Latest news with #hospitalists
Medscape
26-05-2025
- Health
- Medscape
When Hospitalists Have a Bad Day
It was early in the pandemic when hospitalist Ethan Molitch-Hou treated a woman admitted with COVID-19 who was severely ill. 'We had kept her going, but it reached the point where I knew she was not going to make it out of the hospital,' said Molitch-Hou, MD, MPH, now an assistant professor and director of the Hospital Medicine Sub-Internship at the University of Chicago, Chicago. Molitch-Hou joins a few other hospitalists sharing with Medscape Medical News their most difficult day in the hospital, from saving lives to losing them, missing family to second-guessing procedures. Ethan Molitch-Hou, MD, MPH 'As it was the beginning of the pandemic, we had restrictions on visitors,' Molitch-Hou recounted. 'I had been talking with the woman's son every day. Unfortunately, it was Mother's Day when she passed, and I had to hold the phone during their last conversation.' While he served as an intermediary for other patients in this way, Molitch-Hou said the mother-son scenario hit him harder that day because he lost his own mother a year earlier. 'I had been practicing as an attending for 9 years at that point, and I have lost several patients over the years. The pandemic was filled with one sad story after another as we struggled to figure out our best treatment plans, and the day she passed brought a sense of hopelessness. The isolation made it so much harder for patients, and unfortunately, we had many stories like this,' he said. 'In general, any day that you lose a patient or have a bad outcome is challenging, but the frequency of those bad outcomes during COVID made this loss that much worse.' Bearing Witness For Nikhil Sood, one of his most difficult days was bearing witness to a couple in their final distressing hours together. 'I work in a cancer hospital where I care for vulnerable and terminally ill patients,' said Sood, MD, a hospitalist at Banner Gateway Medical Center in Gilbert, Arizona. 'I was caring for a young patient with metastatic cancer who had failed all treatments. The oncologist had recommended hospice care the day before I met him,' explained Sood, who is also an assistant professor and clinical scholar at the University of Arizona College of Medicine in Phoenix. It had been a long, stressful night for the patient and his wife as they grappled with their harsh reality. 'I entered the room and observed a young cachectic patient sitting in bed with tears rolling down his cheeks. Leaning onto his shoulder, I saw his wife, with fear and sadness in her eyes, hoping for a miracle,' Sood recalled. 'I sat down, and we talked about their life and their cancer journey. At the end of our conversation, I asked them, 'How can I help?' The wife hesitantly responded, 'Can you order something for us? We have not eaten in more than 24 hours.' I replied, 'I most certainly can.'' Nikhil Sood, MD The woman broke down in tears while Sood struggled to maintain composure, he recounted. 'As I walked away, I reflected on the difference I made by showing empathy, making them feel heard, connecting with them, and relating to their situation. We transitioned him to comfort care, and he passed away within 24 hours, surrounded by family, in as much peace as we could provide.' That day made Sood evaluate the 'emotional weight of being a hospitalist in a cancer center, not just managing critical illness but shepherding families through the darkest moments of their lives,' he said. 'I carry her memory with me and often think about how we, as hospitalists, hold space for both suffering and grace. It reminded me that medicine is not always about curing; sometimes it's about bearing witness and easing suffering with humanity and humility.' Even the Saves Bring Stress Saving lives also can create a difficult day for a hospitalist. Andrea Braden, MD, recalled such an experience one Christmas Eve. 'I arrived that morning at 8 AM for my shift,' said Braden, an OB/GYN hospitalist and lead clinical educator for TeamHealth in Atlanta. 'In the midst of laughing with a pregnant patient I was caring for about the fact that we would be spending Christmas together that year, I got an emergency call from the labor and delivery charge nurse asking me to come check on a laboring patient,' Braden said. 'From the moment I walked in the patient's room, I knew something was very wrong. I took her back for a stat C-section just in the nick of time. Her uterus had ruptured, and both mom and baby's lives were imminently at risk.' Andrea Braden, MD While Braden was relieved to save lives, she admits the emotional toll of the event lasted much longer than those few tense moments of surgery. 