Larry Beresford

Smartphone use by hospitalists and other hospital staff is becoming ubiquitous, with a recent survey showing 72% of physicians using these devices at work.¹ At the same time, concerns are being raised about clinical distractions and threats to patient privacy, even while such benefits as rapid access to colleagues, medical references, and patient records are touted.

In a study published in the Journal of Hospital Medicine, Rachel Katz-Sidlow, MD, of the department of pediatrics at Jacobi Medical Center in Bronx, N.Y., and colleagues surveyed residents’ and attendings’ perceptions of the use of smartphones during inpatient rounds, both their own and observed behaviors of colleagues.² Fifty-seven percent of residents and 28% of faculty reported using smartphones during inpatient rounds, while significantly higher percentages observed other team members doing so.

The most common smartphone uses were for patient care, but doctors also use them to read and reply to personal texts and emails, as well as for non-patient-care-related Web searches. The authors observe that smartphones “introduce another source of interruption, multitasking, and distraction into the hospital environment,” with potential negative consequences.

Nineteen percent of residents believed they had missed important clinical information because of smartphone distraction during rounds. After seeing the survey results, Jacobi Medical Center instituted a smartphone policy in February 2012, essentially requiring personal mobile communication devices to be silenced at the start of rounds, except for patient care communication or urgent family matters, Dr. Katz-Sidlow wrote in an email to the The Hospitalist.

Confirmation of the spread of communication technology in the hospital toward smartphones and away from traditional pagers comes from data presented at the American Academy of Pediatrics conference in New Orleans in October by Stephanie Kuhlmann, MD, pediatric hospitalist at the University of Kansas at Wichita.³ Dr. Kuhlmann conducted an electronic survey of pediatric hospitalists, with 60% reporting that they receive work-related text messages. Twelve percent sent more than 10 text messages per shift, while 40% expressed concern about HIPAA violations. Most text messages are not encrypted, and many hospitals have yet to implement appropriately secure programs and policies, Dr. Kuhlmann says.

“Hospitals need to be aware of this trend and need to find a way to secure these text messages,” she adds.

Another recent survey by the Orem, Utah-based firm KLAS Research found that while 70% of clinicians report using smartphones or tablets to look up electronic patient records, they are less likely to input information into the EHR on these devices because of the difficulty of entering data on their small screens.⁴

References

1. Dolan B. 72 percent of US physicians use smartphones. Mobi Health News website. Available at: http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/. Accessed Dec. 8, 2012.
2. Katz-Sidlow RJ, Ludwig A, Millers S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. J Hosp Med. 2012;7(8):595-599.
3. Miller NS. Text messages are a growing trend among pediatric hospitalists. Pediatric News Digital Network website. Available at: http://www.pediatricnews.com/news/top-news/single-article/text-messages-are-a-growing-trend-among-pediatric-hospitalists/3dabf7208c75c44d36f368a83221d320.html. Accessed Nov. 1, 2012.
4. Westerlind E. Mobile healthcare applications: can enterprise vendors keep up? KLAS website. Available at: http://www.klasresearch.com/KLASreports. Accessed Dec. 8, 2012.

Smartphone use by hospitalists and other hospital staff is becoming ubiquitous, with a recent survey showing 72% of physicians using these devices at work.¹ At the same time, concerns are being raised about clinical distractions and threats to patient privacy, even while such benefits as rapid access to colleagues, medical references, and patient records are touted.

In a study published in the Journal of Hospital Medicine, Rachel Katz-Sidlow, MD, of the department of pediatrics at Jacobi Medical Center in Bronx, N.Y., and colleagues surveyed residents’ and attendings’ perceptions of the use of smartphones during inpatient rounds, both their own and observed behaviors of colleagues.² Fifty-seven percent of residents and 28% of faculty reported using smartphones during inpatient rounds, while significantly higher percentages observed other team members doing so.

The most common smartphone uses were for patient care, but doctors also use them to read and reply to personal texts and emails, as well as for non-patient-care-related Web searches. The authors observe that smartphones “introduce another source of interruption, multitasking, and distraction into the hospital environment,” with potential negative consequences.

Nineteen percent of residents believed they had missed important clinical information because of smartphone distraction during rounds. After seeing the survey results, Jacobi Medical Center instituted a smartphone policy in February 2012, essentially requiring personal mobile communication devices to be silenced at the start of rounds, except for patient care communication or urgent family matters, Dr. Katz-Sidlow wrote in an email to the The Hospitalist.

Confirmation of the spread of communication technology in the hospital toward smartphones and away from traditional pagers comes from data presented at the American Academy of Pediatrics conference in New Orleans in October by Stephanie Kuhlmann, MD, pediatric hospitalist at the University of Kansas at Wichita.³ Dr. Kuhlmann conducted an electronic survey of pediatric hospitalists, with 60% reporting that they receive work-related text messages. Twelve percent sent more than 10 text messages per shift, while 40% expressed concern about HIPAA violations. Most text messages are not encrypted, and many hospitals have yet to implement appropriately secure programs and policies, Dr. Kuhlmann says.

