Larry Beresford

A research team reports in the Annals of Internal Medicine (2011;155:520-528) that of the 43 recent English-language studies of care-transition strategies they reviewed, none was associated with a reduced risk for 30-day rehospitalization.

The team, from Northwestern Feinberg School of Medicine in Chicago, defined 12 distinct activities done before, after, and during hospital discharge to reduce readmissions. The activities might be familiar to hospitalists who follow this subject, such as medication reconciliation, scheduling of follow-up appointments before discharge, placing follow-up phone calls, and the use of transitions coaches.

As with many such reviews, the Annals article leaves open the question of whether this negative finding reflects limitations in the research literature, "or does it reflect an absolute truth about care-transitions strategies?" says lead author Luke Hansen, MD, MHS. "So you have to make inferences. But we clearly don't have a strong research base."

The study is timely, as many HM groups are preparing for a Medicare policy to start in October 2012 that would penalize hospitals with higher-than-expected readmission rates.

"Hospitals have to change, but unfortunately they'll have to do it without a lot of evidence," Dr. Hansen says. "You probably will have to bundle several strategies together, and the more components you include, the more likely you are to achieve the needed cultural change."

A research team reports in the Annals of Internal Medicine (2011;155:520-528) that of the 43 recent English-language studies of care-transition strategies they reviewed, none was associated with a reduced risk for 30-day rehospitalization.

The team, from Northwestern Feinberg School of Medicine in Chicago, defined 12 distinct activities done before, after, and during hospital discharge to reduce readmissions. The activities might be familiar to hospitalists who follow this subject, such as medication reconciliation, scheduling of follow-up appointments before discharge, placing follow-up phone calls, and the use of transitions coaches.

As with many such reviews, the Annals article leaves open the question of whether this negative finding reflects limitations in the research literature, "or does it reflect an absolute truth about care-transitions strategies?" says lead author Luke Hansen, MD, MHS. "So you have to make inferences. But we clearly don't have a strong research base."

The study is timely, as many HM groups are preparing for a Medicare policy to start in October 2012 that would penalize hospitals with higher-than-expected readmission rates.

"Hospitals have to change, but unfortunately they'll have to do it without a lot of evidence," Dr. Hansen says. "You probably will have to bundle several strategies together, and the more components you include, the more likely you are to achieve the needed cultural change."

A research team reports in the Annals of Internal Medicine (2011;155:520-528) that of the 43 recent English-language studies of care-transition strategies they reviewed, none was associated with a reduced risk for 30-day rehospitalization.

The team, from Northwestern Feinberg School of Medicine in Chicago, defined 12 distinct activities done before, after, and during hospital discharge to reduce readmissions. The activities might be familiar to hospitalists who follow this subject, such as medication reconciliation, scheduling of follow-up appointments before discharge, placing follow-up phone calls, and the use of transitions coaches.

As with many such reviews, the Annals article leaves open the question of whether this negative finding reflects limitations in the research literature, "or does it reflect an absolute truth about care-transitions strategies?" says lead author Luke Hansen, MD, MHS. "So you have to make inferences. But we clearly don't have a strong research base."

The study is timely, as many HM groups are preparing for a Medicare policy to start in October 2012 that would penalize hospitals with higher-than-expected readmission rates.

"Hospitals have to change, but unfortunately they'll have to do it without a lot of evidence," Dr. Hansen says. "You probably will have to bundle several strategies together, and the more components you include, the more likely you are to achieve the needed cultural change."

Gregory Maynard, MD, MSc, SFHM, has high hopes for SHM's new Center for Hospital Innovation and Improvement. Dr. Maynard, recently appointed senior vice president of "The Center," believes The Center's tools, resources, and initiatives in QI and patient safety will advance hospitalists' understanding of the implications of healthcare reform and how recent legislative changes will directly affect their jobs.

Through its Web portal, The Center aims to bring together a wide variety of resources, not only such SHM-branded initiatives as VTE Prevention and Project BOOST (Better Outcomes for Older Adults through Safe Transitions), but also relevant tools from other sources.

"The Center has grown because there's a bigger demand all the time for the skills, knowledge, and leadership required for quality and patient safety," Dr. Maynard says. "We recognize that frontline hospitalists are very busy with day-to-day clinical care. On the other hand, quality and safety efforts increasingly will be tied to hospital reimbursement."

Hospital administrators are paying attention to those trends, and hospitalists are well situated to lead their response, he adds.

New quality developments at the center include:

 

 

• eQUIPS, SHM’s online toolkit for hospital QI, with a data registry and tools for comparing performance with other hospitals;

 

 

• Hospitalists and In-Hospital Resuscitation, a multidisciplinary project for standardizing resuscitation practice;

 

 

• A new initiative for atrial fibrillation and transitions of care; and

 

 

• In-hospital best practices in diabetes care for hospitalist extenders.

 

 

Dr. Maynard is director of hospital medicine and chair of the Patient Safety Committee at the University of California at San Diego (UCSD). He expects to spend one week per month at SHM's Philadelphia office while retaining his leadership position at UCSD.

Gregory Maynard, MD, MSc, SFHM, has high hopes for SHM's new Center for Hospital Innovation and Improvement. Dr. Maynard, recently appointed senior vice president of "The Center," believes The Center's tools, resources, and initiatives in QI and patient safety will advance hospitalists' understanding of the implications of healthcare reform and how recent legislative changes will directly affect their jobs.

Through its Web portal, The Center aims to bring together a wide variety of resources, not only such SHM-branded initiatives as VTE Prevention and Project BOOST (Better Outcomes for Older Adults through Safe Transitions), but also relevant tools from other sources.

"The Center has grown because there's a bigger demand all the time for the skills, knowledge, and leadership required for quality and patient safety," Dr. Maynard says. "We recognize that frontline hospitalists are very busy with day-to-day clinical care. On the other hand, quality and safety efforts increasingly will be tied to hospital reimbursement."

Hospital administrators are paying attention to those trends, and hospitalists are well situated to lead their response, he adds.

New quality developments at the center include:

 

 

• eQUIPS, SHM’s online toolkit for hospital QI, with a data registry and tools for comparing performance with other hospitals;

 

 

• Hospitalists and In-Hospital Resuscitation, a multidisciplinary project for standardizing resuscitation practice;

 

 

• A new initiative for atrial fibrillation and transitions of care; and

 

 

• In-hospital best practices in diabetes care for hospitalist extenders.

 

 

Dr. Maynard is director of hospital medicine and chair of the Patient Safety Committee at the University of California at San Diego (UCSD). He expects to spend one week per month at SHM's Philadelphia office while retaining his leadership position at UCSD.

Gregory Maynard, MD, MSc, SFHM, has high hopes for SHM's new Center for Hospital Innovation and Improvement. Dr. Maynard, recently appointed senior vice president of "The Center," believes The Center's tools, resources, and initiatives in QI and patient safety will advance hospitalists' understanding of the implications of healthcare reform and how recent legislative changes will directly affect their jobs.