'I have seen countless obstetric emergencies in my 18-year career. But for some reason, this one broke me. I couldn't sleep. I kept waking up with a startle every time I did fall asleep. And I couldn't close my eyes without seeing replays of that delivery. I couldn't stop crying.' Braden also admits the honor of saving lives comes at a cost to hospitalists like herself. 'What continues to haunt me is the duality of feeling grateful that I was there that Christmas Eve morning to save a mom and baby's lives and simultaneously resentful for — once again — giving up the opportunity to make precious memories with my own family.' It's the career path she chose, she concedes. 'I have grown accustomed to the fact that I have always been expected to sacrifice nights, weekends, and holidays for the safety of my patients. But it still hurts.' On Your Own The most difficult day for Monique Nugent was her first one after residency without a supervisor. 'I had 18 patients, and I did not get to the last one until 7:30 PM,' said Nugent, MD, MPH, a hospitalist at South Shore Hospital in Weymouth, Massachusetts. 'I didn't eat lunch, and I didn't take a break,' recalled Nugent of her more than 12-hour day caring for patients. 'I was really on my own for the first time, and suddenly I lacked confidence. I was a confident and efficient resident and chief resident. Yet, that day, I was very aware that no one was checking on me, and that realization suddenly made me doubt myself, and I became inefficient.' Nugent said she second-guessed her decisions. 'I was getting stuck on basic information and decisions. I felt overwhelmed. I did not get home till close to 11. I cried to my husband: There is no way I can do this job. I'm not going to be good at it if I can't get through the first day.' Monique Nugent, MD, MPH She even considered not going back to work the next day. 'It was the realization that I was truly a doctor. I truly have to make decisions. There is no one to double-check my work or encourage my professionalism or keep me motivated.' But the next day she gained her confidence back. 'I got much better at what I do. I'm a totally different physician than I was 13 years ago. I was a scared new doctor, but I made it through, and that makes me proud.'
Medscape
16-05-2025
- Health
- Medscape
Hospitalists Lead Charge Against HAIs
It reads like the alphabet soup of healthcare: CDI, MRSA, CAUTI, and VAE. Those letters all fall under the category of hospital or healthcare-acquired infections (HAIs), and they can wreak havoc on patient care. On any given day, about 1 in 31 hospital patients has at least one HAI, according to the Centers for Disease Control and Prevention (CDC). The good news: As of 2023, the numbers demonstrated an improvement from the decade prior, but even a single HAI case is one too many. Most HAIs manifest within 48 hours after hospital admission. They are not only a patient-specific problem but also a community-based problem. Some HAIs — like methicillin-resistant Staphylococcus aureus — are linked to multidrug resistance. Preventing and minimizing the spread of these infections are essential to public health. Risk comes down to a facility's infection control practices, a patient's immune status, and the prevalence of pathogens in a given community. 'Healthcare-acquired infections should be a focus for all hospitals and institutions,' said Reina A. Patel, DO, pediatric hospitalist at Phoenix Children's Hospital, Phoenix. 'Any and all of them can be serious, depending on the host and what all they have going on at the time.' When it comes to HAIs, hospitalists are often at the front line of care. Therefore, it's essential that hospitalists understand how to best work with their team to prevent, identify, and optimally treat patients presenting with HAIs. Prevention as the Best Line of Defense The most common HAIs hospitalists encounter include pneumonia, surgical site infections (SSIs), gastrointestinal infections, urinary tract infections, and catheter-associated bloodstream infections. According to the National Institutes of Health, Clostridium difficile is the leading cause of infections, followed by S aureus and Escherichia coli . Transmission is complex and occurs from a wide variety of sources or combinations thereof. The best line of treatment, according to Patel, is prevention. Care bundles encourage consistent, evidence-based standard practices aimed at preventing HAIs. When implemented together, they can often lead to success. They involve three to five simple, clear steps. The key is that every member of the care team uses them, records it, and does so consistently. While that's ideal, it doesn't always happen. 'If I'm going to take care of a central line, there are certain steps I need to follow,' said Patel. 