Larry Beresford

The largest effort to date to tackle central-line-associated bloodstream infections (CLABSIs) has reduced infection rates in ICUs nationwide by 40%, according to preliminary findings from the federal Agency for Healthcare Research and Quality (AHRQ).

AHRQ attributes the decrease to a CLABSI safety checklist from the Comprehensive Unit-Based Safety Program (CUSP) that encourages hospital staff to wash their hands prior to inserting central lines, avoid the femoral site, remove lines when they are no longer needed, and use the antimicrobial agent chlorhexidine to clean the patient's insertion site.

The checklist was developed by Peter Pronovost, MD, PhD, FCCM, and colleagues at Johns Hopkins University in Baltimore, and originally implemented in ICUs statewide in Michigan as the Keystone Project. Since 2009, CUSP has recruited more than 1,000 participating hospitals in 44 states. CUSP collectively reported a decrease to 1.25 from 1.87 CLABSIs per 1,000 central-line days 10-12 months after implementing the program, according to AHRQ [PDF].

The real game-changer for CLABSIs has been the widespread adoption of chlorhexidine as an insertion site disinfectant, says Sanjay Saint, MD, MPH, director of the Veterans Administration at the University of Michigan Patient Safety Enhancement Program in Ann Arbor and professor of medicine at the University of Michigan. Dr. Saint is on the national leadership team of On the CUSP: Stop CAUTI (Catheter-Associated Urinary Tract Infections), an initiative that aims to reduce mean rates of CAUTI infections by 25% in hospitals nationwide.

Although hospitalists don't routinely place central lines, their role in this procedure is growing, both in nonacademic hospitals that lack intensivists and on hospitals' general medicine floors.

"My take-home message for hospitalists: if you are putting in central lines, if you only make one change in practice, is to use chlorhexidine as the site disinfectant," Dr. Saint says.

Visit our website for more information about central-line-associated bloodstream infections.

The largest effort to date to tackle central-line-associated bloodstream infections (CLABSIs) has reduced infection rates in ICUs nationwide by 40%, according to preliminary findings from the federal Agency for Healthcare Research and Quality (AHRQ).

AHRQ attributes the decrease to a CLABSI safety checklist from the Comprehensive Unit-Based Safety Program (CUSP) that encourages hospital staff to wash their hands prior to inserting central lines, avoid the femoral site, remove lines when they are no longer needed, and use the antimicrobial agent chlorhexidine to clean the patient's insertion site.

The checklist was developed by Peter Pronovost, MD, PhD, FCCM, and colleagues at Johns Hopkins University in Baltimore, and originally implemented in ICUs statewide in Michigan as the Keystone Project. Since 2009, CUSP has recruited more than 1,000 participating hospitals in 44 states. CUSP collectively reported a decrease to 1.25 from 1.87 CLABSIs per 1,000 central-line days 10-12 months after implementing the program, according to AHRQ [PDF].

The real game-changer for CLABSIs has been the widespread adoption of chlorhexidine as an insertion site disinfectant, says Sanjay Saint, MD, MPH, director of the Veterans Administration at the University of Michigan Patient Safety Enhancement Program in Ann Arbor and professor of medicine at the University of Michigan. Dr. Saint is on the national leadership team of On the CUSP: Stop CAUTI (Catheter-Associated Urinary Tract Infections), an initiative that aims to reduce mean rates of CAUTI infections by 25% in hospitals nationwide.

Although hospitalists don't routinely place central lines, their role in this procedure is growing, both in nonacademic hospitals that lack intensivists and on hospitals' general medicine floors.

"My take-home message for hospitalists: if you are putting in central lines, if you only make one change in practice, is to use chlorhexidine as the site disinfectant," Dr. Saint says.

Visit our website for more information about central-line-associated bloodstream infections.

The largest effort to date to tackle central-line-associated bloodstream infections (CLABSIs) has reduced infection rates in ICUs nationwide by 40%, according to preliminary findings from the federal Agency for Healthcare Research and Quality (AHRQ).

