Larry Beresford

Although based in an academic hospital program at the University of Colorado Denver, new SHM board member Jeffrey Glasheen, MD, SFHM, does not view himself as representative of only academic hospitalist groups on the board.

"I'd like to say I represent the constituency that cares about the quality, safety, and efficiency of healthcare delivery—and that includes every hospitalist,” says Dr. Glasheen, who has played major roles in developing SHM's Academic Hospitalist Academy and Academic Hospital Medicine Leadership Summit, and now chairs its Academic Committee.

Dr. Glasheen, who recently resigned as physician editor of the The Hospitalist is a senior deputy editor of the Journal of Hospital Medicine and was course director of HM12 in San Diego earlier this month. He intends to "push the envelope" for quality issues in his service on the board. "Quality is the best conceivable care you can provide, and clearly, where we are today is not there yet," he says.

Dr. Glasheen, who is committed to giving hospitalists the skills they need to elevate the quality of hospital care, says that starts with redesigning residency programs and medical school curriculums to teach quality improvement (QI). He believes that payment and healthcare reform will put hospitalists in a great position to serve as their hospitals' quality leaders, "but it's also going to take inspired leadership," he says. Hospitalists and hospitals need to make quality a major priority, which he recognizes is hard to do when groups are understaffed. As such, he hopes to find solutions to HM's pipeline issues—how to fill the hospitalist positions that will be needed in the future.

"I've been blessed in my situation [at my institution] to have an administration that's really supportive of hospital medicine," he says. "Our administration really gets the value equation, and we as hospitalists do, too. But as I travel around the country, I don't always see that."

Although based in an academic hospital program at the University of Colorado Denver, new SHM board member Jeffrey Glasheen, MD, SFHM, does not view himself as representative of only academic hospitalist groups on the board.

"I'd like to say I represent the constituency that cares about the quality, safety, and efficiency of healthcare delivery—and that includes every hospitalist,” says Dr. Glasheen, who has played major roles in developing SHM's Academic Hospitalist Academy and Academic Hospital Medicine Leadership Summit, and now chairs its Academic Committee.

Dr. Glasheen, who recently resigned as physician editor of the The Hospitalist is a senior deputy editor of the Journal of Hospital Medicine and was course director of HM12 in San Diego earlier this month. He intends to "push the envelope" for quality issues in his service on the board. "Quality is the best conceivable care you can provide, and clearly, where we are today is not there yet," he says.

Dr. Glasheen, who is committed to giving hospitalists the skills they need to elevate the quality of hospital care, says that starts with redesigning residency programs and medical school curriculums to teach quality improvement (QI). He believes that payment and healthcare reform will put hospitalists in a great position to serve as their hospitals' quality leaders, "but it's also going to take inspired leadership," he says. Hospitalists and hospitals need to make quality a major priority, which he recognizes is hard to do when groups are understaffed. As such, he hopes to find solutions to HM's pipeline issues—how to fill the hospitalist positions that will be needed in the future.

"I've been blessed in my situation [at my institution] to have an administration that's really supportive of hospital medicine," he says. "Our administration really gets the value equation, and we as hospitalists do, too. But as I travel around the country, I don't always see that."

Although based in an academic hospital program at the University of Colorado Denver, new SHM board member Jeffrey Glasheen, MD, SFHM, does not view himself as representative of only academic hospitalist groups on the board.

"I'd like to say I represent the constituency that cares about the quality, safety, and efficiency of healthcare delivery—and that includes every hospitalist,” says Dr. Glasheen, who has played major roles in developing SHM's Academic Hospitalist Academy and Academic Hospital Medicine Leadership Summit, and now chairs its Academic Committee.

Dr. Glasheen, who recently resigned as physician editor of the The Hospitalist is a senior deputy editor of the Journal of Hospital Medicine and was course director of HM12 in San Diego earlier this month. He intends to "push the envelope" for quality issues in his service on the board. "Quality is the best conceivable care you can provide, and clearly, where we are today is not there yet," he says.

Dr. Glasheen, who is committed to giving hospitalists the skills they need to elevate the quality of hospital care, says that starts with redesigning residency programs and medical school curriculums to teach quality improvement (QI). He believes that payment and healthcare reform will put hospitalists in a great position to serve as their hospitals' quality leaders, "but it's also going to take inspired leadership," he says. Hospitalists and hospitals need to make quality a major priority, which he recognizes is hard to do when groups are understaffed. As such, he hopes to find solutions to HM's pipeline issues—how to fill the hospitalist positions that will be needed in the future.

