHQ9 depression scores as: normal, 0 to 4, mild, 5 to 9, significant (moderate or severe), 10 to 27. χ2/Fisher exact test was used; significant association between level of depression and survey characteristics were made. P value <0.05 was considered statistically significant.A total of 554 participants completed the survey. A total of 18.9% (nâ=â105) were aged <29âyears, 51.2% (nâ=â284) were between 30 to 39âyears and female represent 70% of all participants. Of all participants, 53.7% (nâ=â298) were nurses, and 38.6% (nâ=â214) were physicians; 68.5% (nâ=â380) worked in central area hospitals in Saudi Arabia. No significant (Pâ=â.432, 95% confidence interval [CI]) association was observed between sex and depression classifications. However, female had high proportion of significant depression 75.0% (nâ=â76) was observed as compared to male 24.8% (nâ=â25). Depression was significant in Saudis 61.4% (nâ=â62) (Pâ<â.001, 95% CI) and medical staff who encountered corona patients 51.5% (nâ=â52) (Pâ<â.002, 95% CI). Hospital preparedness associated with more freedom of depression symptoms 69.1% (nâ=â199/288) (Pâ<â.001, 95% CI).Frontline young health care workers especially physician in Saudi Arabia reported a high rate of depression symptoms. Countermeasures for health care workers represent a key component for the mental and physical well-being as part of public health measures during this pandemic. Attention to hospital preparedness and adequacy of personal protective equipment contributed to milder depression symptoms. Further studies need to be conducted on crisis management and depression.
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Ansiedade , COVID-19 , Depressão , Pessoal de Saúde , Controle de Infecções , Estresse Ocupacional , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , COVID-19/epidemiologia , COVID-19/psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Feminino , Pessoal de Saúde/classificação , Pessoal de Saúde/psicologia , Médicos Hospitalares/psicologia , Médicos Hospitalares/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Masculino , Saúde Mental/estatística & dados numéricos , Saúde Ocupacional/normas , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Equipamento de Proteção Individual/provisão & distribuição , SARS-CoV-2 , Arábia Saudita/epidemiologiaRESUMO
BACKGROUND: Patients with COVID-19 infection requiring in-hospital care are frequently managed by Internal Medicine hospitalists, comprised of physicians, nurse practitioners and physician assistants. There is sparse information on the psychological impact of the COVID-19 pandemic on Internal Medicine hospitalists. METHODS: We surveyed Internal Medicine hospitalists at Mayo Clinic sites in four states (Arizona, Florida, Minnesota, and Wisconsin). We collected demographic information, and used Patient-Reported Outcomes Measurement Information System (PROMIS®) measures to assess global well-being, anxiety, social isolation, and emotional support. Descriptive statistics were used to compare responses between two periods: prior to the pandemic (before March 15th, 2020), and during the pandemic (March 15 through 30 April 2020). The survey was conducted from May 4-25, 2020. RESULTS: Of 295 Internal Medicine hospitalists, 154 (52%) responded. Fifty-six percent were women (n = 85/154) and 54% were physicians (n = 84/154). Most hospitalists (75%; n = 115/154) reported concerns about contracting COVID-19 infection at work, and 5% (n = 8/154) reported changing where they lived during the pandemic. Most hospitalists (73%; n = 112/154) reported relying primarily on institutional resources for COVID-19 information. During the pandemic, the percentage of participants with excellent or very good global well-being decreased (90% prior to pandemic vs. 53% during pandemic), with increases in mean anxiety (-4.88 [95% confidence interval, - 5.61 to - 4.16]; P<.001) and social isolation (-3.91[95% confidence interval, - 4.68 to - 3.13]; P<.001). During the same period, there was a small decrease in mean emotional support (1.46 [95% confidence interval, 0.83 to 2.09]; P<.001). CONCLUSION: During the COVID-19 pandemic, Internal Medicine hospitalists reported lower global well-being, higher anxiety and social isolation, and a small decrease in emotional support. These results provide a framework to develop programs to support hospitalists and potentially mitigate long-term psychological sequelae including burnout.