Through its Web portal, The Center aims to bring together a wide variety of resources, not only such SHM-branded initiatives as VTE Prevention and Project BOOST (Better Outcomes for Older Adults through Safe Transitions), but also relevant tools from other sources.

"The Center has grown because there's a bigger demand all the time for the skills, knowledge, and leadership required for quality and patient safety," Dr. Maynard says. "We recognize that frontline hospitalists are very busy with day-to-day clinical care. On the other hand, quality and safety efforts increasingly will be tied to hospital reimbursement."

Hospital administrators are paying attention to those trends, and hospitalists are well situated to lead their response, he adds.

New quality developments at the center include:

 

 

• eQUIPS, SHM’s online toolkit for hospital QI, with a data registry and tools for comparing performance with other hospitals;

 

 

• Hospitalists and In-Hospital Resuscitation, a multidisciplinary project for standardizing resuscitation practice;

 

 

• A new initiative for atrial fibrillation and transitions of care; and

 

 

• In-hospital best practices in diabetes care for hospitalist extenders.

 

 

Dr. Maynard is director of hospital medicine and chair of the Patient Safety Committee at the University of California at San Diego (UCSD). He expects to spend one week per month at SHM's Philadelphia office while retaining his leadership position at UCSD.

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

In a career with many HM “firsts," Robert M. Wachter, MD, MHM, is in line to become the first hospitalist to chair the American Board of Internal Medicine (ABIM), which provides certification for the majority of working hospitalists. Dr. Wachter, chief of the 50-faculty Division of Hospital Medicine at the University of California at San Francisco, was elected chair-elect by ABIM’s board on July 1, and is expected to become chair in July 2012.

“Bob Wachter becoming chair-elect of the ABIM is certainly an important milestone for our field,” says Scott Flanders, MD, SFHM, a hospitalist at the University of Michigan Health System and past president of SHM. “The ABIM recognized the importance of hospital medicine several years ago when they decided to add a hospitalist to the board. It should come as no surprise that they reached out to the man who is viewed as the father of hospital medicine.”

Christine K. Cassel, MD, ABIM’s president and CEO, says the election is less about recognition for the specialty and more about recognizing Dr. Wachter's transformational leadership in a number of areas, including hospital medicine.

“He has done the same kind of thing in the areas of patient safety and medical errors, and is now focusing on diagnostic accuracy,” she adds. According to Dr. Cassel, Dr. Wachter has helped ABIM focus on the need for transparency in physician performance information and report cards. “But it does indicate the maturity of the [HM] field that you have leaders like Bob—and he’s not the only one. Many emerging national leaders in healthcare are hospitalists,” she says.

ABIM sets standards and certifies physicians practicing in internal medicine and its 19 subspecialties. The board, whose members are all board-certified and represent those various subspecialties, guides the overall mission and direction in improving healthcare quality by the way it sets standards for certification, Dr. Cassel says. “The chair’s specific power and responsibility is to make sure the board runs effectively,” she adds.

In the first year of a Maintenance of Certification (MOC) program for physicians focused in hospital medicine offered by ABIM, 93 hospitalists completed the requirement and earned that designation.

In a career with many HM “firsts," Robert M. Wachter, MD, MHM, is in line to become the first hospitalist to chair the American Board of Internal Medicine (ABIM), which provides certification for the majority of working hospitalists. Dr. Wachter, chief of the 50-faculty Division of Hospital Medicine at the University of California at San Francisco, was elected chair-elect by ABIM’s board on July 1, and is expected to become chair in July 2012.

“Bob Wachter becoming chair-elect of the ABIM is certainly an important milestone for our field,” says Scott Flanders, MD, SFHM, a hospitalist at the University of Michigan Health System and past president of SHM. “The ABIM recognized the importance of hospital medicine several years ago when they decided to add a hospitalist to the board. It should come as no surprise that they reached out to the man who is viewed as the father of hospital medicine.”

Christine K. Cassel, MD, ABIM’s president and CEO, says the election is less about recognition for the specialty and more about recognizing Dr. Wachter's transformational leadership in a number of areas, including hospital medicine.

“He has done the same kind of thing in the areas of patient safety and medical errors, and is now focusing on diagnostic accuracy,” she adds. According to Dr. Cassel, Dr. Wachter has helped ABIM focus on the need for transparency in physician performance information and report cards. “But it does indicate the maturity of the [HM] field that you have leaders like Bob—and he’s not the only one. Many emerging national leaders in healthcare are hospitalists,” she says.

ABIM sets standards and certifies physicians practicing in internal medicine and its 19 subspecialties. The board, whose members are all board-certified and represent those various subspecialties, guides the overall mission and direction in improving healthcare quality by the way it sets standards for certification, Dr. Cassel says. “The chair’s specific power and responsibility is to make sure the board runs effectively,” she adds.

In the first year of a Maintenance of Certification (MOC) program for physicians focused in hospital medicine offered by ABIM, 93 hospitalists completed the requirement and earned that designation.

In a career with many HM “firsts," Robert M. Wachter, MD, MHM, is in line to become the first hospitalist to chair the American Board of Internal Medicine (ABIM), which provides certification for the majority of working hospitalists. Dr. Wachter, chief of the 50-faculty Division of Hospital Medicine at the University of California at San Francisco, was elected chair-elect by ABIM’s board on July 1, and is expected to become chair in July 2012.

“Bob Wachter becoming chair-elect of the ABIM is certainly an important milestone for our field,” says Scott Flanders, MD, SFHM, a hospitalist at the University of Michigan Health System and past president of SHM. “The ABIM recognized the importance of hospital medicine several years ago when they decided to add a hospitalist to the board. It should come as no surprise that they reached out to the man who is viewed as the father of hospital medicine.”

Christine K. Cassel, MD, ABIM’s president and CEO, says the election is less about recognition for the specialty and more about recognizing Dr. Wachter's transformational leadership in a number of areas, including hospital medicine.

“He has done the same kind of thing in the areas of patient safety and medical errors, and is now focusing on diagnostic accuracy,” she adds. According to Dr. Cassel, Dr. Wachter has helped ABIM focus on the need for transparency in physician performance information and report cards. “But it does indicate the maturity of the [HM] field that you have leaders like Bob—and he’s not the only one. Many emerging national leaders in healthcare are hospitalists,” she says.

ABIM sets standards and certifies physicians practicing in internal medicine and its 19 subspecialties. The board, whose members are all board-certified and represent those various subspecialties, guides the overall mission and direction in improving healthcare quality by the way it sets standards for certification, Dr. Cassel says. “The chair’s specific power and responsibility is to make sure the board runs effectively,” she adds.

In the first year of a Maintenance of Certification (MOC) program for physicians focused in hospital medicine offered by ABIM, 93 hospitalists completed the requirement and earned that designation.

Hospitalist Andrea Peterson, MD, of Norwalk Hospital in Norwalk, Conn., whose job involves educating hospitalized patients about their personal health, has found an additional channel for teaching health concepts: She cohosts "Health Talk," a half-hour local cable television show in Fairfield County.

