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Hospital Medicine

Keeping Up with Hospital Medicine Research: Evidence for the Modern Hospitalist

Hospital medicine has developed a distinct and growing evidence base since its recognition as a specialty. Hospitalists manage some of the highest-acuity, most complex patients in the hospital while simultaneously serving as coordinators of multidisciplinary care and champions of care quality. Staying current requires attention to both the clinical evidence and the systems literature that defines excellent hospital care.

The hospitalist's breadth challenge

Hospital medicine is the only specialty defined entirely by the care setting rather than organ system or patient population. A hospitalist may admit a patient with decompensated heart failure in the morning, manage a septic patient in the afternoon, and reconcile medications for a complex polypharmacy patient at discharge. This breadth means the relevant literature spans virtually every organ system — requiring a broader surveillance system than most specialists need.

Core journals for hospitalists

• Journal of Hospital Medicine (JHM) — the Society of Hospital Medicine's flagship journal, dedicated to inpatient clinical and systems literature
• JAMA Internal Medicine — strong on diagnostic reasoning, overuse, and hospitalist-relevant internal medicine
• NEJM and JAMA — landmark clinical trials across all of internal medicine
• Annals of Internal Medicine — clinical reviews and systematic reviews relevant to inpatient practice
• BMJ Quality & Safety — patient safety, quality improvement, and health systems research

Sepsis management: the most actively evolving inpatient domain

Sepsis accounts for a significant proportion of hospitalist clinical work and represents one of the most actively contested areas in evidence-based medicine. Key developments hospitalists must know:

• Hour-1 bundle evolution — the CMS SEP-1 bundle and ongoing debate about lactate-guided vs. clinically-guided fluid resuscitation
• SMART and SALT-ED — balanced crystalloids (lactated Ringer's, PlasmaLyte) vs. normal saline in sepsis and general ICU populations
• Vasopressor timing — early vs. delayed norepinephrine initiation, MAP targets
• Corticosteroids in septic shock — APROCCHSS, ADRENAL trials and current guidance
• Time to antibiotics nuance — the 1-hour vs. 3-hour window debate for sepsis without shock

VTE prophylaxis and treatment: a perpetually evolving area

Venous thromboembolism management has been substantially reorganized by the CHEST guidelines and the expanded evidence base for direct oral anticoagulants (DOACs). Key areas of active evidence:

• DOACs vs. warfarin — which patients still benefit from warfarin over DOACs?
• VTE prophylaxis in medical inpatients — WHO benefits and who does not (MAGELLAN, MARINER trials)
• Extended prophylaxis after hospitalization — patient selection criteria
• Subsegmental PE — to treat or not to treat?
• Intermediate-risk PE — catheter-directed therapy evidence (PEITHO, HI-PEITHO)

Diagnostic stewardship: the overuse literature

A growing body of evidence demonstrates that excessive laboratory ordering, imaging, and testing in hospitalized patients causes harm — through iatrogenic anemia, incidental findings requiring workup, radiation exposure, and healthcare costs. Key diagnostic stewardship evidence:

• Reflexive repeat laboratory testing — evidence that daily CBC and BMP are unnecessary in stable patients
• Blood culture contamination reduction — bundled interventions and their effectiveness
• Urinalysis and urine culture stewardship — asymptomatic bacteriuria treatment avoidance
• Chest X-ray in heart failure monitoring — limited utility vs. clinical assessment
• Troponin in non-ACS contexts — interpretation and management of incidental elevations

Care transitions and readmission prevention

Hospital readmission rates remain a quality metric and financial concern for hospital systems. The evidence on effective readmission prevention interventions:

• Care transitions interventions — Coleman Transitions of Care, Project BOOST evidence
• Post-discharge follow-up — timing and format that actually reduce readmission
• Teach-back and health literacy — patient education approaches with outcome data
• Medication reconciliation — high-risk medication classes and reconciliation protocols

SHM and HMX: hospitalist-specific resources

The Society of Hospital Medicine offers several resources specifically designed for hospitalists:

• SHM Annual Conference (HMX) — the primary hospitalist conference, plenary sessions and small group learning
• The Hospitalist — SHM's member magazine with clinical updates and practice management
• SMART Discharge and other SHM quality improvement toolkits — implementation-focused resources
• SHM Core Competencies in Hospital Medicine — the framework for hospitalist education and self-assessment

Glycemic management in the inpatient setting

Inpatient hyperglycemia management — both in patients with and without diagnosed diabetes — continues to evolve. The Endocrine Society and ADA publish inpatient glycemic management guidance. Key evidence updates include the target glucose range for non-ICU patients (140-180 mg/dL remains standard), subcutaneous insulin protocol best practices, and the emerging evidence on SGLT2 inhibitors in the hospital setting following recent FDA label updates allowing continuation during hospitalization in specific circumstances.

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