Larry Beresford

Last month, the Office of Inspector General (OIG) issued a report (PDF) that estimates 15,000 Medicare patient deaths each month are attributable at least in part to the care they received in hospitals.

The federal watchdog agency tallied adverse events from the National Quality Forum’s list of serious reportable events and other hospital-acquired conditions in the charts of 780 Medicare patients from 2008, then extrapolated the proportions harmed through hospital care (13.5%) or who die as a result of that care (1.5%).

“Because many adverse events we identified were preventable, our study confirms the need and opportunity for hospitals to significantly reduce the incidence of events,” the report concludes. It recommends that the Agency for Healthcare Research and Quality (AHRQ) broadens patient-safety efforts and that the Centers for Medicaid & Medicare Services (CMS) provides further incentives for hospitals to reduce their incidences through its payment and oversight functions.

Confirmation of hospital safety concerns comes from a study published in the New England Journal of Medicine (2010;2363:2124-2134) that found harm to patients in North Carolina hospitals was common and did not decrease from 2002 to 2007.

Christopher Landrigan, MD, of Harvard Medical School and coauthors concluded that 18% of hospitalized patients were harmed through their medical care and, for 2.4%, it caused or contributed to their deaths.

The results of the OIG study are not surprising and might even underestimate the extent of the problem, says Gregory Seymann, MD, a hospitalist at the University of California at San Diego and a member of the Society of Hospital Medicine’s Performance and Standards Committee. The report doesn’t address what proportion of the harmed patients was on a service managed by hospitalists, “but we are in the best position to impact quality and safety—to go to our hospital administrators and get resources earmarked for quality,” he says.

Such results also mirror findings from the Institute of Medicine’s landmark 1999 report To Err is Human, adds Andrew Dunn, MD, a hospitalist at Mount Sinai Medical Center in New York City. “They suggest that medical errors are rampant in hospitals,” he says. “Because the incidence of harm is so broad across the elderly population, quality-improvement efforts in hospitals need to be across the board.”

Every hospitalist should be involved with these efforts, Dr. Dunn says. “There’s no putting your feet up. There’s always room to improve quality,” he adds. He predicts that safety outcomes will increasingly be tied to hospital reimbursement, “which is a good thing. It’s very motivational.”

Last month, the Office of Inspector General (OIG) issued a report (PDF) that estimates 15,000 Medicare patient deaths each month are attributable at least in part to the care they received in hospitals.

The federal watchdog agency tallied adverse events from the National Quality Forum’s list of serious reportable events and other hospital-acquired conditions in the charts of 780 Medicare patients from 2008, then extrapolated the proportions harmed through hospital care (13.5%) or who die as a result of that care (1.5%).

“Because many adverse events we identified were preventable, our study confirms the need and opportunity for hospitals to significantly reduce the incidence of events,” the report concludes. It recommends that the Agency for Healthcare Research and Quality (AHRQ) broadens patient-safety efforts and that the Centers for Medicaid & Medicare Services (CMS) provides further incentives for hospitals to reduce their incidences through its payment and oversight functions.

Confirmation of hospital safety concerns comes from a study published in the New England Journal of Medicine (2010;2363:2124-2134) that found harm to patients in North Carolina hospitals was common and did not decrease from 2002 to 2007.

Christopher Landrigan, MD, of Harvard Medical School and coauthors concluded that 18% of hospitalized patients were harmed through their medical care and, for 2.4%, it caused or contributed to their deaths.

The results of the OIG study are not surprising and might even underestimate the extent of the problem, says Gregory Seymann, MD, a hospitalist at the University of California at San Diego and a member of the Society of Hospital Medicine’s Performance and Standards Committee. The report doesn’t address what proportion of the harmed patients was on a service managed by hospitalists, “but we are in the best position to impact quality and safety—to go to our hospital administrators and get resources earmarked for quality,” he says.

Such results also mirror findings from the Institute of Medicine’s landmark 1999 report To Err is Human, adds Andrew Dunn, MD, a hospitalist at Mount Sinai Medical Center in New York City. “They suggest that medical errors are rampant in hospitals,” he says. “Because the incidence of harm is so broad across the elderly population, quality-improvement efforts in hospitals need to be across the board.”

Every hospitalist should be involved with these efforts, Dr. Dunn says. “There’s no putting your feet up. There’s always room to improve quality,” he adds. He predicts that safety outcomes will increasingly be tied to hospital reimbursement, “which is a good thing. It’s very motivational.”

Last month, the Office of Inspector General (OIG) issued a report (PDF) that estimates 15,000 Medicare patient deaths each month are attributable at least in part to the care they received in hospitals.

The federal watchdog agency tallied adverse events from the National Quality Forum’s list of serious reportable events and other hospital-acquired conditions in the charts of 780 Medicare patients from 2008, then extrapolated the proportions harmed through hospital care (13.5%) or who die as a result of that care (1.5%).

“Because many adverse events we identified were preventable, our study confirms the need and opportunity for hospitals to significantly reduce the incidence of events,” the report concludes. It recommends that the Agency for Healthcare Research and Quality (AHRQ) broadens patient-safety efforts and that the Centers for Medicaid & Medicare Services (CMS) provides further incentives for hospitals to reduce their incidences through its payment and oversight functions.

Confirmation of hospital safety concerns comes from a study published in the New England Journal of Medicine (2010;2363:2124-2134) that found harm to patients in North Carolina hospitals was common and did not decrease from 2002 to 2007.

Christopher Landrigan, MD, of Harvard Medical School and coauthors concluded that 18% of hospitalized patients were harmed through their medical care and, for 2.4%, it caused or contributed to their deaths.

The results of the OIG study are not surprising and might even underestimate the extent of the problem, says Gregory Seymann, MD, a hospitalist at the University of California at San Diego and a member of the Society of Hospital Medicine’s Performance and Standards Committee. The report doesn’t address what proportion of the harmed patients was on a service managed by hospitalists, “but we are in the best position to impact quality and safety—to go to our hospital administrators and get resources earmarked for quality,” he says.

