Stephanie C. MacKiewicz

A new report has found that only a small number of groups included in a government-funded experiment to cut Medicare readmissions actually produced results. However, the less-than-hoped-for results don't necessarily indicate failure, a hospitalist and readmissions expert says.

The Community-based Care Transitions Program (CCTP) is one of several test care-delivery models created by the Affordable Care Act. Its main goal is to improve transitions of Medicare patients from the hospital to community-based settings, such as nursing homes, rehabilitation facilities, and government agencies that provide services to the elderly, and thereby reduce readmissions.

However, a new report [PDF] commissioned by the Centers for Medicare & Medicaid Services found that only four CCTP groups of the 48 studied significantly cut readmissions compared with those of a control group. The report was finished in May 2014 but wasn't made public until January.

"There are so few examples in healthcare where resource alignment makes sense with what we believe are the ideal ways of practicing," says Jeffrey L. Greenwald, MD, associate professor of medicine at Harvard Medical School and a member of the Inpatient Clinician Educator Service at Massachusetts General Hospital, both in Boston. "Things like CCTP, where you have an opportunity to partner a hospital with a community-based organization that can help to support patient transitions still looks promising despite its warts."

CCTP, funded with $300 million over five years, signed its first round of deals with community agencies in late 2011. The report covered partial 2012 results from groups participating in the early rounds.

Dr. Greenwald is one of the cofounders of SHM's Project BOOST, a yearlong QI program in which hospital teams are paired with mentors to help them improve care transitions. He explained that BOOST teams typically need at least 18-24 months to show positive results on length-of-stay or readmissions reductions.

"These are long processes that don't turn around overnight," Dr. Greenwald adds. "If they do, it's probably because [the hospital team] put in place something that is not sustainable, and the minute they stop measuring and keeping an eye on it, it will likely deteriorate.

"There's no magic bullet in care transitions."

Visit our website for more information on ways hospitals can reduce readmissions.

A new report has found that only a small number of groups included in a government-funded experiment to cut Medicare readmissions actually produced results. However, the less-than-hoped-for results don't necessarily indicate failure, a hospitalist and readmissions expert says.

The Community-based Care Transitions Program (CCTP) is one of several test care-delivery models created by the Affordable Care Act. Its main goal is to improve transitions of Medicare patients from the hospital to community-based settings, such as nursing homes, rehabilitation facilities, and government agencies that provide services to the elderly, and thereby reduce readmissions.

However, a new report [PDF] commissioned by the Centers for Medicare & Medicaid Services found that only four CCTP groups of the 48 studied significantly cut readmissions compared with those of a control group. The report was finished in May 2014 but wasn't made public until January.

"There are so few examples in healthcare where resource alignment makes sense with what we believe are the ideal ways of practicing," says Jeffrey L. Greenwald, MD, associate professor of medicine at Harvard Medical School and a member of the Inpatient Clinician Educator Service at Massachusetts General Hospital, both in Boston. "Things like CCTP, where you have an opportunity to partner a hospital with a community-based organization that can help to support patient transitions still looks promising despite its warts."

CCTP, funded with $300 million over five years, signed its first round of deals with community agencies in late 2011. The report covered partial 2012 results from groups participating in the early rounds.

Dr. Greenwald is one of the cofounders of SHM's Project BOOST, a yearlong QI program in which hospital teams are paired with mentors to help them improve care transitions. He explained that BOOST teams typically need at least 18-24 months to show positive results on length-of-stay or readmissions reductions.

"These are long processes that don't turn around overnight," Dr. Greenwald adds. "If they do, it's probably because [the hospital team] put in place something that is not sustainable, and the minute they stop measuring and keeping an eye on it, it will likely deteriorate.

"There's no magic bullet in care transitions."

Visit our website for more information on ways hospitals can reduce readmissions.

A new report has found that only a small number of groups included in a government-funded experiment to cut Medicare readmissions actually produced results. However, the less-than-hoped-for results don't necessarily indicate failure, a hospitalist and readmissions expert says.

The Community-based Care Transitions Program (CCTP) is one of several test care-delivery models created by the Affordable Care Act. Its main goal is to improve transitions of Medicare patients from the hospital to community-based settings, such as nursing homes, rehabilitation facilities, and government agencies that provide services to the elderly, and thereby reduce readmissions.