“Hospitals need to be aware of this trend and need to find a way to secure these text messages,” she adds.

Another recent survey by the Orem, Utah-based firm KLAS Research found that while 70% of clinicians report using smartphones or tablets to look up electronic patient records, they are less likely to input information into the EHR on these devices because of the difficulty of entering data on their small screens.⁴

References

1. Dolan B. 72 percent of US physicians use smartphones. Mobi Health News website. Available at: http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/. Accessed Dec. 8, 2012.
2. Katz-Sidlow RJ, Ludwig A, Millers S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. J Hosp Med. 2012;7(8):595-599.
3. Miller NS. Text messages are a growing trend among pediatric hospitalists. Pediatric News Digital Network website. Available at: http://www.pediatricnews.com/news/top-news/single-article/text-messages-are-a-growing-trend-among-pediatric-hospitalists/3dabf7208c75c44d36f368a83221d320.html. Accessed Nov. 1, 2012.
4. Westerlind E. Mobile healthcare applications: can enterprise vendors keep up? KLAS website. Available at: http://www.klasresearch.com/KLASreports. Accessed Dec. 8, 2012.

Smartphone use by hospitalists and other hospital staff is becoming ubiquitous, with a recent survey showing 72% of physicians using these devices at work.¹ At the same time, concerns are being raised about clinical distractions and threats to patient privacy, even while such benefits as rapid access to colleagues, medical references, and patient records are touted.

In a study published in the Journal of Hospital Medicine, Rachel Katz-Sidlow, MD, of the department of pediatrics at Jacobi Medical Center in Bronx, N.Y., and colleagues surveyed residents’ and attendings’ perceptions of the use of smartphones during inpatient rounds, both their own and observed behaviors of colleagues.² Fifty-seven percent of residents and 28% of faculty reported using smartphones during inpatient rounds, while significantly higher percentages observed other team members doing so.

The most common smartphone uses were for patient care, but doctors also use them to read and reply to personal texts and emails, as well as for non-patient-care-related Web searches. The authors observe that smartphones “introduce another source of interruption, multitasking, and distraction into the hospital environment,” with potential negative consequences.

Nineteen percent of residents believed they had missed important clinical information because of smartphone distraction during rounds. After seeing the survey results, Jacobi Medical Center instituted a smartphone policy in February 2012, essentially requiring personal mobile communication devices to be silenced at the start of rounds, except for patient care communication or urgent family matters, Dr. Katz-Sidlow wrote in an email to the The Hospitalist.

Confirmation of the spread of communication technology in the hospital toward smartphones and away from traditional pagers comes from data presented at the American Academy of Pediatrics conference in New Orleans in October by Stephanie Kuhlmann, MD, pediatric hospitalist at the University of Kansas at Wichita.³ Dr. Kuhlmann conducted an electronic survey of pediatric hospitalists, with 60% reporting that they receive work-related text messages. Twelve percent sent more than 10 text messages per shift, while 40% expressed concern about HIPAA violations. Most text messages are not encrypted, and many hospitals have yet to implement appropriately secure programs and policies, Dr. Kuhlmann says.

“Hospitals need to be aware of this trend and need to find a way to secure these text messages,” she adds.

Another recent survey by the Orem, Utah-based firm KLAS Research found that while 70% of clinicians report using smartphones or tablets to look up electronic patient records, they are less likely to input information into the EHR on these devices because of the difficulty of entering data on their small screens.⁴

References

1. Dolan B. 72 percent of US physicians use smartphones. Mobi Health News website. Available at: http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/. Accessed Dec. 8, 2012.
2. Katz-Sidlow RJ, Ludwig A, Millers S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. J Hosp Med. 2012;7(8):595-599.
3. Miller NS. Text messages are a growing trend among pediatric hospitalists. Pediatric News Digital Network website. Available at: http://www.pediatricnews.com/news/top-news/single-article/text-messages-are-a-growing-trend-among-pediatric-hospitalists/3dabf7208c75c44d36f368a83221d320.html. Accessed Nov. 1, 2012.
4. Westerlind E. Mobile healthcare applications: can enterprise vendors keep up? KLAS website. Available at: http://www.klasresearch.com/KLASreports. Accessed Dec. 8, 2012.

A study of the relationship between hospital adherence to congestive heart failure (CHF) quality performance measures and 30-day readmission rates found little association, except for the assessment of left ventricular function, which, if not performed according to guidelines, was associated with higher readmissions.¹

Lead author Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, looked at adherence to the performance measures, which in recent years have been adopted by quality organizations and third-party payors as surrogate markers for quality of care. These include documented ordering of angiotensin-converting enzyme (ACE) inhibitors, providing discharge instructions to patients, and counseling on smoking cessation.

The study looked retrospectively at 6,000 CHF patients within a four-hospital healthcare system between 2001 and 2009, at a time when adherence to the performance measures rose to 99.9% from 95.8%. The hospital readmission rate for these patients averaged 19.6%.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Mazimba S, Grant N, Parikh A, et al. Heart failure performance measures: Do they have an impact on 30-day readmission rates? Am J Med Qual. 2012 Oct 30 [Epub ahead of print].