AHRQ attributes the decrease to a CLABSI safety checklist from the Comprehensive Unit-Based Safety Program (CUSP) that encourages hospital staff to wash their hands prior to inserting central lines, avoid the femoral site, remove lines when they are no longer needed, and use the antimicrobial agent chlorhexidine to clean the patient's insertion site.

The checklist was developed by Peter Pronovost, MD, PhD, FCCM, and colleagues at Johns Hopkins University in Baltimore, and originally implemented in ICUs statewide in Michigan as the Keystone Project. Since 2009, CUSP has recruited more than 1,000 participating hospitals in 44 states. CUSP collectively reported a decrease to 1.25 from 1.87 CLABSIs per 1,000 central-line days 10-12 months after implementing the program, according to AHRQ [PDF].

The real game-changer for CLABSIs has been the widespread adoption of chlorhexidine as an insertion site disinfectant, says Sanjay Saint, MD, MPH, director of the Veterans Administration at the University of Michigan Patient Safety Enhancement Program in Ann Arbor and professor of medicine at the University of Michigan. Dr. Saint is on the national leadership team of On the CUSP: Stop CAUTI (Catheter-Associated Urinary Tract Infections), an initiative that aims to reduce mean rates of CAUTI infections by 25% in hospitals nationwide.

Although hospitalists don't routinely place central lines, their role in this procedure is growing, both in nonacademic hospitals that lack intensivists and on hospitals' general medicine floors.

"My take-home message for hospitalists: if you are putting in central lines, if you only make one change in practice, is to use chlorhexidine as the site disinfectant," Dr. Saint says.

Visit our website for more information about central-line-associated bloodstream infections.

The new era of penalizing hospitals for higher-than-predicted 30-day avoidable readmissions rates has begun. Under the federal Hospital Readmissions Reduction Program, some calculate a hospital's excessive readmissions rate for each applicable condition.

Penalties for the current fiscal year—FY 2013, which began Oct. 1, 2012—will be based on discharges that occurred during the three-year period from July 1, 2008, to June 30, 2011, according to the program guidelines. For hospitals that don't improve, the penalty grows to a maximum 2% next year (FY14) and 3% in FY15.

Hospitalists are not penalized directly for readmissions, and many hospitalists are wondering about the extent to which they're responsible for a readmission after the patient leaves the hospital, notes Mark Williams, MD, FACP, MHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Williams is the principal investigator of SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), one of several national quality initiatives that teach hospitals and other healthcare providers how to improve transitions of care through such techniques as patient coaching and community partnerships.

"These new penalties mean that hospitals will start talking to their physicians about readmissions, and looking for methods to incentivize the hospitalists to get involved in preventing them," Dr. Williams says.

The new era of penalizing hospitals for higher-than-predicted 30-day avoidable readmissions rates has begun. Under the federal Hospital Readmissions Reduction Program, some calculate a hospital's excessive readmissions rate for each applicable condition.

Penalties for the current fiscal year—FY 2013, which began Oct. 1, 2012—will be based on discharges that occurred during the three-year period from July 1, 2008, to June 30, 2011, according to the program guidelines. For hospitals that don't improve, the penalty grows to a maximum 2% next year (FY14) and 3% in FY15.

Hospitalists are not penalized directly for readmissions, and many hospitalists are wondering about the extent to which they're responsible for a readmission after the patient leaves the hospital, notes Mark Williams, MD, FACP, MHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Williams is the principal investigator of SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), one of several national quality initiatives that teach hospitals and other healthcare providers how to improve transitions of care through such techniques as patient coaching and community partnerships.

"These new penalties mean that hospitals will start talking to their physicians about readmissions, and looking for methods to incentivize the hospitalists to get involved in preventing them," Dr. Williams says.

The new era of penalizing hospitals for higher-than-predicted 30-day avoidable readmissions rates has begun. Under the federal Hospital Readmissions Reduction Program, some calculate a hospital's excessive readmissions rate for each applicable condition.

