Tim Morton

Most companies recognize that social media have become established as viable business tools. Many leaders are using sites like Facebook, Twitter, and LinkedIn to connect to their customers, recruit followers, and promote their services in real time. But the opportunity to connect the dots and utilize social media in a safe and meaningful way has yet to be fully realized. Whoever gets there first has the opportunity to revolutionize and forever change the medical industry.

The Current Situation

Social media sites for the medical industry range from broad, open platforms to niche, narrowly concentrated forums. Facebook, Twitter, and YouTube are broad platforms for individuals and corporations alike to broadcast experiences and opinions large and small. CancerDoc, HealthLine, and RevolutionHealth are more narrowly targeted places for rapidly communicating and connecting to those who are sharing similar experiences, communicating information, and sharing ideas amongst patients and medical industry peers. Expert Q&A sites, such as WebMD and AskDrWiki, are popular with patients who can find credible answers to their health-related questions. Physician networks (e.g. Sermo and Ozmosis) serve as “virtual water coolers” where physicians can collaborate in real time.

But no matter what portal is being used by patient or provider, the single most beneficial aspect of social media is the collaboration enabled by the openness of vast numbers. Most are trying to get their message out, educate, inform, and simply share. The portals themselves, empowered by the strength of their members, are positioning themselves as the source of true, real-time data and insight. Many healthcare facilities use social media to crowdsource, or basically ask for input from users to help develop or improve products and services quickly and efficiently. Others are enabling real-time learning through podcasts of surgeries, which medical students can attend remotely.

In 2010 specifically, we saw a significant jump in medical companies utilizing social media tools. The Mayo Clinic has gained more than 33,000 Facebook fans in a little more than a year. The Mayo “wall” is filled with patients’ thanks, interviews, advice, industry news, and nearly 150 videos. Its presence in this space has strengthened the Mayo name as a thought leader in medical care and innovation.

Future Opportunities

While all this is important to building relationships and brands, these building blocks could be the source for more revolutionary advancements. Over time, the intimate knowledge of a contributor, a regional demographic, or an international group of sufferers could be used as proactive triggers for action. Imagine a device that collects signs of your general well-being, then the data from this blends with your Facebook postings on location, time, diet, and feeling while aggregating information from other users and facilities. When linked to your medical facility and medication status, your pharmacy, your caregiver, or your gym could generate guidance and suggestions, which are sent back to you daily. If a hazardous situation is suspected by auto-analysis of the data, then this could directly alert your doctor to provide personal, quick advice and instructions. The potential to use social media and connected, aware devices for well-being and preventative care is huge, as are the possibilities for predicting and tracking patterns in health globally.

Social media offer unique opportunities for scalable interaction and collaboration, a key reason medical and lifestyle device manufacturers have much opportunity ahead of them. By developing products that become part of the user’s daily lives (think how important your smartphone is to you now), manufacturers will find themselves building a loyal customer base that is not only using their device, but is also interacting with them and providing unparalleled insight into their habits in real time.

Nike is one company that has been quick to the punch. The NikePlus Running Monitor is an application that meshes telehealth devices with social media, monitoring and posting running information on Facebook. All of this tracking and communication serves as a great promoter of the manufacturer, as it’s advertised every time the user posts a status update.

Despite all the progress, challenges remain for medical companies when diving into social media. It remains a very new horizon for an industry that faces hurdles posed by the traditions of the medical and insurance industries. Companies who are agile and able to pivot likely will be the winners. It’s easy to imagine Google as the CDC’s biggest information source in the future, aggregating and reporting clusters of users searching for key disease symptoms through an app portal or tweeting about illnesses. Used as tools for triggers, social media can take the temperature of societal health, allowing the medical community to watch population density or pollution patterns unfold.

If device manufacturers and the medical community figure out how to harness and leverage the power of people’s desire to connect and share, they could achieve groundbreaking contributions to healthcare and the connected world as a whole in the coming years.

Tim Morton,

design director,

Product Development Technologies,

Lake Zurich, Ill.

Journal Venues for Safety and Quality-Improvement Publications

Tim Morton

The message is clear: Conducting business as usual is no longer tenable, nor the “right thing to do” for our patients. In a recent survey of departments of medicine chairs, Staiger et al summarize: “Top-performing academic institutions have recognized that quality improvement/patient safety (QI/PS) activities, leading to improved and measurable patient outcomes, are imperative for strategic survival.”¹

Long before this report, the Society of General Internal Medicine’s Academic Hospitalist Task Force provided a framework to document the scholarship for promotion in academic medical centers and to document improvement activities.² Since then, major academic institutions have incorporated such principles to support academic promotion.

Table 1 (see p. 6) provides venues for publication to advance the science of safety and QI; each is Medline-indexed. The list is not exhaustive and is meant to serve as a starting point of reference. We have not included many other excellent clinical journals that publish QI and patient safety work. When conducting improvement studies, we encourage hospitalists to use the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for publication of quality-improvement articles.^3,4,5

Enjoy a new era in academic medical centers.

Adolfo Peña, MD,

hospitalist,

Saint Joseph Hospital,

London, Ky.;

Benjamin Taylor, MD, MPH,

chief quality officer,

University Hospital,

The University of Alabama at Birmingham,

SGIM Academic Hospitalist Task Force member;

Pat Patrician, RN, PhD,

senior scholar,

Birmingham VA Quality Scholars Program;

Carlos A. Estrada, MD, MS,

senior scholar,

Birmingham VA Quality Scholars Program

References

1. Staiger TO, Wong EY, Schleyer AM, Martin DP, Levinson W, Bremner WJ. The role of quality improvement and patient safety in academic promotion: results of a survey of chairs of departments of internal medicine in North America. Am J Med. 2011;124:277-280.
2. Society of General Internal Medicine (SGIM) Academic Hospitalist Task Force. Quality Portfolio. SGIM website. Available at: www.sgim.org/index.cfm?pageId=844. Accessed May 3, 2011.
3. Davidoff D, Batalden P, Stevens D, Ogrinc D, Mooney S. Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care. 2008;17 Suppl 1:i3-i9.
4. Ogrinc G, Mooney S, Estrada C, et al. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care. 2008;17 Suppl 1:i13-i32.
5. Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for publication of quality improvement articles. SQUIRE website. Available at: http://squire-statement.org. Accessed May 3, 2011.

Tim Morton

Most companies recognize that social media have become established as viable business tools. Many leaders are using sites like Facebook, Twitter, and LinkedIn to connect to their customers, recruit followers, and promote their services in real time. But the opportunity to connect the dots and utilize social media in a safe and meaningful way has yet to be fully realized. Whoever gets there first has the opportunity to revolutionize and forever change the medical industry.

The Current Situation

Social media sites for the medical industry range from broad, open platforms to niche, narrowly concentrated forums. Facebook, Twitter, and YouTube are broad platforms for individuals and corporations alike to broadcast experiences and opinions large and small. CancerDoc, HealthLine, and RevolutionHealth are more narrowly targeted places for rapidly communicating and connecting to those who are sharing similar experiences, communicating information, and sharing ideas amongst patients and medical industry peers. Expert Q&A sites, such as WebMD and AskDrWiki, are popular with patients who can find credible answers to their health-related questions. Physician networks (e.g. Sermo and Ozmosis) serve as “virtual water coolers” where physicians can collaborate in real time.

But no matter what portal is being used by patient or provider, the single most beneficial aspect of social media is the collaboration enabled by the openness of vast numbers. Most are trying to get their message out, educate, inform, and simply share. The portals themselves, empowered by the strength of their members, are positioning themselves as the source of true, real-time data and insight. Many healthcare facilities use social media to crowdsource, or basically ask for input from users to help develop or improve products and services quickly and efficiently. Others are enabling real-time learning through podcasts of surgeries, which medical students can attend remotely.

In 2010 specifically, we saw a significant jump in medical companies utilizing social media tools. The Mayo Clinic has gained more than 33,000 Facebook fans in a little more than a year. The Mayo “wall” is filled with patients’ thanks, interviews, advice, industry news, and nearly 150 videos. Its presence in this space has strengthened the Mayo name as a thought leader in medical care and innovation.

Future Opportunities

While all this is important to building relationships and brands, these building blocks could be the source for more revolutionary advancements. Over time, the intimate knowledge of a contributor, a regional demographic, or an international group of sufferers could be used as proactive triggers for action. Imagine a device that collects signs of your general well-being, then the data from this blends with your Facebook postings on location, time, diet, and feeling while aggregating information from other users and facilities. When linked to your medical facility and medication status, your pharmacy, your caregiver, or your gym could generate guidance and suggestions, which are sent back to you daily. If a hazardous situation is suspected by auto-analysis of the data, then this could directly alert your doctor to provide personal, quick advice and instructions. The potential to use social media and connected, aware devices for well-being and preventative care is huge, as are the possibilities for predicting and tracking patterns in health globally.

Social media offer unique opportunities for scalable interaction and collaboration, a key reason medical and lifestyle device manufacturers have much opportunity ahead of them. By developing products that become part of the user’s daily lives (think how important your smartphone is to you now), manufacturers will find themselves building a loyal customer base that is not only using their device, but is also interacting with them and providing unparalleled insight into their habits in real time.

Nike is one company that has been quick to the punch. The NikePlus Running Monitor is an application that meshes telehealth devices with social media, monitoring and posting running information on Facebook. All of this tracking and communication serves as a great promoter of the manufacturer, as it’s advertised every time the user posts a status update.

Despite all the progress, challenges remain for medical companies when diving into social media. It remains a very new horizon for an industry that faces hurdles posed by the traditions of the medical and insurance industries. Companies who are agile and able to pivot likely will be the winners. It’s easy to imagine Google as the CDC’s biggest information source in the future, aggregating and reporting clusters of users searching for key disease symptoms through an app portal or tweeting about illnesses. Used as tools for triggers, social media can take the temperature of societal health, allowing the medical community to watch population density or pollution patterns unfold.

If device manufacturers and the medical community figure out how to harness and leverage the power of people’s desire to connect and share, they could achieve groundbreaking contributions to healthcare and the connected world as a whole in the coming years.

Tim Morton,

design director,

Product Development Technologies,

Lake Zurich, Ill.

Journal Venues for Safety and Quality-Improvement Publications

Tim Morton

The message is clear: Conducting business as usual is no longer tenable, nor the “right thing to do” for our patients. In a recent survey of departments of medicine chairs, Staiger et al summarize: “Top-performing academic institutions have recognized that quality improvement/patient safety (QI/PS) activities, leading to improved and measurable patient outcomes, are imperative for strategic survival.”¹

Long before this report, the Society of General Internal Medicine’s Academic Hospitalist Task Force provided a framework to document the scholarship for promotion in academic medical centers and to document improvement activities.² Since then, major academic institutions have incorporated such principles to support academic promotion.

Table 1 (see p. 6) provides venues for publication to advance the science of safety and QI; each is Medline-indexed. The list is not exhaustive and is meant to serve as a starting point of reference. We have not included many other excellent clinical journals that publish QI and patient safety work. When conducting improvement studies, we encourage hospitalists to use the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for publication of quality-improvement articles.^3,4,5

Enjoy a new era in academic medical centers.

Adolfo Peña, MD,

hospitalist,

Saint Joseph Hospital,

London, Ky.;

Benjamin Taylor, MD, MPH,

chief quality officer,

University Hospital,

The University of Alabama at Birmingham,

SGIM Academic Hospitalist Task Force member;

Pat Patrician, RN, PhD,

senior scholar,

Birmingham VA Quality Scholars Program;

Carlos A. Estrada, MD, MS,

senior scholar,

Birmingham VA Quality Scholars Program

References

1. Staiger TO, Wong EY, Schleyer AM, Martin DP, Levinson W, Bremner WJ. The role of quality improvement and patient safety in academic promotion: results of a survey of chairs of departments of internal medicine in North America. Am J Med. 2011;124:277-280.
2. Society of General Internal Medicine (SGIM) Academic Hospitalist Task Force. Quality Portfolio. SGIM website. Available at: www.sgim.org/index.cfm?pageId=844. Accessed May 3, 2011.
3. Davidoff D, Batalden P, Stevens D, Ogrinc D, Mooney S. Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care. 2008;17 Suppl 1:i3-i9.
4. Ogrinc G, Mooney S, Estrada C, et al. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care. 2008;17 Suppl 1:i13-i32.
5. Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for publication of quality improvement articles. SQUIRE website. Available at: http://squire-statement.org. Accessed May 3, 2011.

Tim Morton

Most companies recognize that social media have become established as viable business tools. Many leaders are using sites like Facebook, Twitter, and LinkedIn to connect to their customers, recruit followers, and promote their services in real time. But the opportunity to connect the dots and utilize social media in a safe and meaningful way has yet to be fully realized. Whoever gets there first has the opportunity to revolutionize and forever change the medical industry.

The Current Situation

Social media sites for the medical industry range from broad, open platforms to niche, narrowly concentrated forums. Facebook, Twitter, and YouTube are broad platforms for individuals and corporations alike to broadcast experiences and opinions large and small. CancerDoc, HealthLine, and RevolutionHealth are more narrowly targeted places for rapidly communicating and connecting to those who are sharing similar experiences, communicating information, and sharing ideas amongst patients and medical industry peers. Expert Q&A sites, such as WebMD and AskDrWiki, are popular with patients who can find credible answers to their health-related questions. Physician networks (e.g. Sermo and Ozmosis) serve as “virtual water coolers” where physicians can collaborate in real time.

But no matter what portal is being used by patient or provider, the single most beneficial aspect of social media is the collaboration enabled by the openness of vast numbers. Most are trying to get their message out, educate, inform, and simply share. The portals themselves, empowered by the strength of their members, are positioning themselves as the source of true, real-time data and insight. Many healthcare facilities use social media to crowdsource, or basically ask for input from users to help develop or improve products and services quickly and efficiently. Others are enabling real-time learning through podcasts of surgeries, which medical students can attend remotely.

In 2010 specifically, we saw a significant jump in medical companies utilizing social media tools. The Mayo Clinic has gained more than 33,000 Facebook fans in a little more than a year. The Mayo “wall” is filled with patients’ thanks, interviews, advice, industry news, and nearly 150 videos. Its presence in this space has strengthened the Mayo name as a thought leader in medical care and innovation.

Future Opportunities

While all this is important to building relationships and brands, these building blocks could be the source for more revolutionary advancements. Over time, the intimate knowledge of a contributor, a regional demographic, or an international group of sufferers could be used as proactive triggers for action. Imagine a device that collects signs of your general well-being, then the data from this blends with your Facebook postings on location, time, diet, and feeling while aggregating information from other users and facilities. When linked to your medical facility and medication status, your pharmacy, your caregiver, or your gym could generate guidance and suggestions, which are sent back to you daily. If a hazardous situation is suspected by auto-analysis of the data, then this could directly alert your doctor to provide personal, quick advice and instructions. The potential to use social media and connected, aware devices for well-being and preventative care is huge, as are the possibilities for predicting and tracking patterns in health globally.

Social media offer unique opportunities for scalable interaction and collaboration, a key reason medical and lifestyle device manufacturers have much opportunity ahead of them. By developing products that become part of the user’s daily lives (think how important your smartphone is to you now), manufacturers will find themselves building a loyal customer base that is not only using their device, but is also interacting with them and providing unparalleled insight into their habits in real time.

Nike is one company that has been quick to the punch. The NikePlus Running Monitor is an application that meshes telehealth devices with social media, monitoring and posting running information on Facebook. All of this tracking and communication serves as a great promoter of the manufacturer, as it’s advertised every time the user posts a status update.

Despite all the progress, challenges remain for medical companies when diving into social media. It remains a very new horizon for an industry that faces hurdles posed by the traditions of the medical and insurance industries. Companies who are agile and able to pivot likely will be the winners. It’s easy to imagine Google as the CDC’s biggest information source in the future, aggregating and reporting clusters of users searching for key disease symptoms through an app portal or tweeting about illnesses. Used as tools for triggers, social media can take the temperature of societal health, allowing the medical community to watch population density or pollution patterns unfold.

If device manufacturers and the medical community figure out how to harness and leverage the power of people’s desire to connect and share, they could achieve groundbreaking contributions to healthcare and the connected world as a whole in the coming years.

Tim Morton,

design director,

Product Development Technologies,

Lake Zurich, Ill.

Journal Venues for Safety and Quality-Improvement Publications

Tim Morton

The message is clear: Conducting business as usual is no longer tenable, nor the “right thing to do” for our patients. In a recent survey of departments of medicine chairs, Staiger et al summarize: “Top-performing academic institutions have recognized that quality improvement/patient safety (QI/PS) activities, leading to improved and measurable patient outcomes, are imperative for strategic survival.”¹

Long before this report, the Society of General Internal Medicine’s Academic Hospitalist Task Force provided a framework to document the scholarship for promotion in academic medical centers and to document improvement activities.² Since then, major academic institutions have incorporated such principles to support academic promotion.

Table 1 (see p. 6) provides venues for publication to advance the science of safety and QI; each is Medline-indexed. The list is not exhaustive and is meant to serve as a starting point of reference. We have not included many other excellent clinical journals that publish QI and patient safety work. When conducting improvement studies, we encourage hospitalists to use the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for publication of quality-improvement articles.^3,4,5

Enjoy a new era in academic medical centers.