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Ansiedade/psicologia , Esgotamento Profissional/psicologia , COVID-19/psicologia , Médicos Hospitalares/psicologia , Tolerância ao Trabalho Programado/psicologia , Adaptação Psicológica , Adulto , COVID-19/epidemiologia , Feminino , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data. METHODS: This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic. RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone. LIMITATIONS: Selection bias and single-center nature. CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
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Dermatologia/métodos , Hospitalização , Consulta Remota/métodos , Dermatopatias/diagnóstico , Adulto , Idoso , Estudos de Viabilidade , Feminino , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fotografação , Estudos Prospectivos , Pele/diagnóstico por imagem , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção TerciáriaRESUMO
Many studies have examined the impression made on patients by physicians' attire. Regardless of practice location, many patients express most confidence in physicians who wear white coats. The number of physicians in Japan who choose not to wear white coats in practice has been increasing, particularly in primary care settings. However, very few studies have examined physician preference for attire. To clarify Japanese general practitioners' preference for attire by practice setting, we conducted a survey of physician preferences and reasons for attire selection. Subjects were 794 general practitioners certified by the Japan Primary Care Association and recruited from a mailing list. We conducted a web-based questionnaire survey. Physicians were asked to choose one of four different dress styles (semi-formal, white coat, scrubs, and casual) for different practice settings and state the reasons for selection. The response rate was 19.3% (n = 153; men 112). Most subjects chose white coats as usual attire for hospital practice (52%), mainly because of custom and professionalism. In contrast, most subjects chose non-white coats for clinics (59%) and home care (hospital-provided, 58%; clinic-provided, 71%). More subjects chose casual dress for clinic and home care practice, mainly to appear empathic. Most subjects chose white coats as the most appropriate hospital attire (54%), mainly because of patient perceptions of this attire being professional. Most subjects considered non-white coat attire more appropriate for clinic and home care practice. The findings indicate that general practitioners choose their clothes depending on practice location.
Assuntos
Atitude do Pessoal de Saúde , Vestuário , Clínicos Gerais , Médicos Hospitalares , Relações Médico-Paciente/ética , Área de Atuação Profissional/estatística & dados numéricos , Adulto , Comportamento de Escolha , Vestuário/psicologia , Vestuário/estatística & dados numéricos , Empatia , Feminino , Clínicos Gerais/ética , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Médicos Hospitalares/ética , Médicos Hospitalares/psicologia , Médicos Hospitalares/estatística & dados numéricos , Humanos , Japão , Masculino , Profissionalismo , Inquéritos e QuestionáriosRESUMO
Advanced practice providers and physicians at an academic healthcare system comprising more than 15 hospitals across four US states were surveyed to identify barriers to participation in research. Overall, barriers reported by advanced practice providers and physicians were more similar than different, highlighting system-level opportunities to build research skills and accelerate academic productivity.
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Prática Avançada de Enfermagem , Médicos Hospitalares/psicologia , Pesquisa/organização & administração , Adulto , Idoso , Feminino , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: To explore how to integrate the "best" practice into nursing of venous thromboembolism (VTE) based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS: A mixed-methods design was used. A steering group for clinical evidence implementation (EI) was established to conduct pre-implementation baseline surveys, a thorough analysis of the evidence, and an analysis of the survey results. The hindering and enabling factors associated with the clinical implementation of the evidence were analysed based on the three core elements of i-PARIHS, to formulate the clinical implementation plan for VTE nursing evidence. On-site expert reviews and focus group interviews were used to evaluate the feasibility of the draft plan, make adjustments, and finalize the evidence-based practice plan, which was then put into practice and evaluated. RESULTS: A new nursing process, a health education manual and a nursing quality checklist on VTE has been established and proved to be appropriate through the implementation. Compliance with evidence related to VTE nursing increased significantly in the two units, with better compliance in unit B than unit A. The knowledge, attitude and behaviour scores for VTE nursing increased substantially in both nurses and patients. CONCLUSION: The EI programme of incorporating the "best" evidence on VTE nursing into clinical practice using the i-PARIHS framework demonstrated feasibility, appropriateness and effectiveness and could serve as a reference.
