Larry Beresford

A major review of the medical literature from 1978 to 2009 on the overuse of health services found the topic understudied, with limited data except in a few areas, such as antibiotic use for upper respiratory infections.

Overuse of medical services—services with no benefit or for which harm outweighs the benefit—needs more attention and more investment, says Deborah Korenstein, MD, of Mount Sinai School of Medicine in New York, the review's lead author. Until that happens, she says, it will be premature for health policy makers to talk about cost savings to be accrued under healthcare reform from reductions in overuse and waste.

Dr. Korenstein sees opportunities for hospitalists to initiate studies of health resource usage, costs, and opportunities for improving efficiency, making these part of their hospitals' quality initiatives.

"People in healthcare have talked about overuse without understanding what it means, how common it is, and how intractable it can be to remedy," she says, adding it's a difficult subject to study, without recognized standards for measuring overuse. "Some situations are clearly inappropriate—for example, antibiotics for colds. That doesn’t mean they’re easy to get rid of."

The main finding: there is very little evidence on overuse, Dr. Korenstein says. For people on the front lines of healthcare, she recommends mindfulness to the issue.

"Challenge yourself to think about what you're doing and why," she says. "Resist doing interventions just because you can."

A major review of the medical literature from 1978 to 2009 on the overuse of health services found the topic understudied, with limited data except in a few areas, such as antibiotic use for upper respiratory infections.

Overuse of medical services—services with no benefit or for which harm outweighs the benefit—needs more attention and more investment, says Deborah Korenstein, MD, of Mount Sinai School of Medicine in New York, the review's lead author. Until that happens, she says, it will be premature for health policy makers to talk about cost savings to be accrued under healthcare reform from reductions in overuse and waste.

Dr. Korenstein sees opportunities for hospitalists to initiate studies of health resource usage, costs, and opportunities for improving efficiency, making these part of their hospitals' quality initiatives.

"People in healthcare have talked about overuse without understanding what it means, how common it is, and how intractable it can be to remedy," she says, adding it's a difficult subject to study, without recognized standards for measuring overuse. "Some situations are clearly inappropriate—for example, antibiotics for colds. That doesn’t mean they’re easy to get rid of."

The main finding: there is very little evidence on overuse, Dr. Korenstein says. For people on the front lines of healthcare, she recommends mindfulness to the issue.

"Challenge yourself to think about what you're doing and why," she says. "Resist doing interventions just because you can."

A major review of the medical literature from 1978 to 2009 on the overuse of health services found the topic understudied, with limited data except in a few areas, such as antibiotic use for upper respiratory infections.

Overuse of medical services—services with no benefit or for which harm outweighs the benefit—needs more attention and more investment, says Deborah Korenstein, MD, of Mount Sinai School of Medicine in New York, the review's lead author. Until that happens, she says, it will be premature for health policy makers to talk about cost savings to be accrued under healthcare reform from reductions in overuse and waste.

Dr. Korenstein sees opportunities for hospitalists to initiate studies of health resource usage, costs, and opportunities for improving efficiency, making these part of their hospitals' quality initiatives.

"People in healthcare have talked about overuse without understanding what it means, how common it is, and how intractable it can be to remedy," she says, adding it's a difficult subject to study, without recognized standards for measuring overuse. "Some situations are clearly inappropriate—for example, antibiotics for colds. That doesn’t mean they’re easy to get rid of."

The main finding: there is very little evidence on overuse, Dr. Korenstein says. For people on the front lines of healthcare, she recommends mindfulness to the issue.

"Challenge yourself to think about what you're doing and why," she says. "Resist doing interventions just because you can."

New SHM board member Brian Harte, MD, SFHM, traces his passion for leadership in hospital medicine back to his medical residency at the University of California at San Francisco (UCSF) Medical Center, not long after HM pioneer Robert Wachter, MD, MHM, helped coined the term "hospitalist" in a celebrated 1996 New England Journal of Medicine article.

"Scott Flanders was my chief resident and gave me advice about taking my first job," Dr. Harte says. "Andy Auerbach was one of the faculty at UCSF. I worked under Jeff Weise and Steve Pantilat," all of whom are national leaders in the field. Among others, SHM president Shaun Frost, MD, SFHM, FACP, was instrumental in Dr. Harte's career advancement, helping recruit him back to his home state of Ohio, where he was until recently the chief operating officer of Hillcrest Hospital in Mayfield Heights, which is affiliated with Cleveland Clinic.

"I've been fortunate enough to be taken under the wing of a lot of giants in the field—really impressive figures whom I have looked up to as role models," Dr. Harte says.

At Cleveland Clinic, Dr. Harte has worn a number of different hats in a fairly short period of time, quickly advancing from HM department chair to the position he started in April—president of South Pointe Hospital in Warrensville Heights, Ohio, another of the nine community hospitals affiliated with Cleveland Clinic. His experience on that career path, along with a broad range of interests and perspectives, is what he hopes to bring to SHM's board.

"This is a path more hospitalists could be pursuing: physician leadership, hospital and health system leadership, program development. In some cases it means stretching our skills to their capacity and beyond," he says. "At this point, it's not clear what healthcare reform has in store for us. But all of the things we do as hospitalists—leadership, program-building, team—building, clinical care, quality improvement—are very applicable skills that will prepare us for leadership roles."

New SHM board member Brian Harte, MD, SFHM, traces his passion for leadership in hospital medicine back to his medical residency at the University of California at San Francisco (UCSF) Medical Center, not long after HM pioneer Robert Wachter, MD, MHM, helped coined the term "hospitalist" in a celebrated 1996 New England Journal of Medicine article.

"Scott Flanders was my chief resident and gave me advice about taking my first job," Dr. Harte says. "Andy Auerbach was one of the faculty at UCSF. I worked under Jeff Weise and Steve Pantilat," all of whom are national leaders in the field. Among others, SHM president Shaun Frost, MD, SFHM, FACP, was instrumental in Dr. Harte's career advancement, helping recruit him back to his home state of Ohio, where he was until recently the chief operating officer of Hillcrest Hospital in Mayfield Heights, which is affiliated with Cleveland Clinic.

"I've been fortunate enough to be taken under the wing of a lot of giants in the field—really impressive figures whom I have looked up to as role models," Dr. Harte says.

At Cleveland Clinic, Dr. Harte has worn a number of different hats in a fairly short period of time, quickly advancing from HM department chair to the position he started in April—president of South Pointe Hospital in Warrensville Heights, Ohio, another of the nine community hospitals affiliated with Cleveland Clinic. His experience on that career path, along with a broad range of interests and perspectives, is what he hopes to bring to SHM's board.