Such results also mirror findings from the Institute of Medicine’s landmark 1999 report To Err is Human, adds Andrew Dunn, MD, a hospitalist at Mount Sinai Medical Center in New York City. “They suggest that medical errors are rampant in hospitals,” he says. “Because the incidence of harm is so broad across the elderly population, quality-improvement efforts in hospitals need to be across the board.”

Every hospitalist should be involved with these efforts, Dr. Dunn says. “There’s no putting your feet up. There’s always room to improve quality,” he adds. He predicts that safety outcomes will increasingly be tied to hospital reimbursement, “which is a good thing. It’s very motivational.”

An eagerly awaited federal grant program that will allocate $500 million for improving care transitions and reducing rehospitalizations will soon release a solicitation and application instructions, possibly by the end of December.

The Community-Based Care Transitions Program (CCTP), funded for five years starting in January through the Affordable Care Act, is open to hospitals with higher-than-average rehospitalization rates and their community-based partners, and to coalitions of community-based organizations that include hospitals, CMS research analyst Juliana Tiongson explained during an all-day conference Dec. 3 in Baltimore.

Hospitalists and HM groups likely would not qualify directly for these grants, but they can start identifying and partnering with interested hospital leaders and relevant community-based providers. CCTP is designed to encourage communities to work together in ongoing learning collaboratives, drawing on evidence-based models for improving care transitions, Tiongson said. Examples of evidence-based strategies, such as Eric Coleman’s Community Care Transitions Program, Mary Naylor’s Transitional Care Model, and SHM’s Project BOOST, were described during the teleconference.

“We will require applicants to do their homework, including a thorough root cause analysis” of current care-transitions processes and their limitations, Tiongson said. Applications that include multiple stakeholders across the healthcare continuum, such as consumer representation, links to accountable-care organizations (ACOs), and medical homes, and those that are based in the communities they propose to serve, will be favored in the rolling application process. Applicants should demonstrate organizational readiness in terms of staffing, training, and preparation for better managing such transitions as hospital discharges.

An eagerly awaited federal grant program that will allocate $500 million for improving care transitions and reducing rehospitalizations will soon release a solicitation and application instructions, possibly by the end of December.

The Community-Based Care Transitions Program (CCTP), funded for five years starting in January through the Affordable Care Act, is open to hospitals with higher-than-average rehospitalization rates and their community-based partners, and to coalitions of community-based organizations that include hospitals, CMS research analyst Juliana Tiongson explained during an all-day conference Dec. 3 in Baltimore.

Hospitalists and HM groups likely would not qualify directly for these grants, but they can start identifying and partnering with interested hospital leaders and relevant community-based providers. CCTP is designed to encourage communities to work together in ongoing learning collaboratives, drawing on evidence-based models for improving care transitions, Tiongson said. Examples of evidence-based strategies, such as Eric Coleman’s Community Care Transitions Program, Mary Naylor’s Transitional Care Model, and SHM’s Project BOOST, were described during the teleconference.

“We will require applicants to do their homework, including a thorough root cause analysis” of current care-transitions processes and their limitations, Tiongson said. Applications that include multiple stakeholders across the healthcare continuum, such as consumer representation, links to accountable-care organizations (ACOs), and medical homes, and those that are based in the communities they propose to serve, will be favored in the rolling application process. Applicants should demonstrate organizational readiness in terms of staffing, training, and preparation for better managing such transitions as hospital discharges.

An eagerly awaited federal grant program that will allocate $500 million for improving care transitions and reducing rehospitalizations will soon release a solicitation and application instructions, possibly by the end of December.

The Community-Based Care Transitions Program (CCTP), funded for five years starting in January through the Affordable Care Act, is open to hospitals with higher-than-average rehospitalization rates and their community-based partners, and to coalitions of community-based organizations that include hospitals, CMS research analyst Juliana Tiongson explained during an all-day conference Dec. 3 in Baltimore.

Hospitalists and HM groups likely would not qualify directly for these grants, but they can start identifying and partnering with interested hospital leaders and relevant community-based providers. CCTP is designed to encourage communities to work together in ongoing learning collaboratives, drawing on evidence-based models for improving care transitions, Tiongson said. Examples of evidence-based strategies, such as Eric Coleman’s Community Care Transitions Program, Mary Naylor’s Transitional Care Model, and SHM’s Project BOOST, were described during the teleconference.

“We will require applicants to do their homework, including a thorough root cause analysis” of current care-transitions processes and their limitations, Tiongson said. Applications that include multiple stakeholders across the healthcare continuum, such as consumer representation, links to accountable-care organizations (ACOs), and medical homes, and those that are based in the communities they propose to serve, will be favored in the rolling application process. Applicants should demonstrate organizational readiness in terms of staffing, training, and preparation for better managing such transitions as hospital discharges.

Stethoscopes can be magnets for infectious agents. As many as 1 in 3 stethoscopes used in EDs carry methicillin-resistant Staphylococcus aureus (Prehospital Emergency Care. 2009;13:71-74). Cleaning them with alcohol rubs can be cumbersome, however, and the alcohol doesn’t kill such infections as Clostridium difficile, which is common in hospitals and causes colitis, says Richard Ma, MD, chair of hospital medicine at Saints Memorial Medical Center in Lowell, Mass.

“Being a hospitalist, I see a lot around me that is wasteful and inefficient,” Dr. Ma says. Four years ago, he set out to create a product that would protect against C. diff, and that would meet the challenge of keeping the neck, as well as the business end, of the stethoscope clean.

The solution: a disposable, lightweight, slip-on cover about 12 inches in length, which resembles the transparent plastic bags on rollers found in supermarket produce departments. The cover has a built-in, V-shaped seal into which the stethoscope tip is wedged. Dr. Ma plans to distribute his recently patented invention, called the Stethguard, at Saints, where all staff will be trained in its use, and to other hospitals in the state. He also hopes to license it to a medical supply distributor for wider distribution. He says it only costs pennies per bag, even less when mass-produced.

Demand for the Stethguard could be aided by the current national focus on preventing hospital-acquired infections. But will hospitalists embrace his invention? Perhaps not, Dr. Ma says, given that many doctors resist washing their hands before entering patients’ rooms. But if his idea catches on, consumers will eventually learn to demand it, he adds.