A study of the relationship between hospital adherence to congestive heart failure (CHF) quality performance measures and 30-day readmission rates found little association, except for the assessment of left ventricular function, which, if not performed according to guidelines, was associated with higher readmissions.¹

Lead author Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, looked at adherence to the performance measures, which in recent years have been adopted by quality organizations and third-party payors as surrogate markers for quality of care. These include documented ordering of angiotensin-converting enzyme (ACE) inhibitors, providing discharge instructions to patients, and counseling on smoking cessation.

The study looked retrospectively at 6,000 CHF patients within a four-hospital healthcare system between 2001 and 2009, at a time when adherence to the performance measures rose to 99.9% from 95.8%. The hospital readmission rate for these patients averaged 19.6%.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Mazimba S, Grant N, Parikh A, et al. Heart failure performance measures: Do they have an impact on 30-day readmission rates? Am J Med Qual. 2012 Oct 30 [Epub ahead of print].

A study of the relationship between hospital adherence to congestive heart failure (CHF) quality performance measures and 30-day readmission rates found little association, except for the assessment of left ventricular function, which, if not performed according to guidelines, was associated with higher readmissions.¹

Lead author Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, looked at adherence to the performance measures, which in recent years have been adopted by quality organizations and third-party payors as surrogate markers for quality of care. These include documented ordering of angiotensin-converting enzyme (ACE) inhibitors, providing discharge instructions to patients, and counseling on smoking cessation.

The study looked retrospectively at 6,000 CHF patients within a four-hospital healthcare system between 2001 and 2009, at a time when adherence to the performance measures rose to 99.9% from 95.8%. The hospital readmission rate for these patients averaged 19.6%.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Mazimba S, Grant N, Parikh A, et al. Heart failure performance measures: Do they have an impact on 30-day readmission rates? Am J Med Qual. 2012 Oct 30 [Epub ahead of print].

University of Minnesota hospitalist Karyn Baum, MD, MSEd, directs one of six regional training centers for Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based, multimedia curriculum, tool set, and system for healthcare organizations to improve their teamwork.

Using the TeamSTEPPS approach, Dr. Baum collaborated with hospitalist Albertine Beard, MD, and the charge nurse on a 28-bed medical unit at the Minneapolis VA Medical Center to present a half-day training session for all VA staff, including four hospitalists. The seminar mixed didactics, discussions, and simulations, similar to traditional role-playing techniques but using a high-fidelity manikin that talks and displays vital signs.

"Teamwork is a set of knowledge, skills, and attitudes that lead to the creation of a culture where it’s about us as a team, not about who is highest in the hierarchy," Dr. Baum says. Hospitalists want to be leaders, "but we have a responsibility to be intentional leaders, learning the skills and modeling them," she adds.

Improved teamwork benefits patients through more effective communication and reduction in medical errors, Dr. Baum says, "but it also helps to create a healthy environment in which to work, where we all have each other’s backs."

TeamSTEPPS, developed jointly by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, has reached 25% to 30% of U.S. hospitals by annually training about 700 masters. The masters then go back to their institutions and share the techniques.

Read more about why improving teamwork is good for your patients.

University of Minnesota hospitalist Karyn Baum, MD, MSEd, directs one of six regional training centers for Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based, multimedia curriculum, tool set, and system for healthcare organizations to improve their teamwork.

Using the TeamSTEPPS approach, Dr. Baum collaborated with hospitalist Albertine Beard, MD, and the charge nurse on a 28-bed medical unit at the Minneapolis VA Medical Center to present a half-day training session for all VA staff, including four hospitalists. The seminar mixed didactics, discussions, and simulations, similar to traditional role-playing techniques but using a high-fidelity manikin that talks and displays vital signs.

"Teamwork is a set of knowledge, skills, and attitudes that lead to the creation of a culture where it’s about us as a team, not about who is highest in the hierarchy," Dr. Baum says. Hospitalists want to be leaders, "but we have a responsibility to be intentional leaders, learning the skills and modeling them," she adds.

Improved teamwork benefits patients through more effective communication and reduction in medical errors, Dr. Baum says, "but it also helps to create a healthy environment in which to work, where we all have each other’s backs."

TeamSTEPPS, developed jointly by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, has reached 25% to 30% of U.S. hospitals by annually training about 700 masters. The masters then go back to their institutions and share the techniques.

Read more about why improving teamwork is good for your patients.

University of Minnesota hospitalist Karyn Baum, MD, MSEd, directs one of six regional training centers for Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based, multimedia curriculum, tool set, and system for healthcare organizations to improve their teamwork.

Using the TeamSTEPPS approach, Dr. Baum collaborated with hospitalist Albertine Beard, MD, and the charge nurse on a 28-bed medical unit at the Minneapolis VA Medical Center to present a half-day training session for all VA staff, including four hospitalists. The seminar mixed didactics, discussions, and simulations, similar to traditional role-playing techniques but using a high-fidelity manikin that talks and displays vital signs.