Penalties for the current fiscal year—FY 2013, which began Oct. 1, 2012—will be based on discharges that occurred during the three-year period from July 1, 2008, to June 30, 2011, according to the program guidelines. For hospitals that don't improve, the penalty grows to a maximum 2% next year (FY14) and 3% in FY15.

Hospitalists are not penalized directly for readmissions, and many hospitalists are wondering about the extent to which they're responsible for a readmission after the patient leaves the hospital, notes Mark Williams, MD, FACP, MHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Williams is the principal investigator of SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), one of several national quality initiatives that teach hospitals and other healthcare providers how to improve transitions of care through such techniques as patient coaching and community partnerships.

"These new penalties mean that hospitals will start talking to their physicians about readmissions, and looking for methods to incentivize the hospitalists to get involved in preventing them," Dr. Williams says.

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.

A new study tracking the growth of advanced diagnostic imaging techniques found that the rate of growth for such tests is slowing dramatically, even as the total number of tests performed continues to grow.¹ Starting in 2007, the rate of growth dropped sharply to about 1% to 3% from more than 6% per year during the previous decade.

Frank Levy, PhD, professor of urban economics at Massachusetts Institute of Technology in Cambridge, Mass., and one of the study’s authors, suggests that the previous growth of the technology could have been partly attributable to such nonmedical factors as profitability for hospitals and fear of malpractice by physicians. The slowdown, Dr. Levy says, also might reflect increased pushback from insurers, recognition of the cost and waste issues, and growing concerns about radiation exposure.

“There are many medical reasons for using these procedures—and many nonmedical reasons,” Dr. Levy says. “To use healthcare resources more efficiently, you should make sure your reason for ordering these tests is medical.”

SHM is working on a short list of sometimes unnecessary but commonly performed medical procedures, which it plans to submit to the American Board of Internal Medicine’s Choosing Wisely campaign this fall. One of the tests being considered for this list is serial chest X-rays for hospitalized patients outside of the ICU who are clinically stable, says Wendy Nickel, associate vice president of SHM’s Center for Hospital Innovation and Improvement. Unnecessary imaging tests are both a safety and a waste issue, she adds.

In related news, a study in the Journal of the National Cancer Institute found that 95.9% of patients 65 and older who have Stage IV cancer received at least one high-cost advanced imaging procedure (e.g. PET or nuclear medicine), with their utilization rates rising more rapidly than for earlier stages of disease.² Such tests can lead to appropriate palliative measures but also can “distract patients from focusing on achievable end-of-life goals,” explain researchers from the Dana-Farber Cancer Institute in Boston.

References

1. Lee D, Levy F. The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Affairs website. Available at: http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/content/early/2012/07/24/hlthaff.2011.1034&t=h&id=1590. Accessed Aug. 29, 2012.
2. Hu YY, Kwok AC, Jiang W, et al. High-cost imaging in elderly patients with Stage IV cancer. J Natl Cancer Inst. 2012;104(15):1165-1173.

A new study tracking the growth of advanced diagnostic imaging techniques found that the rate of growth for such tests is slowing dramatically, even as the total number of tests performed continues to grow.¹ Starting in 2007, the rate of growth dropped sharply to about 1% to 3% from more than 6% per year during the previous decade.

Frank Levy, PhD, professor of urban economics at Massachusetts Institute of Technology in Cambridge, Mass., and one of the study’s authors, suggests that the previous growth of the technology could have been partly attributable to such nonmedical factors as profitability for hospitals and fear of malpractice by physicians. The slowdown, Dr. Levy says, also might reflect increased pushback from insurers, recognition of the cost and waste issues, and growing concerns about radiation exposure.

“There are many medical reasons for using these procedures—and many nonmedical reasons,” Dr. Levy says. “To use healthcare resources more efficiently, you should make sure your reason for ordering these tests is medical.”

SHM is working on a short list of sometimes unnecessary but commonly performed medical procedures, which it plans to submit to the American Board of Internal Medicine’s Choosing Wisely campaign this fall. One of the tests being considered for this list is serial chest X-rays for hospitalized patients outside of the ICU who are clinically stable, says Wendy Nickel, associate vice president of SHM’s Center for Hospital Innovation and Improvement. Unnecessary imaging tests are both a safety and a waste issue, she adds.