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Prestação Integrada de Cuidados de Saúde/organização & administração , Enfermagem Baseada em Evidências/organização & administração , Implementação de Plano de Saúde/organização & administração , Unidades de Terapia Intensiva/organização & administração , Tromboembolia Venosa/terapia , Adulto , Prestação Integrada de Cuidados de Saúde/métodos , Enfermagem Baseada em Evidências/métodos , Estudos de Viabilidade , Feminino , Grupos Focais , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricosRESUMO
INTRODUCTION: Several research studies have started to investigate the health conditions of medical doctors and nurses in order to find a relationship if any between their work environment, their usually heavy duties and the result of these two parametric on patients' health. AIM: The present research study is an effort to investigate the relationship between the physical activity and sleep disorders among health care professionals, particularly among medical doctors and nurses. METHODS: Participants of the study were asked to fill a questionnaire which was a mixture of other internationally accredited questionnaires regarding physical activity level as well as sleeping functions. Data were collected among 204 physicians and nurses. The statistical analysis revealed a correlation between physical activity and some aspects of sleep disorders. RESULTS: A total number of 204 questionnaires have been distributed to medical doctors and nurses working in public hospitals in Athens Greece from the middle of February until the middle of April 2020. The hospitals were assigned by the health authorities to the fight of the pandemic of COVID 19. The majority of the participants were women 71,3% and 28,7% were men. From a total of 204 half of them were medical doctors and half of them were nurses. 43% were married, 49% were single and 8% were divorced and there were no widows. Regarding the participant nurses, 43% had a university degree and 38,4% had a technological education degree. The results of the statistical analysis showed that there are positive correlations between the level of physical activity during the daily work and the free time of the participants with parameters that are related to sleep disorders. CONCLUSION: The sample of the study was not a large one but nevertheless a stressful situation such as is the epidemic of COVID19 can provide useful information in order to better understand the relationship between physical activity and sleeping disorders in such working conditions.
Assuntos
Infecções por Coronavirus/epidemiologia , Exercício Físico , Médicos Hospitalares , Recursos Humanos de Enfermagem Hospitalar , Estresse Ocupacional , Pneumonia Viral/epidemiologia , Transtornos do Sono-Vigília , Adulto , Atitude do Pessoal de Saúde , Betacoronavirus , COVID-19 , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Grécia/epidemiologia , Médicos Hospitalares/psicologia , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Estresse Ocupacional/etiologia , Estresse Ocupacional/fisiopatologia , Pandemias , SARS-CoV-2 , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários , Equilíbrio Trabalho-Vida , Carga de TrabalhoRESUMO
Traditionally, hospital medicine services have been dominated by the physician and hospital team, with significant barriers to patient- and family-centered care. This article offers principles and associated strategies to reduce those barriers and guide implementation of systemically informed, collaborative, and culturally responsive patient- and family-centered care provided by hospitalist care teams, especially regarding collaborative decision-making for treatment and discharge planning. Such an approach is associated with reduced lengths of stay and hospital costs and lowered rates of medical errors and mortality. It also is linked to improved patient and family cooperation and adherence; enhanced quality of care and clinical outcomes; and increased levels of satisfaction among health care professionals, patients, and families. Such care uses resources wisely and is effective and ethical. We hope articulating and illustrating these principles and strategies will facilitate efforts to shift the health care culture from being physician-centered to truly team-, patient-, and family-centered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Comportamento Cooperativo , Médicos Hospitalares/normas , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Comunicação , Médicos Hospitalares/psicologia , Médicos Hospitalares/estatística & dados numéricos , Hospitalização , Humanos , Assistência Centrada no Paciente/normas , Assistência Centrada no Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Melhoria de QualidadeRESUMO
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.
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Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Docentes de Medicina/estatística & dados numéricos , Médicos Hospitalares/estatística & dados numéricos , Prática Privada/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Docentes de Medicina/organização & administração , Feminino , Médicos Hospitalares/organização & administração , Hospitais Comunitários/organização & administração , Hospitais Comunitários/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Recém-Nascido , Gravidez , Estudos RetrospectivosRESUMO
Following Joint Commission recommendations for standardizing patient handoffs, direct peer observations and feedback were utilized in order to improve patient safety related to transitions of care in the Division of Pediatric Hospital Medicine at Kapi'olani Medical Center for Women & Children. All hospitalist attendings were trained in an evidence-based handoff bundle inclusive of team communication and feedback strategies. For the initial project, each hospitalist performed 12 peer observations and feedback sessions using validated tools for verbal and written handoffs over 6 months. For a subsequent "refresher" project, each hospitalist performed 6 handoff observations. Attendings were surveyed several times before, during, and after completion of the multiple iterations of the project. A qualitative interview was conducted 6 years after the initial handoff project. In total, 204 observations were completed by 17 hospitalists during the initial project. The perceived overall quality of the patient handoff improved significantly across shifts (P < .001 for the quality of each of two critical daily handoffs) as did pediatric hospitalists' confidence in providing peer feedback (P < .001). Downstream effects of this activity led to additional benefits towards the cohesive growth of the division. Themes from post-project qualitative interviews regarding the peer observation and feedback portion of the study included that it was "helpful," "collaborative," and inspired "camaraderie" that led to increased comfort and participation during future opportunities for observation and feedback. Performing direct peer observations with feedback strengthened the workplace culture, promoted growth through collaboration, and allowed acceptance and success of future projects involving peer observations and feedback.
