January 2019 • Vol. 112 • No. 01

Clinical Utility of Routine Chest X-Rays During the Initial Stabilization of Trauma Patients

The Advanced Trauma Life Support (ATLS) course encourages the use of chest x-ray (CXR) to identify injuries that may change clinical management during the initial stage of trauma resuscitations. Several studies have failed to show benefit for the routine use of CXR without a clinical indication however. The authors sought to validate these findings by determining the incidence of clinically significant findings discovered on a portable single-view CXR during the initial stabilization of trauma patients at a level 1 trauma center.

February 2019 • Vol. 112 • No. 02

Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management

Acute pyelonephritis is a common diagnosis, particularly among women of reproductive age and middle-aged women, and leads to a large number of hospitalizations. The current recommendations favor computed tomography (CT) with contrast to evaluate for perinephric abscess in patients at risk of this complication or who do not respond to appropriate medical therapy within a few days.

March 2019 • Vol. 112 • No. 03

Characteristics of Syncope Admissions Among Hospitals of Varying Teaching Intensity

Syncope is a common reason for hospital admission and often is associated with high-cost, low-value diagnostic testing. There is a strong body of research showing that processes of care at teaching hospitals vary significantly from those at nonteaching hospitals. Despite its diagnostic challenge and high incidence, the relation between inpatient syncope management and teaching status has not been extensively studied, and the authors sought to characterize it. Findings of significantly different management of syncope among hospitals of varying teaching intensity would be meaningful for a number of reasons.

April 2019 • Vol. 112 • No. 04

Comparison of Factors Identified by Patients and Physicians Associated with Hospital Readmission (COMPARE2)

Factors contributing to hospital readmission have rarely been sought from the patient perspective. Furthermore, it is unclear how patients and physicians compare in identifying factors contributing to readmission. The objective of the study was to identify and compare factors contributing to hospital readmission identified by patients and physicians by surveying participants upon hospital readmission to a teaching medicine service.

May 2019 • Vol. 112 • No. 05

Patients on Involuntary Hold Status in the Emergency Department

Patients requiring involuntary holds are frequently seen in the emergency department. Much of what is known comes from studies of patients at urban academic centers. Identification of social stressors, psychiatric disorders, substance misuse, and active medical conditions in these patients may help target interventions to improve care in the acute care hospital emergency department.

June 2019 • Vol. 112 • No. 06

Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center

Healthcare professionals are at higher risk for workplace violence (WPV) than workers in other sectors. This elevated risk exists despite the vast underreporting of WPV in the medical setting. The challenge of responding to this risk is compounded by limited empirical research on medical training environments. Understanding trainees’ experience and educating them on workplace safety, WPV reporting, and awareness of resources are shared goals of educational and institutional leadership.

July 2019 • Vol. 112 • No. 07

Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates

The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Postdischarge telephone calls to patients are a relatively simple intervention that could improve the continuity of care and reduce readmission risk as patients transition from an inpatient setting to home with home care.  The authors sought to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients’ ratings of hospital care and hospitalist communication.

August 2019 • Vol. 112 • No. 08

Moral Controversy and Working with Colleagues with a Shared Ethical/Moral Outlook: A National Survey of US Primary Care Physicians

Moral controversy in health care may pose a particular challenge for physicians with lower commitments to theological pluralism. In this national study of PCPs, physicians who identified as religious, spiritual, or having a high sense of calling were found to place a stronger emphasis on the importance of shared ethical/moral outlook with work colleagues regarding morally controversial healthcare practices.

September 2019 • Vol. 112 • No. 09

Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study

Emergency clinicians face an increased risk of burnout because of the nature of their profession. They are considered to be in the medical specialty at highest risk for burnout. Health systems across the United States are incorporating trainings in an effort to decrease the prevalence of burnout among emergency clinicians. It is suggested that education programs can be useful in ameliorating burnout if adapted to a unit’s culture. Healthcare organizations should provide resources to clinicians that provide a toolkit of methods to manage and process workplace stress.

October 2019 • Vol. 112 • No. 10

A More Directive Living Will for Older Adult Patients with End-Stage Medical Conditions?

Many older adult patients want to be treated aggressively for reversible conditions, even when their current quality of life is limited; however, most standard living wills focus on the very end of life and provide little guidance to acute care providers (ACPs) should their older adult patient be admitted with a potentially treatable acute condition and temporarily lose capacity. The authors developed what they believe is a more informational and directive living will for this population, and sought to determine whether ACPs would find the pilot living will more helpful when caring for their older adult patients.

November 2019 • Vol. 112 • No. 11

Impact of β-Lactam Allergies on Antimicrobial Selection in an Outpatient Setting

Many older adult patients want to be treated aggressively for reversible conditions, even when their current quality of life is limited; however, most standard living wills focus on the very end of life and provide little guidance to acute care providers (ACPs) should their older adult patient be admitted with a potentially treatable acute condition and temporarily lose capacity. The authors developed what they believe is a more informational and directive living will for this population, and sought to determine whether ACPs would find the pilot living will more helpful when caring for their older adult patients.

December 2019 • Vol. 112 • No. 12

A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost

Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow and is recognized as one of the primary causes of ED overcrowding. Studies have shown that hospitals operating at or near maximumcapacity have an increased ED length of stay (LOS), which is associated with multiple negative downstream consequences, including patient dissatisfaction, inappropriate utilization of resources, and decreased quality of care. Hospitalist-led management of admitted patients boarding in the ED has been identified as a potential solution to improve patient flow. The authors sought to examine the impact on patient flow and potential for cost savings by an active management of boarded ED medical admissions by a hospitalist-led team, which included a hospitalist, an advanced practitioner, and a case manager.

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