However, a new report [PDF] commissioned by the Centers for Medicare & Medicaid Services found that only four CCTP groups of the 48 studied significantly cut readmissions compared with those of a control group. The report was finished in May 2014 but wasn't made public until January.

"There are so few examples in healthcare where resource alignment makes sense with what we believe are the ideal ways of practicing," says Jeffrey L. Greenwald, MD, associate professor of medicine at Harvard Medical School and a member of the Inpatient Clinician Educator Service at Massachusetts General Hospital, both in Boston. "Things like CCTP, where you have an opportunity to partner a hospital with a community-based organization that can help to support patient transitions still looks promising despite its warts."

CCTP, funded with $300 million over five years, signed its first round of deals with community agencies in late 2011. The report covered partial 2012 results from groups participating in the early rounds.

Dr. Greenwald is one of the cofounders of SHM's Project BOOST, a yearlong QI program in which hospital teams are paired with mentors to help them improve care transitions. He explained that BOOST teams typically need at least 18-24 months to show positive results on length-of-stay or readmissions reductions.

"These are long processes that don't turn around overnight," Dr. Greenwald adds. "If they do, it's probably because [the hospital team] put in place something that is not sustainable, and the minute they stop measuring and keeping an eye on it, it will likely deteriorate.

"There's no magic bullet in care transitions."

Visit our website for more information on ways hospitals can reduce readmissions.

Hospitalists should not only lead efforts to control potential Ebola outbreaks in the U.S. but should also play a role in improving global healthcare, say the authors of a recent article in the Journal of Hospital Medicine.

Author Phuoc Le, MD, MPH, assistant professor of medicine and pediatrics at the University of California San Francisco where he co-directs the Global Health-Hospital Medicine Fellowship, is also cofounder of the HEAL Initiative, a global healthcare campaign designed to improve the health of vulnerable populations worldwide. HEAL, short for Health, Equity, Action, and Leadership, recently won the 2015 SHM Award for Excellence in Humanitarian Service.

Dr. Le recently spoke with TH about why hospitalists are well-equipped to handle global health problems.

Question: In your paper, you call on hospitalists to join the ranks of global health hospitalists. Can you explain?

Answer: Whether it’s Navajo Nation in Arizona or rural Haiti, the healthcare needs of the poor are very similar. Global health hospitalists play an important role in building capacity, running a health system, improving quality while reducing costs, working in teams to provide holistic care for the inpatient, and improving transitions to the outpatient setting.

Q: How do the skills learned in resource-poor settings apply back home?

A: Let's say you have a patient with tuberculosis, which is very common in places like Liberia, and you suspect fluid in the lungs. [In Liberia], you would insert a needle and remove the fluid. In the U.S., a lot of providers would not be able to remove the fluid without getting an ultrasound and multiple other studies. Those costs add up. Global health hospitalists are very well-versed in the skills of ultrasonography because there are no ultrasonographers in the field working with us.

Q: You've spent time in Haiti and said that is where you began to notice volunteers arriving with good intentions but without needed skills. What exactly did you learn?

A: I spent a lot of time there, responding to the earthquake and also the cholera epidemic in 2010. I came across dozens of healthcare volunteers who had passion and commitment but really came ill-prepared, not through any fault of their own but because they never had an opportunity to learn the skills needed to be effective in the field. For example, take a nurse from an ivory-tower hospital and suddenly put her where she doesn’t have IVs to work with or the right type of fluids or tubing. Well, suddenly she feels like her efficacy has gone way down. That could easily lead to a lot of frustration and potential burnout. That’s why we started the HEAL Initiative, which is a two-year program for healthcare workers who want to learn the skills needed to work in poor settings.

Q: How can hospitalists get involved in global health?

A: Come to the Society of Hospital Medicine annual meeting in March where we’ll be hosting a special-interest session called Global Health and Human Rights.

Visit our website for more information about global health hospitalists.

Hospitalists should not only lead efforts to control potential Ebola outbreaks in the U.S. but should also play a role in improving global healthcare, say the authors of a recent article in the Journal of Hospital Medicine.

Author Phuoc Le, MD, MPH, assistant professor of medicine and pediatrics at the University of California San Francisco where he co-directs the Global Health-Hospital Medicine Fellowship, is also cofounder of the HEAL Initiative, a global healthcare campaign designed to improve the health of vulnerable populations worldwide. HEAL, short for Health, Equity, Action, and Leadership, recently won the 2015 SHM Award for Excellence in Humanitarian Service.