"This is a path more hospitalists could be pursuing: physician leadership, hospital and health system leadership, program development. In some cases it means stretching our skills to their capacity and beyond," he says. "At this point, it's not clear what healthcare reform has in store for us. But all of the things we do as hospitalists—leadership, program-building, team—building, clinical care, quality improvement—are very applicable skills that will prepare us for leadership roles."

New SHM board member Brian Harte, MD, SFHM, traces his passion for leadership in hospital medicine back to his medical residency at the University of California at San Francisco (UCSF) Medical Center, not long after HM pioneer Robert Wachter, MD, MHM, helped coined the term "hospitalist" in a celebrated 1996 New England Journal of Medicine article.

"Scott Flanders was my chief resident and gave me advice about taking my first job," Dr. Harte says. "Andy Auerbach was one of the faculty at UCSF. I worked under Jeff Weise and Steve Pantilat," all of whom are national leaders in the field. Among others, SHM president Shaun Frost, MD, SFHM, FACP, was instrumental in Dr. Harte's career advancement, helping recruit him back to his home state of Ohio, where he was until recently the chief operating officer of Hillcrest Hospital in Mayfield Heights, which is affiliated with Cleveland Clinic.

"I've been fortunate enough to be taken under the wing of a lot of giants in the field—really impressive figures whom I have looked up to as role models," Dr. Harte says.

At Cleveland Clinic, Dr. Harte has worn a number of different hats in a fairly short period of time, quickly advancing from HM department chair to the position he started in April—president of South Pointe Hospital in Warrensville Heights, Ohio, another of the nine community hospitals affiliated with Cleveland Clinic. His experience on that career path, along with a broad range of interests and perspectives, is what he hopes to bring to SHM's board.

"This is a path more hospitalists could be pursuing: physician leadership, hospital and health system leadership, program development. In some cases it means stretching our skills to their capacity and beyond," he says. "At this point, it's not clear what healthcare reform has in store for us. But all of the things we do as hospitalists—leadership, program-building, team—building, clinical care, quality improvement—are very applicable skills that will prepare us for leadership roles."

Palliative care in U.S. hospitals is growing, with 1,568 operational programs in nearly 2,500 hospitals, according to the most recent tally from the American Hospital Association and the Center to Advance Palliative Care. And as palliative care becomes a staple of inpatient care, hospitalists across the country become more involved in end-of-life care planning.

At Kaiser Permanente’s San Rafael Medical Center in California, most of the 21-member hospitalist group has been learning palliative-care concepts through grand rounds, practice updates, and self-study. Hospitalists are incorporating the concepts into routine practice and doing palliative-care consults and family meetings, says Robert Lavaysse, MD, who started the inpatient palliative-care team at San Rafael. About 10 hospitalists will join nephrologists, oncologists, and pulmonologists and sit for board certification in hospice and palliative medicine (HPM), a subspecialty recognized by 10 medical boards of the American Board of Medical Specialties. The Oct. 4 board exam is the last time physicians can earn the recognition without first completing a full-year HPM fellowship.

At Monarch Healthcare, a large physician group in Southern California, a dozen employed hospitalists and “SNFists” have been working with the palliative-care team at the University of California Irvine (UCI) Medical Center, says Vincent Nguyen, DO, CMD, Monarch’s medical director for geriatrics and palliative care. The hospitalists, who work seven-on, seven-off schedules, are using “off” weeks to train at UCI. Nine have completed six weeks of training and plan to sit for the HPM boards in October. Dr. Nguyen also pulled in palliative-care experts for 26 hours of didactic presentations, and invited hospices from the community to hold their interdisciplinary team meetings at the medical group’s office so that interested hospitalists could sit in and observe how hospice cases are managed.

“Every physician who has gone through this experience is utilizing it in daily practice and influencing their colleagues,” Dr. Nguyen says. He also says hospitalists need to learn to “slow down a bit” with seriously ill patients, many of whom are good candidates for palliative care. He suggests hospitalists make certain that patient goals of care are elicited and advance directives are captured, and that they are 100% ready for the next care transition.

At Dartmouth-Hitchcock Medical Center in Hanover, N.H., hospitalists and palliative care collaborate in many areas, says HM section chief Edward Merrens, MD, FHM. “I made it a priority to broaden palliative care’s role in the organization, across all subspecialties,” says Dr. Merrens, who started the program in 2004.

Palliative-care consults are embedded in the ICUs at Dartmouth-Hitchcock, and the palliative-care team is involved in the assessment process at its affiliated outpatient cancer center.

“If a cancer patient is admitted to the hospital for reasons other than to receive chemotherapy, we take on the care of that patient, which provides an opportunity for us to collaborate with the inpatient palliative-care team,” Dr. Merrens says. “We do an initial conversation with patients about decision-making and code status within our service, and then work closely with the palliative-care team.”

Palliative care is part of the hospital’s current conversation about preventing unnecessary hospital readmissions. One example is end-stage renal patients, who come from a broad catchment area, and have high rates of mortality. “[They] can get caught in a vortex of readmissions,” he says.

The collaboration is just one example of how the “robust” 25-member hospitalist program “covers virtually everything that hospitalists do,” Dr. Merrens says. “Palliative care is a big part of how we envision the right care for these patients. There are no miracles about what palliative care does, but [caretakers] take the time to sit down and have these conversations. As we continue to take care of sicker, older patients, palliative care will play an ever-larger role.”

Larry Beresford is a freelance writer in Oakland, Calif.

Palliative care in U.S. hospitals is growing, with 1,568 operational programs in nearly 2,500 hospitals, according to the most recent tally from the American Hospital Association and the Center to Advance Palliative Care. And as palliative care becomes a staple of inpatient care, hospitalists across the country become more involved in end-of-life care planning.

At Kaiser Permanente’s San Rafael Medical Center in California, most of the 21-member hospitalist group has been learning palliative-care concepts through grand rounds, practice updates, and self-study. Hospitalists are incorporating the concepts into routine practice and doing palliative-care consults and family meetings, says Robert Lavaysse, MD, who started the inpatient palliative-care team at San Rafael. About 10 hospitalists will join nephrologists, oncologists, and pulmonologists and sit for board certification in hospice and palliative medicine (HPM), a subspecialty recognized by 10 medical boards of the American Board of Medical Specialties. The Oct. 4 board exam is the last time physicians can earn the recognition without first completing a full-year HPM fellowship.

At Monarch Healthcare, a large physician group in Southern California, a dozen employed hospitalists and “SNFists” have been working with the palliative-care team at the University of California Irvine (UCI) Medical Center, says Vincent Nguyen, DO, CMD, Monarch’s medical director for geriatrics and palliative care. The hospitalists, who work seven-on, seven-off schedules, are using “off” weeks to train at UCI. Nine have completed six weeks of training and plan to sit for the HPM boards in October. Dr. Nguyen also pulled in palliative-care experts for 26 hours of didactic presentations, and invited hospices from the community to hold their interdisciplinary team meetings at the medical group’s office so that interested hospitalists could sit in and observe how hospice cases are managed.

