Teams to improve hip fracture, heart failure

This issue looks at comanagement of hip fractures, prescribing for heart failure, antibiotic use in COVID-19, and private equity ownership of hospitals.

Even during a pandemic, elderly people will still break their hips. This month's main story looks at how the involvement of hospitalists can improve both the quality and efficiency of inpatient care for hip fracture. From managing medications and smoothing transitions to identifying when subspecialty consults are not needed, hospitalists who comanage these patients have found a number of ways to add value, as they explain in the article.

Speaking of medication management and transitions, a feature article in this issue focuses on the importance of adequate diuretic prescribing during and after a hospitalization for heart failure. Experts call for hospitalists to take the lead in the multidisciplinary effort to get the regimens of heart failure patients in line with guideline recommendations. In the opposite direction, this month's COVID-19 coverage encourages less prescribing, that is, of antibiotics for patients without bacterial infections. Recent studies have shown that antibiotics were definitely being overused at the start of the pandemic, and although experts say improvements in testing and protocols have helped ameliorate that problem, they note that everyone should continue to remember the critical importance of stewardship.

Another feature story addresses the business of medicine, specifically the potential impacts of private equity investment in hospitals. It offers the cautionary tale of Hahnemann University Hospital in Philadelphia (also covered in our August Q&A, “What Happens When an Academic Hospital Closes?”) and summarizes some recent data on costs and quality at hospitals purchased by private equity investors.

On a much more personal note, a Perspectives piece tells what it has been like for California hospitalists to deal with a series of devastating wildfire seasons, some requiring evacuation of their homes and hospitals. Our thoughts go out to them, as well as everyone affected by our shared natural disaster, COVID-19. Here's hoping for a happier, healthier 2021!

Stacey Butterfield