Dr. Le recently spoke with TH about why hospitalists are well-equipped to handle global health problems.

Question: In your paper, you call on hospitalists to join the ranks of global health hospitalists. Can you explain?

Answer: Whether it’s Navajo Nation in Arizona or rural Haiti, the healthcare needs of the poor are very similar. Global health hospitalists play an important role in building capacity, running a health system, improving quality while reducing costs, working in teams to provide holistic care for the inpatient, and improving transitions to the outpatient setting.

Q: How do the skills learned in resource-poor settings apply back home?

A: Let's say you have a patient with tuberculosis, which is very common in places like Liberia, and you suspect fluid in the lungs. [In Liberia], you would insert a needle and remove the fluid. In the U.S., a lot of providers would not be able to remove the fluid without getting an ultrasound and multiple other studies. Those costs add up. Global health hospitalists are very well-versed in the skills of ultrasonography because there are no ultrasonographers in the field working with us.

Q: You've spent time in Haiti and said that is where you began to notice volunteers arriving with good intentions but without needed skills. What exactly did you learn?

A: I spent a lot of time there, responding to the earthquake and also the cholera epidemic in 2010. I came across dozens of healthcare volunteers who had passion and commitment but really came ill-prepared, not through any fault of their own but because they never had an opportunity to learn the skills needed to be effective in the field. For example, take a nurse from an ivory-tower hospital and suddenly put her where she doesn’t have IVs to work with or the right type of fluids or tubing. Well, suddenly she feels like her efficacy has gone way down. That could easily lead to a lot of frustration and potential burnout. That’s why we started the HEAL Initiative, which is a two-year program for healthcare workers who want to learn the skills needed to work in poor settings.

Q: How can hospitalists get involved in global health?

A: Come to the Society of Hospital Medicine annual meeting in March where we’ll be hosting a special-interest session called Global Health and Human Rights.

Visit our website for more information about global health hospitalists.

Hospitalists should not only lead efforts to control potential Ebola outbreaks in the U.S. but should also play a role in improving global healthcare, say the authors of a recent article in the Journal of Hospital Medicine.

Author Phuoc Le, MD, MPH, assistant professor of medicine and pediatrics at the University of California San Francisco where he co-directs the Global Health-Hospital Medicine Fellowship, is also cofounder of the HEAL Initiative, a global healthcare campaign designed to improve the health of vulnerable populations worldwide. HEAL, short for Health, Equity, Action, and Leadership, recently won the 2015 SHM Award for Excellence in Humanitarian Service.

Dr. Le recently spoke with TH about why hospitalists are well-equipped to handle global health problems.

Question: In your paper, you call on hospitalists to join the ranks of global health hospitalists. Can you explain?

Answer: Whether it’s Navajo Nation in Arizona or rural Haiti, the healthcare needs of the poor are very similar. Global health hospitalists play an important role in building capacity, running a health system, improving quality while reducing costs, working in teams to provide holistic care for the inpatient, and improving transitions to the outpatient setting.

Q: How do the skills learned in resource-poor settings apply back home?

A: Let's say you have a patient with tuberculosis, which is very common in places like Liberia, and you suspect fluid in the lungs. [In Liberia], you would insert a needle and remove the fluid. In the U.S., a lot of providers would not be able to remove the fluid without getting an ultrasound and multiple other studies. Those costs add up. Global health hospitalists are very well-versed in the skills of ultrasonography because there are no ultrasonographers in the field working with us.

Q: You've spent time in Haiti and said that is where you began to notice volunteers arriving with good intentions but without needed skills. What exactly did you learn?

A: I spent a lot of time there, responding to the earthquake and also the cholera epidemic in 2010. I came across dozens of healthcare volunteers who had passion and commitment but really came ill-prepared, not through any fault of their own but because they never had an opportunity to learn the skills needed to be effective in the field. For example, take a nurse from an ivory-tower hospital and suddenly put her where she doesn’t have IVs to work with or the right type of fluids or tubing. Well, suddenly she feels like her efficacy has gone way down. That could easily lead to a lot of frustration and potential burnout. That’s why we started the HEAL Initiative, which is a two-year program for healthcare workers who want to learn the skills needed to work in poor settings.