Stethoscopes can be magnets for infectious agents. As many as 1 in 3 stethoscopes used in EDs carry methicillin-resistant Staphylococcus aureus (Prehospital Emergency Care. 2009;13:71-74). Cleaning them with alcohol rubs can be cumbersome, however, and the alcohol doesn’t kill such infections as Clostridium difficile, which is common in hospitals and causes colitis, says Richard Ma, MD, chair of hospital medicine at Saints Memorial Medical Center in Lowell, Mass.

“Being a hospitalist, I see a lot around me that is wasteful and inefficient,” Dr. Ma says. Four years ago, he set out to create a product that would protect against C. diff, and that would meet the challenge of keeping the neck, as well as the business end, of the stethoscope clean.

The solution: a disposable, lightweight, slip-on cover about 12 inches in length, which resembles the transparent plastic bags on rollers found in supermarket produce departments. The cover has a built-in, V-shaped seal into which the stethoscope tip is wedged. Dr. Ma plans to distribute his recently patented invention, called the Stethguard, at Saints, where all staff will be trained in its use, and to other hospitals in the state. He also hopes to license it to a medical supply distributor for wider distribution. He says it only costs pennies per bag, even less when mass-produced.

Demand for the Stethguard could be aided by the current national focus on preventing hospital-acquired infections. But will hospitalists embrace his invention? Perhaps not, Dr. Ma says, given that many doctors resist washing their hands before entering patients’ rooms. But if his idea catches on, consumers will eventually learn to demand it, he adds.

Stethoscopes can be magnets for infectious agents. As many as 1 in 3 stethoscopes used in EDs carry methicillin-resistant Staphylococcus aureus (Prehospital Emergency Care. 2009;13:71-74). Cleaning them with alcohol rubs can be cumbersome, however, and the alcohol doesn’t kill such infections as Clostridium difficile, which is common in hospitals and causes colitis, says Richard Ma, MD, chair of hospital medicine at Saints Memorial Medical Center in Lowell, Mass.

“Being a hospitalist, I see a lot around me that is wasteful and inefficient,” Dr. Ma says. Four years ago, he set out to create a product that would protect against C. diff, and that would meet the challenge of keeping the neck, as well as the business end, of the stethoscope clean.

The solution: a disposable, lightweight, slip-on cover about 12 inches in length, which resembles the transparent plastic bags on rollers found in supermarket produce departments. The cover has a built-in, V-shaped seal into which the stethoscope tip is wedged. Dr. Ma plans to distribute his recently patented invention, called the Stethguard, at Saints, where all staff will be trained in its use, and to other hospitals in the state. He also hopes to license it to a medical supply distributor for wider distribution. He says it only costs pennies per bag, even less when mass-produced.

Demand for the Stethguard could be aided by the current national focus on preventing hospital-acquired infections. But will hospitalists embrace his invention? Perhaps not, Dr. Ma says, given that many doctors resist washing their hands before entering patients’ rooms. But if his idea catches on, consumers will eventually learn to demand it, he adds.

Pediatric Research in Inpatient Settings (PRIS), a network of pediatric hospitalists practicing at 150 academic and community hospitals, recently landed two federal stimulus grants totaling $12 million, far outstripping past support for research in the field, according to PRIS executive council chair Raj Srivastava, MD, MPH.

"Our mandate is to get federal dollars for multisite, transformative, clinical research for pediatric hospital medicine," says Dr. Srivastava, a pediatric hospitalist at Primary Children's Medical Center in Salt Lake City. "If we are going to be a real specialty, we have to conduct research to define best evidence and best practice: how to translate the evidence out into the field."

PRIS was formed in 2002 with sponsorship from SHM, the American Academy of Pediatrics, and the Academic Pediatric Association. Reorganized last year with a new executive council of active researchers, PRIS convened a strategic planning roundtable to reinvigorate the research agenda. In March, the Child Health Corporation of America, a business alliance of CEOs from 42 nonprofit children’s hospitals, awarded PRIS $1.4 million to support its infrastructure needs and a process that would prioritize research based on prevalence, cost, and variation in practice.

The federal stimulus monies, a pair of three-year grants awarded in September, will fund pediatric inpatient comparative effectiveness research. One of the grants, for $9 million, will support work to link clinical and administrative databases at six children’s hospitals. The second grant, worth $3 million, will be used to study the effectiveness of a resident handoff "bundle" of QI processes designed to enhance communication and improve signouts and transitions of care.

Dr. Srivastava says that, with the infrastructure now in place, more grant support will become possible. Adult hospitalists could use the PRIS experience as a model for building their own multisite research networks, he adds. “This kind of research matters because it is what we are all being asked to do in healthcare anyway,” he says.

Pediatric Research in Inpatient Settings (PRIS), a network of pediatric hospitalists practicing at 150 academic and community hospitals, recently landed two federal stimulus grants totaling $12 million, far outstripping past support for research in the field, according to PRIS executive council chair Raj Srivastava, MD, MPH.

"Our mandate is to get federal dollars for multisite, transformative, clinical research for pediatric hospital medicine," says Dr. Srivastava, a pediatric hospitalist at Primary Children's Medical Center in Salt Lake City. "If we are going to be a real specialty, we have to conduct research to define best evidence and best practice: how to translate the evidence out into the field."

PRIS was formed in 2002 with sponsorship from SHM, the American Academy of Pediatrics, and the Academic Pediatric Association. Reorganized last year with a new executive council of active researchers, PRIS convened a strategic planning roundtable to reinvigorate the research agenda. In March, the Child Health Corporation of America, a business alliance of CEOs from 42 nonprofit children’s hospitals, awarded PRIS $1.4 million to support its infrastructure needs and a process that would prioritize research based on prevalence, cost, and variation in practice.

The federal stimulus monies, a pair of three-year grants awarded in September, will fund pediatric inpatient comparative effectiveness research. One of the grants, for $9 million, will support work to link clinical and administrative databases at six children’s hospitals. The second grant, worth $3 million, will be used to study the effectiveness of a resident handoff "bundle" of QI processes designed to enhance communication and improve signouts and transitions of care.

