CME for Hospitalists: Latest Practice Updates
Hospitalists coordinate inpatient care across specialties, aligning clinical decisions with healthcare system priorities. Inpatient guidelines continue to evolve as new evidence shapes diagnostic and treatment standards, and these changes increasingly reflect value-based care goals, including reducing length of stay, preventing avoidable readmissions and improving care transitions. Learn about these latest practice updates to stay current and inform your continuing education choices.
Perioperative Medicine (Co-Management)
Hospitalists frequently co-manage surgical patients and must apply updated approaches to risk assessment and medication planning. Preoperative cardiac risk assessment uses the Revised Cardiac Risk Index, but updated guidance also emphasizes functional capacity evaluation and selective diagnostic testing. This approach limits delays and reduces testing that does not influence perioperative management.
Direct oral anticoagulant (DOAC) management before and after surgery is also subject to more standards, with current recommendations basing DOAC interruption timing on medication's half-life, the patient's renal function and the risks of major bleeding and thrombosis. Many low-risk procedures require a 24-hour interruption, while higher-risk procedures require longer holds of 48 to 72 hours. Routine perioperative heparin bridging for patients taking DOACs increases bleeding risk and is not part of standard management for most indications.
Postoperative delirium prevention and management for elderly patient populations focuses on nonpharmacologic strategies, such as physical activity, sensory stimulation, relaxation promotion and environmental control. Particularly when combined with a multicomponent intervention and prior to established delirium, these strategies are evidenced to reduce the risk of delirium onset. Per these recommendations, antipsychotic medications are reserved for severe cases and compromised safety and are not used for routine delirium treatment.
Infectious Disease and Stewardship
Infectious disease management represents a significant portion of inpatient decision-making for hospitalists and can affect patient outcomes, discharge timings and antimicrobial resistance.
Recommendations also favor shorter antibiotic courses for common infections, since shorter courses can reduce adverse drug reactions and microbial resistance without compromising treatment effectiveness. For instance, community-acquired pneumonia and urinary tract infections often respond to five days of therapy.
Managing skin and soft tissue infections (SSTI) requires careful clinical skills in diagnosis, pathogen identification, and treatment administration. Management recommendations focus on distinguishing non-purulent and purulent disease, since treatment options differ. Non-purulent cellulitis without systemic signs of infection is treated with narrow-spectrum beta-lactam antibiotics that target streptococci, while purulent infections require incision and drainage as the primary therapeutic step. MRSA-directed antibiotics are added when systemic illness, immunocompromise or other risk factors are present.
To proactively address the spread of Clostridioides difficile (C. diff) infection, recommendations also include new diagnostic and treatment strategies. Two-step testing enables better diagnostic accuracy and reduces the use of C. diff-specific antibiotics, and guidelines also prioritize fidaxomicin over vancomycin and metronidazole since its targeted activity has a significantly lesser effect on gut microbiome and can help reduce the risk of recurring infections. Likewise, treatment using monoclonal antibodies spares microbiome and lowers recurrence rates.
Venous Thromboembolism (VTE)
Recent VTE guidance focuses on selective use of anticoagulation to balance prevention of thrombotic events with the risk of bleeding complications, based on evidence that blanket prophylaxis and aggressive intervention do not improve outcomes for all patients.
Pharmacologic prophylaxis is now based on individualized assessment of thrombotic and bleeding risk. In patients with low VTE risk or elevated bleeding risk, avoiding routine anticoagulation reduces bleeding events without increasing VTE incidence. When anticoagulation is unsafe, mechanical prophylaxis maintains preventive measures while limiting harm.
Treatment recommendations for sub-massive pulmonary embolism favor conservative management for stable patients. Most hemodynamically stable patients respond to anticoagulation alone with close monitoring, so thrombolytic or catheter-based therapies are reserved for patients with clinical deterioration or high risk. Management of cancer-associated thrombosis has also evolved with broader use of DOACs, which improve treatment adherence and reduce recurrence compared with injectable therapy in many patients.
Heart Failure and Diuresis
Heart failure updates focus on using hospitalization as an opportunity to initiate therapies that modify disease progression and improve post-discharge outcomes. Recommendations suggest SGLT2 inhibitors across heart failure phenotypes. Initiating therapy during hospitalization after hemodynamic stabilization increases the likelihood of continued use after discharge and reduces delays in outpatient treatment.
Optimizing heart failure therapy before discharge now considers several evidence-based medications with sodium-glucose cotransporter-2 inhibitors (SGLT2). Quality improvement programs should aim to increase the prescription of GDMT to promote patient outcomes and reduce readmissions and mortality.
In cases where congestion doesn't respond to loop diuretics, recommendations advise adding a secondary thiazide diuretic, such as chlorothiazide or metolazone. This approach helps eliminate excess fluid retention while using the lowest possible dose.
Keep Up With Practice Updates
With updates across perioperative, infectious disease, VTE and other areas, recent practice updates for inpatient care contribute to improved outcomes and avoidance of unnecessary risk. These changes improve safety, efficiency and continuity of care across the hospital stay.
For ongoing education on applying current guidelines in inpatient practice as a hospitalist, explore Oakstone CME products today.