In related news, a study in the Journal of the National Cancer Institute found that 95.9% of patients 65 and older who have Stage IV cancer received at least one high-cost advanced imaging procedure (e.g. PET or nuclear medicine), with their utilization rates rising more rapidly than for earlier stages of disease.² Such tests can lead to appropriate palliative measures but also can “distract patients from focusing on achievable end-of-life goals,” explain researchers from the Dana-Farber Cancer Institute in Boston.

References

1. Lee D, Levy F. The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Affairs website. Available at: http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/content/early/2012/07/24/hlthaff.2011.1034&t=h&id=1590. Accessed Aug. 29, 2012.
2. Hu YY, Kwok AC, Jiang W, et al. High-cost imaging in elderly patients with Stage IV cancer. J Natl Cancer Inst. 2012;104(15):1165-1173.

A new study tracking the growth of advanced diagnostic imaging techniques found that the rate of growth for such tests is slowing dramatically, even as the total number of tests performed continues to grow.¹ Starting in 2007, the rate of growth dropped sharply to about 1% to 3% from more than 6% per year during the previous decade.

Frank Levy, PhD, professor of urban economics at Massachusetts Institute of Technology in Cambridge, Mass., and one of the study’s authors, suggests that the previous growth of the technology could have been partly attributable to such nonmedical factors as profitability for hospitals and fear of malpractice by physicians. The slowdown, Dr. Levy says, also might reflect increased pushback from insurers, recognition of the cost and waste issues, and growing concerns about radiation exposure.

“There are many medical reasons for using these procedures—and many nonmedical reasons,” Dr. Levy says. “To use healthcare resources more efficiently, you should make sure your reason for ordering these tests is medical.”

SHM is working on a short list of sometimes unnecessary but commonly performed medical procedures, which it plans to submit to the American Board of Internal Medicine’s Choosing Wisely campaign this fall. One of the tests being considered for this list is serial chest X-rays for hospitalized patients outside of the ICU who are clinically stable, says Wendy Nickel, associate vice president of SHM’s Center for Hospital Innovation and Improvement. Unnecessary imaging tests are both a safety and a waste issue, she adds.

In related news, a study in the Journal of the National Cancer Institute found that 95.9% of patients 65 and older who have Stage IV cancer received at least one high-cost advanced imaging procedure (e.g. PET or nuclear medicine), with their utilization rates rising more rapidly than for earlier stages of disease.² Such tests can lead to appropriate palliative measures but also can “distract patients from focusing on achievable end-of-life goals,” explain researchers from the Dana-Farber Cancer Institute in Boston.

References

1. Lee D, Levy F. The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Affairs website. Available at: http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/content/early/2012/07/24/hlthaff.2011.1034&t=h&id=1590. Accessed Aug. 29, 2012.
2. Hu YY, Kwok AC, Jiang W, et al. High-cost imaging in elderly patients with Stage IV cancer. J Natl Cancer Inst. 2012;104(15):1165-1173.

Sleep-disturbing noise in the hospital is a big problem “that can really compromise a patient’s recovery process,” according to Orfeu Buxton, PhD, associate neuroscientist in the Division of Sleep Medicine at Brigham & Women’s Hospital in Boston.¹

Researchers exposed a dozen healthy volunteers to typical nocturnal hospital noise while monitoring their sleep patterns and heart rates, systematically quantifying the disruptive capacity of a range of hospital sounds on sleep. Hospitalized patients routinely cite noise as a major factor that negatively affects quality of care, the researchers note. An Aug. 2 New York Times blog post by Pauline Chen, MD, suggests that government policies linking hospital reimbursement to patient satisfaction might finally turn hospital administrators’ focus on the need to bring this noise under better control.²

References

1. Buxton OM, Ellenbogen JM, Wang W, et al. Sleep disruption due to hospital noises: a prospective evaluation. Ann Intern Med. 2012;157(3):170-179.
2. Chen P. The clatter of the hospital room. New York Times website. Available at: http://well.blogs.nytimes.com/2012/08/02/the-clatter-of-the-hospital-room/. Accessed Aug. 29, 2012.

