Our researchers have investigated a wide variety of topics vital to the treatment of hospitalized patients. Studies in anticoagulation and thrombosis have helped determine the optimal approach to perioperative management of patients on anticoagulants undergoing surgery, and improve the transitions of care for patients on anticoagulants. The group has also focused on the management of patients with substance use disorders, including papers examining the potential incorporation of phenobarbital into treatment algorithms for alcohol withdrawal. Studies have examined management of opioid use disorders, including a novel naloxone distribution program. The team has investigated sepsis management, including helping to establish that a “one size fits all” approach to intravenous fluids is not appropriate.

During the COVID-19 pandemic, Icahn Mount Sinai hospitalists stepped up to manage extraordinarily high volume of severely ill patients and contributed important publications on management. One area of focus was on treatment with anticoagulants, which included the first large studies demonstrating the importance of this aspect of treatment and investigating the optimal dose. Other studies helped elucidate risk factors for mortality for patients with COVID-19.   

Clinical care researchers include:

• Andrew S. Dunn, MD, FACP, SFHM
• Michael Herscher, MD
• Samuel Hundert, MD
• Dahlia Rizk, DO, MPH

Icahn Mount Sinai hospitalists have strived to identify approaches that can improve quality, safety, and efficiency. Studies have looked at bedside interdisciplinary rounds, where the interdisciplinary team meets at the bedside rather than a conference room to engage the patient and develop a cohesive plan for the day. Researchers have also been involved in developing co-management programs targeting the highest risk surgical patients. Our Vascular Surgery Co-Management Team was shown to reduce mortality and improve patients’ safety. One of the largest studies of the Hospital at Home model was performed at Icahn Mount Sinai, showing that the model can reduce overall health care costs while maintaining outstanding quality. The Hospital at Home program has grown dramatically at Icahn Mount Sinai and nationally since publication.

The hospitalist team also looks for ways to utilize novel technology and tools to improve care and communication. One example was a grant-funded study where the Division of Hospital Medicine collaborated with Mount Sinai app developers to create an app allowing patients with acute venous thromboembolism to better communicate with their physicians during the transition period after discharge. Our hospitalist team has also examined the use of artificial intelligence tools to facilitate and enhance the safety of inter-hospital transfers.

Health care delivery model researchers include:

• Neil Desai, MD
• Andrew S. Dunn, MD, FACP, SFHN
• Horatio “Teddy” Holzer, MD
• Maria Anaizza Aurora S. Reyna, MD
• Tuyet-Trinh Truong, MD

Icahn Mount Sinai hospitalists have prioritized identifying strategies to reduce waste and increase value. One focus in high-value care has been on reducing unnecessary testing. These efforts have been wide-ranging and effective. Studies have addressed reducing folate testing as part of the routine anemia work-up, reducing amylase orders for patients with suspected pancreatitis, and avoiding ultrasonography to rule out deep vein thrombosis for patients with cellulitis. Studies have also looked at initiatives designed to decrease unnecessary fingerstick glucose monitoring.

Researchers have contributed to areas highlighted by the national Choosing Wisely initiative, including through a program promoting earlier mobilization of hospitalized patients to prevent falls. The group efforts in falls prevention were reported in the “Things We Do For No Reason” section of the Journal of Hospital Medicine. 

High-value care researchers include:

• Mona A. Krouss, MD
• Vinh-Tung Nguyen, MD
• Masih Shinwa, MD

The Division of Hospital Medicine has performed meaningful research in providing patient-centered care. One target has been enhancing sleep. Poor sleep is common in hospitals due to disruption of the circadian rhythm. Our researchers have developed strategies to promote sleep hygiene and presented this work nationally. Researchers have also led a grant-funded study of a novel dynamic lighting system that demonstrated substantially greater sleep for patients who received lighting that better entrains the circadian rhythm compared to standard hospital lighting.

Our diverse patient population provides opportunities to care for patients who are underserved or vulnerable. Studies have looked at the impact of English-language proficiency on sepsis mortality and biases in documenting the chief complaint. Researchers have also focused on strategies to improve physician wellness. One area for this work has been examining ways to reduce the burden of clinical documentation, including a study investigating clinician documentation preferences nationally across a range of modalities. One grant-funded study investigated the use of voice recognition documentation, which has been infrequently implemented on hospitalist services. Other research efforts have examined the use of a scribe on medical wards to decrease the documentation burden on clinicians.

Humanism, DEI, and physician wellness researchers include:

• Krishna Chokshi, MD
• Horatio “Teddy” Holzer, MD
• Anne Linker, MD

Academic hospitalists at Icahn Mount Sinai have translated their innovative work in medical education into important research. Through the student High-Value Care program, students at Icahn Mount Sinai learn the principles of quality improvement and participate with hospitalist mentors in research studies aiming to decrease waste and improve value. The group regularly presents at national meetings and publishes their work, including a paper describing the structure and outcomes of the educational program.

Hospitalist researchers have also investigated strategies to improve house staff education. These initiatives include studies examining how to enhance the efficiency of “electronic medical record pre-rounding.” The group has also examined novel ways to enhance the educational experience of house staff and medical students on night rotations.

Medical education researchers include:

• Michael Herscher, MD
• Horatio “Teddy” Holzer, MD
• Anne Linker, MD
• Vinh-Tung Nguyen, MD

The Division of Hospital Medicine continually works on improving the quality and safety of care and regularly disseminates important findings. Novel approaches have included investigating underlying causes of the “weekend effect,” where patients admitted during weekends tend to have higher mortality. This work has helped prioritize resources to help mitigate the effect. Researchers have also studied ways to enhance mobility to reduce falls and reduce use of urinary catheters to decrease the incidence of catheter-associated bloodstream infections. Recognition of the harmful practice of reflexively treating asymptomatic elevated blood pressure with intravenous anti-hypertensives led the group to develop an initiative to reduce use of this strategy.

Hospitalist researchers have also used artificial intelligence (AI) and machine learning (ML) tools to enhance care. One grant-funded study used an ML algorithm to identify patients with catheter-associated urinary tract infections. Researchers have also looked at an AI tool that helps predict which patients are expected to be stable for discharge within 48 hours, allowing for preparation to be done early to reduce the sense of rush that can delay or jeopardize safe discharges.

Quality and safety researchers include:

• Mona A. Krouss, MD
• Vinh-Tung Nguyen, MD
• Ashwin Sawant, MD
• Tuyet-Trinh Truong, MD