At this year's SHM Converge Conference, the teams for the Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) and Identification and Prevention of Potentially Inappropriate Inter-hospital Transfer (POINT) studies met for their second cross-study meeting. The meeting was led by Drs. Andy Auerbach, Stephanie Mueller, Katie Raffel, and Jeffrey Schnipper.

The ADEPT Study, funded by AHRQ, seeks to create a learning health system which integrates diagnostic error and process assessments into existing quality and safety programs and and shares data, infrastructure, and expertise to catalyze improvement in diagnostic performance.

ADEPT teams came together to dive more deeply into the intervention transition. We explored an RRT-triggered second opinion (or diagnostic cross-check) structure aimed at tapping into collective intelligence and supporting accurate diagnosis. Sites will begin engaging local stakeholders and investigate tailoring of this intervention to their hospital.

The POINT Study, funded by AHRQ, focuses on identifying and reducing potentially inappropriate inter-hospital transfers (IHTs) to enhance patient safety and care efficiency. During the study meeting at SHM Converge 2025, we shared the following updates.

Review of Study Goals

• Define and identify potentially inappropriate IHTs using stakeholder input.
• Estimate the frequency and safety impact of inappropriate transfers.
• Develop predictive models and intervention toolkits.

Study Progress

• Conducted focus groups with clinicians, hospital leaders, and patient advocates.
• Developed a conceptual model and working definition of inappropriate IHT (Paper under review).
• Chart reviews and adjudication underway across 16 sites.
• Early data suggest a meaningful proportion of transfers may be inappropriate.

Next Steps

• Continue chart reviews, start data analysis, later toolkit development to prevent inappropriate IHT.

At the conclusion of the meeting at SHM Converge 2025, both study participants joined together to discuss key pearls for sharing data with health systems. Discussions included a combination of case examples/didactics and table-top discussions to allow for sharing of data tools, processes for data sharing, and pearls and pitfalls across both studies. A summary of discussion points includes the following:

Creating Urgency

• Use compelling stories to spark interest.
• Follow with data to demonstrate the scope of the problem.
• End with a vision of the ideal future state.

Engaging Stakeholders

• Identify key hospital leaders using the org chart.
• Focus on those with high power and aligned interest.
• Understand their goals and frame the message from their perspective.

Effective Data Sharing

• Present high-level comparisons before getting into specific data elements.
• Be transparent about data flaws and also highlight data strengths.
• Relate data to organizational goals.
• Establish a regular cadence for updates and engagement with key leadership.

Resource Advocacy

• Frame requests in terms of shared interests, not positions.
• Highlight potential ROI, even if estimates are imperfect.
• Tie asks to patient care and institutional mission.

Special Event with Hospital Medicine Division Chiefs

HOMERuN Steering Committee members Sunil Kripalani and Jeff Schipper met with chiefs of hospital medicine at SHM Converge to discuss multi-center pragmatic clinical trials and the academic hospital medicine survey.

Learning Health Consortium for Hospital-Based Trials

Dr. Kripalani led continued discussion of using HOMERuN to organize multi-center pragmatic clinical trials. This topic was previously discussed at SHM Converge 2024 and through HOMERuN collaborative calls. He reviewed results of a research capacity survey, which was completed by approximately 60 sites. Ten sites reported key ingredients that would facilitate being part of a vanguard group of clinical trial sites, including faculty experience leading clinical trials, available research staff, ability to customize Epic, an IRB that allows patient screening and enrollment without patient-level consent (where appropriate), and previous engagement in HOMERuN studies. Other HOMERuN sites can remain engaged by generating ideas and working to build capacity for participation in future studies.

Attendees discussed potential clinical trial topics, highlighting those that can answer relevant clinical questions to guide hospitalist practice. Topics ranged from testing different diuretic regimens to protocols for managing withdrawal. Some research questions (e.g., choice of antibiotic) may be straightforward and not require external funding, whereas others are more complex interventions that would require grant funding. Discussions will continue, and sites are encouraged to share additional research ideas.