Dr. Peterson, who started working at Norwalk in 2002 as the hospital's fourth hospitalist, cohosts "Health Talk" with the hospital's vice president and chief medical officer, Eric Mazur, MD. She first appeared on the show as a guest, discussing subjects of professional interest, such as end-of-life care, ethics, patient safety, and spirituality in medicine, then served later as fill-in host before becoming the permanent cohost.

"It's really fun. It's totally different than my day job," she says. "It can also be fatiguing—you have to be bright and energetic on a sustained basis."

Conversations on the air are different than interactions with patients, as the dead space of TV can be deadly, she says. "I had to learn, with the help of a media coach, to start asking the next question while the person is finishing the previous answer. But I've gotten to interact with colleagues in totally different ways and to meet patients with inspiring stories," she says.

The program tapes four shows one day a month. Each program is broadcast several times over the course of a week. Interview subjects are both doctors and patients, and most of the interactions are unscripted.

"Both Eric and I feel it is very important to have topics and discussions that are real and meaningful to people's health, bread-and-butter issues like diabetes, colon-cancer screening, strokes and MI, and medication safety," Dr. Peterson says. "We continually do smoking education. We're always telling people: Talk to your family about what's important to you. Appoint a healthcare surrogate. These are the same messages I give to my patients in the hospital," she says.

Think you may be interesting in hosting your own patient education program? Click here for a list of community and public access TV sites.

Hospitalist Andrea Peterson, MD, of Norwalk Hospital in Norwalk, Conn., whose job involves educating hospitalized patients about their personal health, has found an additional channel for teaching health concepts: She cohosts "Health Talk," a half-hour local cable television show in Fairfield County.

Dr. Peterson, who started working at Norwalk in 2002 as the hospital's fourth hospitalist, cohosts "Health Talk" with the hospital's vice president and chief medical officer, Eric Mazur, MD. She first appeared on the show as a guest, discussing subjects of professional interest, such as end-of-life care, ethics, patient safety, and spirituality in medicine, then served later as fill-in host before becoming the permanent cohost.

"It's really fun. It's totally different than my day job," she says. "It can also be fatiguing—you have to be bright and energetic on a sustained basis."

Conversations on the air are different than interactions with patients, as the dead space of TV can be deadly, she says. "I had to learn, with the help of a media coach, to start asking the next question while the person is finishing the previous answer. But I've gotten to interact with colleagues in totally different ways and to meet patients with inspiring stories," she says.

The program tapes four shows one day a month. Each program is broadcast several times over the course of a week. Interview subjects are both doctors and patients, and most of the interactions are unscripted.

"Both Eric and I feel it is very important to have topics and discussions that are real and meaningful to people's health, bread-and-butter issues like diabetes, colon-cancer screening, strokes and MI, and medication safety," Dr. Peterson says. "We continually do smoking education. We're always telling people: Talk to your family about what's important to you. Appoint a healthcare surrogate. These are the same messages I give to my patients in the hospital," she says.

Think you may be interesting in hosting your own patient education program? Click here for a list of community and public access TV sites.

Hospitalist Andrea Peterson, MD, of Norwalk Hospital in Norwalk, Conn., whose job involves educating hospitalized patients about their personal health, has found an additional channel for teaching health concepts: She cohosts "Health Talk," a half-hour local cable television show in Fairfield County.

Dr. Peterson, who started working at Norwalk in 2002 as the hospital's fourth hospitalist, cohosts "Health Talk" with the hospital's vice president and chief medical officer, Eric Mazur, MD. She first appeared on the show as a guest, discussing subjects of professional interest, such as end-of-life care, ethics, patient safety, and spirituality in medicine, then served later as fill-in host before becoming the permanent cohost.

"It's really fun. It's totally different than my day job," she says. "It can also be fatiguing—you have to be bright and energetic on a sustained basis."

Conversations on the air are different than interactions with patients, as the dead space of TV can be deadly, she says. "I had to learn, with the help of a media coach, to start asking the next question while the person is finishing the previous answer. But I've gotten to interact with colleagues in totally different ways and to meet patients with inspiring stories," she says.

The program tapes four shows one day a month. Each program is broadcast several times over the course of a week. Interview subjects are both doctors and patients, and most of the interactions are unscripted.

"Both Eric and I feel it is very important to have topics and discussions that are real and meaningful to people's health, bread-and-butter issues like diabetes, colon-cancer screening, strokes and MI, and medication safety," Dr. Peterson says. "We continually do smoking education. We're always telling people: Talk to your family about what's important to you. Appoint a healthcare surrogate. These are the same messages I give to my patients in the hospital," she says.

Think you may be interesting in hosting your own patient education program? Click here for a list of community and public access TV sites.

An abstract presented at HM11, “Purposeful Visits for Hospitalized Elderly Patients,” describes a service at the University of Colorado Hospital (UCH) in Denver that has shown improvements in participating patients’ mood, agitation, and orientation.

The purposeful-visit program was started, says senior author Ethan Cumbler, MD, a hospitalist at UCH and director of its Acute Care for the Elderly Service, because hospitals often are a profoundly unfriendly environment, especially for vulnerable, chronically ill patients. “It’s a social and intellectual desert where patients don’t get the stimulation they would receive at home,” he adds.

The program was established to leverage professional resources by training a core cadre of four to six volunteers in communication techniques (e.g. open-ended questioning), says the hospital’s recreational therapist, William Mramor, CTRS, MS. Charge nurses help identify patients and topics to explore, and the volunteers use a prepared script to help guide interactions, Mramor says.

“The purposeful visit directly addresses issues of patients’ feelings and promotes a patient-centered hospital experience,” he says.

Based on assessments using a five-point scale, with scores ranging from “worsening” (1 or 2) to “improving” (4 or 5), patient mood was rated 3.94 by the volunteers and 3.65 by the nurses. Slightly lower scores were recorded for patient agitation and patient orientation but in every case showed improvement.

“What distinguishes these purposeful visits is their goal of enhancing patients’ memory, decreasing their loneliness, and helping them understand the value of reconnecting to things they enjoy,” says Dr. Cumbler. —LB

Technology

New E-Pillbox Actively Monitors Med-Recon, Fights Readmissions

Electronic pillboxes are nothing new, but some hospitalists might not have seen the latest one.

Earlier this year, the FDA approved PillStation, a traditional pillbox married to a software system that uploads data to the system’s maker, SentiCare Inc., which then monitors how well a patient is following their medication regimen. The four-year-old medical firm is pitching the product to hospitals and accountable-care organizations (ACOs), among other potential clients.

And in a sales pitch practically tailored to HM, SentiCare bills itself as a medication adherence system that can help fight readmissions, particularly in cases of chronic disease or congestive heart failure. The device actually takes photographs of the pills to be taken and can record whether a patient has removed them from the device.

“Hospitals need to dramatically reduce their readmissions rates,” Yogendra Jain, chief technology officer and cofounder of SentiCare, wrote in an email to The Hospitalist. “One critical factor is medication and hospital discharge instruction adherence. Through its embedded camera, PillStation can confirm that from day one of departing the hospital... medications are loaded correctly and that the patient is taking it on time.”—RQ

Quality

Home Healthcare Has Fewer Rehospitalizations

A recent study by Avalere Health, a healthcare advisory firm based in Washington, D.C., found that providing home healthcare after hospital discharge for patients with three common conditions resulted in fewer hospital readmissions than for similar patients receiving other post-acute services. Those comparable services included long-term acute-care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospices.

