Cowdell, J. Colt

Hospital medicine offers diverse career opportunities, yet formal guidance for residents pursuing hospitalist careers is often lacking. To address this gap, the Hospital Internal Medicine Interest Group (HIMIG) was launched at an academic institution in the Southeastern United States to provide structured mentorship and professional development. Residents expressing interest completed an entry survey to identify career goals and areas of focus, informing a longitudinal curriculum that included education, leadership, research, quality improvement, and networking. Seventeen residents (≈25% of the IM residency program) joined HIMIG, and 88% completed the initial survey. Education, leadership, and quality improvement were top interests, while mentorship and career guidance were primary motivators. A post-implementation survey revealed all participants met mentors and felt HIMIG supported their career goals. HIMIG demonstrates a flexible, personalized approach to hospitalist career development that may serve as a model for other programs.

Abstract Objectives: Community-acquired intra-abdominal infections (CA-IAIs) are a leading cause of US hospitalizations. Piperacillin-tazobactam is often used to empirically treat CA-IAIs, despite national guidelines recommending narrower-spectrum antibiotics for these infections. The overuse of broad-spectrum agents such as piperacillin-tazobactam contributes to antibiotic resistance, which poses serious public health challenges. This resident-led quality improvement initiative aimed to reduce unnecessary piperacillin-tazobactam use for treating CA-IAIs measured as DOT/1,000 patient-days by 10% without adversely affecting hospital length of stay (LOS). Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we identified barriers to appropriate antibiotic use and developed a treatment algorithm for CA-IAIs that included clear guidelines and exclusion criteria. This algorithm was disseminated to internal medicine residents and emergency department physicians along with educational sessions to highlight updated CA-IAI treatment recommendations, antibiotic resistance, and appropriate antibiotic ordering via the electronic health record. Antimicrobial stewardship pharmacists provided overnight support to assist with de-escalation. Data were collected over a 10-month period spanning 2 intervention phases. The primary outcome was piperacillin-tazobactam use, measured as days of therapy (DOT) per 1,000 patient-days and DOT per patient LOS. Mean LOS served as the balancing measure. Results: Piperacillin-tazobactam use was significantly reduced ( P < .001) after the interventions without increasing the mean LOS. Conclusion: This project raised awareness of antibiotic resistance and led to lasting improvements in reducing the inappropriate use of piperacillin-tazobactam to treat CA-IAIs, without affecting the mean LOS. This was attributed to the strong collaboration among a multidisciplinary team of infectious disease physicians, antimicrobial stewardship team members, residents, emergency department physicians, and faculty.