"Teamwork is a set of knowledge, skills, and attitudes that lead to the creation of a culture where it’s about us as a team, not about who is highest in the hierarchy," Dr. Baum says. Hospitalists want to be leaders, "but we have a responsibility to be intentional leaders, learning the skills and modeling them," she adds.

Improved teamwork benefits patients through more effective communication and reduction in medical errors, Dr. Baum says, "but it also helps to create a healthy environment in which to work, where we all have each other’s backs."

TeamSTEPPS, developed jointly by the federal Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, has reached 25% to 30% of U.S. hospitals by annually training about 700 masters. The masters then go back to their institutions and share the techniques.

Read more about why improving teamwork is good for your patients.

Two recent studies have reached the same surprising conclusion: Adherence to national quality and performance guidelines does not translate into reduced readmissions rates.

Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, focused on congestive heart failure (CHF) patients, documenting compliance with four core CHF performance measures at discharge and subsequent 30-day readmissions. Only one measure-assessment of left ventricular function-had a significant association with readmissions.

A second study published the same month looked at a wider range of diagnoses in a Medicare population at more than 2,000 hospitals nationwide. That study reached similar conclusions about the disconnect between hospitals that followed Hospital Compare process quality measures and their readmission rates.

Dr. Mazimba says hospitalists and other physicians involved in quality improvement (QI) should be more involved in defining quality measures that reflect quality of care for their patients.

“We should be looking for parameters that have a higher yield for outcomes, such as preventing readmissions,” he says, encouraging better symptom management before the CHF patient is hospitalized and enhanced coordination of care after discharge.

Alpesh Amin, MD, MBA, SFHM, professor and chair of the department of medicine and executive director of the hospitalist program at the University of California at Irvine, says the findings are important, but he adds that the core quality measures studied were never designed to address readmissions.

“The challenge is to find a way to connect the dots between the core measures and readmissions,” he says.

Learn more about the four "core" heart failure quality measures for hospitals by visiting the Resource Rooms on the SHM website, or check out this 80-page implementation guide, “Improving Heart Failure Care for Hospitalized Patients [PDF],” also available on SHM’s website.

Read The Hospitalist columnist Win Whitcomb’s take on readmissions penalty programs.

Two recent studies have reached the same surprising conclusion: Adherence to national quality and performance guidelines does not translate into reduced readmissions rates.

Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, focused on congestive heart failure (CHF) patients, documenting compliance with four core CHF performance measures at discharge and subsequent 30-day readmissions. Only one measure-assessment of left ventricular function-had a significant association with readmissions.

A second study published the same month looked at a wider range of diagnoses in a Medicare population at more than 2,000 hospitals nationwide. That study reached similar conclusions about the disconnect between hospitals that followed Hospital Compare process quality measures and their readmission rates.

Dr. Mazimba says hospitalists and other physicians involved in quality improvement (QI) should be more involved in defining quality measures that reflect quality of care for their patients.

“We should be looking for parameters that have a higher yield for outcomes, such as preventing readmissions,” he says, encouraging better symptom management before the CHF patient is hospitalized and enhanced coordination of care after discharge.

Alpesh Amin, MD, MBA, SFHM, professor and chair of the department of medicine and executive director of the hospitalist program at the University of California at Irvine, says the findings are important, but he adds that the core quality measures studied were never designed to address readmissions.

“The challenge is to find a way to connect the dots between the core measures and readmissions,” he says.

Learn more about the four "core" heart failure quality measures for hospitals by visiting the Resource Rooms on the SHM website, or check out this 80-page implementation guide, “Improving Heart Failure Care for Hospitalized Patients [PDF],” also available on SHM’s website.

Read The Hospitalist columnist Win Whitcomb’s take on readmissions penalty programs.

Two recent studies have reached the same surprising conclusion: Adherence to national quality and performance guidelines does not translate into reduced readmissions rates.

Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, focused on congestive heart failure (CHF) patients, documenting compliance with four core CHF performance measures at discharge and subsequent 30-day readmissions. Only one measure-assessment of left ventricular function-had a significant association with readmissions.

A second study published the same month looked at a wider range of diagnoses in a Medicare population at more than 2,000 hospitals nationwide. That study reached similar conclusions about the disconnect between hospitals that followed Hospital Compare process quality measures and their readmission rates.

Dr. Mazimba says hospitalists and other physicians involved in quality improvement (QI) should be more involved in defining quality measures that reflect quality of care for their patients.

“We should be looking for parameters that have a higher yield for outcomes, such as preventing readmissions,” he says, encouraging better symptom management before the CHF patient is hospitalized and enhanced coordination of care after discharge.

Alpesh Amin, MD, MBA, SFHM, professor and chair of the department of medicine and executive director of the hospitalist program at the University of California at Irvine, says the findings are important, but he adds that the core quality measures studied were never designed to address readmissions.

“The challenge is to find a way to connect the dots between the core measures and readmissions,” he says.

Learn more about the four "core" heart failure quality measures for hospitals by visiting the Resource Rooms on the SHM website, or check out this 80-page implementation guide, “Improving Heart Failure Care for Hospitalized Patients [PDF],” also available on SHM’s website.

Read The Hospitalist columnist Win Whitcomb’s take on readmissions penalty programs.

