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Hospitalist Happenings¶
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UNC Division of Hospital Medicine Newsletter¶
Volume 26, Issue 17¶
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| | | View from the Ninth Floor March 24, 2026
Last time, I discussed the progressive maturity of the Throughput work happening around the Medical Center to improve the speed of the care we can provide our patients in the inpatient environment and to reduce length of stay. This is a win-win for all involved. Quicker turnaround helps improve patient experience, increase capacity for other patients and makes most hospital medicine providers happy as it aligns with our fundamental mission. I promised to return the challenges of direct care and how else we hope to address them in this installment.
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| | | We all know that our direct care services are too often the most challenging work we do, especially at the Medical Center. We‘ve talked about how censuses are higher for the MD/APP pairs and our continuity is not the same from where we were 10 years ago. Importantly, acuity is higher. A study published in JAMA IM 2024 reviewing multiple measures of complexity in a very large cohort of hospitalized adults from 2003 to 2017 in Canada confirms what we have felt at UNC: patients are older, have more co-morbid illness, longer LOS, more medications, more previous recent admissions, more transfers.¶
| | | | | | | | | | | | I suspect these trends have only continued or worsened since. These factors also directly correlate with more information in the EHR, which then compounds the difficulty with the discontinuity. Finally, in 2026, capacity constraints have created a scenario which it is hard to get admitted to the scarce resource that is an inpatient bed, as more straightforward patients are discharged or diverted into alternative sites of care such as Advanced Care @ Home. Add it all up, you get a very different landscape of HM.
Now for the good news: UNC Medical Center has multiple approaches to try to counteract these trends.
- More team capacity for the DOM. We are adding a daytime rounding HM provider for the 3rd year running with an additional night provider to help admit to that capacity. The goal is to bring down our individual workloads to levels that allow us to care for these complex patients to the level necessary to meet their needs. We are working out ways to use this bandwidth to improve the resident-attending work with MCAT and relieve the long call hours.
- Additional services at HBR to more effectively use the team and bed space we still have there and avoid the back-forth from our teams and other services to MDH. Endocrine this year, podiatry moving now, hip fractures and increased surgical presence coming. Also coming: more help at night from outside DHM for ICU and surgical coverage.
- More redundancy in providers to minimize the gaps we have been experiencing and volunteerism we have been requiring.
- A reinvigorated attempt to achieve regionalization. The leadership of the new Capacity Command Center and the new CMO Jenny Boyd has recently affirmed their commitment to working with the DOM and DHM on this crucial goal.
- Care Management improvements driven by industry best practices to streamline IDR and communications between providers, nursing and CMs, getting all to work at top of license. Emily will help sponsor and bring our perspective to this work.
- Improvement in support and processes to get follow up appointments for inpatients (including out-of-network), growth of Advanced Care @ Home, continued work with Dispatch Health, and other ways to improve transitions to outpatient care.
- More robust support for back-transfers for both Medicine and other departments to get patients closer to home after their quaternary care needs have been resolved. We are also working with the DOM and other departments to work towards a more coherent strategy around inbound transfers to avoid the conflicts around team placement after arrival.
- Technology to assist us with the EHR demands with Epic AI summaries, Abridge and Evidently being available to all.
There are more coming, but I hope you get the point. There has been a lot of change around and within the division in the last year, but the focus and commitment to improvement has not changed. If you have other ideas and ways to try to improve the day-to-day work for our patients, my door is always open.
Congratulations to the DHM members recognized for their accomplishments at last week’s Triangle SHM Awards presentation:
- Excellence in Teaching – Nelly Bellamy
- Outstanding Service in Hospital Medicine – Erin Finn
- Health Equity Leadership Award – Mukhtar Adem
- Excellence in Research Award – Escher Howard-Williams
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| | | | | | | | | | | | -David Hemsey, MD , Division Chief, Hospital Medicine¶
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| | | APP Updates
Happy spring everyone! We are once again working to fill an open APP position for our daytime rounding (tree) service at main campus. If you know anyone that might be a good fit please send them our way! I also wanted to give a quick update from the Hospital Restraint Committee. A few months ago the policy changed and Bilateral Mitts and Lap Belts now require a restraint order at all time. Using 1 mitt, leaving the other hand free, does not require a restraint order if the patient is capable of removing the mitt using the free hand. Previously, using either of these restraints alone did not require an order.