“Every physician who has gone through this experience is utilizing it in daily practice and influencing their colleagues,” Dr. Nguyen says. He also says hospitalists need to learn to “slow down a bit” with seriously ill patients, many of whom are good candidates for palliative care. He suggests hospitalists make certain that patient goals of care are elicited and advance directives are captured, and that they are 100% ready for the next care transition.

At Dartmouth-Hitchcock Medical Center in Hanover, N.H., hospitalists and palliative care collaborate in many areas, says HM section chief Edward Merrens, MD, FHM. “I made it a priority to broaden palliative care’s role in the organization, across all subspecialties,” says Dr. Merrens, who started the program in 2004.

Palliative-care consults are embedded in the ICUs at Dartmouth-Hitchcock, and the palliative-care team is involved in the assessment process at its affiliated outpatient cancer center.

“If a cancer patient is admitted to the hospital for reasons other than to receive chemotherapy, we take on the care of that patient, which provides an opportunity for us to collaborate with the inpatient palliative-care team,” Dr. Merrens says. “We do an initial conversation with patients about decision-making and code status within our service, and then work closely with the palliative-care team.”

Palliative care is part of the hospital’s current conversation about preventing unnecessary hospital readmissions. One example is end-stage renal patients, who come from a broad catchment area, and have high rates of mortality. “[They] can get caught in a vortex of readmissions,” he says.

The collaboration is just one example of how the “robust” 25-member hospitalist program “covers virtually everything that hospitalists do,” Dr. Merrens says. “Palliative care is a big part of how we envision the right care for these patients. There are no miracles about what palliative care does, but [caretakers] take the time to sit down and have these conversations. As we continue to take care of sicker, older patients, palliative care will play an ever-larger role.”

Larry Beresford is a freelance writer in Oakland, Calif.

Palliative care in U.S. hospitals is growing, with 1,568 operational programs in nearly 2,500 hospitals, according to the most recent tally from the American Hospital Association and the Center to Advance Palliative Care. And as palliative care becomes a staple of inpatient care, hospitalists across the country become more involved in end-of-life care planning.

At Kaiser Permanente’s San Rafael Medical Center in California, most of the 21-member hospitalist group has been learning palliative-care concepts through grand rounds, practice updates, and self-study. Hospitalists are incorporating the concepts into routine practice and doing palliative-care consults and family meetings, says Robert Lavaysse, MD, who started the inpatient palliative-care team at San Rafael. About 10 hospitalists will join nephrologists, oncologists, and pulmonologists and sit for board certification in hospice and palliative medicine (HPM), a subspecialty recognized by 10 medical boards of the American Board of Medical Specialties. The Oct. 4 board exam is the last time physicians can earn the recognition without first completing a full-year HPM fellowship.

At Monarch Healthcare, a large physician group in Southern California, a dozen employed hospitalists and “SNFists” have been working with the palliative-care team at the University of California Irvine (UCI) Medical Center, says Vincent Nguyen, DO, CMD, Monarch’s medical director for geriatrics and palliative care. The hospitalists, who work seven-on, seven-off schedules, are using “off” weeks to train at UCI. Nine have completed six weeks of training and plan to sit for the HPM boards in October. Dr. Nguyen also pulled in palliative-care experts for 26 hours of didactic presentations, and invited hospices from the community to hold their interdisciplinary team meetings at the medical group’s office so that interested hospitalists could sit in and observe how hospice cases are managed.

“Every physician who has gone through this experience is utilizing it in daily practice and influencing their colleagues,” Dr. Nguyen says. He also says hospitalists need to learn to “slow down a bit” with seriously ill patients, many of whom are good candidates for palliative care. He suggests hospitalists make certain that patient goals of care are elicited and advance directives are captured, and that they are 100% ready for the next care transition.

At Dartmouth-Hitchcock Medical Center in Hanover, N.H., hospitalists and palliative care collaborate in many areas, says HM section chief Edward Merrens, MD, FHM. “I made it a priority to broaden palliative care’s role in the organization, across all subspecialties,” says Dr. Merrens, who started the program in 2004.

Palliative-care consults are embedded in the ICUs at Dartmouth-Hitchcock, and the palliative-care team is involved in the assessment process at its affiliated outpatient cancer center.

“If a cancer patient is admitted to the hospital for reasons other than to receive chemotherapy, we take on the care of that patient, which provides an opportunity for us to collaborate with the inpatient palliative-care team,” Dr. Merrens says. “We do an initial conversation with patients about decision-making and code status within our service, and then work closely with the palliative-care team.”

Palliative care is part of the hospital’s current conversation about preventing unnecessary hospital readmissions. One example is end-stage renal patients, who come from a broad catchment area, and have high rates of mortality. “[They] can get caught in a vortex of readmissions,” he says.

The collaboration is just one example of how the “robust” 25-member hospitalist program “covers virtually everything that hospitalists do,” Dr. Merrens says. “Palliative care is a big part of how we envision the right care for these patients. There are no miracles about what palliative care does, but [caretakers] take the time to sit down and have these conversations. As we continue to take care of sicker, older patients, palliative care will play an ever-larger role.”

Larry Beresford is a freelance writer in Oakland, Calif.

Sometimes the first impression really is the right one.

Nearly 150 HM-focused innovations abstracts were submitted for the 2012 Research, Innovations, and Clinical Vignettes poster competition at HM12, and more than 60 of the submitters were invited to display posters in San Diego. A judging committee reviewed 24 poster finalists, and the consensus was that one poster stood out from the start: “Structured Interdisciplinary Bedside Rounds at Emory University School of Medicine in Atlanta, Ga.,” presented by Emory hospitalist Christina Payne, MD.

One of the Innovations judges noted the 73% reduction in mortality rates realized via Emory’s Accountable Care Unit, along with a one-day reduction in length of stay and a 90% reduction in catheter-related bloodstream infections. “My God, what’s going on there?” one judge exclaimed.

Added a second judge: “We tried something like this and didn’t succeed—but we didn’t have a champion like [Dr. Payne].”

SHM’s Innovations co-chair, Andrew Modest, MD, assistant clinical professor of medicine at Harvard Medical School and Mount Auburn Hospital in Cambridge, Mass., explained that the poster contests are a real stepping-stone opportunity for young clinicians—particularly junior faculty and residents. “You can go on to do more elaborate work and, with some statistical analysis, all of a sudden, you have a research paper,” Dr. Modest said, “or else turn it into a true quality-improvement project for your hospital. And if you’re a poster finalist at SHM, that goes on your resume.”

Innovation implies either something new or a new and effective application of existing methods for addressing an issue that all hospitalists deal with, Dr. Modest said. At HM12, posters featured innovative approaches to such issues as scheduling, readmissions, care transitions, and team communication.