A multidisciplinary pain-management research group at Mount Sinai School of Medicine in New York City has been evaluating numerical pain-rating scales, independent predictors of severe pain, their association with patient satisfaction rates, and improved inpatient pain outcomes resulting from targeted interventions with physicians. However, they found that while overall pain scores on medicine floors were lower than for surgical patients, they were also less responsive to the targeted interventions.

The group is piloting a program to promote pain champions in its department of medicine and encourage hospitalists to partner with nurses in focusing on pain assessment and treatment.

David L. Reich, MD, an anesthesiologist at Mount Sinai who leads the pain group, and colleagues recently published results from their research in the American Journal of Medical Quality.¹ Pain increasingly will be an issue for hospitals and hospitalists, he says, with two pain-related questions now included on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is part of the government’s value-based purchasing initiative.

“It is our belief that unrelieved pain is an overall driver of other patient-reported metrics,” Dr. Reich says.

Andrew Dunn, MD, SFHM, head of the hospitalist service at Mount Sinai, acknowledges that medicine floors have been less successful at improving pain management, in part because the patient population is so much more heterogeneous.

“One thing that did not work was to have the pain team join medical rounds. That’s just not systematic or robust enough,” Dr. Dunn says. “We have piloted a program where patients’ pain scores are now delivered twice a day in reports to nurse managers and floor medical directors.”

Consecutive reports of pain scores of 5 or more (on a scale of 0 to 10) trigger consideration of a consultation with either the anesthesiology pain-management service or palliative-care service.

Reference

1. Reich DL, Porter C, Levin MA, et al. Data-driven interdisciplinary interventions to improve inpatient pain management. Am J Med Q. 2012 Sept 25 [Epub ahead of print].

A multidisciplinary pain-management research group at Mount Sinai School of Medicine in New York City has been evaluating numerical pain-rating scales, independent predictors of severe pain, their association with patient satisfaction rates, and improved inpatient pain outcomes resulting from targeted interventions with physicians. However, they found that while overall pain scores on medicine floors were lower than for surgical patients, they were also less responsive to the targeted interventions.

The group is piloting a program to promote pain champions in its department of medicine and encourage hospitalists to partner with nurses in focusing on pain assessment and treatment.

David L. Reich, MD, an anesthesiologist at Mount Sinai who leads the pain group, and colleagues recently published results from their research in the American Journal of Medical Quality.¹ Pain increasingly will be an issue for hospitals and hospitalists, he says, with two pain-related questions now included on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is part of the government’s value-based purchasing initiative.

“It is our belief that unrelieved pain is an overall driver of other patient-reported metrics,” Dr. Reich says.

Andrew Dunn, MD, SFHM, head of the hospitalist service at Mount Sinai, acknowledges that medicine floors have been less successful at improving pain management, in part because the patient population is so much more heterogeneous.

“One thing that did not work was to have the pain team join medical rounds. That’s just not systematic or robust enough,” Dr. Dunn says. “We have piloted a program where patients’ pain scores are now delivered twice a day in reports to nurse managers and floor medical directors.”

Consecutive reports of pain scores of 5 or more (on a scale of 0 to 10) trigger consideration of a consultation with either the anesthesiology pain-management service or palliative-care service.

Reference

1. Reich DL, Porter C, Levin MA, et al. Data-driven interdisciplinary interventions to improve inpatient pain management. Am J Med Q. 2012 Sept 25 [Epub ahead of print].

A multidisciplinary pain-management research group at Mount Sinai School of Medicine in New York City has been evaluating numerical pain-rating scales, independent predictors of severe pain, their association with patient satisfaction rates, and improved inpatient pain outcomes resulting from targeted interventions with physicians. However, they found that while overall pain scores on medicine floors were lower than for surgical patients, they were also less responsive to the targeted interventions.

The group is piloting a program to promote pain champions in its department of medicine and encourage hospitalists to partner with nurses in focusing on pain assessment and treatment.

David L. Reich, MD, an anesthesiologist at Mount Sinai who leads the pain group, and colleagues recently published results from their research in the American Journal of Medical Quality.¹ Pain increasingly will be an issue for hospitals and hospitalists, he says, with two pain-related questions now included on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is part of the government’s value-based purchasing initiative.

“It is our belief that unrelieved pain is an overall driver of other patient-reported metrics,” Dr. Reich says.

Andrew Dunn, MD, SFHM, head of the hospitalist service at Mount Sinai, acknowledges that medicine floors have been less successful at improving pain management, in part because the patient population is so much more heterogeneous.

“One thing that did not work was to have the pain team join medical rounds. That’s just not systematic or robust enough,” Dr. Dunn says. “We have piloted a program where patients’ pain scores are now delivered twice a day in reports to nurse managers and floor medical directors.”

Consecutive reports of pain scores of 5 or more (on a scale of 0 to 10) trigger consideration of a consultation with either the anesthesiology pain-management service or palliative-care service.

Reference

1. Reich DL, Porter C, Levin MA, et al. Data-driven interdisciplinary interventions to improve inpatient pain management. Am J Med Q. 2012 Sept 25 [Epub ahead of print].