Adolfo Peña, MD,

hospitalist,

Saint Joseph Hospital,

London, Ky.;

Benjamin Taylor, MD, MPH,

chief quality officer,

University Hospital,

The University of Alabama at Birmingham,

SGIM Academic Hospitalist Task Force member;

Pat Patrician, RN, PhD,

senior scholar,

Birmingham VA Quality Scholars Program;

Carlos A. Estrada, MD, MS,

senior scholar,

Birmingham VA Quality Scholars Program

References

1. Staiger TO, Wong EY, Schleyer AM, Martin DP, Levinson W, Bremner WJ. The role of quality improvement and patient safety in academic promotion: results of a survey of chairs of departments of internal medicine in North America. Am J Med. 2011;124:277-280.
2. Society of General Internal Medicine (SGIM) Academic Hospitalist Task Force. Quality Portfolio. SGIM website. Available at: www.sgim.org/index.cfm?pageId=844. Accessed May 3, 2011.
3. Davidoff D, Batalden P, Stevens D, Ogrinc D, Mooney S. Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care. 2008;17 Suppl 1:i3-i9.
4. Ogrinc G, Mooney S, Estrada C, et al. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care. 2008;17 Suppl 1:i13-i32.
5. Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines for publication of quality improvement articles. SQUIRE website. Available at: http://squire-statement.org. Accessed May 3, 2011.

With more than 250 hospitals adopting them in the last three years, SHM’s mentored implementation programs make a compelling case for the need to address care transitions, improve the management of diabetes, and prevent VTEs in hospitalized patients. And early results from the sites show that the mentored implementation model, with its combination of a best-practices toolkit and individualized support from national experts, can make a real difference.

“Quality improvement (QI) is the niche of hospital medicine; our mentored implementation programs have achieved both the goals of improving care in a clinical area nationwide as well as creating quality improvement leaders within our ranks,” says Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor of medicine and hospital medicine section chief at the University of New Mexico Health Sciences Center’s Department of Internal Medicine.

That’s the reasoning behind SHM’s new eQUIPS program. In essence, eQUIPS (Electronic Quality Improvement Programs) is SHM’s proven mentored implementation program, but without the mentor. Participants can access the same educational tools and resources, the same data center for tracking performance, and participate in the same online collaborative available to mentored implementation sites.

SHM’s eQUIPS program takes the collective knowledge from the programs and offers it as a self-guided program that includes robust data collection and display programs.—Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor, hospital medicine section chief, Department of Internal Medicine, University of New Mexico Health Sciences Center

“SHM’s eQUIPS program takes the collective knowledge from the programs and offers it as a self-guided program that includes robust data collection and display programs,” Dr. Rogers says. “It will allow hospital quality-improvement teams more time to focus on driving change through the effective use of data, rather than spending their time trying to get the data.”

eQUIPS empowers hospitalists to move forward on valuable QI programs at their own pace, at any time. Hospitalists begin with the confidence that an entire community of likeminded physicians is supporting them, sharing their information, challenges, and successes.

Now, hospitalists can bring best practices to their hospitals and show their directors and executive leadership that they are on the cutting edge of addressing some of the most pervasive challenges in today’s hospitals.

Although they share a similar approach, each of eQUIPS’ three programs tackles the individual challenges of care transitions, VTE, and glycemic control separately. Hospitals can subscribe to any combination of the three topics.

Because eQUIPS is meant for year-after-year use and designed so that its utility grows along with its user base, access to eQUIPS is based on a yearly subscription model. The first year of access to eQUIPS is $2,500, which includes a one-time technology start-up fee. Each following year’s subscription is $1,500.

Hospitalists can apply for eQUIPS at www.hospitalmedicine.org/equips.

click for large version

Educational Resources Get eQUIPS Users Started

Regardless of how far a hospital has advanced its programs, the educational materials that come with the subscription take hospitalists through the best in evidence-based medicine to address care transitions, VTE, and glycemic control, essentially forming a toolkit of relevant journal articles, presentations, step-by-step implementation guides, clinical tools, program files submitted by participants, and on-demand educational webinars facilitated by content experts.

Analysis and Reporting

Most experts agree that tracking and reporting results are the linchpins of QI programs. eQUIPS makes it easier with secure online tools for recording, benchmarking, process management, and tracking milestones.

Plus, eQUIPS enables hospitalists to compare their programs to others across the country. By uploading performance data to the secure eQUIPS data center for performance tracking, hospitals can analyze and compare outcomes from their programs to other eQUIPS sites and national norms (see Figure 1).

And hospitalists can assure their hospitals’ legal staffs that SHM has taken steps to ensure HIPAA compliance through third-party reviews. eQUIPS subscribers log into the site through a secured-password authentication similar to those of other online public health and financial institutions. In addition, SHM’s QI programs have earned the Patient Safety Organization (PSO) designation from the Agency for Healthcare Research and Quality (AHRQ), which makes it easier for hospitals to share performance data with SHM.

Real-Time Collaboration

Every hospital faces unique challenges, but they also have much in common when it comes to implementing new programs. As eQUIPS subscribers join, they can share their QI experiences and ask others for feedback in finding solutions.

The eQUIPS community website feature serves as a central, on-demand repository for sharing documents and educational materials, while the online workspace enables hospitalists to collaborate in real time by posting documents and editing them with other participating eQUIPS sites.

eQUIPS also brings collaboration right to users’ inboxes. Access to QI listservs has been a productive way for hospitalists to connect and benefit from the collective experience of the group; it’s a key component of the eQUIPS programs.

For Rogers, eQUIPS and its collaborative tools are a logistical extension of SHM’s successful QI track record. TH

Brendon Shank is assistant vice president of communications for SHM.

With more than 250 hospitals adopting them in the last three years, SHM’s mentored implementation programs make a compelling case for the need to address care transitions, improve the management of diabetes, and prevent VTEs in hospitalized patients. And early results from the sites show that the mentored implementation model, with its combination of a best-practices toolkit and individualized support from national experts, can make a real difference.

“Quality improvement (QI) is the niche of hospital medicine; our mentored implementation programs have achieved both the goals of improving care in a clinical area nationwide as well as creating quality improvement leaders within our ranks,” says Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor of medicine and hospital medicine section chief at the University of New Mexico Health Sciences Center’s Department of Internal Medicine.

That’s the reasoning behind SHM’s new eQUIPS program. In essence, eQUIPS (Electronic Quality Improvement Programs) is SHM’s proven mentored implementation program, but without the mentor. Participants can access the same educational tools and resources, the same data center for tracking performance, and participate in the same online collaborative available to mentored implementation sites.

SHM’s eQUIPS program takes the collective knowledge from the programs and offers it as a self-guided program that includes robust data collection and display programs.—Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor, hospital medicine section chief, Department of Internal Medicine, University of New Mexico Health Sciences Center

“SHM’s eQUIPS program takes the collective knowledge from the programs and offers it as a self-guided program that includes robust data collection and display programs,” Dr. Rogers says. “It will allow hospital quality-improvement teams more time to focus on driving change through the effective use of data, rather than spending their time trying to get the data.”

eQUIPS empowers hospitalists to move forward on valuable QI programs at their own pace, at any time. Hospitalists begin with the confidence that an entire community of likeminded physicians is supporting them, sharing their information, challenges, and successes.

Now, hospitalists can bring best practices to their hospitals and show their directors and executive leadership that they are on the cutting edge of addressing some of the most pervasive challenges in today’s hospitals.

Although they share a similar approach, each of eQUIPS’ three programs tackles the individual challenges of care transitions, VTE, and glycemic control separately. Hospitals can subscribe to any combination of the three topics.

Because eQUIPS is meant for year-after-year use and designed so that its utility grows along with its user base, access to eQUIPS is based on a yearly subscription model. The first year of access to eQUIPS is $2,500, which includes a one-time technology start-up fee. Each following year’s subscription is $1,500.

Hospitalists can apply for eQUIPS at www.hospitalmedicine.org/equips.

click for large version

Educational Resources Get eQUIPS Users Started

Regardless of how far a hospital has advanced its programs, the educational materials that come with the subscription take hospitalists through the best in evidence-based medicine to address care transitions, VTE, and glycemic control, essentially forming a toolkit of relevant journal articles, presentations, step-by-step implementation guides, clinical tools, program files submitted by participants, and on-demand educational webinars facilitated by content experts.

Analysis and Reporting

Most experts agree that tracking and reporting results are the linchpins of QI programs. eQUIPS makes it easier with secure online tools for recording, benchmarking, process management, and tracking milestones.

Plus, eQUIPS enables hospitalists to compare their programs to others across the country. By uploading performance data to the secure eQUIPS data center for performance tracking, hospitals can analyze and compare outcomes from their programs to other eQUIPS sites and national norms (see Figure 1).

And hospitalists can assure their hospitals’ legal staffs that SHM has taken steps to ensure HIPAA compliance through third-party reviews. eQUIPS subscribers log into the site through a secured-password authentication similar to those of other online public health and financial institutions. In addition, SHM’s QI programs have earned the Patient Safety Organization (PSO) designation from the Agency for Healthcare Research and Quality (AHRQ), which makes it easier for hospitals to share performance data with SHM.

Real-Time Collaboration

Every hospital faces unique challenges, but they also have much in common when it comes to implementing new programs. As eQUIPS subscribers join, they can share their QI experiences and ask others for feedback in finding solutions.

The eQUIPS community website feature serves as a central, on-demand repository for sharing documents and educational materials, while the online workspace enables hospitalists to collaborate in real time by posting documents and editing them with other participating eQUIPS sites.

eQUIPS also brings collaboration right to users’ inboxes. Access to QI listservs has been a productive way for hospitalists to connect and benefit from the collective experience of the group; it’s a key component of the eQUIPS programs.

For Rogers, eQUIPS and its collaborative tools are a logistical extension of SHM’s successful QI track record. TH

Brendon Shank is assistant vice president of communications for SHM.

With more than 250 hospitals adopting them in the last three years, SHM’s mentored implementation programs make a compelling case for the need to address care transitions, improve the management of diabetes, and prevent VTEs in hospitalized patients. And early results from the sites show that the mentored implementation model, with its combination of a best-practices toolkit and individualized support from national experts, can make a real difference.

“Quality improvement (QI) is the niche of hospital medicine; our mentored implementation programs have achieved both the goals of improving care in a clinical area nationwide as well as creating quality improvement leaders within our ranks,” says Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor of medicine and hospital medicine section chief at the University of New Mexico Health Sciences Center’s Department of Internal Medicine.

That’s the reasoning behind SHM’s new eQUIPS program. In essence, eQUIPS (Electronic Quality Improvement Programs) is SHM’s proven mentored implementation program, but without the mentor. Participants can access the same educational tools and resources, the same data center for tracking performance, and participate in the same online collaborative available to mentored implementation sites.

SHM’s eQUIPS program takes the collective knowledge from the programs and offers it as a self-guided program that includes robust data collection and display programs.—Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor, hospital medicine section chief, Department of Internal Medicine, University of New Mexico Health Sciences Center

“SHM’s eQUIPS program takes the collective knowledge from the programs and offers it as a self-guided program that includes robust data collection and display programs,” Dr. Rogers says. “It will allow hospital quality-improvement teams more time to focus on driving change through the effective use of data, rather than spending their time trying to get the data.”

eQUIPS empowers hospitalists to move forward on valuable QI programs at their own pace, at any time. Hospitalists begin with the confidence that an entire community of likeminded physicians is supporting them, sharing their information, challenges, and successes.

Now, hospitalists can bring best practices to their hospitals and show their directors and executive leadership that they are on the cutting edge of addressing some of the most pervasive challenges in today’s hospitals.

Although they share a similar approach, each of eQUIPS’ three programs tackles the individual challenges of care transitions, VTE, and glycemic control separately. Hospitals can subscribe to any combination of the three topics.

Because eQUIPS is meant for year-after-year use and designed so that its utility grows along with its user base, access to eQUIPS is based on a yearly subscription model. The first year of access to eQUIPS is $2,500, which includes a one-time technology start-up fee. Each following year’s subscription is $1,500.

Hospitalists can apply for eQUIPS at www.hospitalmedicine.org/equips.

click for large version

Educational Resources Get eQUIPS Users Started

Regardless of how far a hospital has advanced its programs, the educational materials that come with the subscription take hospitalists through the best in evidence-based medicine to address care transitions, VTE, and glycemic control, essentially forming a toolkit of relevant journal articles, presentations, step-by-step implementation guides, clinical tools, program files submitted by participants, and on-demand educational webinars facilitated by content experts.

Analysis and Reporting

Most experts agree that tracking and reporting results are the linchpins of QI programs. eQUIPS makes it easier with secure online tools for recording, benchmarking, process management, and tracking milestones.

Plus, eQUIPS enables hospitalists to compare their programs to others across the country. By uploading performance data to the secure eQUIPS data center for performance tracking, hospitals can analyze and compare outcomes from their programs to other eQUIPS sites and national norms (see Figure 1).

And hospitalists can assure their hospitals’ legal staffs that SHM has taken steps to ensure HIPAA compliance through third-party reviews. eQUIPS subscribers log into the site through a secured-password authentication similar to those of other online public health and financial institutions. In addition, SHM’s QI programs have earned the Patient Safety Organization (PSO) designation from the Agency for Healthcare Research and Quality (AHRQ), which makes it easier for hospitals to share performance data with SHM.

Real-Time Collaboration

Every hospital faces unique challenges, but they also have much in common when it comes to implementing new programs. As eQUIPS subscribers join, they can share their QI experiences and ask others for feedback in finding solutions.

The eQUIPS community website feature serves as a central, on-demand repository for sharing documents and educational materials, while the online workspace enables hospitalists to collaborate in real time by posting documents and editing them with other participating eQUIPS sites.

eQUIPS also brings collaboration right to users’ inboxes. Access to QI listservs has been a productive way for hospitalists to connect and benefit from the collective experience of the group; it’s a key component of the eQUIPS programs.

For Rogers, eQUIPS and its collaborative tools are a logistical extension of SHM’s successful QI track record. TH

Brendon Shank is assistant vice president of communications for SHM.

On April 12, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius joined the Centers for Medicare & Medicaid Services (CMS) administrator Donald Berwick, MD, in announcing a major patient-safety initiative bringing together hospitals, clinicians, consumers, employers, federal and state governments, and many more groups around two common goals: reducing harm caused to patients in hospitals and reducing hospital readmissions.

SHM was one of the first physician groups to sign on to the Pledge of Support, which aims to reduce hospital-acquired conditions by 40% and decrease preventable readmissions within 30 days of discharge by 20%, both by the end of 2013.

The pledge includes specific expectations for each of the different healthcare entities signing on. By signing, SHM agrees on behalf of hospitalists that they will work together to redesign activities within the hospital to reduce harm, learn from experiences and share best practices, and engage with patients and families to implement practices that foster more patient-centered care that improves safety, communication, and care coordination.

HHS is committing a total of $1 billion from the Patient Protection and Affordable Care Act of 2010 (ACA) to support hospitals and other providers in their efforts to reach these goals. Of the funding, $500 million will come through the Community-Based Care Transitions Program (CCTP) created in the ACA to help community-based organizations partnering with eligible hospitals to improve transitions between settings of care. The other $500 million will come from the Centers for Medicare and Medicaid Innovation (CMMI) to test different models of improving patient care, patient engagement, and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide.

The partnership takes the best ideas from the public and private sectors and accelerates their spread to achieve a safer, higher-quality healthcare system for all Americans. It aligns Dr. Berwick’s triple aim (improve care, improve people’s health, and reduce the overall cost of healthcare) with SHM’s efforts to improve quality and patient safety through innovation and collaboration.

SHM’s Project BOOST (www.hospitalmedicine.org/boost) is listed in the solicitation for applications for the CCTP, and SHM’s VTE resource room is among the resources posted on the partnership website.

For more information on the initiative, visit www.healthcare.gov. TH

On April 12, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius joined the Centers for Medicare & Medicaid Services (CMS) administrator Donald Berwick, MD, in announcing a major patient-safety initiative bringing together hospitals, clinicians, consumers, employers, federal and state governments, and many more groups around two common goals: reducing harm caused to patients in hospitals and reducing hospital readmissions.

SHM was one of the first physician groups to sign on to the Pledge of Support, which aims to reduce hospital-acquired conditions by 40% and decrease preventable readmissions within 30 days of discharge by 20%, both by the end of 2013.

The pledge includes specific expectations for each of the different healthcare entities signing on. By signing, SHM agrees on behalf of hospitalists that they will work together to redesign activities within the hospital to reduce harm, learn from experiences and share best practices, and engage with patients and families to implement practices that foster more patient-centered care that improves safety, communication, and care coordination.

HHS is committing a total of $1 billion from the Patient Protection and Affordable Care Act of 2010 (ACA) to support hospitals and other providers in their efforts to reach these goals. Of the funding, $500 million will come through the Community-Based Care Transitions Program (CCTP) created in the ACA to help community-based organizations partnering with eligible hospitals to improve transitions between settings of care. The other $500 million will come from the Centers for Medicare and Medicaid Innovation (CMMI) to test different models of improving patient care, patient engagement, and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide.

The partnership takes the best ideas from the public and private sectors and accelerates their spread to achieve a safer, higher-quality healthcare system for all Americans. It aligns Dr. Berwick’s triple aim (improve care, improve people’s health, and reduce the overall cost of healthcare) with SHM’s efforts to improve quality and patient safety through innovation and collaboration.

SHM’s Project BOOST (www.hospitalmedicine.org/boost) is listed in the solicitation for applications for the CCTP, and SHM’s VTE resource room is among the resources posted on the partnership website.

For more information on the initiative, visit www.healthcare.gov. TH

On April 12, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius joined the Centers for Medicare & Medicaid Services (CMS) administrator Donald Berwick, MD, in announcing a major patient-safety initiative bringing together hospitals, clinicians, consumers, employers, federal and state governments, and many more groups around two common goals: reducing harm caused to patients in hospitals and reducing hospital readmissions.