'I need to think about all those steps and whether they are clinically indicated. That knowledge is power and can make a difference.' In addition to care bundles, regular, consistent training on infection control is key. The CDC created its STRIVE curriculum to address both the technical and foundational elements of HAIs. Hospitals can use the modules in new hire training, or annual or periodic training, in the case of rising infection rates. Lora Sparkman, an RN and clinical leader with Relias, a workforce education and enablement solutions provider, has spent the past 5 years focused on virtual reality training, with a special focus on HAI control. 'In a perfect world, every member of the healthcare team is following the critical steps to prevent infection,' she said. 'But you're rapidly reassessing and reformulating the emergency in front of you. Steps get missed and you're only as good as your next infection.' Sparkman views the key to prevention as education and, in this case, changing how hospitals carry out that education. In a collaborative effort, Relias and Emory University launched Project Firstline, the CDC's national training collaborative for healthcare infection control. The training turns the traditional didactic approach on its head and, instead, implements virtual reality training. 'Telling people to wash their hands and watching PowerPoints hasn't moved the dial,' said Sparkman. 'With VR [virtual reality] training, clinicians can 'see' the virtual germs that cause infection, which heightens their awareness. They can also see where they might have missed a step in their prevention steps.' The training is assessment-based and designed for hospitals to use more frequently than traditional annual training and in smaller chunks of time. 'The approach creates recall in the brain so that you're carrying it with you longer and better,' said Sparkman. 'When training is faster and to the point, you're also more likely to get doctors to the table.' When Prevention Fails While prevention is ideal, it's still not always successful. In most cases, when a patient acquires an infection, it swiftly complicates their situation. 'You're treating for one condition and now adding another, which increases length of stay,' said Patel. 'As first line of defense, hospitalists are often the first to notice something is amiss.' The key to treating HAIs when they arise is co-management, said Patel. If you're dealing with an SSI, for instance, your co-manager in the patient's care will be the surgeon. But a hospitalist and a surgeon may have different approaches to care, which is where collaboration comes into play. 'A surgeon will think about the surgical site, which they should,' Patel said. 'But a hospitalist might be on the floor and available, and a nurse will reach out because a patient has a fever. A hospitalist will think of the reasons why that fever is there.' Hospitalists, then, have an advantage in HAI care; they are readily available to jump in at the first indication of infection. They can draw blood cultures, send them to the lab, order imaging, and prescribe treatment, if needed. If the infection is related to a surgery, 'reach out to the surgeon and ask to be there to see the site,' said Patel. 'That way you have a baseline of what the site looks like and can monitor it. If you don't do that, you might only have nurses or surgeons looking at the site in a silo.' That's a mistake because hospitalists are typically the physician with the most touch points with patients. Another member of the care team should be the infectious disease specialist. 'Often there's a decision to make, like how long you need to treat an infection before you can resume treating through a central line, for instance,' said Patel. 'It's definitely coordinated care.' Most institutions are focused on lowering their HAI rates and recognize it's a multidisciplinary approach. For example: In 2023, Patel's institution implemented a two-step bathing process prior to surgery. Six months on and with high compliance, the hospital has dramatically lessened its SSI rates. 'Anyone thinking about HAI prevention should consider all the different angles and services that interact with the patient,' Patel said. 'How do we engage everyone to make a difference?' The answer may lie with hospitalists, who regularly interact with many members of the care team. 'The role of the hospitalist is the specialist in the hospital,' said Sparkman. 'They are on staff around the clock, and they cut across the entire hospital.' Patel agreed. 'How you conduct your rounds, whether by yourself or with a group of learners, is critical,' she said. 'It should be a family-centered rounding, including nurses, pharmacists, and hospitalists, and you should always be thinking about what more you can do for infection control.'