“We tried to control for hospital DRG, severity of illness, and comorbidities,” says Emil Parker, Avalere’s director of post-acute and long-term-care practice, although he acknowledges the complexities of risk adjustment.

In comparing Medicare spending and rehospitalization rates after initial hospital visits for patients with diabetes, COPD, and congestive heart failure from 2006 to 2009, the study estimated that referrals to home healthcare resulted in $670 million in Medicare savings from 20,426 fewer readmissions.

“Hospitalists should think about the continuum of institutional support for patients discharged from the hospital with significant support needs,” Parker says. “Our study shows that in this population, provision of home healthcare is cost-effective and benefits patients by improving the continuity of their care.” —LB

Patient Safety

L.A. Hospitals Add HM for Medicaid Patients

In June, Anthem Blue Cross of Woodland Hills, Calif., began offering covered hospitalist services to its adult managed-care members covered by Medi-Cal, the Medicaid program for California residents, at 24 hospitals in Los Angeles County. The service is designed to take advantage of the existing hospitalist presence in those hospitals, which is provided by ApolloMed, a Glendale, Calif.-based medical management services company.

The hospitalist service is designed to enhance quality of care during hospitalization, reduce costs, and plan for more timely discharges and transitions to outpatient care. ApolloMed plans to add more hospitals in the region to the program, as well as additional post-discharge outpatient clinics. —LB

Technology

By the Numbers: 5.9

The percentage of total national health expenditures spent on medical devices in 2009, according to a report released in June by the Advanced Medical Technology Association.

The report highlights that while technology is washing over medicine, and HM in particular, with the adoption of electronic health records, portable ultrasounds, and tablet computing, the $147 billion spent on medical devices in 2009 represented just 5.9% of the $2.5 trillion in national health spending.

The trade group also reported that the average annual rate for medical device spending increased 7.5% in the 20-year period that ended in 2009. That outpaced the average annual rate for overall national heath expenditures, which ticked up 7% over the same time period. —RQ

An abstract presented at HM11, “Purposeful Visits for Hospitalized Elderly Patients,” describes a service at the University of Colorado Hospital (UCH) in Denver that has shown improvements in participating patients’ mood, agitation, and orientation.

The purposeful-visit program was started, says senior author Ethan Cumbler, MD, a hospitalist at UCH and director of its Acute Care for the Elderly Service, because hospitals often are a profoundly unfriendly environment, especially for vulnerable, chronically ill patients. “It’s a social and intellectual desert where patients don’t get the stimulation they would receive at home,” he adds.

The program was established to leverage professional resources by training a core cadre of four to six volunteers in communication techniques (e.g. open-ended questioning), says the hospital’s recreational therapist, William Mramor, CTRS, MS. Charge nurses help identify patients and topics to explore, and the volunteers use a prepared script to help guide interactions, Mramor says.

“The purposeful visit directly addresses issues of patients’ feelings and promotes a patient-centered hospital experience,” he says.

Based on assessments using a five-point scale, with scores ranging from “worsening” (1 or 2) to “improving” (4 or 5), patient mood was rated 3.94 by the volunteers and 3.65 by the nurses. Slightly lower scores were recorded for patient agitation and patient orientation but in every case showed improvement.

“What distinguishes these purposeful visits is their goal of enhancing patients’ memory, decreasing their loneliness, and helping them understand the value of reconnecting to things they enjoy,” says Dr. Cumbler. —LB

Technology

New E-Pillbox Actively Monitors Med-Recon, Fights Readmissions

Electronic pillboxes are nothing new, but some hospitalists might not have seen the latest one.

Earlier this year, the FDA approved PillStation, a traditional pillbox married to a software system that uploads data to the system’s maker, SentiCare Inc., which then monitors how well a patient is following their medication regimen. The four-year-old medical firm is pitching the product to hospitals and accountable-care organizations (ACOs), among other potential clients.

And in a sales pitch practically tailored to HM, SentiCare bills itself as a medication adherence system that can help fight readmissions, particularly in cases of chronic disease or congestive heart failure. The device actually takes photographs of the pills to be taken and can record whether a patient has removed them from the device.

“Hospitals need to dramatically reduce their readmissions rates,” Yogendra Jain, chief technology officer and cofounder of SentiCare, wrote in an email to The Hospitalist. “One critical factor is medication and hospital discharge instruction adherence. Through its embedded camera, PillStation can confirm that from day one of departing the hospital... medications are loaded correctly and that the patient is taking it on time.”—RQ

Quality

Home Healthcare Has Fewer Rehospitalizations

A recent study by Avalere Health, a healthcare advisory firm based in Washington, D.C., found that providing home healthcare after hospital discharge for patients with three common conditions resulted in fewer hospital readmissions than for similar patients receiving other post-acute services. Those comparable services included long-term acute-care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospices.

“We tried to control for hospital DRG, severity of illness, and comorbidities,” says Emil Parker, Avalere’s director of post-acute and long-term-care practice, although he acknowledges the complexities of risk adjustment.

In comparing Medicare spending and rehospitalization rates after initial hospital visits for patients with diabetes, COPD, and congestive heart failure from 2006 to 2009, the study estimated that referrals to home healthcare resulted in $670 million in Medicare savings from 20,426 fewer readmissions.

“Hospitalists should think about the continuum of institutional support for patients discharged from the hospital with significant support needs,” Parker says. “Our study shows that in this population, provision of home healthcare is cost-effective and benefits patients by improving the continuity of their care.” —LB

Patient Safety

L.A. Hospitals Add HM for Medicaid Patients

In June, Anthem Blue Cross of Woodland Hills, Calif., began offering covered hospitalist services to its adult managed-care members covered by Medi-Cal, the Medicaid program for California residents, at 24 hospitals in Los Angeles County. The service is designed to take advantage of the existing hospitalist presence in those hospitals, which is provided by ApolloMed, a Glendale, Calif.-based medical management services company.

The hospitalist service is designed to enhance quality of care during hospitalization, reduce costs, and plan for more timely discharges and transitions to outpatient care. ApolloMed plans to add more hospitals in the region to the program, as well as additional post-discharge outpatient clinics. —LB

Technology

By the Numbers: 5.9

The percentage of total national health expenditures spent on medical devices in 2009, according to a report released in June by the Advanced Medical Technology Association.

The report highlights that while technology is washing over medicine, and HM in particular, with the adoption of electronic health records, portable ultrasounds, and tablet computing, the $147 billion spent on medical devices in 2009 represented just 5.9% of the $2.5 trillion in national health spending.

The trade group also reported that the average annual rate for medical device spending increased 7.5% in the 20-year period that ended in 2009. That outpaced the average annual rate for overall national heath expenditures, which ticked up 7% over the same time period. —RQ

An abstract presented at HM11, “Purposeful Visits for Hospitalized Elderly Patients,” describes a service at the University of Colorado Hospital (UCH) in Denver that has shown improvements in participating patients’ mood, agitation, and orientation.