Q: How can hospitalists get involved in global health?

A: Come to the Society of Hospital Medicine annual meeting in March where we’ll be hosting a special-interest session called Global Health and Human Rights.

Visit our website for more information about global health hospitalists.

Hospitalists caring for patients with chronic liver disease should consider administering the hepatitis A vaccine upon discharge, says an expert from the CDC.

The recommendation is based on a new study published in Hepatology that shows the rate of hospitalizations caused by a hepatitis A virus (HAV) infection declined significantly in the U.S. from 2002 to 2011. It also reports that older patients and those with chronic liver disease are most likely to be hospitalized with HAV, says Melissa Collier, MD, MPH, a medical epidemiologist within the CDC's division of viral hepatitis.

Dr. Collier and colleagues analyzed ICD-9 codes from the National Inpatient Survey discharge data, focusing on U.S. residents hospitalized with a principal hepatitis A diagnosis and accompanying secondary diagnoses. They found that from 2002 to 2011:

• Rates of hospitalization for hepatitis A as a principal diagnosis decreased from 0.72/100,000 to 0.29/100,000 (P

• Mean age of those hospitalized increased from 37.6 years to 45.5 years (P

• Percentage of hepatitis A hospitalizations covered by Medicare increased from 12.4% to 22.7% (P

• Secondary, comorbid discharge diagnoses, including liver disease, hypertension, ischemic heart disease, disorders of lipid metabolism, and chronic liver disease, increased; and
• No changes were reported in patients’ length of stay or in-hospital deaths from hepatitis A, but persons with liver disease were hospitalized longer.

According to Dr. Collier, the drop in hospitalization rates could be explained by lower incidence of hepatitis A since the Advisory Committee on Immunization Practices (ACIP) recommended universal childhood vaccination in 2006.

Dr. Collier, who is a member of the ACIP hepatitis A working group, also points out that the ACIP recommends all patients with chronic liver disease be vaccinated. She says hospitalists should give patients with chronic liver disease the first dose of the vaccine upon discharge and ask those patients' PCPs to administer the second dose.

"Patients don't think about needing to be vaccinated, and if their physicians aren't recommending it, they aren't going to seek it," she says. Dr. Collier noted that data show only about 12% of people age 19 to 49 have received the hepatitis A vaccine. TH

Visit our website for more information on treating liver disease.

Hospitalists caring for patients with chronic liver disease should consider administering the hepatitis A vaccine upon discharge, says an expert from the CDC.

The recommendation is based on a new study published in Hepatology that shows the rate of hospitalizations caused by a hepatitis A virus (HAV) infection declined significantly in the U.S. from 2002 to 2011. It also reports that older patients and those with chronic liver disease are most likely to be hospitalized with HAV, says Melissa Collier, MD, MPH, a medical epidemiologist within the CDC's division of viral hepatitis.

Dr. Collier and colleagues analyzed ICD-9 codes from the National Inpatient Survey discharge data, focusing on U.S. residents hospitalized with a principal hepatitis A diagnosis and accompanying secondary diagnoses. They found that from 2002 to 2011:

• Rates of hospitalization for hepatitis A as a principal diagnosis decreased from 0.72/100,000 to 0.29/100,000 (P

• Mean age of those hospitalized increased from 37.6 years to 45.5 years (P

• Percentage of hepatitis A hospitalizations covered by Medicare increased from 12.4% to 22.7% (P

• Secondary, comorbid discharge diagnoses, including liver disease, hypertension, ischemic heart disease, disorders of lipid metabolism, and chronic liver disease, increased; and
• No changes were reported in patients’ length of stay or in-hospital deaths from hepatitis A, but persons with liver disease were hospitalized longer.

According to Dr. Collier, the drop in hospitalization rates could be explained by lower incidence of hepatitis A since the Advisory Committee on Immunization Practices (ACIP) recommended universal childhood vaccination in 2006.

Dr. Collier, who is a member of the ACIP hepatitis A working group, also points out that the ACIP recommends all patients with chronic liver disease be vaccinated. She says hospitalists should give patients with chronic liver disease the first dose of the vaccine upon discharge and ask those patients' PCPs to administer the second dose.