| | | | | | | | | | | | -Dana Mabry, AGPCNP-BC , APP Service Line Leader¶
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| | | Coding Corner
Hello everyone! For this month’s Coding Corner, let’s talk about acute blood loss anemia.Acute posthemorrhagic anemia develops when a large amount of blood is lost quickly, resulting in a sudden drop in hemoglobin, hematocrit, and red blood cell mass. To support the diagnosis, document the cause of bleeding (e.g., GI bleed, surgical loss, trauma), the timing (“acute”), and the clinical impact, such as tachycardia, hypotension, pallor, or hypovolemia symptoms.
| | | | | | | | | | | | Labs should show decreased Hgb/Hct consistent with the acute event (typically a hemoglobin decrease of at least 15% and a total hemoglobin less than 10), and your note should clearly state “acute blood loss anemia secondary to…” to establish the essential causal link. Treatment—such as transfusions, IV fluids, hemostasis procedures, or oxygen therapy—further supports clinical validity. Bottom line: Name the diagnosis, link it to the bleeding source, include supporting labs and symptoms, and document the treatment response.
-Amy Tierney, MD , Associate Director of CDI
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| | | Admin Updates and Action Items
Hey Team!Hope everyone is doing well! As you know, this is the time of year when reminders begin rolling in—upcoming deadlines for modules, surveys, and other end of fiscal year items. As noted in my email from earlier this month, here are a few upcoming items that will need your attention.
| | | | | | | | | | | | Fit Testing - I’ve received additional guidance from the DOM Central Office indicating that all providers who directly interact with and care for patients must be up to date on fit testing by April 10. If you have completed fit testing between 7/1/2025 and today, please email Saranya directly with the date you completed the testing so we can update our reporting. If you have not yet completed updated fit testing, please schedule a time to do so as soon as possible and notify Saranya once completed so we can update the required reporting form.Both SOM faculty and Healthcare staff clickhereto sign up. Note: there is limited availability.
The Safety Culture Survey will be open until Sunday, April 12. On March 16, all UNC Health teammates should have received an email from Press Ganey on behalf of UNC Health with the subject line “Safety Culture Survey,” including a personal survey link. This survey will give teammates the opportunity to share how we’re doing in keeping patients, visitors and teammates safe, while also offering insight into how supported our teams feel. Note: The survey will be available to all teammates, physicians and APPs across owned and affiliate entities, and UNC School of Medicine (including residents).
Remember to complete your TeamSTEPPS training if you haven’t already. This should be done by June 2026. Let someone from our admin team know if you’re having any issues completing it. Here is the link to sign up through LMS.
Open APP Position- The daytime APP role at Main is now open. Please note that this is a replacement position for Brian; however, since Kelly has transitioned to HBH, we are posting an APP role at Main. Here is the link to the posting.
Admin Office Updates The administrative “office” is currently recruiting for 2 administrative specialists to join our division. One of these positions is a new position that was advocated for with our growth in faculty and the other is a replacement for Sharon’s role. Sharon will be leaving us on May 15th. I am very sad that she will be leaving our team but very excited for her as most of you know she has been going to school to get her Master’s in Clinical Mental Health Counseling. We will have something special for her prior to her departure so please stay tuned.
If you have any questions, please feel free to reach out!
-Taylor Herndon, MHA , Associate Chief of Administration, Divisions of Hospital Medicine and Geriatrics
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| | | As some of you may know, one of my areas of interest is direct care hospitalist teaching services. I’m excited to share that we will have an AI joining us on HBR Cardinal starting April 6 and throughout the spring/summer AI season! The 4th years are excited to have 1:1 opportunities to learn from us and prepare for their IM residency. They will spend 3 weeks on Cardinal and then 5 days M-F on HBR 2nd shift doing admissions and helping with cross coverage - a key skill for intern year!¶
| | | | | | | | | | | | Since this is a new venture, please reach out with questions, concerns, or suggestions through this process. I will also be asking folks to complete short survey about your experience so we can optimize things for us as attendings as well as for our learners. You will get a more detailed email from me with expectations for this particular rotation if you’re on Cardinal in the coming weeks. Also stay tuned for 4th Wednesday education in May where several of us will present on best practice for working with learners on direct care services!
-Anna Gravier Symmes, MD , Assistant Professor of Medicine, Hospital Medicine
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| | | | | | Please email Sharon Baker ([email protected]) if you would like to recognize a fellow peer, share a personal work achievement, family/coworkers photos, or submit an announcement to be featured in future newsletters.¶
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| | Copyright (C) 2026 UNC Division of Hospital Medicine. All rights reserved.
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