The University of California’s Irvine Medical Center has been issuing iPads to its incoming class of 100 medical students and to all 18 resident physicians in its department of emergency medicine.¹ The entire medical curriculum is on the iPad and employs document sharing via the SharePoint collaborative software platform, says Adam Gold, the medical center’s director of emerging technologies.

But the use of these new technologies and subsequent clamoring by students, professors, physicians, and other staff to connect their own mobile devices to the network have led to the establishment of security and management guidelines for monitoring technology use, now spelled out in the new “Bring Your Own Device” policy, Gold explains.

Reference

1. Messmer E. IPad management, security crucial in hospital tablet roll out. Network World website. Available at: http://www.networkworld.com/news/2012/082812-ipad-management-hospital-tablet-261994.html. Accessed Aug 28, 2012.

The University of California’s Irvine Medical Center has been issuing iPads to its incoming class of 100 medical students and to all 18 resident physicians in its department of emergency medicine.¹ The entire medical curriculum is on the iPad and employs document sharing via the SharePoint collaborative software platform, says Adam Gold, the medical center’s director of emerging technologies.

But the use of these new technologies and subsequent clamoring by students, professors, physicians, and other staff to connect their own mobile devices to the network have led to the establishment of security and management guidelines for monitoring technology use, now spelled out in the new “Bring Your Own Device” policy, Gold explains.

Reference

1. Messmer E. IPad management, security crucial in hospital tablet roll out. Network World website. Available at: http://www.networkworld.com/news/2012/082812-ipad-management-hospital-tablet-261994.html. Accessed Aug 28, 2012.

The University of California’s Irvine Medical Center has been issuing iPads to its incoming class of 100 medical students and to all 18 resident physicians in its department of emergency medicine.¹ The entire medical curriculum is on the iPad and employs document sharing via the SharePoint collaborative software platform, says Adam Gold, the medical center’s director of emerging technologies.

But the use of these new technologies and subsequent clamoring by students, professors, physicians, and other staff to connect their own mobile devices to the network have led to the establishment of security and management guidelines for monitoring technology use, now spelled out in the new “Bring Your Own Device” policy, Gold explains.

Reference

1. Messmer E. IPad management, security crucial in hospital tablet roll out. Network World website. Available at: http://www.networkworld.com/news/2012/082812-ipad-management-hospital-tablet-261994.html. Accessed Aug 28, 2012.

Percentage of hospitals participating in the Agency for Healthcare Research and Quality’s Comprehensive Unit-Based Safety Program (CUSP) that reported zero central-line-associated bloodstream infections (CLABSIs) during a quarter of 2011. That figure is up from 27.3% the year before. CUSP (www.OnTheCuspStopHAI.org) was launched in 2009 to promote the use of customizable, standardized checklists of evidence-based interventions to prevent hospital-acquired infections. It now includes 1,055 hospitals in 44 states, and the program collectively charted a decrease from 1.87 CLABSIs per 1,000 central-line days to 1.25, a 33% reduction.

Percentage of hospitals participating in the Agency for Healthcare Research and Quality’s Comprehensive Unit-Based Safety Program (CUSP) that reported zero central-line-associated bloodstream infections (CLABSIs) during a quarter of 2011. That figure is up from 27.3% the year before. CUSP (www.OnTheCuspStopHAI.org) was launched in 2009 to promote the use of customizable, standardized checklists of evidence-based interventions to prevent hospital-acquired infections. It now includes 1,055 hospitals in 44 states, and the program collectively charted a decrease from 1.87 CLABSIs per 1,000 central-line days to 1.25, a 33% reduction.

Percentage of hospitals participating in the Agency for Healthcare Research and Quality’s Comprehensive Unit-Based Safety Program (CUSP) that reported zero central-line-associated bloodstream infections (CLABSIs) during a quarter of 2011. That figure is up from 27.3% the year before. CUSP (www.OnTheCuspStopHAI.org) was launched in 2009 to promote the use of customizable, standardized checklists of evidence-based interventions to prevent hospital-acquired infections. It now includes 1,055 hospitals in 44 states, and the program collectively charted a decrease from 1.87 CLABSIs per 1,000 central-line days to 1.25, a 33% reduction.

University of Colorado at Denver geriatrician Eric Coleman, MD, MPH—who pioneered the celebrated Care Transitions Model (www.caretransitions.org), which sends “coaches” on home visits and has them make phone calls to patients in an effort to smooth post-hospital discharge transitions and enhance self-care—has been honored with a MacArthur Foundation “genius” award.

Dr. Coleman also co-chairs the advisory board for SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions) national quality initiative.

The MacArthur Fellowship is known for honoring individuals who have shown exceptional originality and creativity, bestowing them with a $500,000 award—no strings attached. Dr. Coleman says the award “promotes the opportunity for approaching complex problems in new light—taking risks with new approaches and serving in the role of a ‘change agent.’”

“I look forward to working collaboratively with hospitalists and hospitals on finding new strategies and solutions for improving the discharge experience,” he says.