"Patients don't think about needing to be vaccinated, and if their physicians aren't recommending it, they aren't going to seek it," she says. Dr. Collier noted that data show only about 12% of people age 19 to 49 have received the hepatitis A vaccine. TH

Visit our website for more information on treating liver disease.

Hospitalists caring for patients with chronic liver disease should consider administering the hepatitis A vaccine upon discharge, says an expert from the CDC.

The recommendation is based on a new study published in Hepatology that shows the rate of hospitalizations caused by a hepatitis A virus (HAV) infection declined significantly in the U.S. from 2002 to 2011. It also reports that older patients and those with chronic liver disease are most likely to be hospitalized with HAV, says Melissa Collier, MD, MPH, a medical epidemiologist within the CDC's division of viral hepatitis.

Dr. Collier and colleagues analyzed ICD-9 codes from the National Inpatient Survey discharge data, focusing on U.S. residents hospitalized with a principal hepatitis A diagnosis and accompanying secondary diagnoses. They found that from 2002 to 2011:

• Rates of hospitalization for hepatitis A as a principal diagnosis decreased from 0.72/100,000 to 0.29/100,000 (P

• Mean age of those hospitalized increased from 37.6 years to 45.5 years (P

• Percentage of hepatitis A hospitalizations covered by Medicare increased from 12.4% to 22.7% (P

• Secondary, comorbid discharge diagnoses, including liver disease, hypertension, ischemic heart disease, disorders of lipid metabolism, and chronic liver disease, increased; and
• No changes were reported in patients’ length of stay or in-hospital deaths from hepatitis A, but persons with liver disease were hospitalized longer.

According to Dr. Collier, the drop in hospitalization rates could be explained by lower incidence of hepatitis A since the Advisory Committee on Immunization Practices (ACIP) recommended universal childhood vaccination in 2006.

Dr. Collier, who is a member of the ACIP hepatitis A working group, also points out that the ACIP recommends all patients with chronic liver disease be vaccinated. She says hospitalists should give patients with chronic liver disease the first dose of the vaccine upon discharge and ask those patients' PCPs to administer the second dose.

"Patients don't think about needing to be vaccinated, and if their physicians aren't recommending it, they aren't going to seek it," she says. Dr. Collier noted that data show only about 12% of people age 19 to 49 have received the hepatitis A vaccine. TH

Visit our website for more information on treating liver disease.

Government penalties meant to reduce COPD readmissions will unfairly impact hospitals that care for vulnerable patients, according to a report from the University of Michigan.

Beginning in January 2015, the Centers for Medicare & Medicaid Services will add COPD to its list of medical conditions for which it penalizes hospitals for excessive readmissions and fines them up to 3% of their total Medicare reimbursement for COPD readmissions.

Researchers Michael W. Sjoding, MD, and Colin R. Cooke, MD, MSc, MS, both of the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, evaluated three years of data on 3,018 hospitals and found that COPD readmission rates ranged from 17% to 28% across all hospitals. Hospitals designated as major teaching hospitals, those with a high percentage of patients with low socioeconomic status, and those with a high volume of COPD patients were associated with higher COPD readmission rates (P<0.001 for all).

The findings were published last month in the American Journal of Respiratory and Critical Care Medicine.

"It has been shown that there is a correlation between patients' social structures and support at home and COPD readmissions," Dr. Sjoding says. "Economic resources and education level can also drive readmissions, situations that are beyond hospital control."

Policies that measure hospital quality, Dr. Sjoding says, are important to ensure that patients have access to quality care across the country. However, when creating policies aimed at reducing readmission rates, CMS should level the playing field, he says. For example, academic hospitals caring for complex patients should be compared against their peers.

"It's important that physicians speak up to make sure that policies do the right thing," he says.

Visit our website for more information about managing patients with COPD.

Government penalties meant to reduce COPD readmissions will unfairly impact hospitals that care for vulnerable patients, according to a report from the University of Michigan.

Beginning in January 2015, the Centers for Medicare & Medicaid Services will add COPD to its list of medical conditions for which it penalizes hospitals for excessive readmissions and fines them up to 3% of their total Medicare reimbursement for COPD readmissions.