"I've been blessed in my situation [at my institution] to have an administration that's really supportive of hospital medicine," he says. "Our administration really gets the value equation, and we as hospitalists do, too. But as I travel around the country, I don't always see that."

Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?

Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.

One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.

“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.

One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.

“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”

Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?

Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.

One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.

“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.

One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.

“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”

Could engineering processes and techniques help hospitalists with some of the inherent frustrations of their practice—scheduling, staffing, admission surges, prioritizing which patients to see first?

Jonathan Turner, PhD, an industrial engineer who works as a healthcare engineer with the division of hospital medicine at Northwestern University Medical Center in Chicago, led a workshop on applying techniques such as queuing principles to hospitalist practice on Wednesday morning at the Society of Hospital Medicine’s annual meeting, HM12.

One of those principles is Little's Law which, applied to hospitals, calculates length of stay as the hospital’s census divided by its admission rate, reflecting the rates in and out and waiting times within the hospital.

“A lot of hospital administrators talk about reducing lengths of stay, when what they really want to do is increase admissions without increasing beds,” said Dr. Turner. You could reduce length of stay without actually affecting admissions, he added, which would result in unused capacity. At the same time, as capacity approaches 100% percent, negative consequences such as longer wait times and reduced quality may dilute the gains in efficiency. A better target, he said, may be closer to 85% percent of capacity.

One workshop participant relayed how his hospital struggled with delays in processing admissions. He took Little’s Law to his administration and made the case for additional staffing. The administration agreed to an additional hospitalist FTE, since the alternative was back-ups, and shifts were adjusted to times of greatest need. Currently, on 85% of days at the hospital, there are no delays in admissions.

“We talked about how difficult it is to predict caseload,” said Turner at the end of the workshop. “We can look at spikes and seasonal differences, but it may be easier to see patterns if you start peeling off subsets of your patient population.”

Participants in a Tuesday workshop at HM12 in San Diego learned how using "teach back" as a patient-education strategy can solve some of the barriers to communicating post-discharge information to hospitalized patients.

These barriers include failure to assess a patient's health literacy or to identify the key learner in the patient's family, as well as the sheer volume of important information some patients need, and the lack of time in busy hospital units to convey it all.

The teach-back process involves asking patients to repeat in their own words what the health professional has told them.

"Most people are under the misconception that teaching takes too much time," said Paula Robinson, MSN, RN-BC, manager of patient, family, and consumer education for Lehigh Valley Health System in Allentown, Pa. She advised hospitalists to give patients smaller amounts of information, in three- to five-minute chunks over several days. Further, it may be necessary to prioritize what the patient needs to know, rather than present so much information that the patient won't remember much of it.

Lehigh Valley's commitment to teach back grew out of a QI project mapping patient-flow processes, including care transitions, throughout its health system. It was tested in a pilot unit and included prompts and scripts hardwired into the electronic health record for unit nurses to easily access. Readmission rates at the pilot unit dropped to 14.0% from 28.2% in the year after teach back was implemented; hospital-wide rates shrunk to 21.9% from 25.3%.

Teach back is presented to patients in the spirit of evaluating how effectively the professional has explained the information, and not as a way to test the patient, Robinson said.

Participants in a Tuesday workshop at HM12 in San Diego learned how using "teach back" as a patient-education strategy can solve some of the barriers to communicating post-discharge information to hospitalized patients.

These barriers include failure to assess a patient's health literacy or to identify the key learner in the patient's family, as well as the sheer volume of important information some patients need, and the lack of time in busy hospital units to convey it all.

The teach-back process involves asking patients to repeat in their own words what the health professional has told them.

"Most people are under the misconception that teaching takes too much time," said Paula Robinson, MSN, RN-BC, manager of patient, family, and consumer education for Lehigh Valley Health System in Allentown, Pa. She advised hospitalists to give patients smaller amounts of information, in three- to five-minute chunks over several days. Further, it may be necessary to prioritize what the patient needs to know, rather than present so much information that the patient won't remember much of it.

Lehigh Valley's commitment to teach back grew out of a QI project mapping patient-flow processes, including care transitions, throughout its health system. It was tested in a pilot unit and included prompts and scripts hardwired into the electronic health record for unit nurses to easily access. Readmission rates at the pilot unit dropped to 14.0% from 28.2% in the year after teach back was implemented; hospital-wide rates shrunk to 21.9% from 25.3%.

Teach back is presented to patients in the spirit of evaluating how effectively the professional has explained the information, and not as a way to test the patient, Robinson said.

Participants in a Tuesday workshop at HM12 in San Diego learned how using "teach back" as a patient-education strategy can solve some of the barriers to communicating post-discharge information to hospitalized patients.

