Simple, High-Impact Changes Hospitalists Are Missing (SHM 2026 Takeaways)

With Special Guest Dr. Emily ReamsIn 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 disorderNaltrexone: 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 routinelyBig 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.Support the showWant the cited articles and key takeaways? Join the email list:https://subscribe.inpatientupdate.com/