Dr. Srivastava says that, with the infrastructure now in place, more grant support will become possible. Adult hospitalists could use the PRIS experience as a model for building their own multisite research networks, he adds. “This kind of research matters because it is what we are all being asked to do in healthcare anyway,” he says.

Pediatric Research in Inpatient Settings (PRIS), a network of pediatric hospitalists practicing at 150 academic and community hospitals, recently landed two federal stimulus grants totaling $12 million, far outstripping past support for research in the field, according to PRIS executive council chair Raj Srivastava, MD, MPH.

"Our mandate is to get federal dollars for multisite, transformative, clinical research for pediatric hospital medicine," says Dr. Srivastava, a pediatric hospitalist at Primary Children's Medical Center in Salt Lake City. "If we are going to be a real specialty, we have to conduct research to define best evidence and best practice: how to translate the evidence out into the field."

PRIS was formed in 2002 with sponsorship from SHM, the American Academy of Pediatrics, and the Academic Pediatric Association. Reorganized last year with a new executive council of active researchers, PRIS convened a strategic planning roundtable to reinvigorate the research agenda. In March, the Child Health Corporation of America, a business alliance of CEOs from 42 nonprofit children’s hospitals, awarded PRIS $1.4 million to support its infrastructure needs and a process that would prioritize research based on prevalence, cost, and variation in practice.

The federal stimulus monies, a pair of three-year grants awarded in September, will fund pediatric inpatient comparative effectiveness research. One of the grants, for $9 million, will support work to link clinical and administrative databases at six children’s hospitals. The second grant, worth $3 million, will be used to study the effectiveness of a resident handoff "bundle" of QI processes designed to enhance communication and improve signouts and transitions of care.

Dr. Srivastava says that, with the infrastructure now in place, more grant support will become possible. Adult hospitalists could use the PRIS experience as a model for building their own multisite research networks, he adds. “This kind of research matters because it is what we are all being asked to do in healthcare anyway,” he says.

Hospitalists at the "Management of the Hospitalized Patient" conference, Oct. 14-16 in San Francisco, expressed frustrations during an interactive presentation on how to reduce preventable rehospitalizations.

Participants described the challenges of high-risk patients who lack insurance coverage and a relationship with a primary care physician (PCP), which can negate streamlined outreach to PCPs at the time of discharge. “The people who least need follow-up, I'm able to call their physician. But it seems like the ones who most need follow-up care are the hardest to reach a PCP," one hospitalist observed ruefully. Participants also acknowledged steep learning curves for electronic medical records, even though they hope these could facilitate better discharge processes in the long run.

And careful patient education might not help with cases like the 75-year-old heart failure patient described in the July 28, 2009, issue of The Wall Street Journal, cited by the presenters as a typical example of readmission risk. Despite targeted education on the need to reduce her sodium intake, the patient insisted on eating a hot dog at a Fourth of July picnic and was readmitted to the hospital the following day.

Presenter Michelle Mourad, MD, medical director of CHF and Oncology Hospitalist Services at the University of California at San Francisco, which sponsors the annual conference, challenged hospitalists to identify readmission risk factors for their patients, including diagnoses of heart failure, pneumonia and COPD, high-risk medications and polypharmacy, poor health literacy, poor social support, and advanced age. Patients at risk could then become the focus of strategies designed to minimize rehospitalizations, including follow-up phone calls post-discharge and scheduling a visit to a PCP before the patient leaves the hospital.

Hospitalists have an important role in improving the quality of discharges at their hospitals, Dr. Mourad said. They can start by convening a multidisciplinary team of stakeholders that assesses current practice and designs process improvements.

“At UCSF, our discharge process was broken,” she says. A new QI process led to implementing patient teachback strategies, a hotline phone number discharged patients could call, and "core measures" of discharge quality, as well as designing new discharge folders with a user-friendly yellow medication card for patients to bring home.

Hospitalists at the "Management of the Hospitalized Patient" conference, Oct. 14-16 in San Francisco, expressed frustrations during an interactive presentation on how to reduce preventable rehospitalizations.

Participants described the challenges of high-risk patients who lack insurance coverage and a relationship with a primary care physician (PCP), which can negate streamlined outreach to PCPs at the time of discharge. “The people who least need follow-up, I'm able to call their physician. But it seems like the ones who most need follow-up care are the hardest to reach a PCP," one hospitalist observed ruefully. Participants also acknowledged steep learning curves for electronic medical records, even though they hope these could facilitate better discharge processes in the long run.

And careful patient education might not help with cases like the 75-year-old heart failure patient described in the July 28, 2009, issue of The Wall Street Journal, cited by the presenters as a typical example of readmission risk. Despite targeted education on the need to reduce her sodium intake, the patient insisted on eating a hot dog at a Fourth of July picnic and was readmitted to the hospital the following day.

Presenter Michelle Mourad, MD, medical director of CHF and Oncology Hospitalist Services at the University of California at San Francisco, which sponsors the annual conference, challenged hospitalists to identify readmission risk factors for their patients, including diagnoses of heart failure, pneumonia and COPD, high-risk medications and polypharmacy, poor health literacy, poor social support, and advanced age. Patients at risk could then become the focus of strategies designed to minimize rehospitalizations, including follow-up phone calls post-discharge and scheduling a visit to a PCP before the patient leaves the hospital.

Hospitalists have an important role in improving the quality of discharges at their hospitals, Dr. Mourad said. They can start by convening a multidisciplinary team of stakeholders that assesses current practice and designs process improvements.

“At UCSF, our discharge process was broken,” she says. A new QI process led to implementing patient teachback strategies, a hotline phone number discharged patients could call, and "core measures" of discharge quality, as well as designing new discharge folders with a user-friendly yellow medication card for patients to bring home.

Hospitalists at the "Management of the Hospitalized Patient" conference, Oct. 14-16 in San Francisco, expressed frustrations during an interactive presentation on how to reduce preventable rehospitalizations.

Participants described the challenges of high-risk patients who lack insurance coverage and a relationship with a primary care physician (PCP), which can negate streamlined outreach to PCPs at the time of discharge. “The people who least need follow-up, I'm able to call their physician. But it seems like the ones who most need follow-up care are the hardest to reach a PCP," one hospitalist observed ruefully. Participants also acknowledged steep learning curves for electronic medical records, even though they hope these could facilitate better discharge processes in the long run.