Review of HOMERuN Annual Survey

Following Dr. Kripalani's discussion of pragmatic clinical trials, Dr. Schnipper reviewed the results of the annual survey with hospital medicine chiefs who had completed it. The presentation included descriptive data on outcomes such as sustainability, rates of promotion, satisfaction, burnout, and turnover; thematic data on what works well and doesn't work well in our various programs; and significant correlations between hospital medicine program structure and outcomes. Notable findings included the following:

• Even a little protected time for clinicians and FTE for research are associated with higher rates of promotion.
• Most important correlate of promotion was hospital-medicine-level administrative positions with protected time.
• Swing and co-management shifts and new care models may allow for time to pursue scholarly activities and may prevent turnover.
• High CMI, census, long shifts, and amount of time on direct care (including direct care while on APP services) correlate with burnout and turnover.
• Each hospital medicine chief was given a report to compare their own results with overall results to use in discussions with hospital and health-system leadership. Future plans include further improvements in the design and wording of the survey and changes to make it even more focused on outcomes prioritized by hospital leadership.

HOMERuN Posters and Presentations

UPSIDE Study

"Impact of Clinician Care Team Model on Risk of Diagnostic Errors Among Adults Who Transferred to Intensive Care or Died" featuring Michelle Knees from University of Colorado.

"Is Sepsis More Prone to Diagnostic Errors?: A Secondary Analysis of the Utility of Predictive Systems for Diagnostic Errors (UPSIDE) Study" featuring Priya Prasad from UCSF.

"Unnecessary Inter-Hospital Transfers: Exploring Incidence, Reason, Impact, and Improvement Opportunities" featuring Alan Kubey from Thomas Jefferson Hospital.

ADEPT Study

"Catastrophe Loading and the Clock Is Ticking" featuring Sandhya Tagaram from UMass Memorial Hospital.

"Assessing Organizational Readiness to Pursue Diagnostic Excellence Collaboration" featuring Ellen Barbouche from University of Wisconsin-Madison and Aveena Kochar from Mount Sinai Hospital.

"Hidden in Plain Sight" featuring Nathan Martin and Radha Devi from Washington University in St. Louis.

"Building a Hospital Medicine Diagnostic Excellence Program" featuring Peter Barish and Madison Sui from UCSF.

New Publications and Celebrations!

The Workforce Planning Work Group manuscript on jeopardy systems was recently published in the Journal of Hospital Medicine!

Jeopardy systems — used to cover unexpected staffing gaps — are widespread in hospital medicine, but little is known about their structure, impact, or best practices. Through a multi-methods study involving surveys and focus groups with participants from 31 academic institutions, we found that while jeopardy is essential for 24/7 hospital coverage, it is also a major source of clinician dissatisfaction due to unpredictability, inequitable burden, and limited institutional support for those who activate or cover jeopardy shifts.



The study identifies actionable strategies to improve fairness and sustainability, including deliberate scheduling, formalized sick leave policies, and equitable compensation — offering hospital medicine leaders practical insights to strengthen workforce well-being and system resilience.

Kangelaris KN, Keniston A, Auerbach AD, Bowling C, Burden M, Kulkarni S, Leykum LC, Linker AS, Sakumoto M, Schnipper J, Astik G. A multi‐institutional multi‐methods analysis of jeopardy systems in academic hospital medicine. J Hosp Med. 2025;1-10.

Kudos to our Workforce Planning Work Group!

Their study published in JAMA Internal Medicine, "Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders" was awarded the ABIM Foundation's 15th annual John A. Benson Jr., MD Professionalism Article Prize, which recognizes the best articles published in peer-reviewed journals on professionalism topics.​

Burden M, Astik G, Auerbach AD, Bowling G, Kangelaris KN, Keniston A, Kochar A, Leykum LK, Linker AS, Sakumoto M, Rogers K, Schwatka N, Westergaard S. Identifying and measuring administrative harms experienced by hospitalists and administrative leaders. JAMA Intern Med. 2024;184(9):1014-1023.

HOMERuN was acknowledged in a study!

Published in The Primary Care Companion for CNS Disorders, this study sought to understand what internists and neurologists know and think about catatonia, with the goal of raising catatonia awareness among these practitioners and informing future educational campaigns.

Kaur J, Maeng DD, Wortzel JR, Oldham MA. What internists and neurologists know and think about catatonia. Prim Care Companion CNS Disord. 2025;27(2):24m03853.

Our next meeting will be on June 13, 2025.

Image Attributions: Vector images from vecteezy.com