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

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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