And careful patient education might not help with cases like the 75-year-old heart failure patient described in the July 28, 2009, issue of The Wall Street Journal, cited by the presenters as a typical example of readmission risk. Despite targeted education on the need to reduce her sodium intake, the patient insisted on eating a hot dog at a Fourth of July picnic and was readmitted to the hospital the following day.

Presenter Michelle Mourad, MD, medical director of CHF and Oncology Hospitalist Services at the University of California at San Francisco, which sponsors the annual conference, challenged hospitalists to identify readmission risk factors for their patients, including diagnoses of heart failure, pneumonia and COPD, high-risk medications and polypharmacy, poor health literacy, poor social support, and advanced age. Patients at risk could then become the focus of strategies designed to minimize rehospitalizations, including follow-up phone calls post-discharge and scheduling a visit to a PCP before the patient leaves the hospital.

Hospitalists have an important role in improving the quality of discharges at their hospitals, Dr. Mourad said. They can start by convening a multidisciplinary team of stakeholders that assesses current practice and designs process improvements.

“At UCSF, our discharge process was broken,” she says. A new QI process led to implementing patient teachback strategies, a hotline phone number discharged patients could call, and "core measures" of discharge quality, as well as designing new discharge folders with a user-friendly yellow medication card for patients to bring home.

A national study of trauma patients transferred from one hospital to another (J Trauma. 2010;69:602-606) has found significant rates of "secondary overtriage," which happens when the patient is discharged home less than a day after the transfer without undergoing a surgical procedure.

Such rapid discharge suggests that the transfer might not have been necessary in the first place, says lead author Hayley Osen, BA, research analyst at the University of California-San Diego Center for Surgical Systems and Public Health. The occurrence of secondary overtriage, which can cost nearly $6,000 ($12,000 for transfer by helicopter), was found to be higher among patients under 18 years of age (19.5%, versus 6.9% overall).

Hospitalists can be at both ends of these transfers, which often are between small or rural hospitals and regional medical centers. They can also play important roles in preventing unnecessary transfers, says Cleo Hardin, MD, SFHM, FAAP, section chief for pediatric hospital medicine and outreach at the University of Arizona in Tucson.

"Phone triage is absolutely vital as a first-line approach," Dr. Hardin says. Telemedicine links and teleradiology, the electronic transmission of X-rays for review by a specialist at the regional center, also help with the triage and management of patients at the referring institution, she adds.

Building good working relationships between the two facilities, establishing rapport between key connections, and knowing the resources within each facility can help, says Monika Gottlieb, MD, SFHM, who just left her job at Hospitalist Specialists in Spokane, Wash., to start a new position. "In these cases, a lot depends on understanding the capacity of the local facility, including nurses," she says.

It might be possible to establish mentorships with key specialists at regional centers, with mechanisms for how to reach them, Dr. Gottlieb explains, but hospitalists need to take responsibility for completing successful transfers and handoffs.

A national study of trauma patients transferred from one hospital to another (J Trauma. 2010;69:602-606) has found significant rates of "secondary overtriage," which happens when the patient is discharged home less than a day after the transfer without undergoing a surgical procedure.

Such rapid discharge suggests that the transfer might not have been necessary in the first place, says lead author Hayley Osen, BA, research analyst at the University of California-San Diego Center for Surgical Systems and Public Health. The occurrence of secondary overtriage, which can cost nearly $6,000 ($12,000 for transfer by helicopter), was found to be higher among patients under 18 years of age (19.5%, versus 6.9% overall).

Hospitalists can be at both ends of these transfers, which often are between small or rural hospitals and regional medical centers. They can also play important roles in preventing unnecessary transfers, says Cleo Hardin, MD, SFHM, FAAP, section chief for pediatric hospital medicine and outreach at the University of Arizona in Tucson.

"Phone triage is absolutely vital as a first-line approach," Dr. Hardin says. Telemedicine links and teleradiology, the electronic transmission of X-rays for review by a specialist at the regional center, also help with the triage and management of patients at the referring institution, she adds.

Building good working relationships between the two facilities, establishing rapport between key connections, and knowing the resources within each facility can help, says Monika Gottlieb, MD, SFHM, who just left her job at Hospitalist Specialists in Spokane, Wash., to start a new position. "In these cases, a lot depends on understanding the capacity of the local facility, including nurses," she says.

It might be possible to establish mentorships with key specialists at regional centers, with mechanisms for how to reach them, Dr. Gottlieb explains, but hospitalists need to take responsibility for completing successful transfers and handoffs.

A national study of trauma patients transferred from one hospital to another (J Trauma. 2010;69:602-606) has found significant rates of "secondary overtriage," which happens when the patient is discharged home less than a day after the transfer without undergoing a surgical procedure.

Such rapid discharge suggests that the transfer might not have been necessary in the first place, says lead author Hayley Osen, BA, research analyst at the University of California-San Diego Center for Surgical Systems and Public Health. The occurrence of secondary overtriage, which can cost nearly $6,000 ($12,000 for transfer by helicopter), was found to be higher among patients under 18 years of age (19.5%, versus 6.9% overall).

Hospitalists can be at both ends of these transfers, which often are between small or rural hospitals and regional medical centers. They can also play important roles in preventing unnecessary transfers, says Cleo Hardin, MD, SFHM, FAAP, section chief for pediatric hospital medicine and outreach at the University of Arizona in Tucson.

"Phone triage is absolutely vital as a first-line approach," Dr. Hardin says. Telemedicine links and teleradiology, the electronic transmission of X-rays for review by a specialist at the regional center, also help with the triage and management of patients at the referring institution, she adds.

Building good working relationships between the two facilities, establishing rapport between key connections, and knowing the resources within each facility can help, says Monika Gottlieb, MD, SFHM, who just left her job at Hospitalist Specialists in Spokane, Wash., to start a new position. "In these cases, a lot depends on understanding the capacity of the local facility, including nurses," she says.

