Big brother or big opportunity? Utilization of EHR use metadata in the inpatient setting: A mixed methods study at 16 organizations.

Background: Clinician electronic actions within the electronic health record (EHR) are captured seamlessly in real-time during regular work activities in all major EHRs. Analysis of this EHR use metadata, such as audit log data, is increasingly used to understand the impact of work design on critical patient, workforce, and organizational outcomes.

Objective: Understand experiences and perspectives influencing the use and implementation of audit log data into practice.

Perspectives of In-Hospital Intramuscular Naltrexone and Oral Medications for Alcohol Use Disorder: A Study of Addiction Clinicians and Hospitalized Patients.

Background: Alcohol-related hospitalizations are rising; however, medications for alcohol use disorder (M-AUD) are underprescribed despite their effectiveness to reduce heavy drinking. In-hospital administration of intramuscular (IM)-naltrexone may reduce negative health outcomes among people with AUD who are unable to take daily MAUD.

Objective: To assess addiction clinicians' perceptions of offering and administering IM-naltrexone and to assess hospitalized patients' perspectives on their alcohol use and acceptance of MAUD.

Optimizing learners on direct care teaching services: A qualitative study of hospitalist clinicians at 26 sites.

Background: Academic medical centers are experiencing rapid clinical growth which has outpaced traditional teaching services. Learners such as medical students, advanced practice provider fellows, and residents may be placed onto direct care teaching services (i.e.

Assessing the impact of workload and clinician experience on patient throughput: A multicenter study.

Background: Various strategies have attempted to address increased patient lengths of stay (LOS), but effectiveness varies. Factors related to work design and workforce experience may also play significant roles.

Objective: Utilizing data from the Discharge in the A.

Characterizing hospitalists' comfort and familiarity with LGBTQ clinical topics.

Objectives: Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S.

Characterizing electronic messaging use among hospitalists and its association with patient volumes.

Background: Secure electronic messaging is increasingly being utilized for communications in healthcare settings. While it likely increases efficiency, it has also been associated with interruptions, high message volumes, and risk of errors due to multitasking.

Objectives: We aimed to characterize patterns of secure messaging among hospitalists to understand the volume of messages, message patterns, and impact on hospitalist workload.

A Qualitative Study of Internal Medicine Subspecialty Fellowship Program Directors' Perspectives on Short-Term Hospitalist Employment Prior to Fellowship.

Some internal medicine (IM) residents pursuing subspecialty training choose short-term hospitalist employment prior to fellowship, or "pre-fellowship hospitalist years." Residency and fellowship program directors (PDs) advise residents on this decision, but PD experience with fellows pursuing pre-fellowship hospitalist years and the impact on fellowship applications is unknown. We aimed to explore perceptions of fellowship PDs regarding experience with fellows who pursued pre-fellowship hospitalist years, including perceived effects on how such years affect fellowship application candidacy.

Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders.

Importance: Administrative harm (AH), defined as the adverse consequences of administrative decisions within health care that impact work structure, processes, and programs, is pervasive in medicine, yet poorly understood and described.

Objective: To explore common AHs experienced by hospitalist clinicians and administrative leaders, understand the challenges that exist in identifying and measuring AH, and identify potential approaches to mitigate AH.

Design, Setting, And Participants: A qualitative study using a mixed-methods approach with a 12-question survey and semistructured virtual focus groups was held on June 13 and August 11, 2023.

Language Matters: Is There Gender Bias in Internal Medicine Grand Rounds Introductions?

Purpose:  We performed an exploratory evaluation of gender-specific differences in speakers and their introductions at internal medicine grand rounds.

Method:  Internal medicine grand rounds video archives from three sites between December 2013 and September 2020 were manually transcribed and analyzed using natural language processing techniques. Differences in word usage by gender were compared.

Attention Among Health Care Professionals : A Scoping Review.

Background: The concept of attention can provide insight into the needs of clinicians and how health systems design can impact patient care quality and medical errors.

Purpose: To conduct a scoping review to 1) identify and characterize literature relevant to clinician attention; 2) compile metrics used to measure attention; and 3) create a framework of key concepts.

Data Sources: Cumulated Index to Nursing and Allied Health Literature (CINAHL), Medline (PubMed), and Embase (Ovid) from 2001 to 26 February 2024.

