The Hospital Experience Through the Patients’ Eyes

Background: Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult. Design: Qualitative interview study using grounded theory methodology. Setting: Single-site academic medical center. Patients: Hospitalized general medicine patients. Measurements: Interviews using a semistructured interview guide. Results: We recruited 20 general medicine inpatients from an academic medical center. Of the participants, 12 were women and the mean age was 55 years (range = 22-82 years). We found 4 major themes contributing to the hospital experience: (1) hospital environment (eg, food quality and entertainment), (2) patient factors (eg, indifference and expectations), (3) hospital personnel (eg, care team size and level of helpfulness), and (4) patient feelings (eg, level of control and feeling like an object). We discovered that these emotions arising from hospital experiences, together with the other 3 major themes, led to the patients’ perception of their hospital experience overall. We also explore the role that patient tolerance may play in the reporting of patient satisfaction. Conclusions: This article demonstrates the factors affecting how patients experience hospitalization. It provides insight into possible contributors to posthospital syndrome and offers a blueprint for specific quality improvement initiatives. Lastly, it briefly explores how patient tolerance may prove a challenge to the current system of quality reporting.

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Care Coordination

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0031 ◽

2018 ◽

pp. 163-167

Keyword(s):

Emergency Department ◽

Care Coordination ◽

Medical Center ◽

Academic Medical Center ◽

General Medicine ◽

Ethnically Diverse ◽

Medicine Service ◽

Academic Medical ◽

Diverse Patient Population ◽

Hospital Visits

This case focuses on improving care coordination for patients who have been discharged from the hospital by asking the question: Is it possible to reduce the rate of repeat emergency department and hospital visits after discharge by improving care coordination? The study group included adults admitted to the general medicine service of an urban, academic medical center that serves an “ethnically diverse patient population.” Patients were assigned to nurse discharge advocates who provided the patients with delineated services and assistance during the hospitalization The Project Reengineered Discharge (RED) program substantially reduced repeat emergency department and hospital visits by improving care coordination at the time of hospital discharge.

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Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

Journal of Primary Care & Community Health ◽

10.1177/2150132719840517 ◽

2019 ◽

Vol 10 ◽

pp. 215013271984051 ◽

Cited By ~ 1

Author(s):

Gregory M. Garrison ◽

Rachel L. Keuseman ◽

Christopher L. Boswell ◽

Jennifer L. Horn ◽

Nathaniel T. Nielsen ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Length Of Stay ◽

Medical Center ◽

Academic Medical Center ◽

General Medicine ◽

Inpatient Service ◽

Academic Medical ◽

The Family ◽

Hospital To Home

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

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Expanding access for COVID-19 patients by transforming a burn unit into a closed-circuit unit for surgical patients: experience from an academic medical center in Jordan

Patient Safety in Surgery ◽

10.1186/s13037-020-00251-9 ◽

2020 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Diab Bani Hani ◽

Omar Altal ◽

Abdelwahab Aleshawi ◽

Ala”a Alhowary ◽

Basil Obeidat

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Closed Circuit ◽

Surgical Patients ◽

Academic Medical ◽

Burn Unit ◽

Patients Experience

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Integration of an Academic Medical Center and a Community Hospital: The Brigham and Women???s/Faulkner Hospital Experience

Academic Medicine ◽

10.1097/01.acm.0000235874.96097.ae ◽

2006 ◽

Vol 81 ◽

pp. 18-25

Author(s):

Andrew J. Sussman ◽

Jeffrey R. Otten ◽

Robert C. Goldszer ◽

Margaret Hanson ◽

David J. Trull ◽

...

Keyword(s):

Community Hospital ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Experience ◽

Academic Medical

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Interns' Experiences of Disruptive Behavior in an Academic Medical Center

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00025.1 ◽

2013 ◽

Vol 5 (1) ◽

pp. 25-30 ◽

Cited By ~ 16

Author(s):

Charles P. Mullan ◽

Jo Shapiro ◽

Graham T. McMahon

Keyword(s):

Disruptive Behavior ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Environment ◽

First Year ◽

Convenience Sample ◽

Team Members ◽

Academic Medical ◽

And Gender ◽

Attending Physicians

Abstract Background The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice. Objective To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment. Method All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated. Results A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P = .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P < .001), exclusion from decision making (OR, 6.97; P < .001), and berating (OR, 4.84; P = .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P < .001). Attendings reported other physicians as the most frequent source of disruption. Conclusions Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.

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Integration of an Academic Medical Center and a Community Hospital: The Brigham and Women??s/Faulkner Hospital Experience

Academic Medicine ◽

10.1097/00001888-200503000-00009 ◽

2005 ◽

Vol 80 (3) ◽

pp. 253-260 ◽

Cited By ~ 9

Author(s):

Andrew J. Sussman ◽

Jeffrey R. Otten ◽

Robert C. Goldszer ◽

Margaret Hanson ◽

David J. Trull ◽

...

Keyword(s):

Community Hospital ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Experience ◽

Academic Medical

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Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

Annals of Pharmacotherapy ◽

10.1177/1060028020988734 ◽

2021 ◽

pp. 106002802098873

Author(s):

Nicholas F. Hunt ◽

Kevin C. McLaughlin ◽

Mary P. Kovacevic ◽

Kenneth E. Lupi ◽

Kevin M. Dube

Keyword(s):

Cardiac Arrhythmias ◽

Adverse Drug Events ◽

Medical Center ◽

Academic Medical Center ◽

General Medicine ◽

Inpatient Setting ◽

Academic Medical ◽

Acute Agitation ◽

Emergency Department Patients ◽

Events Data

Background Although approved by the Food and Drug Administration for intramuscular administration only, analyses have described the administration of intravenous push (IVP) olanzapine, particularly for acute agitation. The safety and efficacy of IVP olanzapine has mostly been limited to emergency department patients. Objective To evaluate the safety of IVP olanzapine administration in the inpatient setting. Methods This single-center, retrospective analysis was conducted between July 1, 2018, and December 31, 2019, at Brigham and Women’s Hospital in Boston, Massachusetts. Adult patients who received at least 1 dose of IVP olanzapine were included in the analysis. Safety endpoints analyzed included the following adverse drug events (ADEs): hypotension, bradycardia, cardiac arrhythmias, extrapyramidal adverse effects, and respiratory depressive events. Data on IV site reactions, including phlebitis and infiltration, were also collected. Results A total of 1,247 IVP administrations of olanzapine were identified across 252 patients. Two or more doses were received by 159 patients (63.1%). Most administrations (66%) took place in intensive care units, with 33% administered on general medicine wards. Overall, 104 administrations (8.3%) were associated with at least 1 ADE. Hypotension and bradycardia occurred in 62 (5.2%) and 16 (1.3%) administrations, respectively. Phlebitis occurred with 8 administrations (1.4%). All other adverse events were rare (<1%). Conclusion and Relevance Hypotension, the most commonly noted ADE, occurred more frequently than in previous studies. IVP olanzapine appears to be a safe route of administration in hospitalized patients, including those receiving multiple doses. Further studies are required to evaluate the effect of IV olanzapine on hemodynamics.

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