The purposeful-visit program was started, says senior author Ethan Cumbler, MD, a hospitalist at UCH and director of its Acute Care for the Elderly Service, because hospitals often are a profoundly unfriendly environment, especially for vulnerable, chronically ill patients. “It’s a social and intellectual desert where patients don’t get the stimulation they would receive at home,” he adds.

The program was established to leverage professional resources by training a core cadre of four to six volunteers in communication techniques (e.g. open-ended questioning), says the hospital’s recreational therapist, William Mramor, CTRS, MS. Charge nurses help identify patients and topics to explore, and the volunteers use a prepared script to help guide interactions, Mramor says.

“The purposeful visit directly addresses issues of patients’ feelings and promotes a patient-centered hospital experience,” he says.

Based on assessments using a five-point scale, with scores ranging from “worsening” (1 or 2) to “improving” (4 or 5), patient mood was rated 3.94 by the volunteers and 3.65 by the nurses. Slightly lower scores were recorded for patient agitation and patient orientation but in every case showed improvement.

“What distinguishes these purposeful visits is their goal of enhancing patients’ memory, decreasing their loneliness, and helping them understand the value of reconnecting to things they enjoy,” says Dr. Cumbler. —LB

Technology

New E-Pillbox Actively Monitors Med-Recon, Fights Readmissions

Electronic pillboxes are nothing new, but some hospitalists might not have seen the latest one.

Earlier this year, the FDA approved PillStation, a traditional pillbox married to a software system that uploads data to the system’s maker, SentiCare Inc., which then monitors how well a patient is following their medication regimen. The four-year-old medical firm is pitching the product to hospitals and accountable-care organizations (ACOs), among other potential clients.

And in a sales pitch practically tailored to HM, SentiCare bills itself as a medication adherence system that can help fight readmissions, particularly in cases of chronic disease or congestive heart failure. The device actually takes photographs of the pills to be taken and can record whether a patient has removed them from the device.

“Hospitals need to dramatically reduce their readmissions rates,” Yogendra Jain, chief technology officer and cofounder of SentiCare, wrote in an email to The Hospitalist. “One critical factor is medication and hospital discharge instruction adherence. Through its embedded camera, PillStation can confirm that from day one of departing the hospital... medications are loaded correctly and that the patient is taking it on time.”—RQ

Quality

Home Healthcare Has Fewer Rehospitalizations

A recent study by Avalere Health, a healthcare advisory firm based in Washington, D.C., found that providing home healthcare after hospital discharge for patients with three common conditions resulted in fewer hospital readmissions than for similar patients receiving other post-acute services. Those comparable services included long-term acute-care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospices.

“We tried to control for hospital DRG, severity of illness, and comorbidities,” says Emil Parker, Avalere’s director of post-acute and long-term-care practice, although he acknowledges the complexities of risk adjustment.

In comparing Medicare spending and rehospitalization rates after initial hospital visits for patients with diabetes, COPD, and congestive heart failure from 2006 to 2009, the study estimated that referrals to home healthcare resulted in $670 million in Medicare savings from 20,426 fewer readmissions.

“Hospitalists should think about the continuum of institutional support for patients discharged from the hospital with significant support needs,” Parker says. “Our study shows that in this population, provision of home healthcare is cost-effective and benefits patients by improving the continuity of their care.” —LB

Patient Safety

L.A. Hospitals Add HM for Medicaid Patients

In June, Anthem Blue Cross of Woodland Hills, Calif., began offering covered hospitalist services to its adult managed-care members covered by Medi-Cal, the Medicaid program for California residents, at 24 hospitals in Los Angeles County. The service is designed to take advantage of the existing hospitalist presence in those hospitals, which is provided by ApolloMed, a Glendale, Calif.-based medical management services company.

The hospitalist service is designed to enhance quality of care during hospitalization, reduce costs, and plan for more timely discharges and transitions to outpatient care. ApolloMed plans to add more hospitals in the region to the program, as well as additional post-discharge outpatient clinics. —LB

Technology

By the Numbers: 5.9

The percentage of total national health expenditures spent on medical devices in 2009, according to a report released in June by the Advanced Medical Technology Association.

The report highlights that while technology is washing over medicine, and HM in particular, with the adoption of electronic health records, portable ultrasounds, and tablet computing, the $147 billion spent on medical devices in 2009 represented just 5.9% of the $2.5 trillion in national health spending.

The trade group also reported that the average annual rate for medical device spending increased 7.5% in the 20-year period that ended in 2009. That outpaced the average annual rate for overall national heath expenditures, which ticked up 7% over the same time period. —RQ

Bassett Medical Center in Cooperstown, N.Y., received a Pinnacle Award for Quality and Patient Safety from the Health Care Association of New York State in June, honoring Bassett's program for improving care transitions and reducing hospital readmissions.

Bassett used an evidence-based approach that incorporated readmission screening tools and risk-reduction strategies, a patient services coordinator to make post-discharge follow-up phone calls, and a toll-free number for patients to call any time prior to their first post-discharge medical appointment. The result was a readmission rate that was reduced by 25%, from 17% in 2009 to 13% in 2010. Thirty-day readmissions for high-risk patients fell 70% for the hospital, which is a mentored site in SHM's Project BOOST (Better Outcomes for Older Adults through Safe Transitions).

Hospitalist Komron Ostovar, MD, FHM, and Lorraine Stubley, RN, MS, the hospital's senior director of care coordination, led a multidisciplinary quality group that included primary-care providers and representatives from community settings. They worked to strengthen information flow between inpatient and outpatient providers. One of the most helpful tools, Stubley says, was Project BOOST's "8 Ps" for risk assessment, which identified high-risk patients consistently.

The care-transitions initiative also lays the groundwork for implementing a "geographical care model" at Bassett, with a universal bed unit staffed by nurses who are able to provide for all of the patient's needs for the entire hospitalization, she says.

The facility's hospitalists led daily rounds, emphasized teach-back education, and helped to refine discharge instructions in patient-friendly terms. "Our group of hospitalists understands that we now 'own' the complexity of care transitions," Dr. Ostovar says. "If we, as professionals, don't make every effort to get it right, then who will?"

Bassett Medical Center in Cooperstown, N.Y., received a Pinnacle Award for Quality and Patient Safety from the Health Care Association of New York State in June, honoring Bassett's program for improving care transitions and reducing hospital readmissions.

Bassett used an evidence-based approach that incorporated readmission screening tools and risk-reduction strategies, a patient services coordinator to make post-discharge follow-up phone calls, and a toll-free number for patients to call any time prior to their first post-discharge medical appointment. The result was a readmission rate that was reduced by 25%, from 17% in 2009 to 13% in 2010. Thirty-day readmissions for high-risk patients fell 70% for the hospital, which is a mentored site in SHM's Project BOOST (Better Outcomes for Older Adults through Safe Transitions).