“What I like to see is a buzz in the room,” Dr. Modest said. “Something that people recognize they can just take home and start using.”

In addition to Dr. Payne’s winning poster, the judges also chose five abstracts for oral presentations on Day Two of the annual meeting; one abstract was chosen and orally presented to start the Day Two plenary session before all HM12 attendees.

The Innovations judges, in teams of two, each met with four or five poster finalists in front of their panels; each principal investigator was asked to briefly summarize the innovation.

For example, at the University of Texas Health Sciences Center at San Antonio, financial support to add a fourth chief resident dedicated to quality led to the launch of a procedural service, explained by principal investigator David Schmit, MD. Medical interns now are taught in a one-month rotation to perform a number of medical procedures, aided by ultrasound, using a standardized curriculum, checklists, video training, and practice on a simulator. In Month Two, they perform the procedures on actual patients. Trained interns have performed 342 procedures, with 100% success rates for paracentesis and thoracentesis, Dr. Schmit said.

“This has to be incorporated into physicians’ training,” noted judge James Yturri, MD, a hospitalist from Great Falls, Mont. “How many programs are actually doing this?”

The service, Dr. Schmit said, has required a lot of coordination, infrastructure, and investment from the hospitalist group, residency program, and three participating hospitals.

“How did you get them all to buy in?” Dr. Yturri asked.

“I think the data on patient safety was persuasive,” Dr. Schmit said. “If you look at our low rate of pneumothorax, we saved money.”

When the 10 judges reconvened, discussion focused on innovative telemedicine and real-time reporting of VTE. A statewide collaborative to improve care transitions in Michigan was singled out for its active participation by the state’s health payors.

“I’m partial to the procedural project,” said Michael Pistoria, DO, SFHM, a hospitalist at Lehigh Valley Health Network in Allentown, Pa., and HM13 course director.

Kimberly Tartaglia, MD, was complimented for a succinct presentation of her poster about improving the inpatient management of neonatal jaundice. “Nicely done,” Dr. Modest told the hospitalist from Ohio State University Medical Center in Columbus.

But the judges eventually circled back to the Emory poster about rounds done on a nonteaching, medical accountable-care unit, defined as a unit that is consistently responsible for the outcomes it produces. On the unit, interns are trained to lead team-based, patient-centered rounds.

“They really have learned to love it,” Dr. Payne said.

Rounds start punctually each morning, with five minutes spent in each room for updates from the intern, nurse, social worker, patient and family, leading to a plan for the day with a safety checklist and discharge planning checklist, all entered in real time into the medical record by a second intern.

“How hard is it to get through all that in five minutes?” Dr. Modest queried.

“Every month, I get a new set of learners,” Dr. Payne replied. “At the beginning of the month, it doesn’t work as well. But by Week Two, we’re a well-oiled machine.”

The judges huddled again, but quickly agreed to award the poster prize to Dr. Payne.

Sometimes the first impression really is the right one.

Nearly 150 HM-focused innovations abstracts were submitted for the 2012 Research, Innovations, and Clinical Vignettes poster competition at HM12, and more than 60 of the submitters were invited to display posters in San Diego. A judging committee reviewed 24 poster finalists, and the consensus was that one poster stood out from the start: “Structured Interdisciplinary Bedside Rounds at Emory University School of Medicine in Atlanta, Ga.,” presented by Emory hospitalist Christina Payne, MD.

One of the Innovations judges noted the 73% reduction in mortality rates realized via Emory’s Accountable Care Unit, along with a one-day reduction in length of stay and a 90% reduction in catheter-related bloodstream infections. “My God, what’s going on there?” one judge exclaimed.

Added a second judge: “We tried something like this and didn’t succeed—but we didn’t have a champion like [Dr. Payne].”

SHM’s Innovations co-chair, Andrew Modest, MD, assistant clinical professor of medicine at Harvard Medical School and Mount Auburn Hospital in Cambridge, Mass., explained that the poster contests are a real stepping-stone opportunity for young clinicians—particularly junior faculty and residents. “You can go on to do more elaborate work and, with some statistical analysis, all of a sudden, you have a research paper,” Dr. Modest said, “or else turn it into a true quality-improvement project for your hospital. And if you’re a poster finalist at SHM, that goes on your resume.”

Innovation implies either something new or a new and effective application of existing methods for addressing an issue that all hospitalists deal with, Dr. Modest said. At HM12, posters featured innovative approaches to such issues as scheduling, readmissions, care transitions, and team communication.

“What I like to see is a buzz in the room,” Dr. Modest said. “Something that people recognize they can just take home and start using.”

In addition to Dr. Payne’s winning poster, the judges also chose five abstracts for oral presentations on Day Two of the annual meeting; one abstract was chosen and orally presented to start the Day Two plenary session before all HM12 attendees.

The Innovations judges, in teams of two, each met with four or five poster finalists in front of their panels; each principal investigator was asked to briefly summarize the innovation.

For example, at the University of Texas Health Sciences Center at San Antonio, financial support to add a fourth chief resident dedicated to quality led to the launch of a procedural service, explained by principal investigator David Schmit, MD. Medical interns now are taught in a one-month rotation to perform a number of medical procedures, aided by ultrasound, using a standardized curriculum, checklists, video training, and practice on a simulator. In Month Two, they perform the procedures on actual patients. Trained interns have performed 342 procedures, with 100% success rates for paracentesis and thoracentesis, Dr. Schmit said.

“This has to be incorporated into physicians’ training,” noted judge James Yturri, MD, a hospitalist from Great Falls, Mont. “How many programs are actually doing this?”

The service, Dr. Schmit said, has required a lot of coordination, infrastructure, and investment from the hospitalist group, residency program, and three participating hospitals.

“How did you get them all to buy in?” Dr. Yturri asked.

“I think the data on patient safety was persuasive,” Dr. Schmit said. “If you look at our low rate of pneumothorax, we saved money.”

When the 10 judges reconvened, discussion focused on innovative telemedicine and real-time reporting of VTE. A statewide collaborative to improve care transitions in Michigan was singled out for its active participation by the state’s health payors.

“I’m partial to the procedural project,” said Michael Pistoria, DO, SFHM, a hospitalist at Lehigh Valley Health Network in Allentown, Pa., and HM13 course director.

Kimberly Tartaglia, MD, was complimented for a succinct presentation of her poster about improving the inpatient management of neonatal jaundice. “Nicely done,” Dr. Modest told the hospitalist from Ohio State University Medical Center in Columbus.

But the judges eventually circled back to the Emory poster about rounds done on a nonteaching, medical accountable-care unit, defined as a unit that is consistently responsible for the outcomes it produces. On the unit, interns are trained to lead team-based, patient-centered rounds.

“They really have learned to love it,” Dr. Payne said.

