Clinical research has developed slowly in most hospitalist programs. Although partly related to the field's youth, it likely also reflects a lack of specific expertise about the clinical issues most worthy of study. Because specialists are often involved in the diagnostic approach, treatment, and follow‐up of complex medical patients — in both academic and nonacademic settings — a successful inpatient clinical research program should ideally partner hospitalists with subspecialists.
The goal of the study was to jump‐start inpatient‐based clinical and translational research in a major academic medical center by pairing specialists and hospitalists to collaboratively ask and answer key research questions.
SHARP is directed jointly by a hospitalist and a subspecialist. Other key personnel include a hospitalist investigator, clinical research nurse, research associate, and clinical epidemiologist. An oversight committee consisting of institutional research leadership meets semiannually to assist with project selection and program development. Three initial projects were chosen for support. The first, an infectious diseases‐hospitalist collaboration, is a prospective trial investigating which antiseptic practice best reduces blood culture contamination. Up to 50% of all positive blood cultures are falsely positive, which leads to unnecessary antibiotics and increased resource use. A variety of antiseptic agents and techniques are used to prevent false‐positive cultures, but there is no clear evidence about what should be routinely used. The second project partners hospitalists with geriatricians and clinical pharmacists to assess strategies to reduce medication complications at hospital discharge. Inpatients frequently experience medication changes. The Joint Commission on Accreditation of Healthcare Organizations requires medication reconciliation at discharge in order to prevent errors, yet there are no proven best practices. The third project, led by a cardiologist and a hospitalist, focuses on identifying patient‐ and hospital‐level factors associated with improved quality and rates of survival for in‐hospital cardiac arrest. After identification of these factors, we will study the implementation of a system redesign targeting them. SHARP‐related programmatic metrics include the number of successfully completed projects, extramural grants submitted and funded, and peer‐reviewed publications.
The hospitalist model alters the way clinical problems are approached and creates opportunities for and challenges in implementing best practices. A successful clinical research program will combine specialists and hospitalists working collaboratively to identify the best way to care for inpatients. SHARP — the first specialist‐hospitalist clinical research program in the United States — endeavors to facilitate translational and clinical research. A similar model is also likely to succeed elsewhere.
S. A. Flanders, None; S. Saint, None; B. K. Nallamothu, None.
To cite this abstract:Flanders S, Saint S, Nallamothu B. Jump‐Starting Hospitalist Clinical Research: The Specialist‐Hospitalist Allied Research Program (SHARP). Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 79. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/jumpstarting-hospitalist-clinical-research-the-specialisthospitalist-allied-research-program-sharp/. Accessed March 28, 2020.