Sleep-disturbing noise in the hospital is a big problem “that can really compromise a patient’s recovery process,” according to Orfeu Buxton, PhD, associate neuroscientist in the Division of Sleep Medicine at Brigham & Women’s Hospital in Boston.¹

Researchers exposed a dozen healthy volunteers to typical nocturnal hospital noise while monitoring their sleep patterns and heart rates, systematically quantifying the disruptive capacity of a range of hospital sounds on sleep. Hospitalized patients routinely cite noise as a major factor that negatively affects quality of care, the researchers note. An Aug. 2 New York Times blog post by Pauline Chen, MD, suggests that government policies linking hospital reimbursement to patient satisfaction might finally turn hospital administrators’ focus on the need to bring this noise under better control.²

References

1. Buxton OM, Ellenbogen JM, Wang W, et al. Sleep disruption due to hospital noises: a prospective evaluation. Ann Intern Med. 2012;157(3):170-179.
2. Chen P. The clatter of the hospital room. New York Times website. Available at: http://well.blogs.nytimes.com/2012/08/02/the-clatter-of-the-hospital-room/. Accessed Aug. 29, 2012.

Sleep-disturbing noise in the hospital is a big problem “that can really compromise a patient’s recovery process,” according to Orfeu Buxton, PhD, associate neuroscientist in the Division of Sleep Medicine at Brigham & Women’s Hospital in Boston.¹

Researchers exposed a dozen healthy volunteers to typical nocturnal hospital noise while monitoring their sleep patterns and heart rates, systematically quantifying the disruptive capacity of a range of hospital sounds on sleep. Hospitalized patients routinely cite noise as a major factor that negatively affects quality of care, the researchers note. An Aug. 2 New York Times blog post by Pauline Chen, MD, suggests that government policies linking hospital reimbursement to patient satisfaction might finally turn hospital administrators’ focus on the need to bring this noise under better control.²

References

1. Buxton OM, Ellenbogen JM, Wang W, et al. Sleep disruption due to hospital noises: a prospective evaluation. Ann Intern Med. 2012;157(3):170-179.
2. Chen P. The clatter of the hospital room. New York Times website. Available at: http://well.blogs.nytimes.com/2012/08/02/the-clatter-of-the-hospital-room/. Accessed Aug. 29, 2012.

The number of U.S. residents who have difficulty understanding basic health information, according to a report developed by the University of California at San Francisco and San Francisco General Hospital and published by the Institute of Medicine.¹ The report also suggests ways to bridge the gaps to understanding, such as how to make this a priority at every level of the health organization, avoid stigmatizing patients over literacy issues, and adopt proven educational techniques such as teach-back (see “Teach-Back,” September 2012).

Reference

1. Brach C, Keller D, Hernandez LM, et al. Ten attributes of health literate health care organizations. Institute of Medicine website. Available at: http://iom.edu/Global/Perspectives/2012/HealthLitAttributes.aspx. Accessed Aug. 29, 2012.

The number of U.S. residents who have difficulty understanding basic health information, according to a report developed by the University of California at San Francisco and San Francisco General Hospital and published by the Institute of Medicine.¹ The report also suggests ways to bridge the gaps to understanding, such as how to make this a priority at every level of the health organization, avoid stigmatizing patients over literacy issues, and adopt proven educational techniques such as teach-back (see “Teach-Back,” September 2012).

Reference

1. Brach C, Keller D, Hernandez LM, et al. Ten attributes of health literate health care organizations. Institute of Medicine website. Available at: http://iom.edu/Global/Perspectives/2012/HealthLitAttributes.aspx. Accessed Aug. 29, 2012.