Hospitalist Komron Ostovar, MD, FHM, and Lorraine Stubley, RN, MS, the hospital's senior director of care coordination, led a multidisciplinary quality group that included primary-care providers and representatives from community settings. They worked to strengthen information flow between inpatient and outpatient providers. One of the most helpful tools, Stubley says, was Project BOOST's "8 Ps" for risk assessment, which identified high-risk patients consistently.

The care-transitions initiative also lays the groundwork for implementing a "geographical care model" at Bassett, with a universal bed unit staffed by nurses who are able to provide for all of the patient's needs for the entire hospitalization, she says.

The facility's hospitalists led daily rounds, emphasized teach-back education, and helped to refine discharge instructions in patient-friendly terms. "Our group of hospitalists understands that we now 'own' the complexity of care transitions," Dr. Ostovar says. "If we, as professionals, don't make every effort to get it right, then who will?"

Bassett Medical Center in Cooperstown, N.Y., received a Pinnacle Award for Quality and Patient Safety from the Health Care Association of New York State in June, honoring Bassett's program for improving care transitions and reducing hospital readmissions.

Bassett used an evidence-based approach that incorporated readmission screening tools and risk-reduction strategies, a patient services coordinator to make post-discharge follow-up phone calls, and a toll-free number for patients to call any time prior to their first post-discharge medical appointment. The result was a readmission rate that was reduced by 25%, from 17% in 2009 to 13% in 2010. Thirty-day readmissions for high-risk patients fell 70% for the hospital, which is a mentored site in SHM's Project BOOST (Better Outcomes for Older Adults through Safe Transitions).

Hospitalist Komron Ostovar, MD, FHM, and Lorraine Stubley, RN, MS, the hospital's senior director of care coordination, led a multidisciplinary quality group that included primary-care providers and representatives from community settings. They worked to strengthen information flow between inpatient and outpatient providers. One of the most helpful tools, Stubley says, was Project BOOST's "8 Ps" for risk assessment, which identified high-risk patients consistently.

The care-transitions initiative also lays the groundwork for implementing a "geographical care model" at Bassett, with a universal bed unit staffed by nurses who are able to provide for all of the patient's needs for the entire hospitalization, she says.

The facility's hospitalists led daily rounds, emphasized teach-back education, and helped to refine discharge instructions in patient-friendly terms. "Our group of hospitalists understands that we now 'own' the complexity of care transitions," Dr. Ostovar says. "If we, as professionals, don't make every effort to get it right, then who will?"

In his June 3 blog post at CIO.com, Tom Kaneshige asks: “Can the iPad cure what ails us?” He goes on to describe new applications for iPads in Texas hospitals, including the remote monitoring of patients’ EKGs by nurses roaming the hospital.

“The big revolution in tablet computing for hospitalists, which has been right around the corner for the past decade, hasn’t quite arrived yet,” says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California San Francisco Medical Center. “But I think we’re getting close, even though I’m not convinced that the iPad will be the vehicle.”

One of the hallmarks of such a technological revolution will be to free up hospitalists and other workers from computer work stations, where they are increasingly removed from face-to-face interactions. “Something gets lost in the name of efficiency,” Dr. Cucina says.

Hurdles to the tablet revolution include:

• Short battery life and the lack of rechargeable batteries. “Doctors need to be on the floor longer than eight hours,” Dr. Cucina says.
• Interacting with a tablet using thumbs and a touchscreen is fundamentally different from using a laptop, and applications should recognize the differences.
• Wireless access to secure electronic health records (EHR) throughout the hospital. “This is more of a cost issue than a technical problem,” Dr. Cucina explains. “It’s also incumbent upon us as physicians to develop good security practices with our tablets.”
• The skills to use the screen in the presence of others—in other words, What is the proper etiquette in front of care team members, patients, their families, etc.?

Hospitalists Look to Partner with New Quality Institute

Don’t be surprised if HM eventually gets a piece of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore.

The center, funded through a $10 million gift from Johns Hopkins Medicine board of trustees chairman C. Michael Armstrong, will become the umbrella arm in charge of reducing preventable harm and improving healthcare quality.

Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center’s HM division, already sees that as hospitalist turf and could easily see HM partnering with the new institute. Dr. Howell, who already has reached out to the institute’s head, checklist guru Peter Pronovost, MD, PhD, wrote in an email to The Hospitalist: “Hospitalists at Hopkins have a long tradition of exactly this type of work.”

Dr. Howell points to recent HM-driven research and initiatives to reduce “red alerts,” the term for ambulance diversions in the ICU, and streamlining the admission process to allow outpatient doctors to bypass the ED for patients for whom hospitalist admission is needed. At Howard County General Hospital, a suburb about 15 miles southwest of Baltimore, the HM group is running all rapid response team (RRT) events.

“In short,” Dr. Howell writes, “the Armstrong Institute will find hospitalists to be a willing partner.”

Hospitalists Must Prepare for Primary-Care Shortfalls

The Milwaukee-based American Society for Quality (ASQ) recently surveyed healthcare quality professionals about anticipated shortages of primary-care physicians (PCPs) and other medical staff, particularly as more Americans gain health insurance under the Accountable Care Act and Medicare). The trend is real, says Joseph Fortuna, MD, chair of ASQ’s Health Care Division, and hospitalists will face challenges in discharging patients who lack a defined PCP.

Survey respondents highlighted some strategies for dealing with the primary-care shortage, including the EHR for improving efficiency, teamwork, and checklists. Dr. Fortuna suggests HM groups:

• Work with PCPs and federally qualified health centers to enhance integrated relationships and improve handoffs. Local public health departments will be important collaborators.
• Define quality not just clinically, but also in terms of financial, operational, and cultural domains, using techniques of change management, root cause analysis, and other quality tools.
• Be involved in patient-centered medical homes as “catalysts, coordinators, and facilitators.”

HM Group Redesigns Workflow to Comply with ACGME Rules and Improve Continuity

As academic HM groups react to the new Accreditation Council for Graduation Medical Education (ACGME) guidelines on how long residents can work, they might want to keep the Toyota Production System (TPS) in mind.

Diana Mancini, MD, a hospitalist at Denver Health Medical Center and associate program director of the University of Colorado Internal Medicine Residency, presented data in the Research, Innovations, and Clinical Vignettes competition at HM11 that showed how the use of continuous workflow and standardized tasks—hallmarks of TPS—helped redesign the medicine ward system to both comply with the ACGME rules and improve continuity of care.

The project replaced the traditional call system, and its corresponding floats and moonlighters, with a shift system comprised of two teams of six interns and three residents. At night, one intern worked a “continuity shift.” Using administrative data, Dr. Mancini and colleagues projected that 89% of patients admitted on a continuity shift would be discharged by the end of that intern’s five consecutive shifts. And, by dividing admissions among two teams, the “bolus” effect was halved, she says.

“The continuity shift is crucial for both the patient safety/continuity and educational content/value for the housestaff,” Dr. Mancini wrote in an email. “With the new work hours coming ... the hours would have to be adjusted … but the continuity could most certainly be maintained.”