SHM was one of the first physician groups to sign on to the Pledge of Support, which aims to reduce hospital-acquired conditions by 40% and decrease preventable readmissions within 30 days of discharge by 20%, both by the end of 2013.

The pledge includes specific expectations for each of the different healthcare entities signing on. By signing, SHM agrees on behalf of hospitalists that they will work together to redesign activities within the hospital to reduce harm, learn from experiences and share best practices, and engage with patients and families to implement practices that foster more patient-centered care that improves safety, communication, and care coordination.

HHS is committing a total of $1 billion from the Patient Protection and Affordable Care Act of 2010 (ACA) to support hospitals and other providers in their efforts to reach these goals. Of the funding, $500 million will come through the Community-Based Care Transitions Program (CCTP) created in the ACA to help community-based organizations partnering with eligible hospitals to improve transitions between settings of care. The other $500 million will come from the Centers for Medicare and Medicaid Innovation (CMMI) to test different models of improving patient care, patient engagement, and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide.

The partnership takes the best ideas from the public and private sectors and accelerates their spread to achieve a safer, higher-quality healthcare system for all Americans. It aligns Dr. Berwick’s triple aim (improve care, improve people’s health, and reduce the overall cost of healthcare) with SHM’s efforts to improve quality and patient safety through innovation and collaboration.

SHM’s Project BOOST (www.hospitalmedicine.org/boost) is listed in the solicitation for applications for the CCTP, and SHM’s VTE resource room is among the resources posted on the partnership website.

For more information on the initiative, visit www.healthcare.gov. TH

Dr. Harrington

Dr. Fisher

Robert Harrington Jr., MD, SFHM, and Erin Stucky Fisher, MD, MHM, have been elected to SHM’s board of directors. Dr. Harrington, chief medical officer for Locum Leaders, serves as chair of SHM’s Family Medicine Task Force and board liaison to the IT Core Committee. Dr. Fisher, professor of clinical pediatrics at the University of California at San Diego, is actively involved with quality initiatives for the American Academy of Pediatrics, the Institute for Healthcare Improvement, and the National Association of Children’s Hospitals.

Jasen W. Gundersen, MD, MBA, CPE, SFHM, has been appointed chief medical officer for TeamHealth Hospital Medicine.

IPC: The Hospitalist Company Inc. has appointed Kerry Weiner, MD, to the newly created position of chief clinical officer. Dr. Weiner will lead the clinical functions of the company and continue the development of hospitalist leaders throughout IPC.

Dr. Pantilat

Steven Pantilat, MD, FACP, SFHM, has received a 2011 James Irvine Foundation Leadership Award. Dr. Pantilat, one of five recipients, is professor of clinical medicine, the Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care, and director of the Palliative Care Leadership Center at UCSF. Now in its sixth year, the award celebrates extraordinary leaders who are applying innovative and effective solutions to significant state issues. Dr. Pantilat, a past SHM president, will receive $125,000 in organizational support.

Hospitalist Patrick O’Neil, DO, has been named Lake Regional Health System’s 2011 Physician of the Year. The 116-bed health system serves 1,300 employees in the Land of the Ozarks, Mo., area.

Hospitalist Wiley Robinson, MD, has been named president-elect of the Tennessee Medical Association and will head the organization for 2012-2013. An internal-medicine specialist, Dr. Robinson is cofounder and president of Inpatient Physicians of the Mid-South, a Memphis-based hospitalist group.

Dr. Wachter

The Association of Specialty Professors announced Robert M. Wachter, MD, MHM, will receive the 2011 ASP Eric G. Neilson, MD, Distinguished Professor Award. Dr. Wachter is professor of medicine and the Marc and Lynne Benioff Endowed Chair in Hospital Medicine at the University of California at San Francisco (UCSF) School of Medicine, and a past president of SHM. The Neilson Award is presented annually to a leader who has shaped the internal-medicine landscape and promotes the work of leaders who bring about change for specialty medicine. TH

Dr. Harrington

Dr. Fisher

Robert Harrington Jr., MD, SFHM, and Erin Stucky Fisher, MD, MHM, have been elected to SHM’s board of directors. Dr. Harrington, chief medical officer for Locum Leaders, serves as chair of SHM’s Family Medicine Task Force and board liaison to the IT Core Committee. Dr. Fisher, professor of clinical pediatrics at the University of California at San Diego, is actively involved with quality initiatives for the American Academy of Pediatrics, the Institute for Healthcare Improvement, and the National Association of Children’s Hospitals.

Jasen W. Gundersen, MD, MBA, CPE, SFHM, has been appointed chief medical officer for TeamHealth Hospital Medicine.

IPC: The Hospitalist Company Inc. has appointed Kerry Weiner, MD, to the newly created position of chief clinical officer. Dr. Weiner will lead the clinical functions of the company and continue the development of hospitalist leaders throughout IPC.

Dr. Pantilat

Steven Pantilat, MD, FACP, SFHM, has received a 2011 James Irvine Foundation Leadership Award. Dr. Pantilat, one of five recipients, is professor of clinical medicine, the Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care, and director of the Palliative Care Leadership Center at UCSF. Now in its sixth year, the award celebrates extraordinary leaders who are applying innovative and effective solutions to significant state issues. Dr. Pantilat, a past SHM president, will receive $125,000 in organizational support.

Hospitalist Patrick O’Neil, DO, has been named Lake Regional Health System’s 2011 Physician of the Year. The 116-bed health system serves 1,300 employees in the Land of the Ozarks, Mo., area.

Hospitalist Wiley Robinson, MD, has been named president-elect of the Tennessee Medical Association and will head the organization for 2012-2013. An internal-medicine specialist, Dr. Robinson is cofounder and president of Inpatient Physicians of the Mid-South, a Memphis-based hospitalist group.

Dr. Wachter

The Association of Specialty Professors announced Robert M. Wachter, MD, MHM, will receive the 2011 ASP Eric G. Neilson, MD, Distinguished Professor Award. Dr. Wachter is professor of medicine and the Marc and Lynne Benioff Endowed Chair in Hospital Medicine at the University of California at San Francisco (UCSF) School of Medicine, and a past president of SHM. The Neilson Award is presented annually to a leader who has shaped the internal-medicine landscape and promotes the work of leaders who bring about change for specialty medicine. TH

Dr. Harrington

Dr. Fisher

Robert Harrington Jr., MD, SFHM, and Erin Stucky Fisher, MD, MHM, have been elected to SHM’s board of directors. Dr. Harrington, chief medical officer for Locum Leaders, serves as chair of SHM’s Family Medicine Task Force and board liaison to the IT Core Committee. Dr. Fisher, professor of clinical pediatrics at the University of California at San Diego, is actively involved with quality initiatives for the American Academy of Pediatrics, the Institute for Healthcare Improvement, and the National Association of Children’s Hospitals.

Jasen W. Gundersen, MD, MBA, CPE, SFHM, has been appointed chief medical officer for TeamHealth Hospital Medicine.

IPC: The Hospitalist Company Inc. has appointed Kerry Weiner, MD, to the newly created position of chief clinical officer. Dr. Weiner will lead the clinical functions of the company and continue the development of hospitalist leaders throughout IPC.

Dr. Pantilat

Steven Pantilat, MD, FACP, SFHM, has received a 2011 James Irvine Foundation Leadership Award. Dr. Pantilat, one of five recipients, is professor of clinical medicine, the Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care, and director of the Palliative Care Leadership Center at UCSF. Now in its sixth year, the award celebrates extraordinary leaders who are applying innovative and effective solutions to significant state issues. Dr. Pantilat, a past SHM president, will receive $125,000 in organizational support.

Hospitalist Patrick O’Neil, DO, has been named Lake Regional Health System’s 2011 Physician of the Year. The 116-bed health system serves 1,300 employees in the Land of the Ozarks, Mo., area.

Hospitalist Wiley Robinson, MD, has been named president-elect of the Tennessee Medical Association and will head the organization for 2012-2013. An internal-medicine specialist, Dr. Robinson is cofounder and president of Inpatient Physicians of the Mid-South, a Memphis-based hospitalist group.

Dr. Wachter

The Association of Specialty Professors announced Robert M. Wachter, MD, MHM, will receive the 2011 ASP Eric G. Neilson, MD, Distinguished Professor Award. Dr. Wachter is professor of medicine and the Marc and Lynne Benioff Endowed Chair in Hospital Medicine at the University of California at San Francisco (UCSF) School of Medicine, and a past president of SHM. The Neilson Award is presented annually to a leader who has shaped the internal-medicine landscape and promotes the work of leaders who bring about change for specialty medicine. TH

The difficulties in routinely recalling each and every action to take with a patient has encouraged hospitalists to abide by checklists that remind them of just what to do. So why shouldn’t patients have the same systematic prodding? That’s exactly what two first-year students at the University of Michigan Medical School in Ann Arbor—Andrew Lin and Aaron Farberg—thought two years ago, prompting them to invent Dear Doctor.

With the help of senior physicians, including former SHM president Scott Flanders, MD, SFHM, FACP, Lin and Farberg conducted a three-month study that provided bedside notepads to patients. The patients were encouraged to jot down questions for their doctors whenever a question occurred to them, not just when the physician was in the room. The students produced 1,000 notepads, even shrink-wrapping them with companion pens.

The simple yet seemingly effective approach worked so well that “Dear Doctor: A Tool to Facilitate Patient-Centered Care and Enhance Communication” earned the budding physicians the 2010 Innovation Poster award in the Research, Innovations, and Clinical Vignettes competition at HM10.

“This isn’t groundbreaking work here,” Lin says. “It’s a notepad, scraps of paper. Look around your desk and you’ve got sticky notes around. That’s what this is.”

Lin and Farberg both say they were surprised no one had crafted a similar communication tool as a potential quality-improvement (QI) measure. To wit, they are now working on publishing their research in the Journal of Hospital Medicine to further draw attention to the concept. They envision a day when the notes patients write down could be included in electronic medical records.

The ultimate goal is to give hospitalists and other physicians another way to communicate with their patients. “We want to institutionalize [Dear Doctor] to the point it’s a recognized necessity for the hospital system,” Lin says.—RQ

Toolkit Addresses Small-Business Security Concerns

The Healthcare Information and Management Systems Society (HIMSS) has had a privacy and security toolkit for physicians for a decade, but after its last annual security survey with the Medical Group Management Association (MGMA), it became clear that small- to medium-sized organizations were behind in implementation.

And so was born the HIMSS Privacy and Security Toolkit for Small Provider Organizations. The joint initiative is one that HM groups in rural or small settings should take advantage of, says Lisa Gallagher, HIMSS’ senior director of privacy and security.

Hospitalists “need to understand the reporting environment,” Gallagher says. “They are the subject of a lot of the policies and technology. We need them to be knowledgeable about it. They’re the ones who have access.”

HM’s role at the juncture of different departments and physicians, particularly at smaller hospitals that rely on hospitalists as traffic cops, makes it all the more important for hospitalists to understand the nuances of both privacy and security.

The interactive toolkit allows users to submit their own suggestions for improved processes and features introductions to the Centers for Medicare & Medicaid Services’ (CMS) “meaningful use” standard. Gallagher is hopeful that an engaged physician response to the toolkit will only bolster its efficacy in the coming months. “This is going to continue to evolve,” she says.—RQ

QUALITY RESEARCH

Care Transitions, Readmissions Concern Other Countries

International studies suggest that the recent torrent of attention toward improving care transitions and preventing hospital readmissions is not just an American trend. For example, a literature survey of physician “handovers” (aka handoffs) in international hospitals published in the British Medical Journal for Quality and Safety identified 32 papers on the subject.¹ The authors conclude that the existing literature rarely examines pre- and post-handover phases or evaluates the quality of handover practices, and thus “does not fully identify where communication failures typically occur.” More systematic analysis of all stages of handoffs by physicians is warranted, the authors suggest.

In the same journal, a literature search of English-language publications from 1990 to 2010 found a dozen studies—eight from the U.S.—documenting failure to perform adequate follow-up for patients’ test results.² The lack of follow-up ranged from 20% to 62% for hospitalized patients, and from 1% to 75% for patients treated in the ED. Two areas where problems were particularly evident were critical test results and results for patients moving across healthcare settings. “The existing evidence suggests that the problem of missed test results is considerable and reported negative impacts on patients warrant the exploration of solutions,” the authors conclude. They recommend further study of the effectiveness of such interventions as online endorsement of results, and integration of information technology into clinical work practices.

The World Alliance for Patient Safety, which was convened in 2004 by the World Health Organization, recently pointed to poor test result follow-up as one of the major processes contributing to unsafe patient care internationally.¹ The organization has identified nine “patient-safety solutions,” one of which is ensuring medication accuracy at transitions of care.

For more information on the alliance and WHO’s interest in patient safety, visit http://www.who.int/topics/patient_safety/en/. —LB

References

1. Raduma-Tomás MA, Flin R, Yule S, Williams D. Doctors’ handovers in hospi- tals: a literature review. BMJ Qual Saf. 2011;20:128-133.
2. Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf. 2011;20:194-199.

The difficulties in routinely recalling each and every action to take with a patient has encouraged hospitalists to abide by checklists that remind them of just what to do. So why shouldn’t patients have the same systematic prodding? That’s exactly what two first-year students at the University of Michigan Medical School in Ann Arbor—Andrew Lin and Aaron Farberg—thought two years ago, prompting them to invent Dear Doctor.

With the help of senior physicians, including former SHM president Scott Flanders, MD, SFHM, FACP, Lin and Farberg conducted a three-month study that provided bedside notepads to patients. The patients were encouraged to jot down questions for their doctors whenever a question occurred to them, not just when the physician was in the room. The students produced 1,000 notepads, even shrink-wrapping them with companion pens.

The simple yet seemingly effective approach worked so well that “Dear Doctor: A Tool to Facilitate Patient-Centered Care and Enhance Communication” earned the budding physicians the 2010 Innovation Poster award in the Research, Innovations, and Clinical Vignettes competition at HM10.

“This isn’t groundbreaking work here,” Lin says. “It’s a notepad, scraps of paper. Look around your desk and you’ve got sticky notes around. That’s what this is.”

Lin and Farberg both say they were surprised no one had crafted a similar communication tool as a potential quality-improvement (QI) measure. To wit, they are now working on publishing their research in the Journal of Hospital Medicine to further draw attention to the concept. They envision a day when the notes patients write down could be included in electronic medical records.

The ultimate goal is to give hospitalists and other physicians another way to communicate with their patients. “We want to institutionalize [Dear Doctor] to the point it’s a recognized necessity for the hospital system,” Lin says.—RQ

Toolkit Addresses Small-Business Security Concerns

The Healthcare Information and Management Systems Society (HIMSS) has had a privacy and security toolkit for physicians for a decade, but after its last annual security survey with the Medical Group Management Association (MGMA), it became clear that small- to medium-sized organizations were behind in implementation.

And so was born the HIMSS Privacy and Security Toolkit for Small Provider Organizations. The joint initiative is one that HM groups in rural or small settings should take advantage of, says Lisa Gallagher, HIMSS’ senior director of privacy and security.

Hospitalists “need to understand the reporting environment,” Gallagher says. “They are the subject of a lot of the policies and technology. We need them to be knowledgeable about it. They’re the ones who have access.”

HM’s role at the juncture of different departments and physicians, particularly at smaller hospitals that rely on hospitalists as traffic cops, makes it all the more important for hospitalists to understand the nuances of both privacy and security.

The interactive toolkit allows users to submit their own suggestions for improved processes and features introductions to the Centers for Medicare & Medicaid Services’ (CMS) “meaningful use” standard. Gallagher is hopeful that an engaged physician response to the toolkit will only bolster its efficacy in the coming months. “This is going to continue to evolve,” she says.—RQ

QUALITY RESEARCH

Care Transitions, Readmissions Concern Other Countries

International studies suggest that the recent torrent of attention toward improving care transitions and preventing hospital readmissions is not just an American trend. For example, a literature survey of physician “handovers” (aka handoffs) in international hospitals published in the British Medical Journal for Quality and Safety identified 32 papers on the subject.¹ The authors conclude that the existing literature rarely examines pre- and post-handover phases or evaluates the quality of handover practices, and thus “does not fully identify where communication failures typically occur.” More systematic analysis of all stages of handoffs by physicians is warranted, the authors suggest.

In the same journal, a literature search of English-language publications from 1990 to 2010 found a dozen studies—eight from the U.S.—documenting failure to perform adequate follow-up for patients’ test results.² The lack of follow-up ranged from 20% to 62% for hospitalized patients, and from 1% to 75% for patients treated in the ED. Two areas where problems were particularly evident were critical test results and results for patients moving across healthcare settings. “The existing evidence suggests that the problem of missed test results is considerable and reported negative impacts on patients warrant the exploration of solutions,” the authors conclude. They recommend further study of the effectiveness of such interventions as online endorsement of results, and integration of information technology into clinical work practices.

The World Alliance for Patient Safety, which was convened in 2004 by the World Health Organization, recently pointed to poor test result follow-up as one of the major processes contributing to unsafe patient care internationally.¹ The organization has identified nine “patient-safety solutions,” one of which is ensuring medication accuracy at transitions of care.

For more information on the alliance and WHO’s interest in patient safety, visit http://www.who.int/topics/patient_safety/en/. —LB

References

1. Raduma-Tomás MA, Flin R, Yule S, Williams D. Doctors’ handovers in hospi- tals: a literature review. BMJ Qual Saf. 2011;20:128-133.
2. Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf. 2011;20:194-199.

The difficulties in routinely recalling each and every action to take with a patient has encouraged hospitalists to abide by checklists that remind them of just what to do. So why shouldn’t patients have the same systematic prodding? That’s exactly what two first-year students at the University of Michigan Medical School in Ann Arbor—Andrew Lin and Aaron Farberg—thought two years ago, prompting them to invent Dear Doctor.