Researchers Michael W. Sjoding, MD, and Colin R. Cooke, MD, MSc, MS, both of the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, evaluated three years of data on 3,018 hospitals and found that COPD readmission rates ranged from 17% to 28% across all hospitals. Hospitals designated as major teaching hospitals, those with a high percentage of patients with low socioeconomic status, and those with a high volume of COPD patients were associated with higher COPD readmission rates (P<0.001 for all).

The findings were published last month in the American Journal of Respiratory and Critical Care Medicine.

"It has been shown that there is a correlation between patients' social structures and support at home and COPD readmissions," Dr. Sjoding says. "Economic resources and education level can also drive readmissions, situations that are beyond hospital control."

Policies that measure hospital quality, Dr. Sjoding says, are important to ensure that patients have access to quality care across the country. However, when creating policies aimed at reducing readmission rates, CMS should level the playing field, he says. For example, academic hospitals caring for complex patients should be compared against their peers.

"It's important that physicians speak up to make sure that policies do the right thing," he says.

Visit our website for more information about managing patients with COPD.

Government penalties meant to reduce COPD readmissions will unfairly impact hospitals that care for vulnerable patients, according to a report from the University of Michigan.

Beginning in January 2015, the Centers for Medicare & Medicaid Services will add COPD to its list of medical conditions for which it penalizes hospitals for excessive readmissions and fines them up to 3% of their total Medicare reimbursement for COPD readmissions.

Researchers Michael W. Sjoding, MD, and Colin R. Cooke, MD, MSc, MS, both of the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, evaluated three years of data on 3,018 hospitals and found that COPD readmission rates ranged from 17% to 28% across all hospitals. Hospitals designated as major teaching hospitals, those with a high percentage of patients with low socioeconomic status, and those with a high volume of COPD patients were associated with higher COPD readmission rates (P<0.001 for all).

The findings were published last month in the American Journal of Respiratory and Critical Care Medicine.

"It has been shown that there is a correlation between patients' social structures and support at home and COPD readmissions," Dr. Sjoding says. "Economic resources and education level can also drive readmissions, situations that are beyond hospital control."

Policies that measure hospital quality, Dr. Sjoding says, are important to ensure that patients have access to quality care across the country. However, when creating policies aimed at reducing readmission rates, CMS should level the playing field, he says. For example, academic hospitals caring for complex patients should be compared against their peers.

"It's important that physicians speak up to make sure that policies do the right thing," he says.

Visit our website for more information about managing patients with COPD.

Despite huge strides in the treatment of heart failure, pneumonia and myocardial infarction, hospitals have a long way to go in improving care for patients with sepsis, say the authors of a recent commentary published online in JAMA.

In a related study published in July in JAMA, sepsis was found to contribute to one in every two to three hospital deaths based on mortality results from two independent patient cohorts measured between 2010 and 2012. Additionally, most instances of sepsis were present upon admission, the report notes.

For their part, hospitalists should focus on identifying the signs and symptoms of sepsis early, according to study authors Colin R. Cooke, MD, MSc, MS, and Theodore J. Iwashyna, MD, PhD, of the division of pulmonary and critical care medicine at the University of Michigan in Ann Arbor.

"When patients are admitted for an illness such as pneumonia, we put them in a bin where we know how to treat patients with pneumonia, but we may fail to recognize when they meet the criteria for sepsis," Dr. Cooke says. "If we can recognize a patient has sepsis, then we can get on top of the illness faster by delivering antibiotics and also ensuring the patient gets fluid resuscitation early in the course of the disease."

In their JAMA article, Dr. Cooke and Dr. Iwashyna call on the Centers for Medicare & Medicaid Services to develop quality mandates that would encourage hospitals to share best practices in treating sepsis. The mandates, however, shouldn't include financial penalties, which the authors say "would create perverse incentives to not report delayed diagnosis of sepsis rather than address the problem."

Visit our website for more information on identifying sepsis in hospitalized patients.

Despite huge strides in the treatment of heart failure, pneumonia and myocardial infarction, hospitals have a long way to go in improving care for patients with sepsis, say the authors of a recent commentary published online in JAMA.

In a related study published in July in JAMA, sepsis was found to contribute to one in every two to three hospital deaths based on mortality results from two independent patient cohorts measured between 2010 and 2012. Additionally, most instances of sepsis were present upon admission, the report notes.

For their part, hospitalists should focus on identifying the signs and symptoms of sepsis early, according to study authors Colin R. Cooke, MD, MSc, MS, and Theodore J. Iwashyna, MD, PhD, of the division of pulmonary and critical care medicine at the University of Michigan in Ann Arbor.