Rounds start punctually each morning, with five minutes spent in each room for updates from the intern, nurse, social worker, patient and family, leading to a plan for the day with a safety checklist and discharge planning checklist, all entered in real time into the medical record by a second intern.

“How hard is it to get through all that in five minutes?” Dr. Modest queried.

“Every month, I get a new set of learners,” Dr. Payne replied. “At the beginning of the month, it doesn’t work as well. But by Week Two, we’re a well-oiled machine.”

The judges huddled again, but quickly agreed to award the poster prize to Dr. Payne.

Sometimes the first impression really is the right one.

Nearly 150 HM-focused innovations abstracts were submitted for the 2012 Research, Innovations, and Clinical Vignettes poster competition at HM12, and more than 60 of the submitters were invited to display posters in San Diego. A judging committee reviewed 24 poster finalists, and the consensus was that one poster stood out from the start: “Structured Interdisciplinary Bedside Rounds at Emory University School of Medicine in Atlanta, Ga.,” presented by Emory hospitalist Christina Payne, MD.

One of the Innovations judges noted the 73% reduction in mortality rates realized via Emory’s Accountable Care Unit, along with a one-day reduction in length of stay and a 90% reduction in catheter-related bloodstream infections. “My God, what’s going on there?” one judge exclaimed.

Added a second judge: “We tried something like this and didn’t succeed—but we didn’t have a champion like [Dr. Payne].”

SHM’s Innovations co-chair, Andrew Modest, MD, assistant clinical professor of medicine at Harvard Medical School and Mount Auburn Hospital in Cambridge, Mass., explained that the poster contests are a real stepping-stone opportunity for young clinicians—particularly junior faculty and residents. “You can go on to do more elaborate work and, with some statistical analysis, all of a sudden, you have a research paper,” Dr. Modest said, “or else turn it into a true quality-improvement project for your hospital. And if you’re a poster finalist at SHM, that goes on your resume.”

Innovation implies either something new or a new and effective application of existing methods for addressing an issue that all hospitalists deal with, Dr. Modest said. At HM12, posters featured innovative approaches to such issues as scheduling, readmissions, care transitions, and team communication.

“What I like to see is a buzz in the room,” Dr. Modest said. “Something that people recognize they can just take home and start using.”

In addition to Dr. Payne’s winning poster, the judges also chose five abstracts for oral presentations on Day Two of the annual meeting; one abstract was chosen and orally presented to start the Day Two plenary session before all HM12 attendees.

The Innovations judges, in teams of two, each met with four or five poster finalists in front of their panels; each principal investigator was asked to briefly summarize the innovation.

For example, at the University of Texas Health Sciences Center at San Antonio, financial support to add a fourth chief resident dedicated to quality led to the launch of a procedural service, explained by principal investigator David Schmit, MD. Medical interns now are taught in a one-month rotation to perform a number of medical procedures, aided by ultrasound, using a standardized curriculum, checklists, video training, and practice on a simulator. In Month Two, they perform the procedures on actual patients. Trained interns have performed 342 procedures, with 100% success rates for paracentesis and thoracentesis, Dr. Schmit said.

“This has to be incorporated into physicians’ training,” noted judge James Yturri, MD, a hospitalist from Great Falls, Mont. “How many programs are actually doing this?”

The service, Dr. Schmit said, has required a lot of coordination, infrastructure, and investment from the hospitalist group, residency program, and three participating hospitals.

“How did you get them all to buy in?” Dr. Yturri asked.

“I think the data on patient safety was persuasive,” Dr. Schmit said. “If you look at our low rate of pneumothorax, we saved money.”

When the 10 judges reconvened, discussion focused on innovative telemedicine and real-time reporting of VTE. A statewide collaborative to improve care transitions in Michigan was singled out for its active participation by the state’s health payors.

“I’m partial to the procedural project,” said Michael Pistoria, DO, SFHM, a hospitalist at Lehigh Valley Health Network in Allentown, Pa., and HM13 course director.

Kimberly Tartaglia, MD, was complimented for a succinct presentation of her poster about improving the inpatient management of neonatal jaundice. “Nicely done,” Dr. Modest told the hospitalist from Ohio State University Medical Center in Columbus.

But the judges eventually circled back to the Emory poster about rounds done on a nonteaching, medical accountable-care unit, defined as a unit that is consistently responsible for the outcomes it produces. On the unit, interns are trained to lead team-based, patient-centered rounds.

“They really have learned to love it,” Dr. Payne said.

Rounds start punctually each morning, with five minutes spent in each room for updates from the intern, nurse, social worker, patient and family, leading to a plan for the day with a safety checklist and discharge planning checklist, all entered in real time into the medical record by a second intern.

“How hard is it to get through all that in five minutes?” Dr. Modest queried.

“Every month, I get a new set of learners,” Dr. Payne replied. “At the beginning of the month, it doesn’t work as well. But by Week Two, we’re a well-oiled machine.”

The judges huddled again, but quickly agreed to award the poster prize to Dr. Payne.

Efforts to create a greater sense of urgency over patient satisfaction within the hospitalist service at the Cleveland Clinic using an eight-step model for changing organizational culture were outlined in an abstract presented at HM11.

“Attention to the doctor-patient experience should be our guiding principle,” explains lead author and hospitalist Vicente Velez, MD. “No matter how complex the science of medicine gets, the art is equally important.” Physicians can be taught skills in effective communication with their patients and families, Dr. Velez adds.

The initiative began four years ago after the department identified low patient satisfaction scores as a “credibility crisis.” Leadership sprung into action, promoting a vision that HM should be known for its ability to communicate. “Regardless of individual communication style, a proper self-introduction, eliciting the patient’s perspective, and an explanation of the daily plan of care were things we all had to develop as habits,” he says.

Individual projects to advance the agenda included:

• Communication training offered to all physicians at the Cleveland Clinic;
• New business cards with the hospitalists’ pictures on them;
• A pre-discharge “fly-by” visit from the hospitalist;
• Post-discharge callbacks to patients; and
• Joint physician-nurse rounding.

The service now shares its Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) satisfaction scores for individual physicians in small groups or one-on-one meetings. The department recognizes high performers. Overall satisfaction scores rose to between 76% and 86%, up from 69% at the start of the project, Dr. Velez says.

Reference

1. Accenture. U.S. among leaders in healthcare IT use and adoption, Accenture eight-country study reports. Accenture website. Available at: http://newsroom.accenture.com/news/us-among-leaders-in-healthcare-it-use-and-adoption-accenture-eight-country-study-reports.htm. Accessed March 29, 2012.

Efforts to create a greater sense of urgency over patient satisfaction within the hospitalist service at the Cleveland Clinic using an eight-step model for changing organizational culture were outlined in an abstract presented at HM11.