These barriers include failure to assess a patient's health literacy or to identify the key learner in the patient's family, as well as the sheer volume of important information some patients need, and the lack of time in busy hospital units to convey it all.

The teach-back process involves asking patients to repeat in their own words what the health professional has told them.

"Most people are under the misconception that teaching takes too much time," said Paula Robinson, MSN, RN-BC, manager of patient, family, and consumer education for Lehigh Valley Health System in Allentown, Pa. She advised hospitalists to give patients smaller amounts of information, in three- to five-minute chunks over several days. Further, it may be necessary to prioritize what the patient needs to know, rather than present so much information that the patient won't remember much of it.

Lehigh Valley's commitment to teach back grew out of a QI project mapping patient-flow processes, including care transitions, throughout its health system. It was tested in a pilot unit and included prompts and scripts hardwired into the electronic health record for unit nurses to easily access. Readmission rates at the pilot unit dropped to 14.0% from 28.2% in the year after teach back was implemented; hospital-wide rates shrunk to 21.9% from 25.3%.

Teach back is presented to patients in the spirit of evaluating how effectively the professional has explained the information, and not as a way to test the patient, Robinson said.

Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.

“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.

Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.

There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.

Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.

Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.

“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.

Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.

“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.

Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.

There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.

Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.

Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.

“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.

Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.

“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.

Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.

There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.

Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.

Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.

“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.

Seven percent of Medicare hospital DRGs: That is, potentially, how much Medicare reimbursement will be in play from CMS' hospital value-based purchasing (HVBP) quality initiatives by Fiscal Year 2017, Nell Buhlman, MBA, vice president of clinical products for Press Ganey Associates, said during a Sunday pre-course at SHM 2012. How many of you know your hospital’s profit margin on Medicare?” she posed to the audience. “Is it 7%?”

Buhlman outlined various components of CMS’ quality initiatives for hospitals, which could add up to millions of dollars per year for an average-sized hospital. By 2017 quality measures impacting on reimbursement will include the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), core clinical measures, penalties for higher-than-expected 30-day readmission rates, and meaningful-use reductions.

Hospitals are capable of significant quality improvement, “but the importance of hitting the hospital quality targets every single time will grow,” she said.

“Improving quality is fantastic, but even better is improving faster than everyone else,” Buhlman said, adding that the smallest things can sometimes make a big difference on outcomes scores. She offered the example of giving a notepad and pen to hospitalized patients so they can write down the questions they want to ask their doctor for the next visit.

Seven percent of Medicare hospital DRGs: That is, potentially, how much Medicare reimbursement will be in play from CMS' hospital value-based purchasing (HVBP) quality initiatives by Fiscal Year 2017, Nell Buhlman, MBA, vice president of clinical products for Press Ganey Associates, said during a Sunday pre-course at SHM 2012. How many of you know your hospital’s profit margin on Medicare?” she posed to the audience. “Is it 7%?”

Buhlman outlined various components of CMS’ quality initiatives for hospitals, which could add up to millions of dollars per year for an average-sized hospital. By 2017 quality measures impacting on reimbursement will include the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), core clinical measures, penalties for higher-than-expected 30-day readmission rates, and meaningful-use reductions.

Hospitals are capable of significant quality improvement, “but the importance of hitting the hospital quality targets every single time will grow,” she said.

“Improving quality is fantastic, but even better is improving faster than everyone else,” Buhlman said, adding that the smallest things can sometimes make a big difference on outcomes scores. She offered the example of giving a notepad and pen to hospitalized patients so they can write down the questions they want to ask their doctor for the next visit.

Seven percent of Medicare hospital DRGs: That is, potentially, how much Medicare reimbursement will be in play from CMS' hospital value-based purchasing (HVBP) quality initiatives by Fiscal Year 2017, Nell Buhlman, MBA, vice president of clinical products for Press Ganey Associates, said during a Sunday pre-course at SHM 2012. How many of you know your hospital’s profit margin on Medicare?” she posed to the audience. “Is it 7%?”

Buhlman outlined various components of CMS’ quality initiatives for hospitals, which could add up to millions of dollars per year for an average-sized hospital. By 2017 quality measures impacting on reimbursement will include the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), core clinical measures, penalties for higher-than-expected 30-day readmission rates, and meaningful-use reductions.

Hospitals are capable of significant quality improvement, “but the importance of hitting the hospital quality targets every single time will grow,” she said.