With the help of senior physicians, including former SHM president Scott Flanders, MD, SFHM, FACP, Lin and Farberg conducted a three-month study that provided bedside notepads to patients. The patients were encouraged to jot down questions for their doctors whenever a question occurred to them, not just when the physician was in the room. The students produced 1,000 notepads, even shrink-wrapping them with companion pens.

The simple yet seemingly effective approach worked so well that “Dear Doctor: A Tool to Facilitate Patient-Centered Care and Enhance Communication” earned the budding physicians the 2010 Innovation Poster award in the Research, Innovations, and Clinical Vignettes competition at HM10.

“This isn’t groundbreaking work here,” Lin says. “It’s a notepad, scraps of paper. Look around your desk and you’ve got sticky notes around. That’s what this is.”

Lin and Farberg both say they were surprised no one had crafted a similar communication tool as a potential quality-improvement (QI) measure. To wit, they are now working on publishing their research in the Journal of Hospital Medicine to further draw attention to the concept. They envision a day when the notes patients write down could be included in electronic medical records.

The ultimate goal is to give hospitalists and other physicians another way to communicate with their patients. “We want to institutionalize [Dear Doctor] to the point it’s a recognized necessity for the hospital system,” Lin says.—RQ

Toolkit Addresses Small-Business Security Concerns

The Healthcare Information and Management Systems Society (HIMSS) has had a privacy and security toolkit for physicians for a decade, but after its last annual security survey with the Medical Group Management Association (MGMA), it became clear that small- to medium-sized organizations were behind in implementation.

And so was born the HIMSS Privacy and Security Toolkit for Small Provider Organizations. The joint initiative is one that HM groups in rural or small settings should take advantage of, says Lisa Gallagher, HIMSS’ senior director of privacy and security.

Hospitalists “need to understand the reporting environment,” Gallagher says. “They are the subject of a lot of the policies and technology. We need them to be knowledgeable about it. They’re the ones who have access.”

HM’s role at the juncture of different departments and physicians, particularly at smaller hospitals that rely on hospitalists as traffic cops, makes it all the more important for hospitalists to understand the nuances of both privacy and security.

The interactive toolkit allows users to submit their own suggestions for improved processes and features introductions to the Centers for Medicare & Medicaid Services’ (CMS) “meaningful use” standard. Gallagher is hopeful that an engaged physician response to the toolkit will only bolster its efficacy in the coming months. “This is going to continue to evolve,” she says.—RQ

QUALITY RESEARCH

Care Transitions, Readmissions Concern Other Countries

International studies suggest that the recent torrent of attention toward improving care transitions and preventing hospital readmissions is not just an American trend. For example, a literature survey of physician “handovers” (aka handoffs) in international hospitals published in the British Medical Journal for Quality and Safety identified 32 papers on the subject.¹ The authors conclude that the existing literature rarely examines pre- and post-handover phases or evaluates the quality of handover practices, and thus “does not fully identify where communication failures typically occur.” More systematic analysis of all stages of handoffs by physicians is warranted, the authors suggest.

In the same journal, a literature search of English-language publications from 1990 to 2010 found a dozen studies—eight from the U.S.—documenting failure to perform adequate follow-up for patients’ test results.² The lack of follow-up ranged from 20% to 62% for hospitalized patients, and from 1% to 75% for patients treated in the ED. Two areas where problems were particularly evident were critical test results and results for patients moving across healthcare settings. “The existing evidence suggests that the problem of missed test results is considerable and reported negative impacts on patients warrant the exploration of solutions,” the authors conclude. They recommend further study of the effectiveness of such interventions as online endorsement of results, and integration of information technology into clinical work practices.

The World Alliance for Patient Safety, which was convened in 2004 by the World Health Organization, recently pointed to poor test result follow-up as one of the major processes contributing to unsafe patient care internationally.¹ The organization has identified nine “patient-safety solutions,” one of which is ensuring medication accuracy at transitions of care.

For more information on the alliance and WHO’s interest in patient safety, visit http://www.who.int/topics/patient_safety/en/. —LB

References

1. Raduma-Tomás MA, Flin R, Yule S, Williams D. Doctors’ handovers in hospi- tals: a literature review. BMJ Qual Saf. 2011;20:128-133.
2. Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf. 2011;20:194-199.

GRAPEVINE, Texas—New SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, asked a question at HM11 that might be a first for the relatively nascent field. After explaining to the crowd in the ballroom at the Gaylord Texan Resort and Convention Center that the average hospitalist is 37 years old, Dr. Li asked: “What’s going to happen when the hospitalist gets older and their priorities change?”

A hopeful, if wary, eye on the future of the still-growing field was a common thread throughout HM11, as SHM leaders from the new president to CEO Larry Wellikson, MD, SFHM, laid out the pathway of growth for a 15-year-old specialty. Although each acknowledged uncertainties as they adjust to a domestic healthcare system in the throes of its largest reform in a generation, they agree on a few mainstays.

First, HM should continue to take ownership of quality-improvement (QI) and patient-safety initiatives that improve outcomes and reduce costs for hospitals, as the dual reward of better care for patients and lower costs for chief financial officers can serve as change agents for healthcare and leverage for the next contract.

Second, hospitalists should be careful to balance expansion of their duties—be it via such “hyphenated hospitalists” as laborists, say, or through comanagement of surgical and ED patients—with an appropriate amount of dedicated resources.

Finally, academic hospitalists, from residents to attendings, should continue to plan for this summer’s reduction in work hours and patient caps for residents, new rules from the Accreditation Council for Graduate Medical Education (ACGME) that some fear could create a future cast of ill-prepared internists.

“There’s a lot that’s bearing down on physicians and it’s been compressed in a short period of time,” said AMA President Cecil Wilson, MD. “We cannot go back to where we were and we cannot stay where we are. … We may not have a choice about change, but we do have a choice on how we respond to change and how we influence it.”

Dr. Li sees SHM sitting at the intersection of practical application and influence. He wants to continue with society-sponsored training academies and leadership programs that both impress upon hospitalists how important it is for them to take leadership roles in their hospitals and make sure they have the skills to do so. Dr. Li says the field needs to look no further than other fields adopting the in-hospital practice model as proof that the care model is vital to improving equality.

“We need to be laser-focused in terms of what we want to do. [We] want to improve the quality of care of patients both inside and outside the hospital,” he adds. “I say both inside and outside because, oftentimes, that transition is somewhere in between it. We have many hospitalists, like at my place, who provide care in the outpatient setting, in post-discharge clinics, and other places.”

Dr. Li also says that collaborations with fellow medical societies and organizations are key to SHM’s advocacy role. Society leaders are attending other specialty conferences to build and strengthen relationships that help extend HM’s reach into policy circles. In perhaps one of the strongest relationships, SHM leadership is meeting this summer with Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS). The meeting is even more valuable in context of Dr. Berwick’s recent selection of Patrick Conway, MD, MSc, SFHM, a pediatric hospitalist and director of hospital medicine at Cincinnati Children’s Hospital Medical Center, as CMS’ chief medical officer. The government position is the highest-ranking policy role ever held by a hospitalist (see “Hospitalist Takes Charge” p. 28).

“We’re in a position going forward where we don’t talk alone,” says immediate past SHM president Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “It’s us and our partners talking together. That moves what is currently a loud voice to a stentorian voice. You can imagine where SHM and ACP [American College of Physicians] and the VA [Veterans Administration] and Society of Critical Care Medicine … if they’re all saying the same thing, that’s a very different message than if one organization is saying it alone.”

Adds SHM board member and former SHM Public Policy Committee chairman Eric Siegal, MD, SFHM, a critical-care fellow at the University of Wisconsin School of Medicine and Public Health in Madison, “We’re absolutely at the table in a way that’s, frankly, almost stunning how fast we have evolved [from] several years ago, when we first went to Washington, D.C., for our first advocacy day, and we had to explain to people that hospitalists were not in the hospitality industry. We punch well above our weight class right now.”

It’s a tall order for any specialty society to push the national healthcare discussion, but Dr. Li sees HM as perfectly perched “to train the trainers.” The field has grown to more than 30,000 hospitalists, well beyond the estimated ceiling of 20,000 hospitalists forecasted in the field’s earliest days. That rapid-fire growth–hospitalists are now present in the vast majority of hospitals that can either afford them or need them–means the field can now evolve past simply swelling numbers to creating better physicians. By encouraging more rank-and-file practitioners to become leaders, the logic goes, the number of groups will increase as practices sprout in those remaining hospitals without HM services: more practices, more hospitalists, more presence in future policy discussions.

To that end, Dr. Wellikson notes that SHM continues to introduce training courses and research repositories. Two recent additions are eQUIPS (Electronic Quality Improvement Programs), a series of QI and patient toolkits aimed at transitional care, glycemic control, and VTE prevention, and SQUINT, SHM’s new QI repository, which allows users to upload research projects to a searchable database that other physicians can then mine for data.

“We’re really only at the very beginning,” Dr. Li says. “All of hospital medicine only started 10, 15 years ago. For some folks, they believe that’s a long time. But this really is the very beginning of this movement.”

Richard Quinn is a freelance writer based in New Jersey.

GRAPEVINE, Texas—New SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, asked a question at HM11 that might be a first for the relatively nascent field. After explaining to the crowd in the ballroom at the Gaylord Texan Resort and Convention Center that the average hospitalist is 37 years old, Dr. Li asked: “What’s going to happen when the hospitalist gets older and their priorities change?”

A hopeful, if wary, eye on the future of the still-growing field was a common thread throughout HM11, as SHM leaders from the new president to CEO Larry Wellikson, MD, SFHM, laid out the pathway of growth for a 15-year-old specialty. Although each acknowledged uncertainties as they adjust to a domestic healthcare system in the throes of its largest reform in a generation, they agree on a few mainstays.

First, HM should continue to take ownership of quality-improvement (QI) and patient-safety initiatives that improve outcomes and reduce costs for hospitals, as the dual reward of better care for patients and lower costs for chief financial officers can serve as change agents for healthcare and leverage for the next contract.

Second, hospitalists should be careful to balance expansion of their duties—be it via such “hyphenated hospitalists” as laborists, say, or through comanagement of surgical and ED patients—with an appropriate amount of dedicated resources.

Finally, academic hospitalists, from residents to attendings, should continue to plan for this summer’s reduction in work hours and patient caps for residents, new rules from the Accreditation Council for Graduate Medical Education (ACGME) that some fear could create a future cast of ill-prepared internists.

“There’s a lot that’s bearing down on physicians and it’s been compressed in a short period of time,” said AMA President Cecil Wilson, MD. “We cannot go back to where we were and we cannot stay where we are. … We may not have a choice about change, but we do have a choice on how we respond to change and how we influence it.”

Dr. Li sees SHM sitting at the intersection of practical application and influence. He wants to continue with society-sponsored training academies and leadership programs that both impress upon hospitalists how important it is for them to take leadership roles in their hospitals and make sure they have the skills to do so. Dr. Li says the field needs to look no further than other fields adopting the in-hospital practice model as proof that the care model is vital to improving equality.

“We need to be laser-focused in terms of what we want to do. [We] want to improve the quality of care of patients both inside and outside the hospital,” he adds. “I say both inside and outside because, oftentimes, that transition is somewhere in between it. We have many hospitalists, like at my place, who provide care in the outpatient setting, in post-discharge clinics, and other places.”

Dr. Li also says that collaborations with fellow medical societies and organizations are key to SHM’s advocacy role. Society leaders are attending other specialty conferences to build and strengthen relationships that help extend HM’s reach into policy circles. In perhaps one of the strongest relationships, SHM leadership is meeting this summer with Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS). The meeting is even more valuable in context of Dr. Berwick’s recent selection of Patrick Conway, MD, MSc, SFHM, a pediatric hospitalist and director of hospital medicine at Cincinnati Children’s Hospital Medical Center, as CMS’ chief medical officer. The government position is the highest-ranking policy role ever held by a hospitalist (see “Hospitalist Takes Charge” p. 28).

“We’re in a position going forward where we don’t talk alone,” says immediate past SHM president Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “It’s us and our partners talking together. That moves what is currently a loud voice to a stentorian voice. You can imagine where SHM and ACP [American College of Physicians] and the VA [Veterans Administration] and Society of Critical Care Medicine … if they’re all saying the same thing, that’s a very different message than if one organization is saying it alone.”

Adds SHM board member and former SHM Public Policy Committee chairman Eric Siegal, MD, SFHM, a critical-care fellow at the University of Wisconsin School of Medicine and Public Health in Madison, “We’re absolutely at the table in a way that’s, frankly, almost stunning how fast we have evolved [from] several years ago, when we first went to Washington, D.C., for our first advocacy day, and we had to explain to people that hospitalists were not in the hospitality industry. We punch well above our weight class right now.”

It’s a tall order for any specialty society to push the national healthcare discussion, but Dr. Li sees HM as perfectly perched “to train the trainers.” The field has grown to more than 30,000 hospitalists, well beyond the estimated ceiling of 20,000 hospitalists forecasted in the field’s earliest days. That rapid-fire growth–hospitalists are now present in the vast majority of hospitals that can either afford them or need them–means the field can now evolve past simply swelling numbers to creating better physicians. By encouraging more rank-and-file practitioners to become leaders, the logic goes, the number of groups will increase as practices sprout in those remaining hospitals without HM services: more practices, more hospitalists, more presence in future policy discussions.

To that end, Dr. Wellikson notes that SHM continues to introduce training courses and research repositories. Two recent additions are eQUIPS (Electronic Quality Improvement Programs), a series of QI and patient toolkits aimed at transitional care, glycemic control, and VTE prevention, and SQUINT, SHM’s new QI repository, which allows users to upload research projects to a searchable database that other physicians can then mine for data.

“We’re really only at the very beginning,” Dr. Li says. “All of hospital medicine only started 10, 15 years ago. For some folks, they believe that’s a long time. But this really is the very beginning of this movement.”

Richard Quinn is a freelance writer based in New Jersey.

GRAPEVINE, Texas—New SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, asked a question at HM11 that might be a first for the relatively nascent field. After explaining to the crowd in the ballroom at the Gaylord Texan Resort and Convention Center that the average hospitalist is 37 years old, Dr. Li asked: “What’s going to happen when the hospitalist gets older and their priorities change?”

A hopeful, if wary, eye on the future of the still-growing field was a common thread throughout HM11, as SHM leaders from the new president to CEO Larry Wellikson, MD, SFHM, laid out the pathway of growth for a 15-year-old specialty. Although each acknowledged uncertainties as they adjust to a domestic healthcare system in the throes of its largest reform in a generation, they agree on a few mainstays.

First, HM should continue to take ownership of quality-improvement (QI) and patient-safety initiatives that improve outcomes and reduce costs for hospitals, as the dual reward of better care for patients and lower costs for chief financial officers can serve as change agents for healthcare and leverage for the next contract.

Second, hospitalists should be careful to balance expansion of their duties—be it via such “hyphenated hospitalists” as laborists, say, or through comanagement of surgical and ED patients—with an appropriate amount of dedicated resources.

Finally, academic hospitalists, from residents to attendings, should continue to plan for this summer’s reduction in work hours and patient caps for residents, new rules from the Accreditation Council for Graduate Medical Education (ACGME) that some fear could create a future cast of ill-prepared internists.

“There’s a lot that’s bearing down on physicians and it’s been compressed in a short period of time,” said AMA President Cecil Wilson, MD. “We cannot go back to where we were and we cannot stay where we are. … We may not have a choice about change, but we do have a choice on how we respond to change and how we influence it.”

Dr. Li sees SHM sitting at the intersection of practical application and influence. He wants to continue with society-sponsored training academies and leadership programs that both impress upon hospitalists how important it is for them to take leadership roles in their hospitals and make sure they have the skills to do so. Dr. Li says the field needs to look no further than other fields adopting the in-hospital practice model as proof that the care model is vital to improving equality.

“We need to be laser-focused in terms of what we want to do. [We] want to improve the quality of care of patients both inside and outside the hospital,” he adds. “I say both inside and outside because, oftentimes, that transition is somewhere in between it. We have many hospitalists, like at my place, who provide care in the outpatient setting, in post-discharge clinics, and other places.”

Dr. Li also says that collaborations with fellow medical societies and organizations are key to SHM’s advocacy role. Society leaders are attending other specialty conferences to build and strengthen relationships that help extend HM’s reach into policy circles. In perhaps one of the strongest relationships, SHM leadership is meeting this summer with Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS). The meeting is even more valuable in context of Dr. Berwick’s recent selection of Patrick Conway, MD, MSc, SFHM, a pediatric hospitalist and director of hospital medicine at Cincinnati Children’s Hospital Medical Center, as CMS’ chief medical officer. The government position is the highest-ranking policy role ever held by a hospitalist (see “Hospitalist Takes Charge” p. 28).

“We’re in a position going forward where we don’t talk alone,” says immediate past SHM president Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “It’s us and our partners talking together. That moves what is currently a loud voice to a stentorian voice. You can imagine where SHM and ACP [American College of Physicians] and the VA [Veterans Administration] and Society of Critical Care Medicine … if they’re all saying the same thing, that’s a very different message than if one organization is saying it alone.”

Adds SHM board member and former SHM Public Policy Committee chairman Eric Siegal, MD, SFHM, a critical-care fellow at the University of Wisconsin School of Medicine and Public Health in Madison, “We’re absolutely at the table in a way that’s, frankly, almost stunning how fast we have evolved [from] several years ago, when we first went to Washington, D.C., for our first advocacy day, and we had to explain to people that hospitalists were not in the hospitality industry. We punch well above our weight class right now.”

