Jeffrey Lawrence Schnipper

Background: Data driven tools are increasingly used to support patient safety and quality improvement, yet evidence on the impact of integrated quality and safety dashboards remains limited. Methods: We conducted a pre–post implementation study using interrupted time series analysis to evaluate the impact of an EHR-integrated quality and safety dashboard on clinical processes and patient outcomes, among three general medicine units at a 171-bed community teaching hospital. All adult patients admitted during seven-month pre- and post-implementation periods were included. The primary outcome was the proportion of hospitalizations with at least one adverse event. Secondary and exploratory outcomes included hospital-acquired conditions, adherence to safety-related process measures, and dashboard utilization. Results: A total of 9,023 hospitalizations were included (4,640 pre-implementation; 4,383 post - implementation). The proportion of hospitalizations with at least one adverse event was similar pre-implementation (23.15%; 95% CI, 20.96–25.29) and post-implementation (22.97%; 95% CI, 20.86–25.23). CLABSI per 100 patient-days was reduced (aOR 0.47, 95% CI [0.37-0.60]); and exploratory analyses demonstrated decreases in slope for post-discharge venous thromboembolism (aOR, 0.66; 95% CI, 0.48–0.91; p =0.01) and hospital-acquired pressure injury (aOR, 0.69; 95% CI, 0.48–1.00; p =0.05). Several process measures improved, including code status confirmation, venous thromboembolism prophylaxis, delirium screening, chlorhexidine bathing, and fall precautions. Conclusions: Implementation of an EHR-integrated quality and safety dashboard was associated with meaningful improvements in multiple care processes and CLABSI but not overall adverse events. These findings highlight the potential of workflow-integrated dashboards to support frontline quality improvement, while underscoring the need for additional measures to improve clinical outcomes.

Background: Diagnostic errors are common and represent a leading cause of preventable harm in hospitalized medical patients. Despite growing recognition of this problem, the field lacks a systematic, evidence-based approach for developing, adapting, and selecting diagnostic excellence interventions at scale across multiple institutions. Methods: Using a structured, multi-phase process, the Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) collaborative, a 14-site AHRQ-funded hospital medicine network: (1) conducted an environmental scan of existing diagnostic safety practices across sites; (2) constructed a conceptual framework organizing potential interventions by target (patient, provider/team, health system) and safety paradigm (Safety I and Safety II); (3) convened multidisciplinary working groups to develop detailed proposals for six intervention programs; (4) applied a pre-specified multi-criteria rubric to facilitate group deliberation, and (5) voted to select a single high-priority intervention for collaborative launch. Results: Six interventions were developed, selected, or adapted from prior work, spanning all cells of the target and safety paradigm framework. Finalized proposals were then shared at two separate ADEPT meetings – the first to solicit feedback on interventions and to coordinate activities across groups, and the second where a formal ranked-choice vote was held. This process resulted in selection of the Diagnostic Cross-Check (DXC) — a structured, peer second-opinion program triggered by rapid response team (RRT) events — as the highest priority intervention for collaborative-wide launch. The remaining interventions were designated as components of an ADEPT toolbox for future adaptation, adoption, and evaluation. Discussion: The ADEPT collaborative’s systematic, evidence-informed approach to diagnostic intervention development offers a replicable model for other multi-site quality improvement networks. The resulting portfolio of interventions provides a roadmap for the field of inpatient diagnostic excellence.

Medication treatment for moderate to severe alcohol withdrawal syndrome (AWS) is evolving, particularly with renewed phenobarbital use. However, little research has examined how hospitalists manage AWS. We conducted a multiple‐methods study involving hospitalists from a national US Hospital Medicine research network. Thirty‐three hospitalists from 27 tertiary hospitals completed surveys and participated in seven focus groups on August 8, 2025. Benzodiazepines remained the most common treatment, but phenobarbital use was reported in 67% of emergency departments and 44% of inpatient medical units. Four themes emerged: hospitalists are adaptable in responding to changing practices and drug shortages; a lack of consensus on AWS treatment practices leads to a “wild west approach” to therapy selection; hospitalists prioritize care‐delivery outcomes when selecting medications; and patients are minimally involved in shared decision‐making. Participants strongly supported additional research to guide evidence‐based AWS care. These findings highlight uncertainty and the need for standardized, patient‐centered approaches to AWS management.

Background: The National Academies' Improving Diagnosis in Health Care report outlined eight goals for improving the diagnostic process and building a culture of diagnostic excellence. Despite a decade passing since these recommendations, development of programs remains inconsistent. Objectives: To explore diagnostic excellence improvement efforts across hospital medicine divisions in largely academic settings to identify opportunities. Methods: This study used rapid qualitative methods to analyze focus groups with hospitalist clinicians recruited from sites participating in an AHRQ‐funded study. After creating focus group summaries and an analytical matrix, thematic analysis was conducted using a mixed inductive and deductive method at the semantic level. Results: Seven focus groups were conducted with 30 participants across 14 hospitals. Participants described more than 80 interventions, programs, and tools to improve diagnostic processes. Five themes were identified: (1) current diagnostic excellence efforts were weighted toward reactive rather than proactive interventions; (2) successful diagnostic excellence programs need to focus on both systems issues and clinician performance; (3) clinicians desired greater support in the diagnostic process, especially when cognitive load impairs clinical reasoning; (4) clinicians desired a supportive culture for feedback; and (5) for new ideas to succeed, context of care and resource constraints will need to be considered. Discussion: Our findings highlight limited scope in diagnostic safety efforts, which remain largely centered on retrospective case reviews and conferences. Clinicians desire system‐level redesign encompassing improved team dynamics, reduced cognitive load, psychologically safe feedback, and optimization of the electronic health record. This shift is hindered by cultural, leadership, and resource‐related barriers.