“Improving quality is fantastic, but even better is improving faster than everyone else,” Buhlman said, adding that the smallest things can sometimes make a big difference on outcomes scores. She offered the example of giving a notepad and pen to hospitalized patients so they can write down the questions they want to ask their doctor for the next visit.

With pre-course participants finishing up lunch today, four hospitalists from three hospitals are talking shop. Two of the hospitals are in the process of implementing computerized physician order entry (CPOE), and the third hospital is on track to do the same but got delayed. Each of the hospitalists expresses cautious optimism about the outcomes.

“It’s a necessary evil,” says Gaurav T. Parikh, MD, a Cogent HMG hospitalist practicing at City Hospital in Martinsburg, W.V. “Once we start using it—if it really makes things easier—then it should give us more flexibility. You can use it anywhere in the hospital.

"Sometimes I leave a patient’s room and go to another patient, and then remember, gee, I forget to order something for that first patient.”

With CPOE, Dr. Parikh can enter the additional prescription at a computer terminal or try to reach a nurse on that floor by phone, who then places the order.

Jaydeep Patel, MD, MBA, hospitalist at Grant Medical Center in Columbus,Ohio, says he used CPOE in residency and eagerly is awaiting its implementation at Grant. “I really liked it. There’s just less chance for error, as opposed to 15 charts on the rack,” he says.

Dr. Parikh says his hospital tried for two years to get physicians to enter the date and time on prescriptions. “It didn’t happen,” he says, noting CPOE puts an electronic signature on every prescription. He also says the hospital will have an easier time pulling data on practice. “In a time of increased demands for data and quality, it will help you big time," he adds. "But it won’t necessarily save us time.”

Larry Beresford is a freelance writer covering HM12.

With pre-course participants finishing up lunch today, four hospitalists from three hospitals are talking shop. Two of the hospitals are in the process of implementing computerized physician order entry (CPOE), and the third hospital is on track to do the same but got delayed. Each of the hospitalists expresses cautious optimism about the outcomes.

“It’s a necessary evil,” says Gaurav T. Parikh, MD, a Cogent HMG hospitalist practicing at City Hospital in Martinsburg, W.V. “Once we start using it—if it really makes things easier—then it should give us more flexibility. You can use it anywhere in the hospital.

"Sometimes I leave a patient’s room and go to another patient, and then remember, gee, I forget to order something for that first patient.”

With CPOE, Dr. Parikh can enter the additional prescription at a computer terminal or try to reach a nurse on that floor by phone, who then places the order.

Jaydeep Patel, MD, MBA, hospitalist at Grant Medical Center in Columbus,Ohio, says he used CPOE in residency and eagerly is awaiting its implementation at Grant. “I really liked it. There’s just less chance for error, as opposed to 15 charts on the rack,” he says.

Dr. Parikh says his hospital tried for two years to get physicians to enter the date and time on prescriptions. “It didn’t happen,” he says, noting CPOE puts an electronic signature on every prescription. He also says the hospital will have an easier time pulling data on practice. “In a time of increased demands for data and quality, it will help you big time," he adds. "But it won’t necessarily save us time.”

Larry Beresford is a freelance writer covering HM12.

With pre-course participants finishing up lunch today, four hospitalists from three hospitals are talking shop. Two of the hospitals are in the process of implementing computerized physician order entry (CPOE), and the third hospital is on track to do the same but got delayed. Each of the hospitalists expresses cautious optimism about the outcomes.

“It’s a necessary evil,” says Gaurav T. Parikh, MD, a Cogent HMG hospitalist practicing at City Hospital in Martinsburg, W.V. “Once we start using it—if it really makes things easier—then it should give us more flexibility. You can use it anywhere in the hospital.

"Sometimes I leave a patient’s room and go to another patient, and then remember, gee, I forget to order something for that first patient.”

With CPOE, Dr. Parikh can enter the additional prescription at a computer terminal or try to reach a nurse on that floor by phone, who then places the order.

Jaydeep Patel, MD, MBA, hospitalist at Grant Medical Center in Columbus,Ohio, says he used CPOE in residency and eagerly is awaiting its implementation at Grant. “I really liked it. There’s just less chance for error, as opposed to 15 charts on the rack,” he says.

Dr. Parikh says his hospital tried for two years to get physicians to enter the date and time on prescriptions. “It didn’t happen,” he says, noting CPOE puts an electronic signature on every prescription. He also says the hospital will have an easier time pulling data on practice. “In a time of increased demands for data and quality, it will help you big time," he adds. "But it won’t necessarily save us time.”

Larry Beresford is a freelance writer covering HM12.

