Purpose and Overview

In 1996, Wachter and Goldman named the hospitalist. Within twenty years, the field reached roughly 50,000 physicians, yet its founding evidence was narrow. This Grand Rounds asks two questions. Has the accumulated burden of regulatory, documentation, and measurement requirements in adult inpatient care improved outcomes? And how can we improve inpatient care delivery at UTSW?  The session separates research, which establishes what is true across populations, from evidence-based practice, which applies it to one patient. Ward audits found that about half of inpatient treatments had randomized trial support; the requirements layered around them have never been audited. Studies that hold the detection method constant show no measurable fall in inpatient harm. After the pandemic, staffed beds fell while daily census held steady; mean occupancy rose and admitted emergency patients boarded.