100 Hospitalist Clinical Pearls

A practical reference for hospitalists from CME Getaway.

Cardiovascular

1. Elevated troponin does not always indicate acute myocardial infarction.
2. New-onset atrial fibrillation requires evaluation for reversible triggers.
3. BNP is more helpful to rule out heart failure than to confirm it.
4. Use CHA₂DS₂-VASc to guide anticoagulation decisions.
5. Control ventricular rate before considering rhythm control in most stable patients.
6. Orthostatic hypotension is common in older adults with falls.
7. High-sensitivity troponin trends are more informative than a single value.
8. Avoid excessive IV fluids in patients with heart failure.
9. Not all chest pain is cardiac—consider PE, aortic dissection, and esophageal causes.
10. Repeat ECGs can reveal evolving ischemia.

Pulmonary

11. Oxygen is a medication—target appropriate oxygen saturation goals.
12. Consider pulmonary embolism even without classic symptoms.
13. Early mobilization reduces pulmonary complications.
14. COPD exacerbations often benefit from short steroid courses.
15. Lung ultrasound can outperform chest X-ray for pleural effusions.
16. Incentive spirometry alone does not prevent postoperative pneumonia.
17. Use validated risk scores before CT pulmonary angiography.
18. Pulmonary edema and pneumonia may coexist.
19. Evaluate for aspiration in recurrent pneumonia.
20. Document smoking cessation counseling.

Infectious Diseases

21. Obtain cultures before antibiotics when feasible.
22. De-escalate antibiotics based on culture results.
23. Not every fever requires broad-spectrum antibiotics.
24. Treat the patient, not the laboratory result.
25. Procalcitonin should support—not replace—clinical judgment.
26. Remove infected lines whenever possible.
27. Daily antibiotic review improves stewardship.
28. Most uncomplicated cellulitis is caused by streptococci.
29. Avoid treating asymptomatic bacteriuria except in select situations.
30. Shorter antibiotic courses are appropriate for many infections.

Endocrinology

31. Sliding-scale insulin alone is usually inadequate.
32. Steroids commonly cause afternoon hyperglycemia.
33. Correct sodium for severe hyperglycemia.
34. Check ketones in suspected DKA.
35. Hypoglycemia increases inpatient mortality.
36. Review home diabetes medications before discharge.
37. HHS requires aggressive fluid replacement.
38. Reassess insulin after steroids stop.
39. Metformin is often held during acute illness.
40. Inpatient glucose targets differ from outpatient goals.

Nephrology

41. AKI is often multifactorial.
42. Review nephrotoxic medications daily.
43. Urine microscopy remains valuable.
44. Fractional excretion indices have limitations.
45. Avoid unnecessary contrast exposure.
46. Monitor potassium trends.
47. Volume assessment is more important than creatinine alone.
48. Consider post-renal obstruction.
49. Hyperkalemia requires ECG evaluation.
50. Dose medications according to kidney function.

Gastroenterology

51. Early endoscopy improves outcomes in upper GI bleeding.
52. Start PPIs when upper GI bleeding is suspected.
53. Titrate lactulose to clinical effect.
54. Alcohol withdrawal can mimic hepatic encephalopathy.
55. Calculate severity scores in pancreatitis.
56. Early enteral nutrition is preferred.
57. Monitor for spontaneous bacterial peritonitis.
58. Not every elevated liver enzyme reflects liver disease.
59. Assess bleeding risk before procedures.
60. Constipation frequently contributes to delirium.

Neurology

61. Delirium is often preventable.
62. Stroke mimics are common.
63. Obtain last known well time immediately.
64. Nonconvulsive status epilepticus may present as confusion.
65. Medication review is essential in altered mental status.
66. Avoid unnecessary sedatives in older adults.
67. Early PT reduces deconditioning.
68. Delirium fluctuates throughout the day.
69. Frequent neurologic reassessment is critical.
70. Sleep deprivation worsens delirium.

Hematology

71. Use restrictive transfusion strategies.
72. Evaluate iron deficiency after stabilization.
73. Platelet count alone does not predict bleeding.
74. Consider HIT when platelets fall significantly.
75. Reassess VTE prophylaxis daily.
76. Hospitalization is a major VTE risk factor.
77. Mechanical prophylaxis is not equivalent to pharmacologic.
78. Elevated D-dimer is nonspecific.
79. Review anticoagulant interactions before discharge.
80. Unexplained anemia warrants follow-up.

Hospital Medicine

81. Medication reconciliation prevents adverse events.
82. Daily goals improve multidisciplinary communication.
83. Early discharge planning reduces length of stay.
84. Functional status predicts outcomes better than age.
85. Discuss code status early.
86. Avoid unnecessary daily laboratory testing.
87. Mobility is a vital sign.
88. Review indwelling devices every day.
89. Communicate pending results at discharge.
90. Clear discharge instructions reduce readmissions.

Patient Safety

91. Wash hands before every patient encounter.
92. Use ultrasound guidance whenever appropriate.
93. Review allergies before prescribing antibiotics.
94. High-risk medications require independent verification.
95. Falls are often preventable.
96. Polypharmacy increases complications.
97. Encourage shared decision-making.
98. Document clinical reasoning.
99. Every hospitalization is an opportunity for preventive care.
100. Combine evidence-based medicine with compassionate communication.