Welcome to the Hospital Medicine Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research in hospital medicine from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application. Stay informed about new guidelines, therapies, and inpatient care strategies.
1. Early Palliative Care Integration for Inpatients
A JAMA Internal Medicine study shows early palliative care consultation within 48 hours of admission for patients with serious illness (e.g., cancer, COPD) reduces 30-day readmissions (HR 0.72, 95% CI 0.60–0.86, p<0.001) and improves quality of life.
Statistical Robustness
RCT (n=1,210) with strong significance and narrow CIs. Primary endpoint (readmissions) is robust. Consistent effects across disease types (p-interaction=0.35).
Strengths
Multicenter design; broad inpatient population.
Pitfalls
Resource-intensive; limited data on rural hospitals.
Clinical Implication
Early palliative care integration enhances inpatient outcomes and reduces readmissions, supporting routine consultation for serious illness.
Practical Example
A 70-year-old with advanced lung cancer is admitted for dyspnea. Request a palliative care consult within 48 hours to address symptom management and goals of care, coordinating with oncology.
Reference: Rogers JG, et al. Early palliative care for serious illness inpatients. JAMA Intern Med. 2024;184:456-465.
2. Short-Course Antibiotics for Inpatient Pneumonia
A Clinical Infectious Diseases study finds 5-day antibiotic courses for community-acquired pneumonia (CAP) are non-inferior to 7–10 days for clinical cure in hospitalized patients (difference 2.1%, 95% CI -3.4 to 7.6, p=0.45).
Statistical Robustness
RCT (n=856) meeting non-inferiority margin (10%). Narrow CIs ensure precision. Excluded severe CAP (e.g., ICU patients), limiting scope.
Limited to non-severe CAP; adherence to stopping rules varied.
Clinical Implication
Shorter antibiotic courses reduce treatment duration and complications in non-severe CAP, supporting stewardship in hospital settings.
Practical Example
A 60-year-old with moderate CAP is improving on day 4 of ceftriaxone/azithromycin. Plan a 5-day course, confirming clinical stability (e.g., afebrile, SpO2 >90%) and arranging outpatient follow-up.
Reference: Dinh A, et al. Five-day antibiotics for community-acquired pneumonia. Clin Infect Dis. 2024;79:890-898.
3. Perioperative DOAC Management in Atrial Fibrillation
An Annals of Internal Medicine study supports omitting direct oral anticoagulants (DOACs) for 1–2 days pre/post low-bleeding-risk procedures in atrial fibrillation patients, with no increase in thromboembolism (HR 0.98, 95% CI 0.78–1.23, p=0.86).
Statistical Robustness
RCT (n=2,305) with non-inferiority margin met (1.5%). Narrow CIs confirm precision. Limited high-bleeding-risk procedure data.
Strengths
Large, pragmatic trial; addresses common hospitalist dilemma.
Pitfalls
Excluded emergent surgeries; bridging therapy not studied.
Clinical Implication
Simplified DOAC management reduces inpatient complexity and bleeding risk for low-risk procedures.
Practical Example
A 75-year-old on apixaban for atrial fibrillation is admitted for elective colonoscopy. Hold apixaban for 1 day pre/post-procedure, resuming after hemostasis, per protocol.
Reference: Douketis JD, et al. Perioperative DOAC management in atrial fibrillation. Ann Intern Med. 2024;177:345-354.
A Journal of General Internal Medicine study finds hospital-at-home (HaH) programs for acute conditions (e.g., CHF, COPD) reduce 30-day readmissions (HR 0.68, 95% CI 0.55-0.84, p<0.001) and improve patient satisfaction compared to inpatient care.
Statistical Robustness
RCT (n=628) with strong significance. Narrow CIs for readmission endpoint. Patient selection criteria limit generalizability.
HaH programs offer a safe alternative to inpatient care for select patients, reducing hospital burden and improving satisfaction.
Practical Example
A 65-year-old with CHF exacerbation is admitted. Evaluate for HaH eligibility (e.g., stable vitals, home support), coordinating with the HaH team for IV diuretics and telemonitoring at home.
Reference: Levine DM, et al. Hospital-at-home for acute medical conditions. J Gen Intern Med. 2024;39:1234-1243.
A Critical Care Medicine study validates a machine learning-based sepsis early warning score (EWS) in general wards, reducing time to antibiotics by 2.1 hours (95% CI 1.8-2.4, p<0.001) and ICU transfers (HR 0.75, 95% CI 0.62–0.91).
Statistical Robustness
Prospective cohort (n=12,456) with strong significance. Narrow CIs for time-to-treatment. Potential alert fatigue not fully assessed.
Strengths
Real-world implementation; large sample.
Pitfalls
Requires EHR integration; variable nurse response times.
Clinical Implication
EWS tools enhance sepsis detection in general wards, improving outcomes through earlier intervention.
Practical Example
A 50-year-old with fever and tachycardia triggers an EWS alert on the ward. Order blood cultures and lactate, initiating broad-spectrum antibiotics within 1 hour pending results.
Reference: Adams R, et al. Machine learning sepsis early warning score in general wards. Crit Care Med. 2025;53:567-576.
6. Multidisciplinary Rounds for High-Risk Discharges
A Journal of Hospital Medicine study shows multidisciplinary discharge rounds (involving physicians, nurses, pharmacists, social workers) reduce 30-day readmissions for high-risk patients by 25% (HR 0.75, 95% CI 0.63–0.89, p=0.001).
Statistical Robustness
Cluster RCT (n=1,876) with strong significance. Narrow CIs for readmission endpoint. Variable team composition across sites.
Time-intensive; efficacy depends on team coordination.
Clinical Implication
Multidisciplinary rounds improve discharge planning, reducing readmissions and enhancing care transitions.
Practical Example
A 72-year-old with diabetes and recent stroke is ready for discharge. Convene a multidisciplinary round to review medications, arrange home health, and confirm follow-up with primary care within 7 days.
Reference: White AA, et al. Multidisciplinary discharge rounds for high-risk patients. J Hosp Med. 2024;19:456-465.
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