It’s a tall order for any specialty society to push the national healthcare discussion, but Dr. Li sees HM as perfectly perched “to train the trainers.” The field has grown to more than 30,000 hospitalists, well beyond the estimated ceiling of 20,000 hospitalists forecasted in the field’s earliest days. That rapid-fire growth–hospitalists are now present in the vast majority of hospitals that can either afford them or need them–means the field can now evolve past simply swelling numbers to creating better physicians. By encouraging more rank-and-file practitioners to become leaders, the logic goes, the number of groups will increase as practices sprout in those remaining hospitals without HM services: more practices, more hospitalists, more presence in future policy discussions.

To that end, Dr. Wellikson notes that SHM continues to introduce training courses and research repositories. Two recent additions are eQUIPS (Electronic Quality Improvement Programs), a series of QI and patient toolkits aimed at transitional care, glycemic control, and VTE prevention, and SQUINT, SHM’s new QI repository, which allows users to upload research projects to a searchable database that other physicians can then mine for data.

“We’re really only at the very beginning,” Dr. Li says. “All of hospital medicine only started 10, 15 years ago. For some folks, they believe that’s a long time. But this really is the very beginning of this movement.”

Richard Quinn is a freelance writer based in New Jersey.

GRAPEVINE, Texas—Hospitalist Michael Monge, MD, of Cogent Healthcare in San Bernardino, Calif., watched an instructor squeeze the lubricating gel on the transponder and press it gently, but firmly, into the crook of a woman’s arm. Veins practically popped off an ultrasound monitor, serving as a literal road map for vascular access.

And he thought: Wouldn’t it be great if I had this technology all the time, just like I remember from my residency?

“A lot of my ER attendings were able to do a study at the bedside in a manner of minutes, not 30 or 45 minutes,” says Dr. Monge, who practices at Saint Bernardine Medical Center. “If they saw something abnormal, sure enough, they got the full study. But they were able to get that glimpse. Ultimately, it’s just better patient care.”

Dr. Monge’s ultrasound lesson was a first for the SHM annual meeting. In past years, training on ultrasounds was wrapped into the “Medical Procedures for the Hospitalist” pre-course. But at HM11, thanks to the growing prevalence and portability of the technology, the training was expanded into its own half-day pre-course, appropriately dubbed “Portable Ultrasound for the Hospitalist.”

“The ultrasound will be the stethoscope of the 21st century,” says Mark Ault, director of the Division of General Internal Medicine and assistant chairman for clinical affairs of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. “And the goal will be to have an ultrasound in the hands of every internist.”

Only time will tell whether portable ultrasound becomes as commonplace as Dr. Ault envisions, but what is clear is that the evolution of the technology makes it widely applicable to hospitalists, says Bradley Rosen, MD, MBA, medical director of the Inpatient Specialty Program (ISP) at Cedars-Sinai Medical Center.

Pricing is one such example. In years past, ultrasound machines were bulky and costly, with price tags in the hundreds of thousands of dollars. Now, portable units, depending on the number of transducers and functionality, can come as low as $20,000, though more-advanced machines quickly jump into the $40,000 to $60,000 range.

Still, Dr. Rosen views the practical uses of the technology as almost endless, and could include vascular access, placing central and PICC lines, and insertion and removal of catheters. Most hospitalists, however, continue to have limited experience with portable ultrasound, meaning those interested in learning more likely have to seek out physicians in other departments to provide the training and mentorship required. Dr. Rosen suggests working with ED physicians, OB-GYNs, and radiologists, although he notes you should be careful to be clear that the HM community is not looking to supplant anyone, or take billing opportunities away.

Hospitalists “don’t know how to use it, and people don’t know where to go to learn how to use it,” he says. “This is a starting point that will allow people … to take these ideas back and, hopefully, generate enough of a critical mass that it becomes a louder and louder chorus asking for this technology.”

GRAPEVINE, Texas—Hospitalist Michael Monge, MD, of Cogent Healthcare in San Bernardino, Calif., watched an instructor squeeze the lubricating gel on the transponder and press it gently, but firmly, into the crook of a woman’s arm. Veins practically popped off an ultrasound monitor, serving as a literal road map for vascular access.

And he thought: Wouldn’t it be great if I had this technology all the time, just like I remember from my residency?

“A lot of my ER attendings were able to do a study at the bedside in a manner of minutes, not 30 or 45 minutes,” says Dr. Monge, who practices at Saint Bernardine Medical Center. “If they saw something abnormal, sure enough, they got the full study. But they were able to get that glimpse. Ultimately, it’s just better patient care.”

Dr. Monge’s ultrasound lesson was a first for the SHM annual meeting. In past years, training on ultrasounds was wrapped into the “Medical Procedures for the Hospitalist” pre-course. But at HM11, thanks to the growing prevalence and portability of the technology, the training was expanded into its own half-day pre-course, appropriately dubbed “Portable Ultrasound for the Hospitalist.”

“The ultrasound will be the stethoscope of the 21st century,” says Mark Ault, director of the Division of General Internal Medicine and assistant chairman for clinical affairs of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. “And the goal will be to have an ultrasound in the hands of every internist.”

Only time will tell whether portable ultrasound becomes as commonplace as Dr. Ault envisions, but what is clear is that the evolution of the technology makes it widely applicable to hospitalists, says Bradley Rosen, MD, MBA, medical director of the Inpatient Specialty Program (ISP) at Cedars-Sinai Medical Center.

Pricing is one such example. In years past, ultrasound machines were bulky and costly, with price tags in the hundreds of thousands of dollars. Now, portable units, depending on the number of transducers and functionality, can come as low as $20,000, though more-advanced machines quickly jump into the $40,000 to $60,000 range.

Still, Dr. Rosen views the practical uses of the technology as almost endless, and could include vascular access, placing central and PICC lines, and insertion and removal of catheters. Most hospitalists, however, continue to have limited experience with portable ultrasound, meaning those interested in learning more likely have to seek out physicians in other departments to provide the training and mentorship required. Dr. Rosen suggests working with ED physicians, OB-GYNs, and radiologists, although he notes you should be careful to be clear that the HM community is not looking to supplant anyone, or take billing opportunities away.

Hospitalists “don’t know how to use it, and people don’t know where to go to learn how to use it,” he says. “This is a starting point that will allow people … to take these ideas back and, hopefully, generate enough of a critical mass that it becomes a louder and louder chorus asking for this technology.”

GRAPEVINE, Texas—Hospitalist Michael Monge, MD, of Cogent Healthcare in San Bernardino, Calif., watched an instructor squeeze the lubricating gel on the transponder and press it gently, but firmly, into the crook of a woman’s arm. Veins practically popped off an ultrasound monitor, serving as a literal road map for vascular access.

And he thought: Wouldn’t it be great if I had this technology all the time, just like I remember from my residency?

“A lot of my ER attendings were able to do a study at the bedside in a manner of minutes, not 30 or 45 minutes,” says Dr. Monge, who practices at Saint Bernardine Medical Center. “If they saw something abnormal, sure enough, they got the full study. But they were able to get that glimpse. Ultimately, it’s just better patient care.”

Dr. Monge’s ultrasound lesson was a first for the SHM annual meeting. In past years, training on ultrasounds was wrapped into the “Medical Procedures for the Hospitalist” pre-course. But at HM11, thanks to the growing prevalence and portability of the technology, the training was expanded into its own half-day pre-course, appropriately dubbed “Portable Ultrasound for the Hospitalist.”

“The ultrasound will be the stethoscope of the 21st century,” says Mark Ault, director of the Division of General Internal Medicine and assistant chairman for clinical affairs of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. “And the goal will be to have an ultrasound in the hands of every internist.”

Only time will tell whether portable ultrasound becomes as commonplace as Dr. Ault envisions, but what is clear is that the evolution of the technology makes it widely applicable to hospitalists, says Bradley Rosen, MD, MBA, medical director of the Inpatient Specialty Program (ISP) at Cedars-Sinai Medical Center.

Pricing is one such example. In years past, ultrasound machines were bulky and costly, with price tags in the hundreds of thousands of dollars. Now, portable units, depending on the number of transducers and functionality, can come as low as $20,000, though more-advanced machines quickly jump into the $40,000 to $60,000 range.

Still, Dr. Rosen views the practical uses of the technology as almost endless, and could include vascular access, placing central and PICC lines, and insertion and removal of catheters. Most hospitalists, however, continue to have limited experience with portable ultrasound, meaning those interested in learning more likely have to seek out physicians in other departments to provide the training and mentorship required. Dr. Rosen suggests working with ED physicians, OB-GYNs, and radiologists, although he notes you should be careful to be clear that the HM community is not looking to supplant anyone, or take billing opportunities away.

Hospitalists “don’t know how to use it, and people don’t know where to go to learn how to use it,” he says. “This is a starting point that will allow people … to take these ideas back and, hopefully, generate enough of a critical mass that it becomes a louder and louder chorus asking for this technology.”

It was only natural when SHM started hosting Special Interest Forums a few meetings ago that a chat devoted to quality would emerge. So it was no surprise when some 60 HM11 attendees crowded into a room to talk about just that. But part of preaching the value of quality is knowing how to preach.

To that end, Mangla Gulati, MD, FACP, assistant professor in the Department of Medicine at the University of Maryland School of Medicine in Baltimore, wants resources to teach her how to talk with administrators on their level. “We need to know the language to parlay with our CFO or CEO,” she says. “That’s what’s helpful for us.”

Joe Miller, SHM’s senior vice president and chief solutions officer, suggested the society could create a microsite within www.hospitalmedicine.org dedicated to the topic. He says there are online toolkits the society has developed in the past, and will continue to develop, that will help introduce hospitalists to already-existing quality initiatives they simply don’t know about. He particularly noted SQUINT, SHM’s searchable database for quality projects that is just getting off the ground.

“The stuff that’s there, I use and I love it,” says Dorothy Pusateri, MD, of Allegheny Hospitalist Service in Pittsburgh. “The stuff on Project BOOST [Better Outcomes for Older Adults through Safer Transitions] was enough to teach me.”

Rural Hospitalists

Small-town hospitalists from every corner of the country discussed recruiting issues, scheduling solutions, advocacy concerns, and more. A group of 15 rural hospitalists shared concerns about brutal, “72-hour” shifts and potential solutions to hiring and staffing issues, including growing your own hospitalists and hiring nonphysician providers (NPPs) to supplement 24/7 coverage.

“You can’t sustain mentally if you are doing all of it by yourself all day, all night,” said Martin Johns, MD, a hospitalist at 25-bed Gifford Medical Center in Randolph, Vt. Dr. Johns suggested rural groups think about utilizing NPPs and physician assistants (PAs) to fill coverage gaps; however, the opinions varied widely in what was considered proper compensation and responsibilities for nonphysicians.

“Our PAs make almost as much as our docs,” said Dale Vizcarra, MD, medical director of the hospitalist group at St. Mary’s Healthcare, a 68-bed critical-care hospital in Pierre, S.D.

The group also discussed at length the difficulties in bringing doctors to small towns. Although compensation can be higher than in large urban centers, the group agreed that the “one-man show” aspect of working as a small-town hospitalist is a detractor.

“I hear it all the time,” said forum moderator Alan Himmelstein, a regional vice president for Sound Physicians. “I can take care of gunshot wounds, but I forgot everything I know about community-acquired pneumonia. You aren’t surrounded by 23 specialists; in rural communities, you guys are the top of the heap. Your skill set, by definition, has to make you comfortable to take care of everything that comes through the door. You don’t have another facility a half-hour away; a lot of your geography doesn’t allow helicopters to fly 365 days.”

Rural hospitalists, who as a group admit nearly 40% of all hospital admissions nationwide, also are looking for a voice. “We’re a huge constituency,” Dr. Johns said, “and we are under-represented.”

Jason Carris, editor of The Hospitalist, contributed to this report.

It was only natural when SHM started hosting Special Interest Forums a few meetings ago that a chat devoted to quality would emerge. So it was no surprise when some 60 HM11 attendees crowded into a room to talk about just that. But part of preaching the value of quality is knowing how to preach.

To that end, Mangla Gulati, MD, FACP, assistant professor in the Department of Medicine at the University of Maryland School of Medicine in Baltimore, wants resources to teach her how to talk with administrators on their level. “We need to know the language to parlay with our CFO or CEO,” she says. “That’s what’s helpful for us.”

Joe Miller, SHM’s senior vice president and chief solutions officer, suggested the society could create a microsite within www.hospitalmedicine.org dedicated to the topic. He says there are online toolkits the society has developed in the past, and will continue to develop, that will help introduce hospitalists to already-existing quality initiatives they simply don’t know about. He particularly noted SQUINT, SHM’s searchable database for quality projects that is just getting off the ground.

“The stuff that’s there, I use and I love it,” says Dorothy Pusateri, MD, of Allegheny Hospitalist Service in Pittsburgh. “The stuff on Project BOOST [Better Outcomes for Older Adults through Safer Transitions] was enough to teach me.”

Rural Hospitalists

Small-town hospitalists from every corner of the country discussed recruiting issues, scheduling solutions, advocacy concerns, and more. A group of 15 rural hospitalists shared concerns about brutal, “72-hour” shifts and potential solutions to hiring and staffing issues, including growing your own hospitalists and hiring nonphysician providers (NPPs) to supplement 24/7 coverage.

“You can’t sustain mentally if you are doing all of it by yourself all day, all night,” said Martin Johns, MD, a hospitalist at 25-bed Gifford Medical Center in Randolph, Vt. Dr. Johns suggested rural groups think about utilizing NPPs and physician assistants (PAs) to fill coverage gaps; however, the opinions varied widely in what was considered proper compensation and responsibilities for nonphysicians.

“Our PAs make almost as much as our docs,” said Dale Vizcarra, MD, medical director of the hospitalist group at St. Mary’s Healthcare, a 68-bed critical-care hospital in Pierre, S.D.

The group also discussed at length the difficulties in bringing doctors to small towns. Although compensation can be higher than in large urban centers, the group agreed that the “one-man show” aspect of working as a small-town hospitalist is a detractor.

“I hear it all the time,” said forum moderator Alan Himmelstein, a regional vice president for Sound Physicians. “I can take care of gunshot wounds, but I forgot everything I know about community-acquired pneumonia. You aren’t surrounded by 23 specialists; in rural communities, you guys are the top of the heap. Your skill set, by definition, has to make you comfortable to take care of everything that comes through the door. You don’t have another facility a half-hour away; a lot of your geography doesn’t allow helicopters to fly 365 days.”

Rural hospitalists, who as a group admit nearly 40% of all hospital admissions nationwide, also are looking for a voice. “We’re a huge constituency,” Dr. Johns said, “and we are under-represented.”

Jason Carris, editor of The Hospitalist, contributed to this report.

It was only natural when SHM started hosting Special Interest Forums a few meetings ago that a chat devoted to quality would emerge. So it was no surprise when some 60 HM11 attendees crowded into a room to talk about just that. But part of preaching the value of quality is knowing how to preach.

To that end, Mangla Gulati, MD, FACP, assistant professor in the Department of Medicine at the University of Maryland School of Medicine in Baltimore, wants resources to teach her how to talk with administrators on their level. “We need to know the language to parlay with our CFO or CEO,” she says. “That’s what’s helpful for us.”

Joe Miller, SHM’s senior vice president and chief solutions officer, suggested the society could create a microsite within www.hospitalmedicine.org dedicated to the topic. He says there are online toolkits the society has developed in the past, and will continue to develop, that will help introduce hospitalists to already-existing quality initiatives they simply don’t know about. He particularly noted SQUINT, SHM’s searchable database for quality projects that is just getting off the ground.

“The stuff that’s there, I use and I love it,” says Dorothy Pusateri, MD, of Allegheny Hospitalist Service in Pittsburgh. “The stuff on Project BOOST [Better Outcomes for Older Adults through Safer Transitions] was enough to teach me.”

Rural Hospitalists

Small-town hospitalists from every corner of the country discussed recruiting issues, scheduling solutions, advocacy concerns, and more. A group of 15 rural hospitalists shared concerns about brutal, “72-hour” shifts and potential solutions to hiring and staffing issues, including growing your own hospitalists and hiring nonphysician providers (NPPs) to supplement 24/7 coverage.

“You can’t sustain mentally if you are doing all of it by yourself all day, all night,” said Martin Johns, MD, a hospitalist at 25-bed Gifford Medical Center in Randolph, Vt. Dr. Johns suggested rural groups think about utilizing NPPs and physician assistants (PAs) to fill coverage gaps; however, the opinions varied widely in what was considered proper compensation and responsibilities for nonphysicians.

“Our PAs make almost as much as our docs,” said Dale Vizcarra, MD, medical director of the hospitalist group at St. Mary’s Healthcare, a 68-bed critical-care hospital in Pierre, S.D.

The group also discussed at length the difficulties in bringing doctors to small towns. Although compensation can be higher than in large urban centers, the group agreed that the “one-man show” aspect of working as a small-town hospitalist is a detractor.

“I hear it all the time,” said forum moderator Alan Himmelstein, a regional vice president for Sound Physicians. “I can take care of gunshot wounds, but I forgot everything I know about community-acquired pneumonia. You aren’t surrounded by 23 specialists; in rural communities, you guys are the top of the heap. Your skill set, by definition, has to make you comfortable to take care of everything that comes through the door. You don’t have another facility a half-hour away; a lot of your geography doesn’t allow helicopters to fly 365 days.”

Rural hospitalists, who as a group admit nearly 40% of all hospital admissions nationwide, also are looking for a voice. “We’re a huge constituency,” Dr. Johns said, “and we are under-represented.”

