As the year draws to a close, the Today’s Hospitalist staff is looking back at the articles that best represent the year. We factored in the attention readers gave articles on our Web site and social media outlets and in letters to the editor, as well as our own favorites. Here are our picks for the top Today’s Hospitalist articles of 2018.
1. SCOPE OF PRACTICE. One ever-evolving topic is hospitalists’ scope of practice. In “Transitional care clinic delivers fewer readmissions” (May), hospitalists in one Appalachian health system provide immediate post-discharge care to high-risk patients. “Getting virtual care off the ground” (November) explores another promising avenue that hospitalists—as “virtualists”—may choose to take.
“Hospital at home” (August) presents a type of practice some hospitalists will want to embrace. But our top pick generated the most heat: “No one taking your calls?” (July) explores the reality that hospitalists are now the nation’s de facto intensivists—a practice, some readers said, that crosses a line, with hospitalists taking on care they’re not trained to provide. But other readers pointed out that hospitalists are in the ICU to stay, and they need training without a three-year fellowship.
2. YOUR CAREER. Several articles showed hospitalists either boosting their skills or filling new leadership roles. In “Physician advisors: Young doctors should apply” (May), we report on hospitalists pushing the advisor role into system redesign. “Disaster planning: Why aren’t hospitalists at the table?” (December) makes the case for hospitalists leading emergency planning and management in their hospitals.
The top pick lays out a unique career approach. In “Per diem work: Is the grass really greener?” (March), we look at how PRN doctoring—with physicians choosing where and how often they practice—works out for both the hospitalists making that choice and the programs that hire them.
3. PRACTICE MANAGEMENT. Practice management is one of our most covered topics, and this year was no exception. “Who owns what in inpatient metrics?” (October) reports on how one group attributes personal performance. “Recruiting: It’s everyone’s job No. 1” (July) suggests ways in which group members can help “sell” their practice and safeguard their work-life balance.
“Keeping nocturnists happy” (January) proves yet again that satisfied nocturnists are key to a successful program. And “What’s in your incentive plan?” (November) looks at how bonuses and incentives influence group practice.
Our top pick: “Want to succeed with unit-based care?” (April) revisits one of hospital medicine’s biggest innovations, and one of its toughest to implement.
4. CLINICAL MEDICINE. “The five most common errors in the ICU” (March) lays out what both hospitalists and intensivists get wrong. “This year’s big stroke headlines” (December) reports new evidence that expands the time frame for thrombectomy—and puts pressure on hospitals to transfer patients to centers that can do that procedure.
“Treating opioid use disorder in the hospital” (May) highlights the growing need for hospitalists to begin initiating opioid agonist therapy. And “SNF bouncebacks: Which patients are at high risk?” (July) presented interventions to reduce SNF readmissions.
The popularity of the top pick—”Periop meds: What should you hold?” (June)—speaks to hospitalists’ big roles in preop evaluations and surgical comanagement.
5. MEDICAL OVERUSE. Many articles took a hard look at common practices that need to be curtailed or eliminated. “How to avoid C. diff overtesting” (September) reports on modifying electronic test orders to prevent unneeded treatment. “Cutting back on unnecessary telemetry” (October) suggests ways to scale back that costly monitoring.
“What’s the evidence? Weak at best” (September) delves into two common practices that may be harmful. This year’s top pick: “Time to scale back VTE prophylaxis?” (August) presents new evidence revealing rampant prophylactic overuse.
6. COMMUNICATIONS. Several articles explored ways clinicians communicate, including the technology they use. “How are you connecting?” (September) discusses secure mobile texting, while “Tired of chasing consultants?” (December) proposes solutions to smooth out consultant communications.
This year’s top pick: “In a standoff with the ED?” (February) takes on what one source in the article calls “a very complex communication scenario”: who gets to make admission decisions.
7. PATIENT SAFETY AND EXPERIENCE. In “A big tent helps cut infection rates” (June), daily safety huddles engage an entire hospital in infection control. “Turn it up!” (January) presents surprising solutions to improve patients’ sleep.
Our top pick: “When nutrition is the best medicine” (March) describes an intervention—delivering fresh food to patients with diabetes, heart failure and hypertension—that many hospitals can’t offer. But it speaks to the growing trend of hospitals launching interventions to address socioeconomic factors and improve community health.
8. COMMENTARY. Today’s Hospitalist has always had readers who are also excellent writers. This year, “Doctor, I am just double-checking … ” (November) gives a nod to a changing culture where nurses can speak up. In “Quality of life and the EMR” (June), the sixth-grade daughter of a hospitalist provides sound science and this important message: Your kids would love you to spend time with them, not your computer.
Other commentaries were more hard-hitting. In “Over-sharing” (March), a hospitalist confronts what he sees as failing a patient. In “Coping with grief and guilt” (May), an intensivist describes helping family members make excruciating decisions, lessons he’s learned not only through his practice but through losing a child of his own.
In our top pick, “Physician suicide: going beyond wellness” (July), two authors share their research into soaring rates of physician suicide. They also recount friends and family members who were doctors who died by their own hand.
9. BY THE NUMBERS. This far-ranging department covers not only the ins and outs of billing—like “Switching inpatient to obs: How do you bill?” (May)—but data that hospitalists can use to inform their practice.
“Cutting down” (June), for instance, gives hospitalists the evidence they need to talk to patients about their alcohol use. “Going berserk” (September) highlights a checklist to help clinicians determine which hospitalized patients are at high risk of violence.
Our top pick—”Mix madness” (April)—delves into payer mix, which may seem “like a macroeconomic force light years from the point of care,” its author writes. But that mix can determine how many daily encounters you have and how solvent your program will be.
10. PROGRESS NOTES. It’s our pleasure to host this delightful, biting department with comic commentaries written by a hospitalist. Just in time for this year’s midterms, “A capital idea” (October) makes the case that policy-makers assume that hospitals can solve just about any problem. “Translate MD” (April) highlights the phrases hospitalists resort to when they have bad news or aren’t sure of a diagnosis.
Our top pick—”Burnout and its solutions” (August) is a funny take on a very serious topic. Solving burnout isn’t about relaxation techniques or mindfulness training, according to the piece, but a lower census and fewer “stupid little administrative tasks.”