A project to formalize “local leadership models”—partnering leadership teams comprising a hospitalist and a nurse manager on each participating unit—at the University of Michigan Health System helped to redefine the role of unit medical director and led to allocating sufficient time (15% to 20% of an FTE) for hospitalists to fill that role. The process also led to a joint role description for the physician and nurse leaders.

“In our organization, we had the medical director concept in place previously, but things were missing, with no direct accountability, no dedicated effort, and lack of clarity on reporting,” explains hospitalist Christopher Kim, MD, MBA, lead author of an article about the project published in the American Journal of Medical Quality.¹ “We learned from other organizations, and one of the first things we learned was to make sure we hired the right person as medical director. We need an energetic, enthusiastic physician who can reach out to nurses and bridge gaps in communication and coordination of care.”

The clinical partnership model was piloted on five units—four adult and one pediatric—and has since been adopted by eight others. The physician/nurse leaders work on such issues as improving care transitions, reducing pressure ulcers and catheter-related urinary tract infections, developing multi-disciplinary rounding on the units, and sharing quality data with staff.

“Take UTIs or pressure ulcers; we’re all familiar with recommended practice, but how it gets played out on the units varies. If team leaders understand this, they can champion the processes and

create an educational push for them,” Dr. Kim says. “Those organizations that have done this well cite higher staff satisfaction as a result.”

Study results show that the initial five units were “among the highest-performing units in our facility on satisfaction,” he adds. “It’s an exciting opportunity to bring change processes necessary to build a local clinical care environment that will improve the overall experience of the patient.”

Reference

1. Kim CS, Calarco M, Jacobs T, et al. Leadership at the front line: A clinical partnership model on general care inpatient units. Am J Med Qual. 2011 (epub ahead of print).

A project to formalize “local leadership models”—partnering leadership teams comprising a hospitalist and a nurse manager on each participating unit—at the University of Michigan Health System helped to redefine the role of unit medical director and led to allocating sufficient time (15% to 20% of an FTE) for hospitalists to fill that role. The process also led to a joint role description for the physician and nurse leaders.

“In our organization, we had the medical director concept in place previously, but things were missing, with no direct accountability, no dedicated effort, and lack of clarity on reporting,” explains hospitalist Christopher Kim, MD, MBA, lead author of an article about the project published in the American Journal of Medical Quality.¹ “We learned from other organizations, and one of the first things we learned was to make sure we hired the right person as medical director. We need an energetic, enthusiastic physician who can reach out to nurses and bridge gaps in communication and coordination of care.”

The clinical partnership model was piloted on five units—four adult and one pediatric—and has since been adopted by eight others. The physician/nurse leaders work on such issues as improving care transitions, reducing pressure ulcers and catheter-related urinary tract infections, developing multi-disciplinary rounding on the units, and sharing quality data with staff.

“Take UTIs or pressure ulcers; we’re all familiar with recommended practice, but how it gets played out on the units varies. If team leaders understand this, they can champion the processes and

create an educational push for them,” Dr. Kim says. “Those organizations that have done this well cite higher staff satisfaction as a result.”

Study results show that the initial five units were “among the highest-performing units in our facility on satisfaction,” he adds. “It’s an exciting opportunity to bring change processes necessary to build a local clinical care environment that will improve the overall experience of the patient.”

Reference

1. Kim CS, Calarco M, Jacobs T, et al. Leadership at the front line: A clinical partnership model on general care inpatient units. Am J Med Qual. 2011 (epub ahead of print).

A project to formalize “local leadership models”—partnering leadership teams comprising a hospitalist and a nurse manager on each participating unit—at the University of Michigan Health System helped to redefine the role of unit medical director and led to allocating sufficient time (15% to 20% of an FTE) for hospitalists to fill that role. The process also led to a joint role description for the physician and nurse leaders.

“In our organization, we had the medical director concept in place previously, but things were missing, with no direct accountability, no dedicated effort, and lack of clarity on reporting,” explains hospitalist Christopher Kim, MD, MBA, lead author of an article about the project published in the American Journal of Medical Quality.¹ “We learned from other organizations, and one of the first things we learned was to make sure we hired the right person as medical director. We need an energetic, enthusiastic physician who can reach out to nurses and bridge gaps in communication and coordination of care.”

The clinical partnership model was piloted on five units—four adult and one pediatric—and has since been adopted by eight others. The physician/nurse leaders work on such issues as improving care transitions, reducing pressure ulcers and catheter-related urinary tract infections, developing multi-disciplinary rounding on the units, and sharing quality data with staff.