“Attention to the doctor-patient experience should be our guiding principle,” explains lead author and hospitalist Vicente Velez, MD. “No matter how complex the science of medicine gets, the art is equally important.” Physicians can be taught skills in effective communication with their patients and families, Dr. Velez adds.

The initiative began four years ago after the department identified low patient satisfaction scores as a “credibility crisis.” Leadership sprung into action, promoting a vision that HM should be known for its ability to communicate. “Regardless of individual communication style, a proper self-introduction, eliciting the patient’s perspective, and an explanation of the daily plan of care were things we all had to develop as habits,” he says.

Individual projects to advance the agenda included:

• Communication training offered to all physicians at the Cleveland Clinic;
• New business cards with the hospitalists’ pictures on them;
• A pre-discharge “fly-by” visit from the hospitalist;
• Post-discharge callbacks to patients; and
• Joint physician-nurse rounding.

The service now shares its Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) satisfaction scores for individual physicians in small groups or one-on-one meetings. The department recognizes high performers. Overall satisfaction scores rose to between 76% and 86%, up from 69% at the start of the project, Dr. Velez says.

Reference

1. Accenture. U.S. among leaders in healthcare IT use and adoption, Accenture eight-country study reports. Accenture website. Available at: http://newsroom.accenture.com/news/us-among-leaders-in-healthcare-it-use-and-adoption-accenture-eight-country-study-reports.htm. Accessed March 29, 2012.

Efforts to create a greater sense of urgency over patient satisfaction within the hospitalist service at the Cleveland Clinic using an eight-step model for changing organizational culture were outlined in an abstract presented at HM11.

“Attention to the doctor-patient experience should be our guiding principle,” explains lead author and hospitalist Vicente Velez, MD. “No matter how complex the science of medicine gets, the art is equally important.” Physicians can be taught skills in effective communication with their patients and families, Dr. Velez adds.

The initiative began four years ago after the department identified low patient satisfaction scores as a “credibility crisis.” Leadership sprung into action, promoting a vision that HM should be known for its ability to communicate. “Regardless of individual communication style, a proper self-introduction, eliciting the patient’s perspective, and an explanation of the daily plan of care were things we all had to develop as habits,” he says.

Individual projects to advance the agenda included:

• Communication training offered to all physicians at the Cleveland Clinic;
• New business cards with the hospitalists’ pictures on them;
• A pre-discharge “fly-by” visit from the hospitalist;
• Post-discharge callbacks to patients; and
• Joint physician-nurse rounding.

The service now shares its Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) satisfaction scores for individual physicians in small groups or one-on-one meetings. The department recognizes high performers. Overall satisfaction scores rose to between 76% and 86%, up from 69% at the start of the project, Dr. Velez says.

Reference

1. Accenture. U.S. among leaders in healthcare IT use and adoption, Accenture eight-country study reports. Accenture website. Available at: http://newsroom.accenture.com/news/us-among-leaders-in-healthcare-it-use-and-adoption-accenture-eight-country-study-reports.htm. Accessed March 29, 2012.

Approximate number of million-dollar hospitalization bills in Northern California hospitals in 2010, up from 430 a decade earlier, according to statistics from the Office of Statewide Health Planning and Development.¹ More than 20% of the giant bills—typically for complicated, life-saving procedures and lengthy hospital stays following critical illness or trauma—went to the parents of newborn babies with catastrophic illnesses. Organ transplants were also associated with extended hospital stays and million-dollar price tags.

Medical bills are a major factor in two-thirds of personal bankruptcy cases, although most of the largest bills will be lowered significantly, as much as 80%, after negotiations between hospitals and insurers.

Reference

1. Reese P, Smith D. Million-dollar hospital bills rise sharply in Northern California. Sacramento Bee website. Available at: http://www.sacbee.com/2012/03/11/4328036/million-dollar-hospital-bills.html. Accessed March 29, 2012.

Approximate number of million-dollar hospitalization bills in Northern California hospitals in 2010, up from 430 a decade earlier, according to statistics from the Office of Statewide Health Planning and Development.¹ More than 20% of the giant bills—typically for complicated, life-saving procedures and lengthy hospital stays following critical illness or trauma—went to the parents of newborn babies with catastrophic illnesses. Organ transplants were also associated with extended hospital stays and million-dollar price tags.

Medical bills are a major factor in two-thirds of personal bankruptcy cases, although most of the largest bills will be lowered significantly, as much as 80%, after negotiations between hospitals and insurers.

Reference

1. Reese P, Smith D. Million-dollar hospital bills rise sharply in Northern California. Sacramento Bee website. Available at: http://www.sacbee.com/2012/03/11/4328036/million-dollar-hospital-bills.html. Accessed March 29, 2012.

Approximate number of million-dollar hospitalization bills in Northern California hospitals in 2010, up from 430 a decade earlier, according to statistics from the Office of Statewide Health Planning and Development.¹ More than 20% of the giant bills—typically for complicated, life-saving procedures and lengthy hospital stays following critical illness or trauma—went to the parents of newborn babies with catastrophic illnesses. Organ transplants were also associated with extended hospital stays and million-dollar price tags.

Medical bills are a major factor in two-thirds of personal bankruptcy cases, although most of the largest bills will be lowered significantly, as much as 80%, after negotiations between hospitals and insurers.

Reference

1. Reese P, Smith D. Million-dollar hospital bills rise sharply in Northern California. Sacramento Bee website. Available at: http://www.sacbee.com/2012/03/11/4328036/million-dollar-hospital-bills.html. Accessed March 29, 2012.

Both incidence and deaths related to the bacterial infection Clostridium difficile have reached an all-time high, according to the federal Centers for Disease Control and Prevention (CDC), which calls C. diff “a formidable opponent” and a widespread safety issue. A total of 14,000 deaths related to C. diff were reported during the period of 2006-2007, compared with 3,000 in 1999-2000. A quarter of infections now appear first in hospitalized patients, with the rest in nursing home residents or patients in doctors’ offices.

L. Clifford McDonald, MD, CDC epidemiologist and lead author of a recent CDC Vital Signs report on the subject, recommended several steps for reducing C. diff infections, starting with better antibiotic stewardship, early detection and isolation for those who test positive, use of gloves and gowns when treating them, and informing the receiving medical team when those patients are transferred.¹ Dr. McDonald also noted that state-led hospital collaboratives in Illinois, Massachusetts, and New York have reduced infection rates by 20%.

Another recent example of successful antibiotic stewardship comes from the University of Maryland Medical Center (UMMC) and Health Day News, summarizing a study in the journal Infection Control and Hospital Epidemiology.²

A seven-year stewardship program using an anti-microbial monitoring team generated a $3 million reduction in the hospital’s annual budget for antibiotics by its third year, with no increase in death rates, hospital readmissions, or length of stay. After seven years, antibiotic spending per patient per day had been cut by nearly half. The antibiotic stewardship program was canceled in 2008 in favor of providing more infectious-disease consulting as an alternative mode of stewardship. Over the subsequent two years, antibiotic costs went back up 32%, reports lead author Harold Standiford, MD.