It might be possible to establish mentorships with key specialists at regional centers, with mechanisms for how to reach them, Dr. Gottlieb explains, but hospitalists need to take responsibility for completing successful transfers and handoffs.

Hospitalist leader Adam Singer, MD, is to be formally named physician executive of the year on Oct. 26 by the Medical Group Management Association (MGMA), a national association of 21,500 administrators and leaders of physician group practices. Dr. Singer, who learned of the award last month, is the first hospitalist honoree.

The award recognizes physician executives who have exhibited outstanding leadership and achieved exceptional performance in healthcare delivery.

Dr. Singer, 50, who is founder, CEO, and chief medical officer of IPC: The Hospitalist Company, took the North Hollywood, Calif.-based company public in 2008. A founding member of SHM, Dr. Singer's award represents a milestone in the growing acceptance of HM as a medical business and of its business model, says Dan Fuller, president of IN Compass Health of Alpharetta, Ga.

“We’re seeing more attention to hospitalist compensation models, payment incentives, and recognition of the need to align these with both productivity and quality,” says Dr. Fuller, a member of SHM's Practice Management Committee. The award “is great for Adam, but really exciting for our movement.”

Steven Deitelzweig, MD, chair of hospital medicine for Ochsner Health System in New Orleans and chair of SHM’s Practice Management Committee, says the MGMA honor reflects growing recognition of the role hospitalists will play in the changing business of hospital care under Affordable Care Act reforms. “Hospitalists will be the ones senior hospital leaders come to for help in figuring out healthcare reform,” he says.

Dr. Singer says the award recognizes his success, as a physician, and as an entrepreneur, and is a "signpost for hospital medicine as a whole. They're recognizing HM not just as a medical specialty that has emerged in recent years, but our success as a business," he says. "HM is a business, at least as we practice it at IPC. We've shown that it can be profitable as a standalone medical service, without requiring subsidization."

Hospitalist leader Adam Singer, MD, is to be formally named physician executive of the year on Oct. 26 by the Medical Group Management Association (MGMA), a national association of 21,500 administrators and leaders of physician group practices. Dr. Singer, who learned of the award last month, is the first hospitalist honoree.

The award recognizes physician executives who have exhibited outstanding leadership and achieved exceptional performance in healthcare delivery.

Dr. Singer, 50, who is founder, CEO, and chief medical officer of IPC: The Hospitalist Company, took the North Hollywood, Calif.-based company public in 2008. A founding member of SHM, Dr. Singer's award represents a milestone in the growing acceptance of HM as a medical business and of its business model, says Dan Fuller, president of IN Compass Health of Alpharetta, Ga.

“We’re seeing more attention to hospitalist compensation models, payment incentives, and recognition of the need to align these with both productivity and quality,” says Dr. Fuller, a member of SHM's Practice Management Committee. The award “is great for Adam, but really exciting for our movement.”

Steven Deitelzweig, MD, chair of hospital medicine for Ochsner Health System in New Orleans and chair of SHM’s Practice Management Committee, says the MGMA honor reflects growing recognition of the role hospitalists will play in the changing business of hospital care under Affordable Care Act reforms. “Hospitalists will be the ones senior hospital leaders come to for help in figuring out healthcare reform,” he says.

Dr. Singer says the award recognizes his success, as a physician, and as an entrepreneur, and is a "signpost for hospital medicine as a whole. They're recognizing HM not just as a medical specialty that has emerged in recent years, but our success as a business," he says. "HM is a business, at least as we practice it at IPC. We've shown that it can be profitable as a standalone medical service, without requiring subsidization."

Hospitalist leader Adam Singer, MD, is to be formally named physician executive of the year on Oct. 26 by the Medical Group Management Association (MGMA), a national association of 21,500 administrators and leaders of physician group practices. Dr. Singer, who learned of the award last month, is the first hospitalist honoree.

The award recognizes physician executives who have exhibited outstanding leadership and achieved exceptional performance in healthcare delivery.

Dr. Singer, 50, who is founder, CEO, and chief medical officer of IPC: The Hospitalist Company, took the North Hollywood, Calif.-based company public in 2008. A founding member of SHM, Dr. Singer's award represents a milestone in the growing acceptance of HM as a medical business and of its business model, says Dan Fuller, president of IN Compass Health of Alpharetta, Ga.

“We’re seeing more attention to hospitalist compensation models, payment incentives, and recognition of the need to align these with both productivity and quality,” says Dr. Fuller, a member of SHM's Practice Management Committee. The award “is great for Adam, but really exciting for our movement.”

Steven Deitelzweig, MD, chair of hospital medicine for Ochsner Health System in New Orleans and chair of SHM’s Practice Management Committee, says the MGMA honor reflects growing recognition of the role hospitalists will play in the changing business of hospital care under Affordable Care Act reforms. “Hospitalists will be the ones senior hospital leaders come to for help in figuring out healthcare reform,” he says.

Dr. Singer says the award recognizes his success, as a physician, and as an entrepreneur, and is a "signpost for hospital medicine as a whole. They're recognizing HM not just as a medical specialty that has emerged in recent years, but our success as a business," he says. "HM is a business, at least as we practice it at IPC. We've shown that it can be profitable as a standalone medical service, without requiring subsidization."

John Harney, COO at University of Colorado Hospital, moved west in 2008 after working at New York University Hospitals Center. The East Coast hospital had used a grant to establish a palliative-care program and witnessed immediate results.

“We truly believed it resulted in reductions in length of stay, as well as humanistic benefits,” Harney says. “When I came out to Colorado, I was pleasantly surprised at the breadth and depth of the programs here.”

Harney says he believes HM is a logical place to advance palliative care to the next level, as most HM groups already possess an in-house presence and commitment to efficient throughput. Hospital administrators will be concerned with consistency, routines, and protocols, he says, as well as the palliative-care service’s commitment to quality improvement. Those same administrators appreciate the need for program and salary support, although he advises palliative-care advocates to do their homework and develop a viable business plan.

“Hospital administrators will quickly figure out the math,” Harney says. “If you’re coming to speak to us, you need to have your numbers in order. You also need some monitoring in place.”