Jason Carris, editor of The Hospitalist, contributed to this report.

Dr. Wachter

GRAPEVINE, Texas—The most successful companies tend to have superior branding. Starbucks owns coffee. Disney owns family fun. And hospitalists own patient-safety and quality-improvement (QI) initiatives within their hospitals.

“We were pretty confident that if we embraced this, we would have a clear running field to ourselves,” says Robert Wachter, MD, MHM, professor, chief of the Division of Hospital Medicine, and chief of the Medical Service at the University of California at San Francisco Medical Center, former SHM president, and author of the Wachter’s World blog. “No other physician field would do the same thing, and by owning the patient-safety field, we would distinguish ourselves.”

Now comes the really hard part, though.

Three keynote speakers at HM11—Dr. Wachter, AMA President Cecil Wilson, MD, and Robert Kocher, MD, a healthcare policy advisor to President Obama—pointed to hospitalists as the physician cohort that can help shepherd the conceptual reform passed last year by Congress into daily practice in America’s hospitals. And all three also point to HM’s role at the vanguard of patient safety as a primary reason why.

Hurdles will arise, Dr. Wilson says. A solo practitioner most of his career, he says hospitalists can play a key role in the coming years as more patients receive insurance, but looming doctor shortages could stymie the cause. While many caution that the flood of newly insured patients will overburden primary-care physicians (PCPs), the expected shortage of physicians will plague HM as well.

“Hospitalists are primary-care physicians; the vast majority of them are general internists,” Dr. Wilson says. “… So when we say that the number of people who are going into primary care, particularly general internal medicine, is reducing, that reduces not only the pool of physicians in the community, but also the hospitalist pool. We’re in that boat together.”

Dr. Kocher, director of the McKinsey Center for U.S. Health System Reform in Washington, D.C., says hospitalists are in the best position to push for on-the-ground reform as they are the doctors who bridge all hospital departments, floors, and wards. He sees four broad areas where HM can take a particularly leading role:

I’m positive, as long as hospitalists are confident—and I think they should be—that they can deliver, more consistently, better care than those who aren’t hospitalists practicing in hospitals … and they’re going to do better economically.—Bob Kocher, MD, director, McKinsey Center for U.S. Health System Reform, Washington, D.C.

• Increasing labor productivity. HM’s role as a link between specialties from cardiology to the pharmacy makes HM a natural conduit to push institutional values from a unique vantage point.
• Driving decision-making. Whether it’s recommending less costly drugs with similar outcomes, questioning whether expensive test batteries are truly necessary or being done for fear of missing something, or pausing to ask whether a “90-year-old hip replacement patient should receive orthopedic implants that will last far longer than their grandkids will be alive,” hospitalists can use their data to be a common-sense lynchpin of daily operations.
• Using technology to lower delivery costs. Many insurance companies are willing to enter into risk-based contracts with hospitals, but some hospital executives worry whether they will be able to perform well enough to justify the risk. “Hospitalists can help say, ‘We can do this. We can hit the thresholds.’ ”
• Shifting compensation models from “selling work RVUs to selling years of health.”

“The biggest thing [hospitalists] should begin doing,” Dr. Kocher adds, “is stop thinking about units of work, or RVUs, and start thinking about how much better patients can be by virtue of the care they’re delivering, how many readmissions are they avoiding, how many core measures/outcomes are they hitting, how much better is the patient experience, and how much smoother is the handoff.”

The push to improve quality and show better outcomes, of course, is intrinsically tied to payment reform. Bundled payments that reimburse a set fee for a case from pre-admission to a preset post-discharge deadline worry some hospitalists, who fear how the payments will be divvied up and who will be in charge of said payment decisions. Dr. Kocher says that even when the initial rules are set, the system is likely to evolve.

However, the hospitalist’s role as a driver of QI positions the field well, all three speakers noted. By quarterbacking patient handoffs and continuing to be seen by hospital executives as quality and safety leaders, HM groups can make the argument that they are worth the financial support they ask for in negotiations. Dr. Wachter adds that while quality research has become a staple of academics and residents, hospitalists should look to now tie value to the equation, effectively linking better patient outcomes to HM’s bottom line.

“There’s no question that physicians that can care for patients more efficiently, in a higher-quality way, in hospitals at lower costs, are going to do better no matter how the system evolves,” Dr. Kocher says. “I’m positive, as long as hospitalists are confident—and I think they should be—that they can deliver, more consistently, better care than those who aren’t hospitalists practicing in hospitals … and they’re going to do better economically.”

Dr. Wachter

GRAPEVINE, Texas—The most successful companies tend to have superior branding. Starbucks owns coffee. Disney owns family fun. And hospitalists own patient-safety and quality-improvement (QI) initiatives within their hospitals.

“We were pretty confident that if we embraced this, we would have a clear running field to ourselves,” says Robert Wachter, MD, MHM, professor, chief of the Division of Hospital Medicine, and chief of the Medical Service at the University of California at San Francisco Medical Center, former SHM president, and author of the Wachter’s World blog. “No other physician field would do the same thing, and by owning the patient-safety field, we would distinguish ourselves.”

Now comes the really hard part, though.

Three keynote speakers at HM11—Dr. Wachter, AMA President Cecil Wilson, MD, and Robert Kocher, MD, a healthcare policy advisor to President Obama—pointed to hospitalists as the physician cohort that can help shepherd the conceptual reform passed last year by Congress into daily practice in America’s hospitals. And all three also point to HM’s role at the vanguard of patient safety as a primary reason why.

Hurdles will arise, Dr. Wilson says. A solo practitioner most of his career, he says hospitalists can play a key role in the coming years as more patients receive insurance, but looming doctor shortages could stymie the cause. While many caution that the flood of newly insured patients will overburden primary-care physicians (PCPs), the expected shortage of physicians will plague HM as well.

“Hospitalists are primary-care physicians; the vast majority of them are general internists,” Dr. Wilson says. “… So when we say that the number of people who are going into primary care, particularly general internal medicine, is reducing, that reduces not only the pool of physicians in the community, but also the hospitalist pool. We’re in that boat together.”

Dr. Kocher, director of the McKinsey Center for U.S. Health System Reform in Washington, D.C., says hospitalists are in the best position to push for on-the-ground reform as they are the doctors who bridge all hospital departments, floors, and wards. He sees four broad areas where HM can take a particularly leading role:

I’m positive, as long as hospitalists are confident—and I think they should be—that they can deliver, more consistently, better care than those who aren’t hospitalists practicing in hospitals … and they’re going to do better economically.—Bob Kocher, MD, director, McKinsey Center for U.S. Health System Reform, Washington, D.C.

• Increasing labor productivity. HM’s role as a link between specialties from cardiology to the pharmacy makes HM a natural conduit to push institutional values from a unique vantage point.
• Driving decision-making. Whether it’s recommending less costly drugs with similar outcomes, questioning whether expensive test batteries are truly necessary or being done for fear of missing something, or pausing to ask whether a “90-year-old hip replacement patient should receive orthopedic implants that will last far longer than their grandkids will be alive,” hospitalists can use their data to be a common-sense lynchpin of daily operations.
• Using technology to lower delivery costs. Many insurance companies are willing to enter into risk-based contracts with hospitals, but some hospital executives worry whether they will be able to perform well enough to justify the risk. “Hospitalists can help say, ‘We can do this. We can hit the thresholds.’ ”
• Shifting compensation models from “selling work RVUs to selling years of health.”

“The biggest thing [hospitalists] should begin doing,” Dr. Kocher adds, “is stop thinking about units of work, or RVUs, and start thinking about how much better patients can be by virtue of the care they’re delivering, how many readmissions are they avoiding, how many core measures/outcomes are they hitting, how much better is the patient experience, and how much smoother is the handoff.”

The push to improve quality and show better outcomes, of course, is intrinsically tied to payment reform. Bundled payments that reimburse a set fee for a case from pre-admission to a preset post-discharge deadline worry some hospitalists, who fear how the payments will be divvied up and who will be in charge of said payment decisions. Dr. Kocher says that even when the initial rules are set, the system is likely to evolve.

However, the hospitalist’s role as a driver of QI positions the field well, all three speakers noted. By quarterbacking patient handoffs and continuing to be seen by hospital executives as quality and safety leaders, HM groups can make the argument that they are worth the financial support they ask for in negotiations. Dr. Wachter adds that while quality research has become a staple of academics and residents, hospitalists should look to now tie value to the equation, effectively linking better patient outcomes to HM’s bottom line.

“There’s no question that physicians that can care for patients more efficiently, in a higher-quality way, in hospitals at lower costs, are going to do better no matter how the system evolves,” Dr. Kocher says. “I’m positive, as long as hospitalists are confident—and I think they should be—that they can deliver, more consistently, better care than those who aren’t hospitalists practicing in hospitals … and they’re going to do better economically.”

Dr. Wachter

GRAPEVINE, Texas—The most successful companies tend to have superior branding. Starbucks owns coffee. Disney owns family fun. And hospitalists own patient-safety and quality-improvement (QI) initiatives within their hospitals.

“We were pretty confident that if we embraced this, we would have a clear running field to ourselves,” says Robert Wachter, MD, MHM, professor, chief of the Division of Hospital Medicine, and chief of the Medical Service at the University of California at San Francisco Medical Center, former SHM president, and author of the Wachter’s World blog. “No other physician field would do the same thing, and by owning the patient-safety field, we would distinguish ourselves.”

Now comes the really hard part, though.

Three keynote speakers at HM11—Dr. Wachter, AMA President Cecil Wilson, MD, and Robert Kocher, MD, a healthcare policy advisor to President Obama—pointed to hospitalists as the physician cohort that can help shepherd the conceptual reform passed last year by Congress into daily practice in America’s hospitals. And all three also point to HM’s role at the vanguard of patient safety as a primary reason why.

Hurdles will arise, Dr. Wilson says. A solo practitioner most of his career, he says hospitalists can play a key role in the coming years as more patients receive insurance, but looming doctor shortages could stymie the cause. While many caution that the flood of newly insured patients will overburden primary-care physicians (PCPs), the expected shortage of physicians will plague HM as well.

“Hospitalists are primary-care physicians; the vast majority of them are general internists,” Dr. Wilson says. “… So when we say that the number of people who are going into primary care, particularly general internal medicine, is reducing, that reduces not only the pool of physicians in the community, but also the hospitalist pool. We’re in that boat together.”

Dr. Kocher, director of the McKinsey Center for U.S. Health System Reform in Washington, D.C., says hospitalists are in the best position to push for on-the-ground reform as they are the doctors who bridge all hospital departments, floors, and wards. He sees four broad areas where HM can take a particularly leading role:

I’m positive, as long as hospitalists are confident—and I think they should be—that they can deliver, more consistently, better care than those who aren’t hospitalists practicing in hospitals … and they’re going to do better economically.—Bob Kocher, MD, director, McKinsey Center for U.S. Health System Reform, Washington, D.C.

• Increasing labor productivity. HM’s role as a link between specialties from cardiology to the pharmacy makes HM a natural conduit to push institutional values from a unique vantage point.
• Driving decision-making. Whether it’s recommending less costly drugs with similar outcomes, questioning whether expensive test batteries are truly necessary or being done for fear of missing something, or pausing to ask whether a “90-year-old hip replacement patient should receive orthopedic implants that will last far longer than their grandkids will be alive,” hospitalists can use their data to be a common-sense lynchpin of daily operations.
• Using technology to lower delivery costs. Many insurance companies are willing to enter into risk-based contracts with hospitals, but some hospital executives worry whether they will be able to perform well enough to justify the risk. “Hospitalists can help say, ‘We can do this. We can hit the thresholds.’ ”
• Shifting compensation models from “selling work RVUs to selling years of health.”

“The biggest thing [hospitalists] should begin doing,” Dr. Kocher adds, “is stop thinking about units of work, or RVUs, and start thinking about how much better patients can be by virtue of the care they’re delivering, how many readmissions are they avoiding, how many core measures/outcomes are they hitting, how much better is the patient experience, and how much smoother is the handoff.”

The push to improve quality and show better outcomes, of course, is intrinsically tied to payment reform. Bundled payments that reimburse a set fee for a case from pre-admission to a preset post-discharge deadline worry some hospitalists, who fear how the payments will be divvied up and who will be in charge of said payment decisions. Dr. Kocher says that even when the initial rules are set, the system is likely to evolve.

However, the hospitalist’s role as a driver of QI positions the field well, all three speakers noted. By quarterbacking patient handoffs and continuing to be seen by hospital executives as quality and safety leaders, HM groups can make the argument that they are worth the financial support they ask for in negotiations. Dr. Wachter adds that while quality research has become a staple of academics and residents, hospitalists should look to now tie value to the equation, effectively linking better patient outcomes to HM’s bottom line.

“There’s no question that physicians that can care for patients more efficiently, in a higher-quality way, in hospitals at lower costs, are going to do better no matter how the system evolves,” Dr. Kocher says. “I’m positive, as long as hospitalists are confident—and I think they should be—that they can deliver, more consistently, better care than those who aren’t hospitalists practicing in hospitals … and they’re going to do better economically.”

QUALITY

Utilizing Technology to Improve the Clinical and Operational Performance of Hospitalists

SPEAKERS: Jason Stein, MD, SFHM, associate vice chair for quality, Department of Medicine, Bryce Gartland, MD, FHM, associate director, section of hospital medicine, Emory University School of Medicine, Atlanta

In an age of increasing technology, just getting technology into a hospital isn’t the answer. It’s about integrating it into practice to improve care.

At Emory, the marriage of “low-tech solutions” and patented data displays has resulted in what Drs. Stein and Gartland call an accountable-care unit (ACU). The unit-based team features geographic ownership and structured interdisciplinary bedside rounds (SIBR). Perhaps more important, the unit generates real-time data captured on monitors, allowing teams of hospitalists, nonphysician providers (NPPs), residents, interns, and social workers to “visually digest immense amounts of information in a very short time period,” Dr. Gartland said.

Dr. Stein defined an ACU as a bounded geographic inpatient area responsible for the clinical, service, and cost outcomes it produces. To help manage beds, Emory instituted a system called “e-Bed,” a McKesson system that tracks room availability. The system shows whether rooms are occupied, being cleaned, or somewhere in between. It has icons to show whether patients are elsewhere in the hospital for treatment, as well as clinical data capacities. Unit teams round together and use a portable workstation or tablet computer to input clinical data, notes, or other comments into real-time dashboards that can then show everything from VTE prophylaxis to whether a patient is at high risk for falls.

The project has been in the works for several years, and Dr. Garltand noted that any hospitalists looking to push similar initiatives at their institution need to ensure that they have buy-in from providers and a commitment to seeing the project through.

“Timing is everything,” he said. “If we tried to force this … a few years ago, it would not have worked.”

PRACTICE MANAGEMENT

Recruiting and Retaining Hospitalists: Developing a Talent Facilitation Framework

SPEAKERS: Patrick Kneeland, MD, hospitalist, Providence Regional Medical Center, Everett, Wash.; Christine Kneeland, COO, Center Partners, Fort Collins, Colo.; Niraj Sehgal, associate professor of medicine, associate chair for quality and safety, Department of Medicine, University of California at San Francisco

Lincoln Godfrey, DO, a hospitalist at Baxter Regional Medical Center in Mountain Home, Ark., was sitting and listening to strategies to lure and keep hospitalists when his hospital CEO sent him a text asking how his recruiting efforts were going with a would-be hire.

“I said I’d get back to him,” Dr. Godfrey jokes.

The C-suite’s passion is understandable, though, as the fight to hire experienced staff outside of major markets continues to stymie many HM groups. Dr. Godfrey says he can’t hire anybody without first getting them to the Ozark Mountains to learn the hospital, its people, and its community.

“There’s going to be a limited talent pool of people who will come at all,” he says. “But I don’t get anybody who doesn’t work with us for a bit first.”

Christine Kneeland—Dr. Kneeland’s mother—said HM leaders tasked with their group’s personnel duties should focus on a few main concepts:

• Think outside the bank. Some physicians look only to earn as much as they can as quickly as they can, but many seek personal and professional satisfaction.
• Engagement is instrumental. A one-day orientation program for a lifetime job doesn’t sound like enough, does it?

In the coming years, hiring managers will have to focus on “millennials”—the generation of doctors born between 1977 and 1999—which Christine Kneeland described as tech-savvy doctors interested in a blended lifestyle of work and leisure. And while some might not agree with or understand their perspective, they’d better get used to it, she said. “The millennials are here, the workplace has changed, and they are leading that change,” she added. “Just embrace it.”

QUALITY

Patient Satisfaction: Tips for Improving Your HCAHPS Scores

MODERATORS: Win Whitcomb, MD, MHM, medical director of healthcare quality, Baystate Medical Center, Springfield, Mass.; Steven Deitelzweig, MD, MMM, SFHM, system chairman, Department of Hospital Medicine, regional vice president of medical affairs, Ochsner Health System, New Orleans

Patient satisfaction scores are a big deal right now, as many HM groups tie the scores to compensation and the federal government tethers the scores and a portion of hospital payment through the value-based purchasing (VBP) program.

So how does a hospitalist improve their HCAHPS score? Here’s what the experts said:

• Personalize things. Give a business card with a picture. Sit down. Smile. Ask the patient if they understand what you’ve said, and don’t get frustrated if they don’t.
• First and last. Make good impressions when introducing yourself to the patient and when it’s time to discharge or transition them to a different facility. “When the hospitalist hands a patient off,” Dr. Whitcomb said, “it doesn’t cut it to pull out your brochure of 40 practitioners when the patient asks, ‘Who am I going to see tomorrow?’”
• Be professional. Don’t vent about workplace issues in front of patients. Dr. Deitelzweig illustrated the point with the case of an elderly patient who got out of bed to help a practitioner they heard complaining about a heavy workload. The patient fell.
• Creative use of white space. Consider using in-room white boards to help keep patients informed of a day’s care plan.