The number of U.S. residents who have difficulty understanding basic health information, according to a report developed by the University of California at San Francisco and San Francisco General Hospital and published by the Institute of Medicine.¹ The report also suggests ways to bridge the gaps to understanding, such as how to make this a priority at every level of the health organization, avoid stigmatizing patients over literacy issues, and adopt proven educational techniques such as teach-back (see “Teach-Back,” September 2012).

Reference

1. Brach C, Keller D, Hernandez LM, et al. Ten attributes of health literate health care organizations. Institute of Medicine website. Available at: http://iom.edu/Global/Perspectives/2012/HealthLitAttributes.aspx. Accessed Aug. 29, 2012.

U.S. News and World Report recently named its 156 "most connected" U.S. hospitals, singled out for their combination of high quality and early adoption of information technology. But what does "most connected" really mean for hospitalists working on the wards?

"I've been in hospital medicine for a few years, and I can still remember the old days of going down to the medical records room and pulling a chart off the shelf," says hospitalist Kristian Feterik, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, which is on the U.S. News list. "The transition from paper to electronic medical records has just been tremendous. We're almost 100% paperless here."

Going paperless means hospitalists and other clinicians can access medical records anywhere in the hospital or at home using multiple interfaces, including their own tablet, Dr. Feterik says. "We're now piloting an application for smartphones that would notify us of pending tests. Plus, the applications support access to radiology studies, for example, without having to re-enter patient identification numbers once you're in the patient's record."

UPMC clinicians have access to a number of applications, some still in beta testing. 

But technology also has its downside. "We need to be mindful about how we write our orders, because it's so easy to order things electronically," Dr. Feterik adds. "I stress to the residents: You need to take a moment and think, 'Why are you ordering this test?'"

U.S. News and World Report recently named its 156 "most connected" U.S. hospitals, singled out for their combination of high quality and early adoption of information technology. But what does "most connected" really mean for hospitalists working on the wards?

"I've been in hospital medicine for a few years, and I can still remember the old days of going down to the medical records room and pulling a chart off the shelf," says hospitalist Kristian Feterik, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, which is on the U.S. News list. "The transition from paper to electronic medical records has just been tremendous. We're almost 100% paperless here."

Going paperless means hospitalists and other clinicians can access medical records anywhere in the hospital or at home using multiple interfaces, including their own tablet, Dr. Feterik says. "We're now piloting an application for smartphones that would notify us of pending tests. Plus, the applications support access to radiology studies, for example, without having to re-enter patient identification numbers once you're in the patient's record."

UPMC clinicians have access to a number of applications, some still in beta testing. 

But technology also has its downside. "We need to be mindful about how we write our orders, because it's so easy to order things electronically," Dr. Feterik adds. "I stress to the residents: You need to take a moment and think, 'Why are you ordering this test?'"

U.S. News and World Report recently named its 156 "most connected" U.S. hospitals, singled out for their combination of high quality and early adoption of information technology. But what does "most connected" really mean for hospitalists working on the wards?

"I've been in hospital medicine for a few years, and I can still remember the old days of going down to the medical records room and pulling a chart off the shelf," says hospitalist Kristian Feterik, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, which is on the U.S. News list. "The transition from paper to electronic medical records has just been tremendous. We're almost 100% paperless here."

Going paperless means hospitalists and other clinicians can access medical records anywhere in the hospital or at home using multiple interfaces, including their own tablet, Dr. Feterik says. "We're now piloting an application for smartphones that would notify us of pending tests. Plus, the applications support access to radiology studies, for example, without having to re-enter patient identification numbers once you're in the patient's record."

UPMC clinicians have access to a number of applications, some still in beta testing. 

But technology also has its downside. "We need to be mindful about how we write our orders, because it's so easy to order things electronically," Dr. Feterik adds. "I stress to the residents: You need to take a moment and think, 'Why are you ordering this test?'"

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Kerry Weiner, MD, acknowledges gaps in the continuity of care for many hospitalized patients, with the critical time being the first few days, or even hours, after leaving the hospital. The only provider who "really understands" what needs to happen next for the patient "is the hospitalist,” says Dr. Weiner, chief clinical officer for IPC The Hospitalist Co.