Feds Delay Deadline for Stage 2 “Meaningful Use” Application Process

If your HM group is among the first cohort that reaches Stage 1 attestation this year for meaningful use of electronic health records (EHR), you may get more time to reach Stage 2. The federal Health Information Technology (HIT) policy committee has voted for a 12-month delay in implementing the criteria for that second stage, agreeing with those who say the current deadline of October 2013 “poses a nearly insurmountable timing challenge.”

The HIT is pushing to delay the deadline until 2014, which would mean providers have three years to verify that they have met Stage 1 meaningful use requirements, according to Government HealthIT. A cadre of medical trade groups, led by the AMA, is now pushing the Department of Health and Human Services to adopt the new timeline.

The ultimate decision rests with the Centers for Medicaid & Medicare Services (CMS).

By the numbers

Number of months without a central-line-associated bloodstream infection (BSI) on the eight-bed ICU at Beaufort Memorial Hospital, a 197-bed community hospital in Beaufort, S.C.

The hospital, which had a higher rate of BSIs than the national average in 2005, created a team to reduce its BSIs, led by infection-prevention specialist Beverly Yoder, RN, and involving hospitalists. Beaufort joined the Institute for Healthcare Improvement’s 100K Lives Campaign and the South Carolina Hospital Association’s Stop BSI Project.

The team implemented a central-line “bundle” of quality practices, then simplified the bundle and incorporated it into its EHR. The unit celebrated its 30-month achievement with a luncheon in June.

For information, contact critical-care director Diane Razo, RN, MSN, PCCN, at [email protected]. (For more information about central-line infection prevention, visit SHM's Resource Room (www.hospitalmedicine.org/resource)

In his June 3 blog post at CIO.com, Tom Kaneshige asks: “Can the iPad cure what ails us?” He goes on to describe new applications for iPads in Texas hospitals, including the remote monitoring of patients’ EKGs by nurses roaming the hospital.

“The big revolution in tablet computing for hospitalists, which has been right around the corner for the past decade, hasn’t quite arrived yet,” says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California San Francisco Medical Center. “But I think we’re getting close, even though I’m not convinced that the iPad will be the vehicle.”

One of the hallmarks of such a technological revolution will be to free up hospitalists and other workers from computer work stations, where they are increasingly removed from face-to-face interactions. “Something gets lost in the name of efficiency,” Dr. Cucina says.

Hurdles to the tablet revolution include:

• Short battery life and the lack of rechargeable batteries. “Doctors need to be on the floor longer than eight hours,” Dr. Cucina says.
• Interacting with a tablet using thumbs and a touchscreen is fundamentally different from using a laptop, and applications should recognize the differences.
• Wireless access to secure electronic health records (EHR) throughout the hospital. “This is more of a cost issue than a technical problem,” Dr. Cucina explains. “It’s also incumbent upon us as physicians to develop good security practices with our tablets.”
• The skills to use the screen in the presence of others—in other words, What is the proper etiquette in front of care team members, patients, their families, etc.?

Hospitalists Look to Partner with New Quality Institute

Don’t be surprised if HM eventually gets a piece of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore.

The center, funded through a $10 million gift from Johns Hopkins Medicine board of trustees chairman C. Michael Armstrong, will become the umbrella arm in charge of reducing preventable harm and improving healthcare quality.

Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center’s HM division, already sees that as hospitalist turf and could easily see HM partnering with the new institute. Dr. Howell, who already has reached out to the institute’s head, checklist guru Peter Pronovost, MD, PhD, wrote in an email to The Hospitalist: “Hospitalists at Hopkins have a long tradition of exactly this type of work.”

Dr. Howell points to recent HM-driven research and initiatives to reduce “red alerts,” the term for ambulance diversions in the ICU, and streamlining the admission process to allow outpatient doctors to bypass the ED for patients for whom hospitalist admission is needed. At Howard County General Hospital, a suburb about 15 miles southwest of Baltimore, the HM group is running all rapid response team (RRT) events.

“In short,” Dr. Howell writes, “the Armstrong Institute will find hospitalists to be a willing partner.”

Hospitalists Must Prepare for Primary-Care Shortfalls

The Milwaukee-based American Society for Quality (ASQ) recently surveyed healthcare quality professionals about anticipated shortages of primary-care physicians (PCPs) and other medical staff, particularly as more Americans gain health insurance under the Accountable Care Act and Medicare). The trend is real, says Joseph Fortuna, MD, chair of ASQ’s Health Care Division, and hospitalists will face challenges in discharging patients who lack a defined PCP.

Survey respondents highlighted some strategies for dealing with the primary-care shortage, including the EHR for improving efficiency, teamwork, and checklists. Dr. Fortuna suggests HM groups:

• Work with PCPs and federally qualified health centers to enhance integrated relationships and improve handoffs. Local public health departments will be important collaborators.
• Define quality not just clinically, but also in terms of financial, operational, and cultural domains, using techniques of change management, root cause analysis, and other quality tools.
• Be involved in patient-centered medical homes as “catalysts, coordinators, and facilitators.”

HM Group Redesigns Workflow to Comply with ACGME Rules and Improve Continuity

As academic HM groups react to the new Accreditation Council for Graduation Medical Education (ACGME) guidelines on how long residents can work, they might want to keep the Toyota Production System (TPS) in mind.

Diana Mancini, MD, a hospitalist at Denver Health Medical Center and associate program director of the University of Colorado Internal Medicine Residency, presented data in the Research, Innovations, and Clinical Vignettes competition at HM11 that showed how the use of continuous workflow and standardized tasks—hallmarks of TPS—helped redesign the medicine ward system to both comply with the ACGME rules and improve continuity of care.

The project replaced the traditional call system, and its corresponding floats and moonlighters, with a shift system comprised of two teams of six interns and three residents. At night, one intern worked a “continuity shift.” Using administrative data, Dr. Mancini and colleagues projected that 89% of patients admitted on a continuity shift would be discharged by the end of that intern’s five consecutive shifts. And, by dividing admissions among two teams, the “bolus” effect was halved, she says.

“The continuity shift is crucial for both the patient safety/continuity and educational content/value for the housestaff,” Dr. Mancini wrote in an email. “With the new work hours coming ... the hours would have to be adjusted … but the continuity could most certainly be maintained.”

Feds Delay Deadline for Stage 2 “Meaningful Use” Application Process

If your HM group is among the first cohort that reaches Stage 1 attestation this year for meaningful use of electronic health records (EHR), you may get more time to reach Stage 2. The federal Health Information Technology (HIT) policy committee has voted for a 12-month delay in implementing the criteria for that second stage, agreeing with those who say the current deadline of October 2013 “poses a nearly insurmountable timing challenge.”

The HIT is pushing to delay the deadline until 2014, which would mean providers have three years to verify that they have met Stage 1 meaningful use requirements, according to Government HealthIT. A cadre of medical trade groups, led by the AMA, is now pushing the Department of Health and Human Services to adopt the new timeline.

The ultimate decision rests with the Centers for Medicaid & Medicare Services (CMS).

