Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. ⋯ This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.
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Authors of clinical reasoning exercises analyze diagnostic dilemmas and serve as role models of clinical excellence. We investigated the percentage of women authors in the clinical problem-solving series of three general medicine journals from the inaugural article in each series until July 2019. ⋯ While the percentage of women among first and all authors has increased, women still constituted <40% of all authors and ≤25% of last authors, and there have been no significant increases in women last authors in any of the three journals. Including more women in clinical reasoning exercises is an opportunity to amplify the voices of women as master clinicians.
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Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.