The initial salvo should include confirmation that HM group leaders have done their homework: surveyed their HM staff and discussed the idea with oncologists and other specialists. “It’s also helpful to have real champions in nursing and social work,” Harney says. “It’s never easy to get financial support for a new program, but if you have those ducks lined up, it goes better.”

John Harney, COO at University of Colorado Hospital, moved west in 2008 after working at New York University Hospitals Center. The East Coast hospital had used a grant to establish a palliative-care program and witnessed immediate results.

“We truly believed it resulted in reductions in length of stay, as well as humanistic benefits,” Harney says. “When I came out to Colorado, I was pleasantly surprised at the breadth and depth of the programs here.”

Harney says he believes HM is a logical place to advance palliative care to the next level, as most HM groups already possess an in-house presence and commitment to efficient throughput. Hospital administrators will be concerned with consistency, routines, and protocols, he says, as well as the palliative-care service’s commitment to quality improvement. Those same administrators appreciate the need for program and salary support, although he advises palliative-care advocates to do their homework and develop a viable business plan.

“Hospital administrators will quickly figure out the math,” Harney says. “If you’re coming to speak to us, you need to have your numbers in order. You also need some monitoring in place.”

The initial salvo should include confirmation that HM group leaders have done their homework: surveyed their HM staff and discussed the idea with oncologists and other specialists. “It’s also helpful to have real champions in nursing and social work,” Harney says. “It’s never easy to get financial support for a new program, but if you have those ducks lined up, it goes better.”

John Harney, COO at University of Colorado Hospital, moved west in 2008 after working at New York University Hospitals Center. The East Coast hospital had used a grant to establish a palliative-care program and witnessed immediate results.

“We truly believed it resulted in reductions in length of stay, as well as humanistic benefits,” Harney says. “When I came out to Colorado, I was pleasantly surprised at the breadth and depth of the programs here.”

Harney says he believes HM is a logical place to advance palliative care to the next level, as most HM groups already possess an in-house presence and commitment to efficient throughput. Hospital administrators will be concerned with consistency, routines, and protocols, he says, as well as the palliative-care service’s commitment to quality improvement. Those same administrators appreciate the need for program and salary support, although he advises palliative-care advocates to do their homework and develop a viable business plan.

“Hospital administrators will quickly figure out the math,” Harney says. “If you’re coming to speak to us, you need to have your numbers in order. You also need some monitoring in place.”

The initial salvo should include confirmation that HM group leaders have done their homework: surveyed their HM staff and discussed the idea with oncologists and other specialists. “It’s also helpful to have real champions in nursing and social work,” Harney says. “It’s never easy to get financial support for a new program, but if you have those ducks lined up, it goes better.”

Could U.S. hospitals learn from how HM is practiced in developing nations such as Ecuador? David Gaus, MD, MS, founder and director of Andean Health and Development (AHD), thinks so.

Dr. Gaus, who spends half the year as assistant clinical professor of medicine and teaching hospitalist at the University of Wisconsin and the other half with AHD in Ecuador, was inspired to pursue a medical degree by doing development work in Ecuador. When he returned to Ecuador in 1995 to be a doctor to the poor, he discovered a major gap in the healthcare system, between undertrained rural PCPs and the specialist-heavy medical practice in the country’s capital of Quito.

Under his leadership, AHD established a hospital in the rural community of Pedro Vicente Maldonado; it opened in 2000 and now is financially self-sufficient. “The focus was on the need for cost-effective, high-quality hospital services in a country with a dearth of hospitals,” he says.

At the hospital, family-practice physicians serve as hospitalists and deal with a wide spectrum of clinical needs ranging from car accidents and complicated pregnancies to snake bites and toxic organic phosphate herbicide exposure.

“Rural hospitals can’t afford five or six types of attendings, but if you have well-trained family practitioners backed by a general surgeon, they can handle most of the spectrum of clinical needs and the chaos management,” he says. Increasingly, those clinical needs include such chronic degenerative diseases as diabetes, hypertension, and arthritis, for which Ecuador’s cadre of rural PCPs are not trained.

Dr. Gaus is planning a second hospital in the larger Ecuadorean city of Santo Domingo (population 400,000), with the support of the Ministry of Public Health and the Social Security system. The new facility, using the same model and hospitalist roles, will open in 12 to 18 months and will increase the number of three-year family-practice residency slots from six to 20.

Could U.S. hospitals learn from how HM is practiced in developing nations such as Ecuador? David Gaus, MD, MS, founder and director of Andean Health and Development (AHD), thinks so.

Dr. Gaus, who spends half the year as assistant clinical professor of medicine and teaching hospitalist at the University of Wisconsin and the other half with AHD in Ecuador, was inspired to pursue a medical degree by doing development work in Ecuador. When he returned to Ecuador in 1995 to be a doctor to the poor, he discovered a major gap in the healthcare system, between undertrained rural PCPs and the specialist-heavy medical practice in the country’s capital of Quito.

Under his leadership, AHD established a hospital in the rural community of Pedro Vicente Maldonado; it opened in 2000 and now is financially self-sufficient. “The focus was on the need for cost-effective, high-quality hospital services in a country with a dearth of hospitals,” he says.

At the hospital, family-practice physicians serve as hospitalists and deal with a wide spectrum of clinical needs ranging from car accidents and complicated pregnancies to snake bites and toxic organic phosphate herbicide exposure.

“Rural hospitals can’t afford five or six types of attendings, but if you have well-trained family practitioners backed by a general surgeon, they can handle most of the spectrum of clinical needs and the chaos management,” he says. Increasingly, those clinical needs include such chronic degenerative diseases as diabetes, hypertension, and arthritis, for which Ecuador’s cadre of rural PCPs are not trained.

Dr. Gaus is planning a second hospital in the larger Ecuadorean city of Santo Domingo (population 400,000), with the support of the Ministry of Public Health and the Social Security system. The new facility, using the same model and hospitalist roles, will open in 12 to 18 months and will increase the number of three-year family-practice residency slots from six to 20.

Could U.S. hospitals learn from how HM is practiced in developing nations such as Ecuador? David Gaus, MD, MS, founder and director of Andean Health and Development (AHD), thinks so.