“Take UTIs or pressure ulcers; we’re all familiar with recommended practice, but how it gets played out on the units varies. If team leaders understand this, they can champion the processes and

create an educational push for them,” Dr. Kim says. “Those organizations that have done this well cite higher staff satisfaction as a result.”

Study results show that the initial five units were “among the highest-performing units in our facility on satisfaction,” he adds. “It’s an exciting opportunity to bring change processes necessary to build a local clinical care environment that will improve the overall experience of the patient.”

Reference

1. Kim CS, Calarco M, Jacobs T, et al. Leadership at the front line: A clinical partnership model on general care inpatient units. Am J Med Qual. 2011 (epub ahead of print).

In January, the Centers for Medicare & Medicaid Services (CMS) selected 73 professionals as the initial set of advisors for its Innovation Center (http://innovations.cms.gov/). The advisors include 37 physicians, as well as some nurses and health administrators. Each advisor will receive six months of intensive training in quality-improvement (QI) methods and health systems research in order to deepen skills that could help drive improvements in patient care across the system.

Each of the 920 applicants named a project they wanted to pursue at their home institution; many already are involved in quality activities, says Fran Griffin, the program coordinator. CMS hopes that advisors will become “change agents” and mentors to others within their organizations and communities, she adds. “But we are clear that we are not funding research. We want people to come and be educated, and we want to know if they are learning these skills and applying what they learn in real time,” Griffin says.

Advisors will participate in four in-person meetings, the first of which was held in January, as well as four conference calls or webinars each month. The Innovation Center aims to eventually bring 200 advisors on board, with a second cycle of applications and selections expected later this spring.Funded by the Affordable Care Act, the program provides a stipend of up to $20,000 to the advisor’s institution to free up 10 hours a week for training and to complete their projects. Of the initial set of advisors, at least two are hospitalists: Stephen Liu, MD, MPH, FACPM, of Dartmouth-Hitchcock Medical Center in Hanover, N.H., and Jason Stein, MD, SFHM, director of the clinical research program at Emory School of Medicine in Atlanta. Topics pursued by the advisors include unnecessary hospital readmissions, improving care transitions, chronic disease management, and the development of medical homes outside the hospital.

Dr. Liu’s proposed project is to re-engineer and improve geriatric inpatient stays to help preserve patients’ functional status. “Overall, I had a great experience at the first meeting of the advisors,” Dr. Liu says. “It was great to discuss the challenges and opportunities for improvement at each of the different settings represented, and to learn that many of the challenges are similar to those we face in the inpatient setting, such as communication with primary-care providers, transitions of care, and avoiding complications from hospitalizations.”

For more information or to receive email updates, visit www.innovations.cms.gov/initiatives.

In January, the Centers for Medicare & Medicaid Services (CMS) selected 73 professionals as the initial set of advisors for its Innovation Center (http://innovations.cms.gov/). The advisors include 37 physicians, as well as some nurses and health administrators. Each advisor will receive six months of intensive training in quality-improvement (QI) methods and health systems research in order to deepen skills that could help drive improvements in patient care across the system.

Each of the 920 applicants named a project they wanted to pursue at their home institution; many already are involved in quality activities, says Fran Griffin, the program coordinator. CMS hopes that advisors will become “change agents” and mentors to others within their organizations and communities, she adds. “But we are clear that we are not funding research. We want people to come and be educated, and we want to know if they are learning these skills and applying what they learn in real time,” Griffin says.

Advisors will participate in four in-person meetings, the first of which was held in January, as well as four conference calls or webinars each month. The Innovation Center aims to eventually bring 200 advisors on board, with a second cycle of applications and selections expected later this spring.Funded by the Affordable Care Act, the program provides a stipend of up to $20,000 to the advisor’s institution to free up 10 hours a week for training and to complete their projects. Of the initial set of advisors, at least two are hospitalists: Stephen Liu, MD, MPH, FACPM, of Dartmouth-Hitchcock Medical Center in Hanover, N.H., and Jason Stein, MD, SFHM, director of the clinical research program at Emory School of Medicine in Atlanta. Topics pursued by the advisors include unnecessary hospital readmissions, improving care transitions, chronic disease management, and the development of medical homes outside the hospital.

Dr. Liu’s proposed project is to re-engineer and improve geriatric inpatient stays to help preserve patients’ functional status. “Overall, I had a great experience at the first meeting of the advisors,” Dr. Liu says. “It was great to discuss the challenges and opportunities for improvement at each of the different settings represented, and to learn that many of the challenges are similar to those we face in the inpatient setting, such as communication with primary-care providers, transitions of care, and avoiding complications from hospitalizations.”