David Jaworski, MD, director of the hospitalist service at Windham Hospital in Willimantic, Conn., says honesty was a key piece of advice he gleaned from the session.

“I think one of the things people appreciate the most when they’re in the hospital is being honest about our uncertainties,” he says. “I have had more people thank me for saying, ‘I don’t know, but we will find out by doing this, this, and this.’ ”

ACADEMIC

The Role of Hospital Medicine in Adapting to the New ACGME Requirements

SPEAKER: Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center, New Orleans

The new Accreditation Council for Graduate Medical Education (ACGME) work-hour rules that take effect July 1 have received a lot of attention since they were announced last summer. The guideline that has attracted the bulk of the attention limits intern shifts to 16 hours, with upper-level residents capped at 24 consecutive hours, with four hours of administrative follow-on allowed with the caveat that strategic napping is “strongly suggested.”

“I’m all for work hours,” said Dr. Wiese, immediate past president of SHM. “It’s the right thing to do; it’s safer. But I think we have to be careful we don’t super-fragment the system or double the intensity of the system. And on both of those plates, if you don’t do it right, what you end up with is people who will be ill-prepared.”

Dr. Wiese said an easy way to question the validity of one ACGME rule is to examine the guideline that limits a first-year resident’s census to 10 patients. He wondered which scenario offers more teaching opportunities: a roster of six chest-pain cases, two pneumonia cases, and two similarly familiar or relatively safe cases, or a resident with only four cases but each one having multiple comorbidities and complex decisions?

The new rules provide hospitals and HM groups an opportunity to change their way of thinking, adds Jeffrey Schnipper, MD, MPH, FHM, of Brigham and Women’s Hospital and Massachusetts General Hospital in Boston. “Every program has to change its entire way of doing business anyway, so let’s be at the table and say, ‘Well, while you’re redesigning your entire program, let’s inject patent safety and quality of care, and good pedagogy into the system,’” he says.

CLINICAL

Skin is In: Dermatological Images Every Hospitalist Should Recognize

MODERATOR: Paul Aronowitz, MD, FACP, internal medicine residency program director, California Pacific Medical Center, San Francisco

A patient comes into the ED with a blistering skin condition, but the diagnosis escapes the triage doctor on the case. The problem turns out to be bullosis diabeticorum, but the ED doc doesn’t know that yet and pushes to add a patient to the upstairs HM roster.

“The ED will usually try to admit because they’re worried [the patient has] some terrible drug eruption, but they can actually go home,” Dr. Aronowitz explained. “Hospitalists can help tell the difference.”

HM groups shouldn’t work to become amateur dermatologists, Dr. Aronowitz added. However, given that many hospitalists find themselves confronted by dermatologic cases several times a month, a rudimentary pedigree is a good idea to help sift out which cases require admission and which would take up bed space required for others.

He referred to it as knowing enough to know whether you know enough. “For sure, a hospitalist can diagnose a hypersensitivity reaction from a classic drug like Dilantin,” Dr. Aronowitz said, “and then stop the drug, because that would be one of the best things they could do.”

The session exposed hospitalists to dozens of images of skin conditions theymight come across in daily rounds, from snakebites to drug reactions to argyria.

“The idea is to help hospitalists recognize what’s serious and what’s not,” he said. “If you recognize those initial cutaneous clues, you can guide your antibiotic therapy, or whether you need antibiotics.”

CAREER

This Disease Is Easy; It’s the Patient Who’s Difficult

Speaker: Susan Block, chair, Department of Psychosocial Oncology and Palliative Care at Dana Farber Cancer Institute, Boston

Every physician will have their “button pushed” by a patient now and then, and hospitalists are in the unfortunate position of having little or no previous relationship with most patients, according to Dr. Block, a national expert in physician-patient conflict resolution who said “interpersonal challenges are an onerous part” of the job.

“We want to make sure we provide really good care to these patients, but it can be very challenging,” she said, noting that between 10% and 30% of patients in the healthcare setting present with difficult behaviors.

Whether it’s an empowered patient, a traumatized patient, an intrusive family member, or a patient with clear psychosocial issues, Dr. Block explained that “these patients can make physicians feel lousy. … Being aware of that and trying to stop that process is one of the key issues in professionalism and competence in working with difficult patients.”

She also warned hospitalists to recognize when they become a “magnet” for difficult patients, as many times the expert in the group will become the “go-to” doc. “I don’t think anyone can take care of a large panel of these patients; it’s just too much,” she said, noting you have to negotiate some limits or you will “burn out and lose perspective.”

Many doctors are very uncomfortable with scared or crying patients, Dr. Block said, explaining these are some of her most difficult patients. “Show me a patient in the hospital who isn’t scared,” she said. “Even it they aren’t, they are scared of dying.”

Other sources of workplace discomfort include the dependent or “needy” patient, the suspicious patient, and the extremely pushy patient. Dr. Block suggested setting clear boundaries with patients; she also noted physicians should be ready and willing to identify and reflect on your own emotions so that “you have the capacity to get perspective on the problem and keep yourself from being part of the problem.

“Limit-setting is one of the most therapeutic things you can do with difficult patients,” she said. “It feels to us as a form of sadism, as though we are punishing patients. But for many patients, the most dangerous, scary, and dysfunctional thing you can do for patients is not set limits.”

CLINICAL

The Art of Clinical Problem-Solving: Mystery Cases

SPEAKER: Gupreet Dhaliwal, MD, University of California at San Francisco

Humility, patience, and practice: Those are the keys to improving one’s clinical diagnostic skills, according to Dr. Dhaliwal, an acclaimed educator and clinician at UCSF who walked a packed room through two blind cases and encouraged hospitalists to work hard at their craft.

“If you want to reach your maximum potential, you have to view it the same way we do other things, the same way a great musician rehearses and a great soccer player scrimmages,” he said. “All of us are busy, but you either have to increase the number of cases you put your mind through, or you take the cases you have and you analyze them, you seek feedback, you try to improve the process around the diagnostic.

“The message isn’t always fun, because both of those things equal more work, but there is no way to hide it because there is no field in which people get better without more work.”

Dr. Dhaliwal says hospitalists should be “humble about diagnosis.” He explained that the more experienced people become, the more we shift from analytical reasoning, “thinking hard like we did when we were students and residents,” to intuitive reasoning, which “is basically saying, ‘I recognize a pattern, this is an old friend, I’ve seen gout before.’ I think any of us can be guilty of forgetting that it has pitfalls. And there is a whole list of cognitive biases that are associated with moving fast and building patterns.”

He also believes hospitalists who dedicate themselves to clinical greatness can parlay such improvement in the quality realm. “Every one of us has used diagnosis as a core part of our identity, but in terms of getting the community or other stakeholders behind improving diagnosis or improving judgment, I think the umbrella of quality and reducing diagnostic errors is the most appealing and most logical,” he says. “I think we start to take for granted we are good at it, but I think there are ways many of us, especially if we work at it, can become great at it.”

CLINICAL

The How, When, and Why of Noninvasive Ventilation

SPEAKER: Eric Siegal, MD, SFHM, critical care fellow, University of Wisconsin School of Medicine, Madison

Dr. Siegal’s review of literature in front of a packed crowd provided a road map to Noninvasive Positive Pressure Ventilation (NPPV) usage. In the end, NPPV should be a hospitalist’s first choice for patients with hypercarbic COPD exacerbations, and likely in patients with acute cardiogenic pulmonary edema, hypoxemic respiratory failure, immunocompromised patients, and pre-intubation patients.

Dr. Siegal stressed the use of NPPV in COPD, which has been studied thoroughly and “held up to repeated scrutiny.”

“If you put people on NPPV instead of intubating them … mortality is halved, intubation rate is less than half, treatment failure is much lower, you have a third of the complications, and huge reductions in length of stay,” Dr. Siegal said.

In the absence of contraindications, he stressed, NPPV should be the first line of therapy for patients with hypercarbic COPD exacerbations. “In fact, I would argue that you really should be asking yourself, ‘Why can’t I put these patients on NPPV?’ ” he asked, “because this has really shown to be life-saving.”

Dr. Siegal also explored recent findings on NPPV in acute cardiogenic pulmonary edema patients, which surprisingly showed “no better than supplemental oxygen.” He concluded that if your patient is not hypercarbic, “there is no advantage to adding pressure support.” He also said the benefit is more robust in ACPE patients who have acute coronary syndrome.

Dr. Siegal advised hospitalists to pick the right patients, start NPPV therapy early, and if the patient doesn’t improve within one or two hours, “it’s time to move on.”

QUALITY

Utilizing Technology to Improve the Clinical and Operational Performance of Hospitalists

SPEAKERS: Jason Stein, MD, SFHM, associate vice chair for quality, Department of Medicine, Bryce Gartland, MD, FHM, associate director, section of hospital medicine, Emory University School of Medicine, Atlanta

In an age of increasing technology, just getting technology into a hospital isn’t the answer. It’s about integrating it into practice to improve care.

At Emory, the marriage of “low-tech solutions” and patented data displays has resulted in what Drs. Stein and Gartland call an accountable-care unit (ACU). The unit-based team features geographic ownership and structured interdisciplinary bedside rounds (SIBR). Perhaps more important, the unit generates real-time data captured on monitors, allowing teams of hospitalists, nonphysician providers (NPPs), residents, interns, and social workers to “visually digest immense amounts of information in a very short time period,” Dr. Gartland said.

Dr. Stein defined an ACU as a bounded geographic inpatient area responsible for the clinical, service, and cost outcomes it produces. To help manage beds, Emory instituted a system called “e-Bed,” a McKesson system that tracks room availability. The system shows whether rooms are occupied, being cleaned, or somewhere in between. It has icons to show whether patients are elsewhere in the hospital for treatment, as well as clinical data capacities. Unit teams round together and use a portable workstation or tablet computer to input clinical data, notes, or other comments into real-time dashboards that can then show everything from VTE prophylaxis to whether a patient is at high risk for falls.

The project has been in the works for several years, and Dr. Garltand noted that any hospitalists looking to push similar initiatives at their institution need to ensure that they have buy-in from providers and a commitment to seeing the project through.

“Timing is everything,” he said. “If we tried to force this … a few years ago, it would not have worked.”

PRACTICE MANAGEMENT

Recruiting and Retaining Hospitalists: Developing a Talent Facilitation Framework

SPEAKERS: Patrick Kneeland, MD, hospitalist, Providence Regional Medical Center, Everett, Wash.; Christine Kneeland, COO, Center Partners, Fort Collins, Colo.; Niraj Sehgal, associate professor of medicine, associate chair for quality and safety, Department of Medicine, University of California at San Francisco

Lincoln Godfrey, DO, a hospitalist at Baxter Regional Medical Center in Mountain Home, Ark., was sitting and listening to strategies to lure and keep hospitalists when his hospital CEO sent him a text asking how his recruiting efforts were going with a would-be hire.

“I said I’d get back to him,” Dr. Godfrey jokes.

The C-suite’s passion is understandable, though, as the fight to hire experienced staff outside of major markets continues to stymie many HM groups. Dr. Godfrey says he can’t hire anybody without first getting them to the Ozark Mountains to learn the hospital, its people, and its community.

“There’s going to be a limited talent pool of people who will come at all,” he says. “But I don’t get anybody who doesn’t work with us for a bit first.”

Christine Kneeland—Dr. Kneeland’s mother—said HM leaders tasked with their group’s personnel duties should focus on a few main concepts:

• Think outside the bank. Some physicians look only to earn as much as they can as quickly as they can, but many seek personal and professional satisfaction.
• Engagement is instrumental. A one-day orientation program for a lifetime job doesn’t sound like enough, does it?

In the coming years, hiring managers will have to focus on “millennials”—the generation of doctors born between 1977 and 1999—which Christine Kneeland described as tech-savvy doctors interested in a blended lifestyle of work and leisure. And while some might not agree with or understand their perspective, they’d better get used to it, she said. “The millennials are here, the workplace has changed, and they are leading that change,” she added. “Just embrace it.”

QUALITY

Patient Satisfaction: Tips for Improving Your HCAHPS Scores

MODERATORS: Win Whitcomb, MD, MHM, medical director of healthcare quality, Baystate Medical Center, Springfield, Mass.; Steven Deitelzweig, MD, MMM, SFHM, system chairman, Department of Hospital Medicine, regional vice president of medical affairs, Ochsner Health System, New Orleans

Patient satisfaction scores are a big deal right now, as many HM groups tie the scores to compensation and the federal government tethers the scores and a portion of hospital payment through the value-based purchasing (VBP) program.

So how does a hospitalist improve their HCAHPS score? Here’s what the experts said:

• Personalize things. Give a business card with a picture. Sit down. Smile. Ask the patient if they understand what you’ve said, and don’t get frustrated if they don’t.
• First and last. Make good impressions when introducing yourself to the patient and when it’s time to discharge or transition them to a different facility. “When the hospitalist hands a patient off,” Dr. Whitcomb said, “it doesn’t cut it to pull out your brochure of 40 practitioners when the patient asks, ‘Who am I going to see tomorrow?’”
• Be professional. Don’t vent about workplace issues in front of patients. Dr. Deitelzweig illustrated the point with the case of an elderly patient who got out of bed to help a practitioner they heard complaining about a heavy workload. The patient fell.
• Creative use of white space. Consider using in-room white boards to help keep patients informed of a day’s care plan.

David Jaworski, MD, director of the hospitalist service at Windham Hospital in Willimantic, Conn., says honesty was a key piece of advice he gleaned from the session.

“I think one of the things people appreciate the most when they’re in the hospital is being honest about our uncertainties,” he says. “I have had more people thank me for saying, ‘I don’t know, but we will find out by doing this, this, and this.’ ”

ACADEMIC

The Role of Hospital Medicine in Adapting to the New ACGME Requirements

SPEAKER: Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center, New Orleans

The new Accreditation Council for Graduate Medical Education (ACGME) work-hour rules that take effect July 1 have received a lot of attention since they were announced last summer. The guideline that has attracted the bulk of the attention limits intern shifts to 16 hours, with upper-level residents capped at 24 consecutive hours, with four hours of administrative follow-on allowed with the caveat that strategic napping is “strongly suggested.”

“I’m all for work hours,” said Dr. Wiese, immediate past president of SHM. “It’s the right thing to do; it’s safer. But I think we have to be careful we don’t super-fragment the system or double the intensity of the system. And on both of those plates, if you don’t do it right, what you end up with is people who will be ill-prepared.”

Dr. Wiese said an easy way to question the validity of one ACGME rule is to examine the guideline that limits a first-year resident’s census to 10 patients. He wondered which scenario offers more teaching opportunities: a roster of six chest-pain cases, two pneumonia cases, and two similarly familiar or relatively safe cases, or a resident with only four cases but each one having multiple comorbidities and complex decisions?

The new rules provide hospitals and HM groups an opportunity to change their way of thinking, adds Jeffrey Schnipper, MD, MPH, FHM, of Brigham and Women’s Hospital and Massachusetts General Hospital in Boston. “Every program has to change its entire way of doing business anyway, so let’s be at the table and say, ‘Well, while you’re redesigning your entire program, let’s inject patent safety and quality of care, and good pedagogy into the system,’” he says.

CLINICAL

Skin is In: Dermatological Images Every Hospitalist Should Recognize

MODERATOR: Paul Aronowitz, MD, FACP, internal medicine residency program director, California Pacific Medical Center, San Francisco

A patient comes into the ED with a blistering skin condition, but the diagnosis escapes the triage doctor on the case. The problem turns out to be bullosis diabeticorum, but the ED doc doesn’t know that yet and pushes to add a patient to the upstairs HM roster.

“The ED will usually try to admit because they’re worried [the patient has] some terrible drug eruption, but they can actually go home,” Dr. Aronowitz explained. “Hospitalists can help tell the difference.”

HM groups shouldn’t work to become amateur dermatologists, Dr. Aronowitz added. However, given that many hospitalists find themselves confronted by dermatologic cases several times a month, a rudimentary pedigree is a good idea to help sift out which cases require admission and which would take up bed space required for others.

He referred to it as knowing enough to know whether you know enough. “For sure, a hospitalist can diagnose a hypersensitivity reaction from a classic drug like Dilantin,” Dr. Aronowitz said, “and then stop the drug, because that would be one of the best things they could do.”

The session exposed hospitalists to dozens of images of skin conditions theymight come across in daily rounds, from snakebites to drug reactions to argyria.

“The idea is to help hospitalists recognize what’s serious and what’s not,” he said. “If you recognize those initial cutaneous clues, you can guide your antibiotic therapy, or whether you need antibiotics.”

CAREER

This Disease Is Easy; It’s the Patient Who’s Difficult

Speaker: Susan Block, chair, Department of Psychosocial Oncology and Palliative Care at Dana Farber Cancer Institute, Boston

Every physician will have their “button pushed” by a patient now and then, and hospitalists are in the unfortunate position of having little or no previous relationship with most patients, according to Dr. Block, a national expert in physician-patient conflict resolution who said “interpersonal challenges are an onerous part” of the job.

“We want to make sure we provide really good care to these patients, but it can be very challenging,” she said, noting that between 10% and 30% of patients in the healthcare setting present with difficult behaviors.

Whether it’s an empowered patient, a traumatized patient, an intrusive family member, or a patient with clear psychosocial issues, Dr. Block explained that “these patients can make physicians feel lousy. … Being aware of that and trying to stop that process is one of the key issues in professionalism and competence in working with difficult patients.”