By the numbers

Number of months without a central-line-associated bloodstream infection (BSI) on the eight-bed ICU at Beaufort Memorial Hospital, a 197-bed community hospital in Beaufort, S.C.

The hospital, which had a higher rate of BSIs than the national average in 2005, created a team to reduce its BSIs, led by infection-prevention specialist Beverly Yoder, RN, and involving hospitalists. Beaufort joined the Institute for Healthcare Improvement’s 100K Lives Campaign and the South Carolina Hospital Association’s Stop BSI Project.

The team implemented a central-line “bundle” of quality practices, then simplified the bundle and incorporated it into its EHR. The unit celebrated its 30-month achievement with a luncheon in June.

For information, contact critical-care director Diane Razo, RN, MSN, PCCN, at [email protected]. (For more information about central-line infection prevention, visit SHM's Resource Room (www.hospitalmedicine.org/resource)

In his June 3 blog post at CIO.com, Tom Kaneshige asks: “Can the iPad cure what ails us?” He goes on to describe new applications for iPads in Texas hospitals, including the remote monitoring of patients’ EKGs by nurses roaming the hospital.

“The big revolution in tablet computing for hospitalists, which has been right around the corner for the past decade, hasn’t quite arrived yet,” says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California San Francisco Medical Center. “But I think we’re getting close, even though I’m not convinced that the iPad will be the vehicle.”

One of the hallmarks of such a technological revolution will be to free up hospitalists and other workers from computer work stations, where they are increasingly removed from face-to-face interactions. “Something gets lost in the name of efficiency,” Dr. Cucina says.

Hurdles to the tablet revolution include:

• Short battery life and the lack of rechargeable batteries. “Doctors need to be on the floor longer than eight hours,” Dr. Cucina says.
• Interacting with a tablet using thumbs and a touchscreen is fundamentally different from using a laptop, and applications should recognize the differences.
• Wireless access to secure electronic health records (EHR) throughout the hospital. “This is more of a cost issue than a technical problem,” Dr. Cucina explains. “It’s also incumbent upon us as physicians to develop good security practices with our tablets.”
• The skills to use the screen in the presence of others—in other words, What is the proper etiquette in front of care team members, patients, their families, etc.?

Hospitalists Look to Partner with New Quality Institute

Don’t be surprised if HM eventually gets a piece of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore.

The center, funded through a $10 million gift from Johns Hopkins Medicine board of trustees chairman C. Michael Armstrong, will become the umbrella arm in charge of reducing preventable harm and improving healthcare quality.

Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center’s HM division, already sees that as hospitalist turf and could easily see HM partnering with the new institute. Dr. Howell, who already has reached out to the institute’s head, checklist guru Peter Pronovost, MD, PhD, wrote in an email to The Hospitalist: “Hospitalists at Hopkins have a long tradition of exactly this type of work.”

Dr. Howell points to recent HM-driven research and initiatives to reduce “red alerts,” the term for ambulance diversions in the ICU, and streamlining the admission process to allow outpatient doctors to bypass the ED for patients for whom hospitalist admission is needed. At Howard County General Hospital, a suburb about 15 miles southwest of Baltimore, the HM group is running all rapid response team (RRT) events.

“In short,” Dr. Howell writes, “the Armstrong Institute will find hospitalists to be a willing partner.”

Hospitalists Must Prepare for Primary-Care Shortfalls

The Milwaukee-based American Society for Quality (ASQ) recently surveyed healthcare quality professionals about anticipated shortages of primary-care physicians (PCPs) and other medical staff, particularly as more Americans gain health insurance under the Accountable Care Act and Medicare). The trend is real, says Joseph Fortuna, MD, chair of ASQ’s Health Care Division, and hospitalists will face challenges in discharging patients who lack a defined PCP.

Survey respondents highlighted some strategies for dealing with the primary-care shortage, including the EHR for improving efficiency, teamwork, and checklists. Dr. Fortuna suggests HM groups:

• Work with PCPs and federally qualified health centers to enhance integrated relationships and improve handoffs. Local public health departments will be important collaborators.
• Define quality not just clinically, but also in terms of financial, operational, and cultural domains, using techniques of change management, root cause analysis, and other quality tools.
• Be involved in patient-centered medical homes as “catalysts, coordinators, and facilitators.”

HM Group Redesigns Workflow to Comply with ACGME Rules and Improve Continuity

As academic HM groups react to the new Accreditation Council for Graduation Medical Education (ACGME) guidelines on how long residents can work, they might want to keep the Toyota Production System (TPS) in mind.

Diana Mancini, MD, a hospitalist at Denver Health Medical Center and associate program director of the University of Colorado Internal Medicine Residency, presented data in the Research, Innovations, and Clinical Vignettes competition at HM11 that showed how the use of continuous workflow and standardized tasks—hallmarks of TPS—helped redesign the medicine ward system to both comply with the ACGME rules and improve continuity of care.

The project replaced the traditional call system, and its corresponding floats and moonlighters, with a shift system comprised of two teams of six interns and three residents. At night, one intern worked a “continuity shift.” Using administrative data, Dr. Mancini and colleagues projected that 89% of patients admitted on a continuity shift would be discharged by the end of that intern’s five consecutive shifts. And, by dividing admissions among two teams, the “bolus” effect was halved, she says.

“The continuity shift is crucial for both the patient safety/continuity and educational content/value for the housestaff,” Dr. Mancini wrote in an email. “With the new work hours coming ... the hours would have to be adjusted … but the continuity could most certainly be maintained.”

Feds Delay Deadline for Stage 2 “Meaningful Use” Application Process

If your HM group is among the first cohort that reaches Stage 1 attestation this year for meaningful use of electronic health records (EHR), you may get more time to reach Stage 2. The federal Health Information Technology (HIT) policy committee has voted for a 12-month delay in implementing the criteria for that second stage, agreeing with those who say the current deadline of October 2013 “poses a nearly insurmountable timing challenge.”

The HIT is pushing to delay the deadline until 2014, which would mean providers have three years to verify that they have met Stage 1 meaningful use requirements, according to Government HealthIT. A cadre of medical trade groups, led by the AMA, is now pushing the Department of Health and Human Services to adopt the new timeline.

The ultimate decision rests with the Centers for Medicaid & Medicare Services (CMS).

By the numbers

Number of months without a central-line-associated bloodstream infection (BSI) on the eight-bed ICU at Beaufort Memorial Hospital, a 197-bed community hospital in Beaufort, S.C.

The hospital, which had a higher rate of BSIs than the national average in 2005, created a team to reduce its BSIs, led by infection-prevention specialist Beverly Yoder, RN, and involving hospitalists. Beaufort joined the Institute for Healthcare Improvement’s 100K Lives Campaign and the South Carolina Hospital Association’s Stop BSI Project.

The team implemented a central-line “bundle” of quality practices, then simplified the bundle and incorporated it into its EHR. The unit celebrated its 30-month achievement with a luncheon in June.

For information, contact critical-care director Diane Razo, RN, MSN, PCCN, at [email protected]. (For more information about central-line infection prevention, visit SHM's Resource Room (www.hospitalmedicine.org/resource)