University of Colorado at Denver geriatrician Eric Coleman, MD, MPH—who pioneered the celebrated Care Transitions Model (www.caretransitions.org), which sends “coaches” on home visits and has them make phone calls to patients in an effort to smooth post-hospital discharge transitions and enhance self-care—has been honored with a MacArthur Foundation “genius” award.

Dr. Coleman also co-chairs the advisory board for SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions) national quality initiative.

The MacArthur Fellowship is known for honoring individuals who have shown exceptional originality and creativity, bestowing them with a $500,000 award—no strings attached. Dr. Coleman says the award “promotes the opportunity for approaching complex problems in new light—taking risks with new approaches and serving in the role of a ‘change agent.’”

“I look forward to working collaboratively with hospitalists and hospitals on finding new strategies and solutions for improving the discharge experience,” he says.

University of Colorado at Denver geriatrician Eric Coleman, MD, MPH—who pioneered the celebrated Care Transitions Model (www.caretransitions.org), which sends “coaches” on home visits and has them make phone calls to patients in an effort to smooth post-hospital discharge transitions and enhance self-care—has been honored with a MacArthur Foundation “genius” award.

Dr. Coleman also co-chairs the advisory board for SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions) national quality initiative.

The MacArthur Fellowship is known for honoring individuals who have shown exceptional originality and creativity, bestowing them with a $500,000 award—no strings attached. Dr. Coleman says the award “promotes the opportunity for approaching complex problems in new light—taking risks with new approaches and serving in the role of a ‘change agent.’”

“I look forward to working collaboratively with hospitalists and hospitals on finding new strategies and solutions for improving the discharge experience,” he says.

An abstract poster presented at HM12 in San Diego called the “Hospitalist Morale Assessment” a validated tool for identifying HM groups’ strengths and weaknesses by quantifying their members’ morale. Morale involves more than just job satisfaction, says Shalini Chandra, MD, MS, a hospitalist at Johns Hopkins Bayview Medical Center in Baltimore and lead author of both the abstract and the assessment instrument.

“We’ve been measuring morale here since 2006. We’ve tried to drill down to what drives hospitalists’ morale. We’ve learned that it is not one-size-fits-all,” Dr. Chandra says.

The tool has gradually been refined to quantify both importance of and contentment with 36 domains of hospitalist morale.

Five hospitals and 93 physicians participated in the 2011 survey. Each hospital received a “morale report” that broke out its results. Overall, survey respondents ranked “family time” as the most important morale factor. “Supportive and effective leadership” was rated as next important.

At Johns Hopkins Bayview, results from the annual surveys have led to the opening of a lactation room to accommodate physicians who are new mothers and to the elimination of mandatory double shifts when staffing is short.

Morale is a critical issue in staff retention and in the prevention of costly and time-consuming recruitment searches to address turnover.

“You can’t expect to have happy patients if you don’t have happy providers who exude an air that suggests to patients, ‘I’m happy to be here and you’re my No. 1 priority,’” Dr. Chandra says. “From my perspective, it is important to address morale as an issue if we’re going to keep growing as hospitalist groups and as a specialty.”

For more information or to join future morale surveys, contact Dr. Chandra at [email protected].

Larry Beresford is a freelance writer in Oakland, Calif.

An abstract poster presented at HM12 in San Diego called the “Hospitalist Morale Assessment” a validated tool for identifying HM groups’ strengths and weaknesses by quantifying their members’ morale. Morale involves more than just job satisfaction, says Shalini Chandra, MD, MS, a hospitalist at Johns Hopkins Bayview Medical Center in Baltimore and lead author of both the abstract and the assessment instrument.

“We’ve been measuring morale here since 2006. We’ve tried to drill down to what drives hospitalists’ morale. We’ve learned that it is not one-size-fits-all,” Dr. Chandra says.

The tool has gradually been refined to quantify both importance of and contentment with 36 domains of hospitalist morale.

Five hospitals and 93 physicians participated in the 2011 survey. Each hospital received a “morale report” that broke out its results. Overall, survey respondents ranked “family time” as the most important morale factor. “Supportive and effective leadership” was rated as next important.

At Johns Hopkins Bayview, results from the annual surveys have led to the opening of a lactation room to accommodate physicians who are new mothers and to the elimination of mandatory double shifts when staffing is short.

Morale is a critical issue in staff retention and in the prevention of costly and time-consuming recruitment searches to address turnover.

“You can’t expect to have happy patients if you don’t have happy providers who exude an air that suggests to patients, ‘I’m happy to be here and you’re my No. 1 priority,’” Dr. Chandra says. “From my perspective, it is important to address morale as an issue if we’re going to keep growing as hospitalist groups and as a specialty.”

For more information or to join future morale surveys, contact Dr. Chandra at [email protected].

Larry Beresford is a freelance writer in Oakland, Calif.

An abstract poster presented at HM12 in San Diego called the “Hospitalist Morale Assessment” a validated tool for identifying HM groups’ strengths and weaknesses by quantifying their members’ morale. Morale involves more than just job satisfaction, says Shalini Chandra, MD, MS, a hospitalist at Johns Hopkins Bayview Medical Center in Baltimore and lead author of both the abstract and the assessment instrument.