Dr. Gaus, who spends half the year as assistant clinical professor of medicine and teaching hospitalist at the University of Wisconsin and the other half with AHD in Ecuador, was inspired to pursue a medical degree by doing development work in Ecuador. When he returned to Ecuador in 1995 to be a doctor to the poor, he discovered a major gap in the healthcare system, between undertrained rural PCPs and the specialist-heavy medical practice in the country’s capital of Quito.

Under his leadership, AHD established a hospital in the rural community of Pedro Vicente Maldonado; it opened in 2000 and now is financially self-sufficient. “The focus was on the need for cost-effective, high-quality hospital services in a country with a dearth of hospitals,” he says.

At the hospital, family-practice physicians serve as hospitalists and deal with a wide spectrum of clinical needs ranging from car accidents and complicated pregnancies to snake bites and toxic organic phosphate herbicide exposure.

“Rural hospitals can’t afford five or six types of attendings, but if you have well-trained family practitioners backed by a general surgeon, they can handle most of the spectrum of clinical needs and the chaos management,” he says. Increasingly, those clinical needs include such chronic degenerative diseases as diabetes, hypertension, and arthritis, for which Ecuador’s cadre of rural PCPs are not trained.

Dr. Gaus is planning a second hospital in the larger Ecuadorean city of Santo Domingo (population 400,000), with the support of the Ministry of Public Health and the Social Security system. The new facility, using the same model and hospitalist roles, will open in 12 to 18 months and will increase the number of three-year family-practice residency slots from six to 20.

A new study comparing physicians who were trained in the U.S. with those trained in medical schools abroad should offer reassurance to patients, families, and professional peers who hold biases against foreign-born or foreign-trained physicians, the lead author says.

John Norcini, PhD, CEO of the Foundation for Advancement of International Medical Education and Research, and colleagues studied 244,000 hospitalized Pennsylvania patients with congestive heart failure and acute myocardial infarction. They found that mortality rates were slightly lower for physicians who were trained abroad and were not U.S. citizens when they entered medical school. The study showed higher rates for U.S. citizens who went overseas for their medical training.

The Norcini study (Health Affairs. 2010;29:1461-1468) focused on family medicine, internal medicine, and cardiology physicians, but it did not identify hospitalists. One-quarter of all physicians practicing in the U.S. are foreign-trained; however, a greater proportion are found in primary care and internal medicine. For hospitalists, the foreign-trained percentage might be even higher, 40% according to Philip Miller of the physician recruiting firm Merritt Hawkins.

One thing that can be said about international medical graduates is that they are a “crucial and growing part of the hospital medicine workforce, and we welcome them,” says Winthrop Whitcomb, MD, MHM, former SHM president and medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. “I find, having worked with physicians trained all over the world, that for the best ones, it’s what they do every day, not where they came from. Are they consistent, careful, compassionate and committed to improving day by day?”

The challenge for hospitalist groups, he adds is to clearly state expectations for physicians, hold them accountable, make sure they understand the group’s goals and standards, and offer the tools they need to improve. An example could be access to English as a Second Language instruction to enhance communication.

A new study comparing physicians who were trained in the U.S. with those trained in medical schools abroad should offer reassurance to patients, families, and professional peers who hold biases against foreign-born or foreign-trained physicians, the lead author says.

John Norcini, PhD, CEO of the Foundation for Advancement of International Medical Education and Research, and colleagues studied 244,000 hospitalized Pennsylvania patients with congestive heart failure and acute myocardial infarction. They found that mortality rates were slightly lower for physicians who were trained abroad and were not U.S. citizens when they entered medical school. The study showed higher rates for U.S. citizens who went overseas for their medical training.

The Norcini study (Health Affairs. 2010;29:1461-1468) focused on family medicine, internal medicine, and cardiology physicians, but it did not identify hospitalists. One-quarter of all physicians practicing in the U.S. are foreign-trained; however, a greater proportion are found in primary care and internal medicine. For hospitalists, the foreign-trained percentage might be even higher, 40% according to Philip Miller of the physician recruiting firm Merritt Hawkins.

One thing that can be said about international medical graduates is that they are a “crucial and growing part of the hospital medicine workforce, and we welcome them,” says Winthrop Whitcomb, MD, MHM, former SHM president and medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. “I find, having worked with physicians trained all over the world, that for the best ones, it’s what they do every day, not where they came from. Are they consistent, careful, compassionate and committed to improving day by day?”

The challenge for hospitalist groups, he adds is to clearly state expectations for physicians, hold them accountable, make sure they understand the group’s goals and standards, and offer the tools they need to improve. An example could be access to English as a Second Language instruction to enhance communication.

A new study comparing physicians who were trained in the U.S. with those trained in medical schools abroad should offer reassurance to patients, families, and professional peers who hold biases against foreign-born or foreign-trained physicians, the lead author says.

John Norcini, PhD, CEO of the Foundation for Advancement of International Medical Education and Research, and colleagues studied 244,000 hospitalized Pennsylvania patients with congestive heart failure and acute myocardial infarction. They found that mortality rates were slightly lower for physicians who were trained abroad and were not U.S. citizens when they entered medical school. The study showed higher rates for U.S. citizens who went overseas for their medical training.

The Norcini study (Health Affairs. 2010;29:1461-1468) focused on family medicine, internal medicine, and cardiology physicians, but it did not identify hospitalists. One-quarter of all physicians practicing in the U.S. are foreign-trained; however, a greater proportion are found in primary care and internal medicine. For hospitalists, the foreign-trained percentage might be even higher, 40% according to Philip Miller of the physician recruiting firm Merritt Hawkins.

One thing that can be said about international medical graduates is that they are a “crucial and growing part of the hospital medicine workforce, and we welcome them,” says Winthrop Whitcomb, MD, MHM, former SHM president and medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. “I find, having worked with physicians trained all over the world, that for the best ones, it’s what they do every day, not where they came from. Are they consistent, careful, compassionate and committed to improving day by day?”

The challenge for hospitalist groups, he adds is to clearly state expectations for physicians, hold them accountable, make sure they understand the group’s goals and standards, and offer the tools they need to improve. An example could be access to English as a Second Language instruction to enhance communication.