Virtual hospital care development and deployment: A rapid qualitative study of frontline clinicians and leaders.

Background: Virtual hospitalist programs are rapidly growing in popularity due to worsening clinician shortages and increased pressure for flexible work options. These programs also have the potential to establish sustainable staffing models across multiple hospitals optimizing cost. We aimed to explore the current state of virtual hospitalist services at various health systems, challenges and opportunities that exist in providing virtual care, and future opportunities for these types of services.

The development and pilot of a novel mobile application to assess clinician perception of workload and work environment.

Background: Traditional measures of workload such as wRVUs may not be adequate to understand the impact of workload on key outcomes.

Objective: The objective of this study was to develop a mobile application to assess, in near real time, clinicians' perception of workload and work environment.

Designs, Settings And Participants: We developed the GrittyWork™ application (GW App) using the Chokshi and Mann process model for user-centered digital development.

Impact of billing reforms on academic hospitalist physician and advanced practice provider collaboration: A qualitative study.

Background: Medicare previously announced plans for new billing reforms for inpatient visits that are shared by physicians and advanced practice providers (APPs) whereby the clinician spending the most time on the patient visit would bill for the visit.

Objective: To understand how inpatient hospital medicine teams utilize APPs in patient care and how the proposed billing policies might impact future APP utilization.

Design, Setting And Participants: We conducted focus groups with hospitalist physicians, APPs, and other leaders from 21 academic hospitals across the United States.

Hospitalist Shared Leadership for Safety, Health, and Well-Being at Work: United States, 2022‒2023.

We assessed how hospitalists frame workplace safety, health, and well-being (SHW); their perception of hospital supports for SHW; and whether and how they are sharing leadership responsibility for each other's SHW. Our findings highlight the important role of local support for hospitalist SHW and reveal the systemic, hospital-wide problems that may impede their SHW. We believe that positioning hospitalists as leaders for SHW will result in systems-wide changes in practices to support the SHW of all care team members.

A patient follow-up intervention to improve medical decision making at an internal medicine residency program.

Objectives: Practice-based learning and improvement (PBLI) is an ACGME (Accreditation Council for Graduate Medical Education) core competency. Learning and reflecting on patients through follow-up is one method to help achieve this competency. We therefore designed a study evaluating a structured patient follow-up intervention for senior internal medicine (IM) residents at the University of Colorado Hospital (UCH).

The Impact of Completing X-Waiver Training and Clinical Addiction Exposure on Internal Medicine Residents Treating Patients With Opioid Use Disorder.

Background: Treating opioid use disorder (OUD) with buprenorphine or methadone significantly reduces overdose and all-cause mortality. Prior studies demonstrate that clinicians and residents reported a lack of preparedness to diagnose or treat OUD. Little is known about how clinical exposure or buprenorphine X-waiver training impacts OUD care delivery by resident physicians.

Evaluation of a Guided Nature and Forest Therapy Walk for Internal Medical Residents - A Brief Report.

Background: Medical residents commonly face compassion fatigue, burnout, anxiety, and depression. Studies of nature-based interventions show improved mental and physical health; few focus on healthcare providers.

Objective: To explore potential benefits of forest bathing for medical residents' wellbeing.

Impact of Clinical Demands on the Educational Mission in Hospital Medicine at 17 Academic Medical Centers : A Qualitative Analysis.

Background: Clinical growth is outpacing the growth of traditional educational opportunities at academic medical centers (AMCs).

Objective: To understand the impact of clinical growth on the educational mission for academic hospitalists.

Design: Qualitative study using semistructured interviews that were analyzed using a mixed inductive and deductive method at the semantic level.

Interventions to Reduce Inappropriate Physical Therapy Consultation in the Inpatient Setting: A Quality Improvement Initiative.

Physical therapy (PT) in inpatient settings is a limited and valuable resource. Inappropriate PT consultation is costly and can lead to delays in care and discharge planning. Baseline data at an academic hospital revealed that approximately one in four PT consults were inappropriate (n = 29,230) across all services, as defined by an activity measure post-acute care "6-Clicks" basic mobility score of >22.

Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.

Background: Few hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors.

Objectives: To build surveillance for diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates.

Methods And Analysis: Achieving diagnostic excellence through prevention and teamwork (ADEPT) is a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes.

Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial.

Importance: Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.