“Our results clearly show that an antimicrobial stewardship program like the one at UMMC is safe, effective, and makes good financial sense,” he says, adding physicians should eliminate wasteful healthcare spending.

References

1. Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm. Accessed March 29, 2012.
2. Standiford HC, Chan S, Tripoli M, Weekes E, Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol. 2012;33(4);338-345.

Both incidence and deaths related to the bacterial infection Clostridium difficile have reached an all-time high, according to the federal Centers for Disease Control and Prevention (CDC), which calls C. diff “a formidable opponent” and a widespread safety issue. A total of 14,000 deaths related to C. diff were reported during the period of 2006-2007, compared with 3,000 in 1999-2000. A quarter of infections now appear first in hospitalized patients, with the rest in nursing home residents or patients in doctors’ offices.

L. Clifford McDonald, MD, CDC epidemiologist and lead author of a recent CDC Vital Signs report on the subject, recommended several steps for reducing C. diff infections, starting with better antibiotic stewardship, early detection and isolation for those who test positive, use of gloves and gowns when treating them, and informing the receiving medical team when those patients are transferred.¹ Dr. McDonald also noted that state-led hospital collaboratives in Illinois, Massachusetts, and New York have reduced infection rates by 20%.

Another recent example of successful antibiotic stewardship comes from the University of Maryland Medical Center (UMMC) and Health Day News, summarizing a study in the journal Infection Control and Hospital Epidemiology.²

A seven-year stewardship program using an anti-microbial monitoring team generated a $3 million reduction in the hospital’s annual budget for antibiotics by its third year, with no increase in death rates, hospital readmissions, or length of stay. After seven years, antibiotic spending per patient per day had been cut by nearly half. The antibiotic stewardship program was canceled in 2008 in favor of providing more infectious-disease consulting as an alternative mode of stewardship. Over the subsequent two years, antibiotic costs went back up 32%, reports lead author Harold Standiford, MD.

“Our results clearly show that an antimicrobial stewardship program like the one at UMMC is safe, effective, and makes good financial sense,” he says, adding physicians should eliminate wasteful healthcare spending.

References

1. Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm. Accessed March 29, 2012.
2. Standiford HC, Chan S, Tripoli M, Weekes E, Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol. 2012;33(4);338-345.

Both incidence and deaths related to the bacterial infection Clostridium difficile have reached an all-time high, according to the federal Centers for Disease Control and Prevention (CDC), which calls C. diff “a formidable opponent” and a widespread safety issue. A total of 14,000 deaths related to C. diff were reported during the period of 2006-2007, compared with 3,000 in 1999-2000. A quarter of infections now appear first in hospitalized patients, with the rest in nursing home residents or patients in doctors’ offices.

L. Clifford McDonald, MD, CDC epidemiologist and lead author of a recent CDC Vital Signs report on the subject, recommended several steps for reducing C. diff infections, starting with better antibiotic stewardship, early detection and isolation for those who test positive, use of gloves and gowns when treating them, and informing the receiving medical team when those patients are transferred.¹ Dr. McDonald also noted that state-led hospital collaboratives in Illinois, Massachusetts, and New York have reduced infection rates by 20%.

Another recent example of successful antibiotic stewardship comes from the University of Maryland Medical Center (UMMC) and Health Day News, summarizing a study in the journal Infection Control and Hospital Epidemiology.²

A seven-year stewardship program using an anti-microbial monitoring team generated a $3 million reduction in the hospital’s annual budget for antibiotics by its third year, with no increase in death rates, hospital readmissions, or length of stay. After seven years, antibiotic spending per patient per day had been cut by nearly half. The antibiotic stewardship program was canceled in 2008 in favor of providing more infectious-disease consulting as an alternative mode of stewardship. Over the subsequent two years, antibiotic costs went back up 32%, reports lead author Harold Standiford, MD.

“Our results clearly show that an antimicrobial stewardship program like the one at UMMC is safe, effective, and makes good financial sense,” he says, adding physicians should eliminate wasteful healthcare spending.

References

1. Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm. Accessed March 29, 2012.
2. Standiford HC, Chan S, Tripoli M, Weekes E, Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol. 2012;33(4);338-345.

In January, the American Medical Association (AMA) announced a redesigned website for its Practice Management Center (PMC), a resource designed to help physicians manage their practice more effectively. The PMC includes an online library of tools to help physicians streamline their administrative and business practices, with new sections on practice operations, claims revenue cycle management, and health insurer relations.

An estimated 7,000 visitors access the center each month. Physicians can sign up for practice management alerts or join an online community.

One particular resource that might be useful to hospitalists is a sample hospital-physician employment agreement.

In January, the American Medical Association (AMA) announced a redesigned website for its Practice Management Center (PMC), a resource designed to help physicians manage their practice more effectively. The PMC includes an online library of tools to help physicians streamline their administrative and business practices, with new sections on practice operations, claims revenue cycle management, and health insurer relations.

An estimated 7,000 visitors access the center each month. Physicians can sign up for practice management alerts or join an online community.

One particular resource that might be useful to hospitalists is a sample hospital-physician employment agreement.

In January, the American Medical Association (AMA) announced a redesigned website for its Practice Management Center (PMC), a resource designed to help physicians manage their practice more effectively. The PMC includes an online library of tools to help physicians streamline their administrative and business practices, with new sections on practice operations, claims revenue cycle management, and health insurer relations.

An estimated 7,000 visitors access the center each month. Physicians can sign up for practice management alerts or join an online community.

One particular resource that might be useful to hospitalists is a sample hospital-physician employment agreement.

A study in the March issue of Health Affairs concludes that Hospital Compare, the government’s national hospital quality data reporting system, has produced no reductions in 30-day mortality rates for heart attacks and pneumonia, beyond what would be expected due to existing trends and ongoing innovations in care.¹ The data were inconclusive on the impact of reporting on heart failure.

The survey covers Medicare claims data from 2000 to 2008. Its authors say it is one of the strongest studies yet, suggesting that Medicare’s public reporting has little or no impact on actual hospital quality—at least according to current metrics. The jury is still out on Medicare’s efforts to improve hospital quality of care with public reporting, with more study needed, according to lead author Andrew Ryan, MD, of Weill Cornell Medical College in New York City.

Reference

1. Ryan AM, Nallamothu BK, Dimick JB. Medicare’s public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Aff (Millwood). 2012;31(3):585-592.

A study in the March issue of Health Affairs concludes that Hospital Compare, the government’s national hospital quality data reporting system, has produced no reductions in 30-day mortality rates for heart attacks and pneumonia, beyond what would be expected due to existing trends and ongoing innovations in care.¹ The data were inconclusive on the impact of reporting on heart failure.