For the past decade, IPC has staffed a care-transitions call center at its corporate headquarters in North Hollywood, Calif. Twenty nurses, case managers, and patient representatives attempt to contact all patients discharged to home by IPC hospitalists within 48 to 72 hours.

According to data presented last December at an Institute for Healthcare Improvement national quality forum, IPC call centers reached out to nearly 350,000 patients discharged between October 2010 and September 2011. The calls were successful 30% of the time, and a fifth of the contacted patients needed an intervention. IPC calculates that those interventions prevented 1,782 avoidable readmissions.

According to Dr. Weiner, call center staff follow discharge instructions from the hospitalists using brief, customized, technology-driven reports. They focus on key points that could become health issues in the first few days after discharge.

IPC hopes to expand its care-transitions continuum, in part by prioritizing those patients who need to be called and reaching more of them, he adds.

Kerry Weiner, MD, acknowledges gaps in the continuity of care for many hospitalized patients, with the critical time being the first few days, or even hours, after leaving the hospital. The only provider who "really understands" what needs to happen next for the patient "is the hospitalist,” says Dr. Weiner, chief clinical officer for IPC The Hospitalist Co.

For the past decade, IPC has staffed a care-transitions call center at its corporate headquarters in North Hollywood, Calif. Twenty nurses, case managers, and patient representatives attempt to contact all patients discharged to home by IPC hospitalists within 48 to 72 hours.

According to data presented last December at an Institute for Healthcare Improvement national quality forum, IPC call centers reached out to nearly 350,000 patients discharged between October 2010 and September 2011. The calls were successful 30% of the time, and a fifth of the contacted patients needed an intervention. IPC calculates that those interventions prevented 1,782 avoidable readmissions.

According to Dr. Weiner, call center staff follow discharge instructions from the hospitalists using brief, customized, technology-driven reports. They focus on key points that could become health issues in the first few days after discharge.

IPC hopes to expand its care-transitions continuum, in part by prioritizing those patients who need to be called and reaching more of them, he adds.

Kerry Weiner, MD, acknowledges gaps in the continuity of care for many hospitalized patients, with the critical time being the first few days, or even hours, after leaving the hospital. The only provider who "really understands" what needs to happen next for the patient "is the hospitalist,” says Dr. Weiner, chief clinical officer for IPC The Hospitalist Co.

For the past decade, IPC has staffed a care-transitions call center at its corporate headquarters in North Hollywood, Calif. Twenty nurses, case managers, and patient representatives attempt to contact all patients discharged to home by IPC hospitalists within 48 to 72 hours.

According to data presented last December at an Institute for Healthcare Improvement national quality forum, IPC call centers reached out to nearly 350,000 patients discharged between October 2010 and September 2011. The calls were successful 30% of the time, and a fifth of the contacted patients needed an intervention. IPC calculates that those interventions prevented 1,782 avoidable readmissions.

According to Dr. Weiner, call center staff follow discharge instructions from the hospitalists using brief, customized, technology-driven reports. They focus on key points that could become health issues in the first few days after discharge.

IPC hopes to expand its care-transitions continuum, in part by prioritizing those patients who need to be called and reaching more of them, he adds.

Sometimes a hospitalist is put in the difficult position of communicating information that involves bad news—for instance, a poor prognosis to a patient or clarifying treatment options and goals for care to a family member of a patient with an advanced illness. A workshop at HM12 offered a technique that hospitalists can use to convey such difficult messages.

“Ask-Tell-Ask” is a back-and-forth cycle between the patient and health professional that addresses four essential components: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations by the professional.

“In the setting of an advanced illness, the patient’s perspective needs to be more fully explored so that we can figure out what information they need and want,” says Kristen Schaefer, MD, a palliative-care physician and director of residency education at Brigham and Women’s Hospital in Boston who spoke at an HM12 workshop. “That communication needs to be multidirectional to promote shared decision-making. All of these communication techniques are based on a better understanding of the patient’s perspective, but with Ask-Tell-Ask, you are clarifying their emotional response to illness, their values and personal goals in life, and how they cope with setbacks.”