Hospitalist researchers are facing many new threats to their careers due to changes in the funding environment. To overcome these challenges and ensure our researcher pipeline, academic institutions will need to invest in and support investigators most at risk, senior investigators will need to provide increased support to mentees and advocate for resources, and all investigators will need to diversify their funding portfolios.

Background: Diagnostic errors among hospitalized adults are prevalent and costly. Traditional approaches that focus on identifying and fixing mistakes (Safety‐I) may fall short in the dynamic and complex hospital environment. Instead, focusing on approaches that emphasize the understanding of how things go right and adapt to challenges (Safety‐II) may offer better insights into what contributes to accurate and timely diagnoses. Objectives: We sought to characterize hospitalists' perceptions of diagnostic excellence and the factors and adaptations needed to achieve it. Methods: Focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, researchers, and patient representatives about (1) recognition of diagnostic excellence, (2) what makes diagnostic journeys go well, and (3) factors that facilitate diagnosis in difficult situations. Rapid qualitative methods including templated summaries and matrix analysis were applied to analyze these focus groups. Results: We conducted five focus groups with 36 individuals from 23 unique institutions. Participants shared three factors that facilitate a successful diagnostic journey: clinical reasoning that is structured yet adaptive, collaborative diagnosis through teamwork, and systems‐level support for diagnostic capacity. Participants readily recognized diagnostic excellence, though noted the challenge in systematically identifying these cases. Conclusions: While diagnostic excellence case identification is seen as a challenge, providers do note people, process, and technology opportunities to support better diagnosis. Optimization of diagnosis in hospital medicine may benefit from a focus on team and communication redesign, adaptive technology development, and workload management.

Team‐based care enhances accurate diagnosis in hospitalized patients. In addition to formal inter‐professional collaboration, such as specialty consultation, many hospitalists use informal strategies, such as peer diagnostic second opinions. Little is known about this practice. We conducted a cross‐sectional survey among hospital medicine physicians and Advanced Practice Providers at 13 hospitals. We assessed the frequency of requesting and providing peer second opinions, comfort discussing diagnostic uncertainty, and perceived barriers to second opinions. 338 hospitalists responded. Half (51.5%) reported routinely seeking a second opinion when facing diagnostic uncertainty. 98.2% felt psychologically safe discussing uncertainty, and 97.3% believed second opinions improved diagnostic accuracy. The most common barriers to seeking a peer‐second opinion were time constraints (64.3%) and fear of bothering colleagues (56.6%). Less experienced hospitalists were more likely to report vulnerability as a barrier (39.2% vs. 26.8%, p = .03). Strengthening systems that facilitate peer consultation and support junior clinicians could improve diagnostic collaboration and accuracy.

Objective: To assess the clinical effectiveness of a pilot multifaceted intervention to prevent persistent opioid use among patients undergoing orthopedic and spine surgery.Design: Pre–post pilot study.Setting: Two hospitals (academic medical center and affiliated community hospital) in a single healthcare system. Preintervention period was July 1, 2021 to June 1, 2022; post-intervention period was June 2, 2022 to February 28, 2023. Patients: A total of 171 inpatient orthopedic and neurosurgical spine patients. Intervention: Multifaceted persistent Opioid use Prevention Program (MOPP), including standardized order sets, pharmacist-led discharge counseling, a virtual post-discharge visit, and a mobile app for tracking pain, function, and opioid use for up to 180 days after hospital discharge.Main outcome measures: Persistent opioid use within 180 days post-discharge.Results: Outcome assessors were blinded. Of 115 patients in the intervention group, 91 (79 percent) received at least one component of MOPP. Persistent opioid use was observed in 10.9 percent of usual care patients and 4.5 percent in intervention patients (weighted difference –6.4 percent, 95 percent confidence interval [CI] –21 percent, +8.2, p = 0.37). In subgroup analyses, the intervention demonstrated a significant reduction in persistent opioid use among nonopioidnaive patients (weighted difference –40 percent, 95 percent CI –76 percent, –4.2 percent), with evidence of effect modification by opioid-naive status (p value for interaction term 0.005).Conclusions: This pilot study demonstrated a nonsignificant overall effect on the primary outcome, with significant effects on nonopioid-naive patients. Further research with a larger trial is needed to validate these findings.

Background: Transitions of care (ToC) programs are important for patient safety, but their implementation and success remain highly variable across US hospitals, particularly for patients with multimorbidity and health‐related social needs (HRSNs). Hospitalists, as key decision‐makers at discharge, encounter firsthand the factors that hinder the success of ToC programs. Objective: To explore hospitalists' perspectives on successes, shortcomings, and implementation barriers in ToC programs, particularly during transitions from hospital to community settings. Methods: Rapid qualitative study featuring virtual focus groups with participants from the Hospital Medicine Reengineering Network (HOMERuN). Data were analyzed using a mixed inductive‐deductive framework to identify key themes. Results: Twenty‐two individuals from 19 different organizations participated in focus groups. None of the organizations offered comprehensive ToC programs to all patients. Four major themes emerged: (1) Diagnosis‐specific ToC programs are effective but contribute to care fragmentation, particularly for patients with multimorbidity; (2) postdischarge follow‐up is hindered by limited appointment availability, insurance barriers, and geographic challenges; (3) ToC programs often fail to address patient preferences, HRSNs, and health literacy, and lack adequate resources and leadership support; (4) successful programs require institutional commitment, dedicated funding, interprofessional collaboration, and community engagement. Participants emphasized the need to prioritize patient‐centered care over financial return on investment. Conclusions: Current ToC programs are fragmented, undermining safe and equitable transitions. Addressing HRSNs, fostering leadership support, and prioritizing patient‐centered care over short‐term financial metrics are essential for improving ToC outcomes.