The survey covers Medicare claims data from 2000 to 2008. Its authors say it is one of the strongest studies yet, suggesting that Medicare’s public reporting has little or no impact on actual hospital quality—at least according to current metrics. The jury is still out on Medicare’s efforts to improve hospital quality of care with public reporting, with more study needed, according to lead author Andrew Ryan, MD, of Weill Cornell Medical College in New York City.

Reference

1. Ryan AM, Nallamothu BK, Dimick JB. Medicare’s public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Aff (Millwood). 2012;31(3):585-592.

A study in the March issue of Health Affairs concludes that Hospital Compare, the government’s national hospital quality data reporting system, has produced no reductions in 30-day mortality rates for heart attacks and pneumonia, beyond what would be expected due to existing trends and ongoing innovations in care.¹ The data were inconclusive on the impact of reporting on heart failure.

The survey covers Medicare claims data from 2000 to 2008. Its authors say it is one of the strongest studies yet, suggesting that Medicare’s public reporting has little or no impact on actual hospital quality—at least according to current metrics. The jury is still out on Medicare’s efforts to improve hospital quality of care with public reporting, with more study needed, according to lead author Andrew Ryan, MD, of Weill Cornell Medical College in New York City.

Reference

1. Ryan AM, Nallamothu BK, Dimick JB. Medicare’s public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Aff (Millwood). 2012;31(3):585-592.

Nearly five years ago, when Nasim Afsar, MD, SFHM, was launching her career as a hospitalist at the University of California Los Angeles Medical Center, she began to appreciate the importance of quality issues for the field of hospital medicine.

Dr. Afsar, who recently was elected to the SHM board of directors, says, "I realized that evidence-based medicine should be the standard of care in hospitals, but we were nowhere near where we should be in addressing that at a systemic level."

Believing that her medical training had not fully prepared her for quality work, Dr. Afsar attended the Advanced Training Program at Intermountain Healthcare in Salt Lake City. "With that foundation, my focus ever since has been on improvement initiatives," she says.

In the years since, Dr. Afsar's quality responsibilities have grown steadily. She is now associate medical director of quality and safety at UCLA, executive director for quality and safety in its department of medicine, and director of quality for neurosurgery. That means about 80% of her work week is devoted to quality improvement (QI). And while her time seeing patients is less, she says the "clinical work is what inspires and motivates me, gives me my best ideas, and keeps me grounded."

Among the more than 40 quality and safety projects she has implemented at UCLA is "The ABCs of Hospitalized Patients," a multidisciplinary checklist designed to reduce the risk of eight common hospital-acquired conditions. "Within three weeks of implementing it, we started seeing significant improvement in every area, and we have been able to sustain that," she says. In 2009, she implemented a systemwide QI curriculum for the residents and fellows at UCLA.

Dr. Afsar, chair of SHM's Hospital Quality and Patient Safety Committee, says HM is challenged to make these kinds of quality approaches the standard of practice nationwide.

"Different institutions are doing different pieces of the quality movement very well," and SHM and its leaders on the board need to find a way to disseminate those best practices and integrate them into hospital practice, she says. "There are no simple ways to do that, but we know there are a lot of solutions out there."

Nearly five years ago, when Nasim Afsar, MD, SFHM, was launching her career as a hospitalist at the University of California Los Angeles Medical Center, she began to appreciate the importance of quality issues for the field of hospital medicine.

Dr. Afsar, who recently was elected to the SHM board of directors, says, "I realized that evidence-based medicine should be the standard of care in hospitals, but we were nowhere near where we should be in addressing that at a systemic level."

Believing that her medical training had not fully prepared her for quality work, Dr. Afsar attended the Advanced Training Program at Intermountain Healthcare in Salt Lake City. "With that foundation, my focus ever since has been on improvement initiatives," she says.

In the years since, Dr. Afsar's quality responsibilities have grown steadily. She is now associate medical director of quality and safety at UCLA, executive director for quality and safety in its department of medicine, and director of quality for neurosurgery. That means about 80% of her work week is devoted to quality improvement (QI). And while her time seeing patients is less, she says the "clinical work is what inspires and motivates me, gives me my best ideas, and keeps me grounded."

Among the more than 40 quality and safety projects she has implemented at UCLA is "The ABCs of Hospitalized Patients," a multidisciplinary checklist designed to reduce the risk of eight common hospital-acquired conditions. "Within three weeks of implementing it, we started seeing significant improvement in every area, and we have been able to sustain that," she says. In 2009, she implemented a systemwide QI curriculum for the residents and fellows at UCLA.

Dr. Afsar, chair of SHM's Hospital Quality and Patient Safety Committee, says HM is challenged to make these kinds of quality approaches the standard of practice nationwide.

"Different institutions are doing different pieces of the quality movement very well," and SHM and its leaders on the board need to find a way to disseminate those best practices and integrate them into hospital practice, she says. "There are no simple ways to do that, but we know there are a lot of solutions out there."

Nearly five years ago, when Nasim Afsar, MD, SFHM, was launching her career as a hospitalist at the University of California Los Angeles Medical Center, she began to appreciate the importance of quality issues for the field of hospital medicine.

Dr. Afsar, who recently was elected to the SHM board of directors, says, "I realized that evidence-based medicine should be the standard of care in hospitals, but we were nowhere near where we should be in addressing that at a systemic level."

Believing that her medical training had not fully prepared her for quality work, Dr. Afsar attended the Advanced Training Program at Intermountain Healthcare in Salt Lake City. "With that foundation, my focus ever since has been on improvement initiatives," she says.

In the years since, Dr. Afsar's quality responsibilities have grown steadily. She is now associate medical director of quality and safety at UCLA, executive director for quality and safety in its department of medicine, and director of quality for neurosurgery. That means about 80% of her work week is devoted to quality improvement (QI). And while her time seeing patients is less, she says the "clinical work is what inspires and motivates me, gives me my best ideas, and keeps me grounded."

Among the more than 40 quality and safety projects she has implemented at UCLA is "The ABCs of Hospitalized Patients," a multidisciplinary checklist designed to reduce the risk of eight common hospital-acquired conditions. "Within three weeks of implementing it, we started seeing significant improvement in every area, and we have been able to sustain that," she says. In 2009, she implemented a systemwide QI curriculum for the residents and fellows at UCLA.

Dr. Afsar, chair of SHM's Hospital Quality and Patient Safety Committee, says HM is challenged to make these kinds of quality approaches the standard of practice nationwide.

"Different institutions are doing different pieces of the quality movement very well," and SHM and its leaders on the board need to find a way to disseminate those best practices and integrate them into hospital practice, she says. "There are no simple ways to do that, but we know there are a lot of solutions out there."