She also warned hospitalists to recognize when they become a “magnet” for difficult patients, as many times the expert in the group will become the “go-to” doc. “I don’t think anyone can take care of a large panel of these patients; it’s just too much,” she said, noting you have to negotiate some limits or you will “burn out and lose perspective.”

Many doctors are very uncomfortable with scared or crying patients, Dr. Block said, explaining these are some of her most difficult patients. “Show me a patient in the hospital who isn’t scared,” she said. “Even it they aren’t, they are scared of dying.”

Other sources of workplace discomfort include the dependent or “needy” patient, the suspicious patient, and the extremely pushy patient. Dr. Block suggested setting clear boundaries with patients; she also noted physicians should be ready and willing to identify and reflect on your own emotions so that “you have the capacity to get perspective on the problem and keep yourself from being part of the problem.

“Limit-setting is one of the most therapeutic things you can do with difficult patients,” she said. “It feels to us as a form of sadism, as though we are punishing patients. But for many patients, the most dangerous, scary, and dysfunctional thing you can do for patients is not set limits.”

CLINICAL

The Art of Clinical Problem-Solving: Mystery Cases

SPEAKER: Gupreet Dhaliwal, MD, University of California at San Francisco

Humility, patience, and practice: Those are the keys to improving one’s clinical diagnostic skills, according to Dr. Dhaliwal, an acclaimed educator and clinician at UCSF who walked a packed room through two blind cases and encouraged hospitalists to work hard at their craft.

“If you want to reach your maximum potential, you have to view it the same way we do other things, the same way a great musician rehearses and a great soccer player scrimmages,” he said. “All of us are busy, but you either have to increase the number of cases you put your mind through, or you take the cases you have and you analyze them, you seek feedback, you try to improve the process around the diagnostic.

“The message isn’t always fun, because both of those things equal more work, but there is no way to hide it because there is no field in which people get better without more work.”

Dr. Dhaliwal says hospitalists should be “humble about diagnosis.” He explained that the more experienced people become, the more we shift from analytical reasoning, “thinking hard like we did when we were students and residents,” to intuitive reasoning, which “is basically saying, ‘I recognize a pattern, this is an old friend, I’ve seen gout before.’ I think any of us can be guilty of forgetting that it has pitfalls. And there is a whole list of cognitive biases that are associated with moving fast and building patterns.”

He also believes hospitalists who dedicate themselves to clinical greatness can parlay such improvement in the quality realm. “Every one of us has used diagnosis as a core part of our identity, but in terms of getting the community or other stakeholders behind improving diagnosis or improving judgment, I think the umbrella of quality and reducing diagnostic errors is the most appealing and most logical,” he says. “I think we start to take for granted we are good at it, but I think there are ways many of us, especially if we work at it, can become great at it.”

CLINICAL

The How, When, and Why of Noninvasive Ventilation

SPEAKER: Eric Siegal, MD, SFHM, critical care fellow, University of Wisconsin School of Medicine, Madison

Dr. Siegal’s review of literature in front of a packed crowd provided a road map to Noninvasive Positive Pressure Ventilation (NPPV) usage. In the end, NPPV should be a hospitalist’s first choice for patients with hypercarbic COPD exacerbations, and likely in patients with acute cardiogenic pulmonary edema, hypoxemic respiratory failure, immunocompromised patients, and pre-intubation patients.

Dr. Siegal stressed the use of NPPV in COPD, which has been studied thoroughly and “held up to repeated scrutiny.”

“If you put people on NPPV instead of intubating them … mortality is halved, intubation rate is less than half, treatment failure is much lower, you have a third of the complications, and huge reductions in length of stay,” Dr. Siegal said.

In the absence of contraindications, he stressed, NPPV should be the first line of therapy for patients with hypercarbic COPD exacerbations. “In fact, I would argue that you really should be asking yourself, ‘Why can’t I put these patients on NPPV?’ ” he asked, “because this has really shown to be life-saving.”

Dr. Siegal also explored recent findings on NPPV in acute cardiogenic pulmonary edema patients, which surprisingly showed “no better than supplemental oxygen.” He concluded that if your patient is not hypercarbic, “there is no advantage to adding pressure support.” He also said the benefit is more robust in ACPE patients who have acute coronary syndrome.

Dr. Siegal advised hospitalists to pick the right patients, start NPPV therapy early, and if the patient doesn’t improve within one or two hours, “it’s time to move on.”

QUALITY

Utilizing Technology to Improve the Clinical and Operational Performance of Hospitalists

SPEAKERS: Jason Stein, MD, SFHM, associate vice chair for quality, Department of Medicine, Bryce Gartland, MD, FHM, associate director, section of hospital medicine, Emory University School of Medicine, Atlanta

In an age of increasing technology, just getting technology into a hospital isn’t the answer. It’s about integrating it into practice to improve care.

At Emory, the marriage of “low-tech solutions” and patented data displays has resulted in what Drs. Stein and Gartland call an accountable-care unit (ACU). The unit-based team features geographic ownership and structured interdisciplinary bedside rounds (SIBR). Perhaps more important, the unit generates real-time data captured on monitors, allowing teams of hospitalists, nonphysician providers (NPPs), residents, interns, and social workers to “visually digest immense amounts of information in a very short time period,” Dr. Gartland said.

Dr. Stein defined an ACU as a bounded geographic inpatient area responsible for the clinical, service, and cost outcomes it produces. To help manage beds, Emory instituted a system called “e-Bed,” a McKesson system that tracks room availability. The system shows whether rooms are occupied, being cleaned, or somewhere in between. It has icons to show whether patients are elsewhere in the hospital for treatment, as well as clinical data capacities. Unit teams round together and use a portable workstation or tablet computer to input clinical data, notes, or other comments into real-time dashboards that can then show everything from VTE prophylaxis to whether a patient is at high risk for falls.

The project has been in the works for several years, and Dr. Garltand noted that any hospitalists looking to push similar initiatives at their institution need to ensure that they have buy-in from providers and a commitment to seeing the project through.

“Timing is everything,” he said. “If we tried to force this … a few years ago, it would not have worked.”

PRACTICE MANAGEMENT

Recruiting and Retaining Hospitalists: Developing a Talent Facilitation Framework

SPEAKERS: Patrick Kneeland, MD, hospitalist, Providence Regional Medical Center, Everett, Wash.; Christine Kneeland, COO, Center Partners, Fort Collins, Colo.; Niraj Sehgal, associate professor of medicine, associate chair for quality and safety, Department of Medicine, University of California at San Francisco

Lincoln Godfrey, DO, a hospitalist at Baxter Regional Medical Center in Mountain Home, Ark., was sitting and listening to strategies to lure and keep hospitalists when his hospital CEO sent him a text asking how his recruiting efforts were going with a would-be hire.

“I said I’d get back to him,” Dr. Godfrey jokes.

The C-suite’s passion is understandable, though, as the fight to hire experienced staff outside of major markets continues to stymie many HM groups. Dr. Godfrey says he can’t hire anybody without first getting them to the Ozark Mountains to learn the hospital, its people, and its community.

“There’s going to be a limited talent pool of people who will come at all,” he says. “But I don’t get anybody who doesn’t work with us for a bit first.”

Christine Kneeland—Dr. Kneeland’s mother—said HM leaders tasked with their group’s personnel duties should focus on a few main concepts:

• Think outside the bank. Some physicians look only to earn as much as they can as quickly as they can, but many seek personal and professional satisfaction.
• Engagement is instrumental. A one-day orientation program for a lifetime job doesn’t sound like enough, does it?

In the coming years, hiring managers will have to focus on “millennials”—the generation of doctors born between 1977 and 1999—which Christine Kneeland described as tech-savvy doctors interested in a blended lifestyle of work and leisure. And while some might not agree with or understand their perspective, they’d better get used to it, she said. “The millennials are here, the workplace has changed, and they are leading that change,” she added. “Just embrace it.”

QUALITY

Patient Satisfaction: Tips for Improving Your HCAHPS Scores

MODERATORS: Win Whitcomb, MD, MHM, medical director of healthcare quality, Baystate Medical Center, Springfield, Mass.; Steven Deitelzweig, MD, MMM, SFHM, system chairman, Department of Hospital Medicine, regional vice president of medical affairs, Ochsner Health System, New Orleans

Patient satisfaction scores are a big deal right now, as many HM groups tie the scores to compensation and the federal government tethers the scores and a portion of hospital payment through the value-based purchasing (VBP) program.

So how does a hospitalist improve their HCAHPS score? Here’s what the experts said:

• Personalize things. Give a business card with a picture. Sit down. Smile. Ask the patient if they understand what you’ve said, and don’t get frustrated if they don’t.
• First and last. Make good impressions when introducing yourself to the patient and when it’s time to discharge or transition them to a different facility. “When the hospitalist hands a patient off,” Dr. Whitcomb said, “it doesn’t cut it to pull out your brochure of 40 practitioners when the patient asks, ‘Who am I going to see tomorrow?’”
• Be professional. Don’t vent about workplace issues in front of patients. Dr. Deitelzweig illustrated the point with the case of an elderly patient who got out of bed to help a practitioner they heard complaining about a heavy workload. The patient fell.
• Creative use of white space. Consider using in-room white boards to help keep patients informed of a day’s care plan.

David Jaworski, MD, director of the hospitalist service at Windham Hospital in Willimantic, Conn., says honesty was a key piece of advice he gleaned from the session.

“I think one of the things people appreciate the most when they’re in the hospital is being honest about our uncertainties,” he says. “I have had more people thank me for saying, ‘I don’t know, but we will find out by doing this, this, and this.’ ”

ACADEMIC

The Role of Hospital Medicine in Adapting to the New ACGME Requirements

SPEAKER: Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center, New Orleans

The new Accreditation Council for Graduate Medical Education (ACGME) work-hour rules that take effect July 1 have received a lot of attention since they were announced last summer. The guideline that has attracted the bulk of the attention limits intern shifts to 16 hours, with upper-level residents capped at 24 consecutive hours, with four hours of administrative follow-on allowed with the caveat that strategic napping is “strongly suggested.”

“I’m all for work hours,” said Dr. Wiese, immediate past president of SHM. “It’s the right thing to do; it’s safer. But I think we have to be careful we don’t super-fragment the system or double the intensity of the system. And on both of those plates, if you don’t do it right, what you end up with is people who will be ill-prepared.”

Dr. Wiese said an easy way to question the validity of one ACGME rule is to examine the guideline that limits a first-year resident’s census to 10 patients. He wondered which scenario offers more teaching opportunities: a roster of six chest-pain cases, two pneumonia cases, and two similarly familiar or relatively safe cases, or a resident with only four cases but each one having multiple comorbidities and complex decisions?

The new rules provide hospitals and HM groups an opportunity to change their way of thinking, adds Jeffrey Schnipper, MD, MPH, FHM, of Brigham and Women’s Hospital and Massachusetts General Hospital in Boston. “Every program has to change its entire way of doing business anyway, so let’s be at the table and say, ‘Well, while you’re redesigning your entire program, let’s inject patent safety and quality of care, and good pedagogy into the system,’” he says.

CLINICAL

Skin is In: Dermatological Images Every Hospitalist Should Recognize

MODERATOR: Paul Aronowitz, MD, FACP, internal medicine residency program director, California Pacific Medical Center, San Francisco

A patient comes into the ED with a blistering skin condition, but the diagnosis escapes the triage doctor on the case. The problem turns out to be bullosis diabeticorum, but the ED doc doesn’t know that yet and pushes to add a patient to the upstairs HM roster.

“The ED will usually try to admit because they’re worried [the patient has] some terrible drug eruption, but they can actually go home,” Dr. Aronowitz explained. “Hospitalists can help tell the difference.”

HM groups shouldn’t work to become amateur dermatologists, Dr. Aronowitz added. However, given that many hospitalists find themselves confronted by dermatologic cases several times a month, a rudimentary pedigree is a good idea to help sift out which cases require admission and which would take up bed space required for others.

He referred to it as knowing enough to know whether you know enough. “For sure, a hospitalist can diagnose a hypersensitivity reaction from a classic drug like Dilantin,” Dr. Aronowitz said, “and then stop the drug, because that would be one of the best things they could do.”

The session exposed hospitalists to dozens of images of skin conditions theymight come across in daily rounds, from snakebites to drug reactions to argyria.

“The idea is to help hospitalists recognize what’s serious and what’s not,” he said. “If you recognize those initial cutaneous clues, you can guide your antibiotic therapy, or whether you need antibiotics.”

CAREER

This Disease Is Easy; It’s the Patient Who’s Difficult

Speaker: Susan Block, chair, Department of Psychosocial Oncology and Palliative Care at Dana Farber Cancer Institute, Boston

Every physician will have their “button pushed” by a patient now and then, and hospitalists are in the unfortunate position of having little or no previous relationship with most patients, according to Dr. Block, a national expert in physician-patient conflict resolution who said “interpersonal challenges are an onerous part” of the job.

“We want to make sure we provide really good care to these patients, but it can be very challenging,” she said, noting that between 10% and 30% of patients in the healthcare setting present with difficult behaviors.

Whether it’s an empowered patient, a traumatized patient, an intrusive family member, or a patient with clear psychosocial issues, Dr. Block explained that “these patients can make physicians feel lousy. … Being aware of that and trying to stop that process is one of the key issues in professionalism and competence in working with difficult patients.”

She also warned hospitalists to recognize when they become a “magnet” for difficult patients, as many times the expert in the group will become the “go-to” doc. “I don’t think anyone can take care of a large panel of these patients; it’s just too much,” she said, noting you have to negotiate some limits or you will “burn out and lose perspective.”

Many doctors are very uncomfortable with scared or crying patients, Dr. Block said, explaining these are some of her most difficult patients. “Show me a patient in the hospital who isn’t scared,” she said. “Even it they aren’t, they are scared of dying.”

Other sources of workplace discomfort include the dependent or “needy” patient, the suspicious patient, and the extremely pushy patient. Dr. Block suggested setting clear boundaries with patients; she also noted physicians should be ready and willing to identify and reflect on your own emotions so that “you have the capacity to get perspective on the problem and keep yourself from being part of the problem.

“Limit-setting is one of the most therapeutic things you can do with difficult patients,” she said. “It feels to us as a form of sadism, as though we are punishing patients. But for many patients, the most dangerous, scary, and dysfunctional thing you can do for patients is not set limits.”

CLINICAL

The Art of Clinical Problem-Solving: Mystery Cases

SPEAKER: Gupreet Dhaliwal, MD, University of California at San Francisco

Humility, patience, and practice: Those are the keys to improving one’s clinical diagnostic skills, according to Dr. Dhaliwal, an acclaimed educator and clinician at UCSF who walked a packed room through two blind cases and encouraged hospitalists to work hard at their craft.

“If you want to reach your maximum potential, you have to view it the same way we do other things, the same way a great musician rehearses and a great soccer player scrimmages,” he said. “All of us are busy, but you either have to increase the number of cases you put your mind through, or you take the cases you have and you analyze them, you seek feedback, you try to improve the process around the diagnostic.

“The message isn’t always fun, because both of those things equal more work, but there is no way to hide it because there is no field in which people get better without more work.”

Dr. Dhaliwal says hospitalists should be “humble about diagnosis.” He explained that the more experienced people become, the more we shift from analytical reasoning, “thinking hard like we did when we were students and residents,” to intuitive reasoning, which “is basically saying, ‘I recognize a pattern, this is an old friend, I’ve seen gout before.’ I think any of us can be guilty of forgetting that it has pitfalls. And there is a whole list of cognitive biases that are associated with moving fast and building patterns.”

He also believes hospitalists who dedicate themselves to clinical greatness can parlay such improvement in the quality realm. “Every one of us has used diagnosis as a core part of our identity, but in terms of getting the community or other stakeholders behind improving diagnosis or improving judgment, I think the umbrella of quality and reducing diagnostic errors is the most appealing and most logical,” he says. “I think we start to take for granted we are good at it, but I think there are ways many of us, especially if we work at it, can become great at it.”

CLINICAL

The How, When, and Why of Noninvasive Ventilation

SPEAKER: Eric Siegal, MD, SFHM, critical care fellow, University of Wisconsin School of Medicine, Madison

Dr. Siegal’s review of literature in front of a packed crowd provided a road map to Noninvasive Positive Pressure Ventilation (NPPV) usage. In the end, NPPV should be a hospitalist’s first choice for patients with hypercarbic COPD exacerbations, and likely in patients with acute cardiogenic pulmonary edema, hypoxemic respiratory failure, immunocompromised patients, and pre-intubation patients.

Dr. Siegal stressed the use of NPPV in COPD, which has been studied thoroughly and “held up to repeated scrutiny.”

“If you put people on NPPV instead of intubating them … mortality is halved, intubation rate is less than half, treatment failure is much lower, you have a third of the complications, and huge reductions in length of stay,” Dr. Siegal said.

In the absence of contraindications, he stressed, NPPV should be the first line of therapy for patients with hypercarbic COPD exacerbations. “In fact, I would argue that you really should be asking yourself, ‘Why can’t I put these patients on NPPV?’ ” he asked, “because this has really shown to be life-saving.”

Dr. Siegal also explored recent findings on NPPV in acute cardiogenic pulmonary edema patients, which surprisingly showed “no better than supplemental oxygen.” He concluded that if your patient is not hypercarbic, “there is no advantage to adding pressure support.” He also said the benefit is more robust in ACPE patients who have acute coronary syndrome.

Dr. Siegal advised hospitalists to pick the right patients, start NPPV therapy early, and if the patient doesn’t improve within one or two hours, “it’s time to move on.”