Assuntos
Retroalimentação , Médicos Hospitalares/normas , Cultura Organizacional , Segurança do Paciente/normas , Revisão por Pares/métodos , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Médicos Hospitalares/psicologia , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Segurança do Paciente/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Pesquisa Qualitativa , Local de Trabalho/psicologia , Local de Trabalho/normas , Local de Trabalho/estatística & dados numéricosRESUMO
OBJECTIVES: Hospitalists are increasingly the attending physician for hospitalized patients, and the scheduling of their shifts can affect patient continuity. For dementia patients, the impact is unknown. DESIGN: Longitudinal study using physician billing claims between 2000 and 2014 to examine the association of continuity of care with the insertion of a feeding tube (FT). SETTING: US hospitals. PARTICIPANTS: Between 2000 and 2014, 166,056 hospitalizations of patients with a prior nursing home stay, advanced cognitive impairment, and impairments in four or more activities of daily living (mean age = 84.2 years; 30.4% male; 81.0% white). MEASUREMENTS: Continuity of care measured at the hospital level with the Sequential Continuity Index (SECON; range = 0 to 100; higher score indicates higher continuity). RESULTS: Rates of a hospitalist acting as the attending physician increased from 9.6% in 2000 to 22.6% in 2010, whereas a primary care physician with a predominant outpatient focus acting as the attending physician decreased from 50.3% in 2000 to 12.6% in 2014. Post-2010, a mixture of physician specialties increased from 55.5% to 66.4% with a reduction in hospitalists from 22.6% (2010) to 14.1% (2013). Continuity of care decreased over time with SECON dropping from 63.0 to 43.5. Adjusting for patient baseline risk factors, a nonlinear association was observed between SECON and FT insertion. Using cubic splines in the multivariate logistics regression model, the risk of FT insertion in hospitals where the SECON score dropped from 82 to 23 had an adjusted risk ratio (ARR) of FT insertion of 1.48 (95% confidence interval [CI] = 1.34-1.63); hospitals in which SECON dropped from 51 to 23 had an ARR of FT insertion of 1.38 (95% CI = 1.27-1.50). CONCLUSION: Hospitalized dementia patients in hospitals in which continuity of care was lower had higher rates of FT insertions. Newer models of care are needed to enhance care continuity and thus ensure treatment consistent with likely outcomes of care and goals of care. J Am Geriatr Soc 68:1852-1856, 2020.
Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Demência/enfermagem , Médicos Hospitalares/estatística & dados numéricos , Intubação Gastrointestinal/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Atividades Cotidianas , Idoso de 80 Anos ou mais , Demência/terapia , Feminino , Humanos , Estudos Longitudinais , Masculino , Casas de SaúdeRESUMO
BACKGROUND: Since the launch of pilot programs in 2016, varying ranges of hospitalist coverage exist in Korea. We evaluated the effects of differing depths of hospitalist coverage on clinical outcomes. METHODS: This study retrospectively reviewed the records of 513 patients admitted to a medical hospitalist unit through emergency department at Seoul National University Hospital. The full-time group included patients admitted in 2018 who received 24/7 hospitalist service, whereas the weekday group included patients admitted in 2019 with only weekday hospitalist service. In-hospital clinical outcomes were compared between the two groups. RESULTS: Unplanned intensive care unit admission rate was lower in the full-time group than in the weekday group (0.4% vs. 2.9%; P = 0.042). Discharges to local hospitals for subacute or chronic care were more frequent in the full-time group than in the weekday group (12.6% vs. 5.8%; P = 0.007). The weekday coverage was a predictive factor of in-ward mortality (odds ratio, 2.00; 95% confidence interval, 1.01-3.99) after adjusting for potential confounding factors. CONCLUSION: Uninterrupted weekend coverage hospitalist service is helpful for care-plan decision and timely care transitions for acutely and severely ill patients.
