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With Special Guest Dr. Emily Reams

In this special episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Emily Reams to break down the most practice-changing takeaways from SHM Converge 2026.

No fluff — just what you can start doing on rounds tomorrow.

Topics include:

• Flu shots in heart failure — real mortality benefit
• Stopping aspirin in patients on DOACs
• Anticoagulation in AFib despite fall risk
• Naltrexone for alcohol use disorder — start inpatient
• Phenobarbital for withdrawal — coming soon
• Metformin in the hospital — dogma challenged
• Transfusion thresholds in MI
• “Things We Do for No Reason” highlights

Practical take-homes and what to actually change this week.

Practice-Changing Highlights

💉 Flu shots in heart failure
NNT ≈ 17 for death/readmission
→ Vaccinate before discharge during flu season

💊 Stop aspirin with DOACs
↑ bleeding and mortality without benefit
→ Stop aspirin ~6–12 months post-stent (most patients)

🧠 AFib + fall risk
Benefit >> risk (would need >450 falls/year to offset)
→ Don’t withhold anticoagulation for falls alone

🍺 Alcohol use disorder

• Naltrexone: start before discharge → ↓ cravings, ↓ readmissions
• Phenobarbital: increasing use, likely future standard

💊 Metformin inpatient
May be safe in select patients
→ Consider if GFR ≥30 and no lactic acidosis

🩸 Transfusion in MI
Target Hgb ~10 may reduce mortality
→ Evolving — keep on radar

💊 Anticoagulation updates

• Apixaban preferred over rivaroxaban
• Reduce dose after 3–6 months for VTE
  → Reassess dosing routinely

Big Picture

• Biggest wins = simple changes
• Often: stop meds or use basics better
• Hospitalists have high-impact touchpoints

If You Change Nothing Else This Week

• Give flu shots in heart failure
• Stop aspirin in DOAC patients (when appropriate)
• Anticoagulate AFib despite fall risk
• Start naltrexone before discharge

Small changes. Massive reach. Real impact.

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Episode 5: De-escalating Sepsis Antibiotics & When to Pull the IV w/ Nicholas Linde, PA

With Special Guest Nicholas Linde, PA

In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist PA Nick Linde to tackle two everyday decisions that impact nearly every inpatient service:

• De-escalating broad-spectrum antibiotics in sepsis — is it safe to stop vancomycin and zosyn earlier than we think?
• Routine peripheral IV use — are we leaving IVs in too long and causing harm?

Practical take-homes, real-world cases, and what to change on rounds tomorrow.

Articles & PubMed Links

Antibiotic De-escalation in Adults Hospitalized With Community-Onset Sepsis

JAMA Internal Medicine (2026)

Compared:

• Continue broad-spectrum antibiotics beyond day 4
  vs
• De-escalate at day 4

Key Findings

• No difference in 90-day mortality (OR ≈ 1.0)
• Shorter hospital length of stay
  
  • ~1 day shorter (MRSA de-escalation)
  • ~2 days shorter (pseudomonal de-escalation)
  • No clear harm signal with de-escalation

Takeaway

In clinically improving patients with negative or non-MDR cultures, early de-escalation at day 4 is safe and reduces hospital stay.

Pubmed: https://pubmed.ncbi.nlm.nih.gov/41428290/

Things We Do for No Reason™: Routinely Maintaining Intravenous Access in Hospitalized Patients

Journal of Hospital Medicine (2026)

Key Points

• ~25% of inpatient IVs are idle (not in use)
• Peripheral IVs contribute to morbidity:
  • ~20% of MSSA bacteremia

When to Remove

• No IV medications or fluids needed
• Clinically stable patient
• Oral alternatives available

When to Keep

• High risk of decompensation
• Anticipated procedures or IV contrast
• Ongoing electrolyte replacement or IV therapy

Takeaway

Peripheral IVs are not benign — if you’re not using it, seriously consider removing it.

Pubmed: https://pmc.ncbi.nlm.nih.gov/articles/PMC12865233/

Practice-Changing Takeaways

• Sepsis: At day 4, reassess. If cultures are negative and patient improving, de-escalate broad-spectrum antibiotics.
• IVs: “Use it or lose it.” Idle IVs carry real risk — don’t leave them in by default.
• These are high-frequency decisions → small changes = big impact.

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Episode 4: Faster Hypernatremia Correction & Long-Acting Antibiotics for Staph Bacteremia

With Special Guest Dr. Kevin Baker

In this episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Kevin Baker to discuss two studies that challenge long-held dogma in inpatient medicine:

• Faster correction of hypernatremia — is the traditional “go slow” rule actually harming patients?
• Dalbavancin for Staph aureus bacteremia (DOTS Trial) — can two long-acting antibiotic injections replace weeks of IV therapy and PICC lines?

Practical take-homes, real-world discussion, and what to change on rounds tomorrow (with a couple of bourbons).

Articles & PubMed Links

Clinical outcomes of early fast compared to slow sodium correction rate in adults with severe hypernatremia: A comparative effectiveness study

Journal of Critical Care (2025)

Key Findings

• Faster correction associated with lower 30-day mortality
• Shorter ICU length of stay
• Shorter hospital length of stay
• No signal for neurologic complications from rapid correction

Supporting data from prior studies:

• 2023 JAMA observational cohort
  Faster correction associated with lower mortality
  No neurologic complications reported
• 2025 Journal of Critical Care meta-analysis
  Faster correction not associated with worse outcomes

Takeaway

For adult hypernatremia, especially in critically ill patients, more aggressive correction appears safe and may improve outcomes.

Pubmed: https://pubmed.ncbi.nlm.nih.gov/41240509/

Dalbavancin for Treatment of Staphylococcus aureus Bacteremia: The DOTS Randomized Clinical Trial

JAMA 2025

Compared:

Standard Therapy

• 4–8 weeks IV antibiotics
• Cefazolin / anti-staphylococcal penicillin (MSSA)
• Vancomycin or daptomycin (MRSA)

vs

Dalbavancin Strategy

• 1500 mg IV day 1
• 1500 mg IV day 8

Long-acting lipoglycopeptide with ~14-day half-life, allowing completion of therapy without PICC lines.

Population

• Complicated Staph aureus bacteremia

Key Results

Clinical efficacy:

• Dalbavancin: 73%
• Standard therapy: 72%

Microbiologic success:

• Dalbavancin: 98.8%
• Standard therapy: 96.3%

Met criteria for non-inferiority.

Takeaway

For selected patients with cleared Staph aureus bacteremia, two doses of dalbavancin may replace weeks of IV antibiotics and PICC lines.

Potential advantages:

• Avoids central line complications
• Simplifies discharge planning
• Useful in patients with difficult social situations or IV access concerns

Pubmed: https://pubmed.ncbi.nlm.nih.gov/40802264/

Practice-Changing Takeaways

• Hypernatremia: Faster correction appears safe in adults and IMPROVES mortality.
• Staph bacteremia: Long-acting dalbavancin offers a PICC-free alternative for completing therapy in selected patients.
• Hospital medicine continues to move toward shorter and simpler antibiotic strategies.