Physicians should always start in an open-ended way, asking questions and listening to the response, Dr. Schaefer explains. “Then you can tailor the information you provide to what they have told you. There’s always emotional content around these issues, and you need to clarify that emotion,” she says. “If there is a big emotion in the room, and it hasn’t been addressed, it doesn’t matter what you teach the patient. You’ll never get to the underlying problems.”

Another effective technique, Dr. Schaefer says, is the judicious use of silence. She says healthcare providers can learn to listen more, talk less, and always start with the patient’s perspective as the basis for communication.

“It makes for more satisfying work—and it’s also more effective,” she says.

Larry Beresford is a freelance writer in Oakland, Calif.

Sometimes a hospitalist is put in the difficult position of communicating information that involves bad news—for instance, a poor prognosis to a patient or clarifying treatment options and goals for care to a family member of a patient with an advanced illness. A workshop at HM12 offered a technique that hospitalists can use to convey such difficult messages.

“Ask-Tell-Ask” is a back-and-forth cycle between the patient and health professional that addresses four essential components: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations by the professional.

“In the setting of an advanced illness, the patient’s perspective needs to be more fully explored so that we can figure out what information they need and want,” says Kristen Schaefer, MD, a palliative-care physician and director of residency education at Brigham and Women’s Hospital in Boston who spoke at an HM12 workshop. “That communication needs to be multidirectional to promote shared decision-making. All of these communication techniques are based on a better understanding of the patient’s perspective, but with Ask-Tell-Ask, you are clarifying their emotional response to illness, their values and personal goals in life, and how they cope with setbacks.”

Physicians should always start in an open-ended way, asking questions and listening to the response, Dr. Schaefer explains. “Then you can tailor the information you provide to what they have told you. There’s always emotional content around these issues, and you need to clarify that emotion,” she says. “If there is a big emotion in the room, and it hasn’t been addressed, it doesn’t matter what you teach the patient. You’ll never get to the underlying problems.”

Another effective technique, Dr. Schaefer says, is the judicious use of silence. She says healthcare providers can learn to listen more, talk less, and always start with the patient’s perspective as the basis for communication.

“It makes for more satisfying work—and it’s also more effective,” she says.

Larry Beresford is a freelance writer in Oakland, Calif.

Sometimes a hospitalist is put in the difficult position of communicating information that involves bad news—for instance, a poor prognosis to a patient or clarifying treatment options and goals for care to a family member of a patient with an advanced illness. A workshop at HM12 offered a technique that hospitalists can use to convey such difficult messages.

“Ask-Tell-Ask” is a back-and-forth cycle between the patient and health professional that addresses four essential components: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations by the professional.

“In the setting of an advanced illness, the patient’s perspective needs to be more fully explored so that we can figure out what information they need and want,” says Kristen Schaefer, MD, a palliative-care physician and director of residency education at Brigham and Women’s Hospital in Boston who spoke at an HM12 workshop. “That communication needs to be multidirectional to promote shared decision-making. All of these communication techniques are based on a better understanding of the patient’s perspective, but with Ask-Tell-Ask, you are clarifying their emotional response to illness, their values and personal goals in life, and how they cope with setbacks.”

Physicians should always start in an open-ended way, asking questions and listening to the response, Dr. Schaefer explains. “Then you can tailor the information you provide to what they have told you. There’s always emotional content around these issues, and you need to clarify that emotion,” she says. “If there is a big emotion in the room, and it hasn’t been addressed, it doesn’t matter what you teach the patient. You’ll never get to the underlying problems.”

Another effective technique, Dr. Schaefer says, is the judicious use of silence. She says healthcare providers can learn to listen more, talk less, and always start with the patient’s perspective as the basis for communication.

“It makes for more satisfying work—and it’s also more effective,” she says.

Larry Beresford is a freelance writer in Oakland, Calif.