Assuntos
Médicos Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente , República da Coreia , Estudos RetrospectivosAssuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Médicos Hospitalares/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Pediatras/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , Criança , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Humanos , Irã (Geográfico)/epidemiologia , Doenças Profissionais/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Fatores de Risco , SARS-CoV-2RESUMO
Importance: Evidence is lacking on the consequences of high rates of inpatient consultation. Objective: To examine outcomes and resource use of patients cared for by hospitalists who use more inpatient consultation than their colleagues. Design, Setting, and Participants: A retrospective cohort study of medical admissions to hospitalists among fee-for-service Medicare beneficiaries was conducted. Hospitalist consultation tendency was identified from January 1, 2013, to December 31, 2014; admissions were calculated in 2013; and outcomes were measured in 2014. Data were analyzed from January 31, 2017, to May 9, 2019. A total of 711â¯654 admissions with patients receiving care from 14â¯584 hospitalists at 737 hospitals were included. Exposure: Admission to high-consulting hospitalists, considered to be those who were in the top 25% of the distribution of consulting frequency at their own hospital (adjusted for patient case mix). Main Outcomes and Measures: Outcomes included length of stay, Medicare Part B inpatient charges, discharge destination, all-cause 7- and 30-day readmissions, 90-day outpatient specialist visits, and 30-day mortality. Results: The 711â¯654 hospital admissions included 408 489 women (57.4%); mean (SD) age of the population was 80 (8.5) years. Length of stay of patients cared for by high-consulting hospitalists was longer compared with other hospitalists (adjusted incidence rate ratio, 1.04; 95% CI, 1.03-1.05). The admissions resulted in a mean of $137.91 (95% CI, $118.89-$156.93) more in Medicare Part B charges and were less likely to end with the patient going home (adjusted odds ratio [aOR], 0.96; 95% CI, 0.94-0.98) compared with patients cared for by other hospitalists in the cohort. Patients cared for by high-consulting hospitalists also were 7% more likely than patients cared for by other hospitalists to see an outpatient specialist at 90 days (aOR 1.07; 95% CI, 1.05-1.09), with no significant differences in 30-day mortality (aOR 1.01, 95% CI, 0.98-1.03) or readmissions (7-day readmissions: aOR 1.01; 95% CI, 0.98-1.03; 30-day readmissions: aOR, 1.01; 95% CI, 0.99-1.03). Conclusions and Relevance: Hospitalists who obtain consultations more than their colleagues at the same institution were associated with greater use of health care resources without apparent mortality benefit. Further investigation should identify whether reducing high rates of consultation can reduce resource use without harming patients.
Assuntos
Médicos Hospitalares/estatística & dados numéricos , Hospitalização , Medicare , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Inpatient dermatology has been shown to improve patient outcomes at a reduced cost. Few hospitals have dermatologists available. Teledermatology may allow dermatologists to assess hospitalized patients remotely. OBJECTIVE: To examine the diagnostic concordance between a hospitalist, dermatologist, and teledermatologist using store-and-forward teledermatology. METHODS: For 100 consecutive patients requiring inpatient dermatology consultation, a survey was conducted by all 3 raters to convey diagnostic impressions and therapeutic recommendations. Complete and partial agreements were assessed using the Cohen kappa statistic. RESULTS: Inpatient dermatology consultation often resulted in a change in diagnosis (50.9%) and a change in systemic therapy (41.5%). Likewise, virtual teledermatology consultation would have resulted in a change in diagnosis (54.7%) and a change in systemic therapy (47.2%) at similar rates. Comparing the dermatologist and teledermatologists, diagnostic complete and partial agreement were 52.8% and 84.9%, respectively. Systemic therapy agreement was 77.4%. Teledermatologists recommended biopsy more often (68.5% vs 43.5%). LIMITATIONS: Small sample size, tertiary academic medical center, single rater for inpatient teledermatology with specific inpatient niche. CONCLUSION: Teledermatologists performed comparably to an in-person dermatologist for the diagnosis and management of hospitalized patients with skin conditions. Teledermatology may be a suitable alternative for delivery of inpatient care if no dermatologist is available.