“We’ve been measuring morale here since 2006. We’ve tried to drill down to what drives hospitalists’ morale. We’ve learned that it is not one-size-fits-all,” Dr. Chandra says.

The tool has gradually been refined to quantify both importance of and contentment with 36 domains of hospitalist morale.

Five hospitals and 93 physicians participated in the 2011 survey. Each hospital received a “morale report” that broke out its results. Overall, survey respondents ranked “family time” as the most important morale factor. “Supportive and effective leadership” was rated as next important.

At Johns Hopkins Bayview, results from the annual surveys have led to the opening of a lactation room to accommodate physicians who are new mothers and to the elimination of mandatory double shifts when staffing is short.

Morale is a critical issue in staff retention and in the prevention of costly and time-consuming recruitment searches to address turnover.

“You can’t expect to have happy patients if you don’t have happy providers who exude an air that suggests to patients, ‘I’m happy to be here and you’re my No. 1 priority,’” Dr. Chandra says. “From my perspective, it is important to address morale as an issue if we’re going to keep growing as hospitalist groups and as a specialty.”

For more information or to join future morale surveys, contact Dr. Chandra at [email protected].

Larry Beresford is a freelance writer in Oakland, Calif.

John Almquist, MD, FHM, director of hospitalist services for Ministry Health Care, a 15-hospital system serving rural Wisconsin, believes that an "e-hospitalist" pilot project now being tested at Ministry St. Mary's Hospital in Rhinelander, Wis., could be a boon for rural communities that have difficulty recruiting primary-care physicians (PCPs).

When the hospitals in those communities are unable to offer hospitalist coverage, it makes the setting less attractive to PCPs because they might have to follow their patients in the hospital day and night, he explains.

Ministry recruited and trained two nurse practitioners who will soon be deployed at a critical-access hospital in Eagle River, population 1,443, supported remotely by the eight-member HM group in Rhinelander for consultations, supervision, and multidisciplinary rounds. The training is bolstered by written order sets focused on 30 common medical conditions that lead to admissions to rural hospitals.

"The hospitalist in Rhinelander is also able to talk directly to the patient at the remote site," Dr. Almquist says.

The e-hospitalist program uses a telehealth network developed by Marshfield Clinic, a multispecialty physician group practice based in Marshfield, Wis. The clinic recently received a $1 million grant from the federal government to expand its 15-year-old telemedicine program. Part of the grant money is being used to expand the ehospitalist approach to new sites.

Visit our website for more information about hospitalists and telemedicine.

John Almquist, MD, FHM, director of hospitalist services for Ministry Health Care, a 15-hospital system serving rural Wisconsin, believes that an "e-hospitalist" pilot project now being tested at Ministry St. Mary's Hospital in Rhinelander, Wis., could be a boon for rural communities that have difficulty recruiting primary-care physicians (PCPs).

When the hospitals in those communities are unable to offer hospitalist coverage, it makes the setting less attractive to PCPs because they might have to follow their patients in the hospital day and night, he explains.

Ministry recruited and trained two nurse practitioners who will soon be deployed at a critical-access hospital in Eagle River, population 1,443, supported remotely by the eight-member HM group in Rhinelander for consultations, supervision, and multidisciplinary rounds. The training is bolstered by written order sets focused on 30 common medical conditions that lead to admissions to rural hospitals.

"The hospitalist in Rhinelander is also able to talk directly to the patient at the remote site," Dr. Almquist says.

The e-hospitalist program uses a telehealth network developed by Marshfield Clinic, a multispecialty physician group practice based in Marshfield, Wis. The clinic recently received a $1 million grant from the federal government to expand its 15-year-old telemedicine program. Part of the grant money is being used to expand the ehospitalist approach to new sites.

Visit our website for more information about hospitalists and telemedicine.

John Almquist, MD, FHM, director of hospitalist services for Ministry Health Care, a 15-hospital system serving rural Wisconsin, believes that an "e-hospitalist" pilot project now being tested at Ministry St. Mary's Hospital in Rhinelander, Wis., could be a boon for rural communities that have difficulty recruiting primary-care physicians (PCPs).

When the hospitals in those communities are unable to offer hospitalist coverage, it makes the setting less attractive to PCPs because they might have to follow their patients in the hospital day and night, he explains.

Ministry recruited and trained two nurse practitioners who will soon be deployed at a critical-access hospital in Eagle River, population 1,443, supported remotely by the eight-member HM group in Rhinelander for consultations, supervision, and multidisciplinary rounds. The training is bolstered by written order sets focused on 30 common medical conditions that lead to admissions to rural hospitals.

"The hospitalist in Rhinelander is also able to talk directly to the patient at the remote site," Dr. Almquist says.

The e-hospitalist program uses a telehealth network developed by Marshfield Clinic, a multispecialty physician group practice based in Marshfield, Wis. The clinic recently received a $1 million grant from the federal government to expand its 15-year-old telemedicine program. Part of the grant money is being used to expand the ehospitalist approach to new sites.

Visit our website for more information about hospitalists and telemedicine.