For more information or to receive email updates, visit www.innovations.cms.gov/initiatives.

In January, the Centers for Medicare & Medicaid Services (CMS) selected 73 professionals as the initial set of advisors for its Innovation Center (http://innovations.cms.gov/). The advisors include 37 physicians, as well as some nurses and health administrators. Each advisor will receive six months of intensive training in quality-improvement (QI) methods and health systems research in order to deepen skills that could help drive improvements in patient care across the system.

Each of the 920 applicants named a project they wanted to pursue at their home institution; many already are involved in quality activities, says Fran Griffin, the program coordinator. CMS hopes that advisors will become “change agents” and mentors to others within their organizations and communities, she adds. “But we are clear that we are not funding research. We want people to come and be educated, and we want to know if they are learning these skills and applying what they learn in real time,” Griffin says.

Advisors will participate in four in-person meetings, the first of which was held in January, as well as four conference calls or webinars each month. The Innovation Center aims to eventually bring 200 advisors on board, with a second cycle of applications and selections expected later this spring.Funded by the Affordable Care Act, the program provides a stipend of up to $20,000 to the advisor’s institution to free up 10 hours a week for training and to complete their projects. Of the initial set of advisors, at least two are hospitalists: Stephen Liu, MD, MPH, FACPM, of Dartmouth-Hitchcock Medical Center in Hanover, N.H., and Jason Stein, MD, SFHM, director of the clinical research program at Emory School of Medicine in Atlanta. Topics pursued by the advisors include unnecessary hospital readmissions, improving care transitions, chronic disease management, and the development of medical homes outside the hospital.

Dr. Liu’s proposed project is to re-engineer and improve geriatric inpatient stays to help preserve patients’ functional status. “Overall, I had a great experience at the first meeting of the advisors,” Dr. Liu says. “It was great to discuss the challenges and opportunities for improvement at each of the different settings represented, and to learn that many of the challenges are similar to those we face in the inpatient setting, such as communication with primary-care providers, transitions of care, and avoiding complications from hospitalizations.”

For more information or to receive email updates, visit www.innovations.cms.gov/initiatives.

Results from a survey to assess physicians’ and medical trainees’ perceptions and attitudes about the culture of patient safety at the University of California at San Francisco (UCSF) Medical Center were reported at HM11 in Dallas by Patrick Kneeland, MD, who has since moved to Providence Regional Medical Center’s Everett Clinic in Seattle, where he co-chairs the Medical Quality Review Committee.

“We were interested in perceptions about what most determines a safety culture within a hospital,” and about differences and similarities between faculty, fellows, and residents, Dr. Kneeland explains. A positive safety culture is essential to enhancing patient safety, and it requires support and commitment at multiple levels.

Dr. Kneeland and colleagues used an established, validated instrument, the federal Agency for Healthcare Research and Quality’s “Hospital Survey on Patient Safety Culture,” which is used by hospitals to assess their staffs’ attitudes toward safety. But the UCSF team

modified the instrument to include additional survey dimensions, such as trainee supervision, event disclosure to patients, and physician-to-physician handoffs.¹ Of 290 physicians surveyed in UCSF’s Department of Medicine, 53% completed the survey.

“What was surprising from our survey was the overall high degree of agreement, but with some interesting differences,” Dr. Kneeland explains. In terms of the overall rating of safety culture, on a 1-to-5 scale with five being the highest, fellows rated the safety culture the highest, followed by faculty, and then residents. “Even though, across the board, 70 percent or more said adverse events should be disclosed to patients, only half of the trainees felt encouraged to do so, and half felt there is some danger in doing so,” he says.

Findings led to a major educational initiative around error disclosure, and to having the chief residents openly discuss overnight adverse patient events at morning rounds. The goal is to make event reporting part of customary practice. UCSF plans to repeat the survey in five years, using the initial results as a benchmark, Dr. Kneeland adds.

For more information or to request a copy of the modified survey, email Dr. Kneeland at [email protected].

Larry Beresford is a freelance writer in Oakland, Calif.

Reference

1. Hospital Survey on Patient Safety Culture. AHRQ website. Available at: http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm. Accessed Feb. 24, 2012.

Results from a survey to assess physicians’ and medical trainees’ perceptions and attitudes about the culture of patient safety at the University of California at San Francisco (UCSF) Medical Center were reported at HM11 in Dallas by Patrick Kneeland, MD, who has since moved to Providence Regional Medical Center’s Everett Clinic in Seattle, where he co-chairs the Medical Quality Review Committee.

“We were interested in perceptions about what most determines a safety culture within a hospital,” and about differences and similarities between faculty, fellows, and residents, Dr. Kneeland explains. A positive safety culture is essential to enhancing patient safety, and it requires support and commitment at multiple levels.

Dr. Kneeland and colleagues used an established, validated instrument, the federal Agency for Healthcare Research and Quality’s “Hospital Survey on Patient Safety Culture,” which is used by hospitals to assess their staffs’ attitudes toward safety. But the UCSF team

modified the instrument to include additional survey dimensions, such as trainee supervision, event disclosure to patients, and physician-to-physician handoffs.¹ Of 290 physicians surveyed in UCSF’s Department of Medicine, 53% completed the survey.

“What was surprising from our survey was the overall high degree of agreement, but with some interesting differences,” Dr. Kneeland explains. In terms of the overall rating of safety culture, on a 1-to-5 scale with five being the highest, fellows rated the safety culture the highest, followed by faculty, and then residents. “Even though, across the board, 70 percent or more said adverse events should be disclosed to patients, only half of the trainees felt encouraged to do so, and half felt there is some danger in doing so,” he says.

Findings led to a major educational initiative around error disclosure, and to having the chief residents openly discuss overnight adverse patient events at morning rounds. The goal is to make event reporting part of customary practice. UCSF plans to repeat the survey in five years, using the initial results as a benchmark, Dr. Kneeland adds.

For more information or to request a copy of the modified survey, email Dr. Kneeland at [email protected].

Larry Beresford is a freelance writer in Oakland, Calif.

Reference

1. Hospital Survey on Patient Safety Culture. AHRQ website. Available at: http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm. Accessed Feb. 24, 2012.

Results from a survey to assess physicians’ and medical trainees’ perceptions and attitudes about the culture of patient safety at the University of California at San Francisco (UCSF) Medical Center were reported at HM11 in Dallas by Patrick Kneeland, MD, who has since moved to Providence Regional Medical Center’s Everett Clinic in Seattle, where he co-chairs the Medical Quality Review Committee.

“We were interested in perceptions about what most determines a safety culture within a hospital,” and about differences and similarities between faculty, fellows, and residents, Dr. Kneeland explains. A positive safety culture is essential to enhancing patient safety, and it requires support and commitment at multiple levels.

Dr. Kneeland and colleagues used an established, validated instrument, the federal Agency for Healthcare Research and Quality’s “Hospital Survey on Patient Safety Culture,” which is used by hospitals to assess their staffs’ attitudes toward safety. But the UCSF team

modified the instrument to include additional survey dimensions, such as trainee supervision, event disclosure to patients, and physician-to-physician handoffs.¹ Of 290 physicians surveyed in UCSF’s Department of Medicine, 53% completed the survey.

“What was surprising from our survey was the overall high degree of agreement, but with some interesting differences,” Dr. Kneeland explains. In terms of the overall rating of safety culture, on a 1-to-5 scale with five being the highest, fellows rated the safety culture the highest, followed by faculty, and then residents. “Even though, across the board, 70 percent or more said adverse events should be disclosed to patients, only half of the trainees felt encouraged to do so, and half felt there is some danger in doing so,” he says.

Findings led to a major educational initiative around error disclosure, and to having the chief residents openly discuss overnight adverse patient events at morning rounds. The goal is to make event reporting part of customary practice. UCSF plans to repeat the survey in five years, using the initial results as a benchmark, Dr. Kneeland adds.

For more information or to request a copy of the modified survey, email Dr. Kneeland at [email protected].

Larry Beresford is a freelance writer in Oakland, Calif.

Reference

1. Hospital Survey on Patient Safety Culture. AHRQ website. Available at: http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm. Accessed Feb. 24, 2012.

8.3%1 in 12 adults ages 21 and older Discharged from the hospital to the community were readmitted within 30 days, according to the National Institute for Health Care Reform. One in 3 (32.9%) were readmitted within one year, suggesting that a significant number of patients remain at risk for readmission far beyond the typically measured 30-day window.

8.3%1 in 12 adults ages 21 and older Discharged from the hospital to the community were readmitted within 30 days, according to the National Institute for Health Care Reform. One in 3 (32.9%) were readmitted within one year, suggesting that a significant number of patients remain at risk for readmission far beyond the typically measured 30-day window.

8.3%1 in 12 adults ages 21 and older Discharged from the hospital to the community were readmitted within 30 days, according to the National Institute for Health Care Reform. One in 3 (32.9%) were readmitted within one year, suggesting that a significant number of patients remain at risk for readmission far beyond the typically measured 30-day window.