"When patients are admitted for an illness such as pneumonia, we put them in a bin where we know how to treat patients with pneumonia, but we may fail to recognize when they meet the criteria for sepsis," Dr. Cooke says. "If we can recognize a patient has sepsis, then we can get on top of the illness faster by delivering antibiotics and also ensuring the patient gets fluid resuscitation early in the course of the disease."

In their JAMA article, Dr. Cooke and Dr. Iwashyna call on the Centers for Medicare & Medicaid Services to develop quality mandates that would encourage hospitals to share best practices in treating sepsis. The mandates, however, shouldn't include financial penalties, which the authors say "would create perverse incentives to not report delayed diagnosis of sepsis rather than address the problem."

Visit our website for more information on identifying sepsis in hospitalized patients.

Despite huge strides in the treatment of heart failure, pneumonia and myocardial infarction, hospitals have a long way to go in improving care for patients with sepsis, say the authors of a recent commentary published online in JAMA.

In a related study published in July in JAMA, sepsis was found to contribute to one in every two to three hospital deaths based on mortality results from two independent patient cohorts measured between 2010 and 2012. Additionally, most instances of sepsis were present upon admission, the report notes.

For their part, hospitalists should focus on identifying the signs and symptoms of sepsis early, according to study authors Colin R. Cooke, MD, MSc, MS, and Theodore J. Iwashyna, MD, PhD, of the division of pulmonary and critical care medicine at the University of Michigan in Ann Arbor.

"When patients are admitted for an illness such as pneumonia, we put them in a bin where we know how to treat patients with pneumonia, but we may fail to recognize when they meet the criteria for sepsis," Dr. Cooke says. "If we can recognize a patient has sepsis, then we can get on top of the illness faster by delivering antibiotics and also ensuring the patient gets fluid resuscitation early in the course of the disease."

In their JAMA article, Dr. Cooke and Dr. Iwashyna call on the Centers for Medicare & Medicaid Services to develop quality mandates that would encourage hospitals to share best practices in treating sepsis. The mandates, however, shouldn't include financial penalties, which the authors say "would create perverse incentives to not report delayed diagnosis of sepsis rather than address the problem."

Visit our website for more information on identifying sepsis in hospitalized patients.

A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient's immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

"We have to be able to recognize that just writing a discharge order is not meeting any of our patients' needs," says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. "It's hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs."

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

"Some patients are dealing with financial issues," he says. "Some have acute family crises they're dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things."

One of Dr. Misky's current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for "patient dumping," Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky's tips for providing better discharges:

• Be aware: Not all patients are equal. It's important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.

A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient's immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

"We have to be able to recognize that just writing a discharge order is not meeting any of our patients' needs," says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. "It's hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs."

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

"Some patients are dealing with financial issues," he says. "Some have acute family crises they're dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things."

One of Dr. Misky's current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for "patient dumping," Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky's tips for providing better discharges:

• Be aware: Not all patients are equal. It's important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.

A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient's immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

"We have to be able to recognize that just writing a discharge order is not meeting any of our patients' needs," says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. "It's hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs."

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

"Some patients are dealing with financial issues," he says. "Some have acute family crises they're dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things."

One of Dr. Misky's current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for "patient dumping," Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky's tips for providing better discharges:

• Be aware: Not all patients are equal. It's important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.

How well is your patient eating?

How often you ask this question could improve your hospital's readmission and length-of-stay rates, says Melissa Parkhurst, MD, FHM, medical director of hospital medicine and nutrition support at the University of Kansas Hospital in Kansas City.

A recent report from the Alliance to Advance Patient Nutrition [PDF]—a partnership of four organizations, including SHM, organized to improve nutrition screening and intervention among hospitalized patients—notes that about one in three patients admitted to a hospital meets the criteria for being malnourished. If left untreated, two-thirds of these patients will become more malnourished in the hospital.

"Often patients aren't eating because of testing or because their appetites are depressed because they're ill and not feeling well," says Dr. Parkhurst, an Alliance representative. "Sometimes their medications can alter their tastes, make them nauseated, or give them diarrhea."

Released last month, the findings are included in the partnership's first progress report. It describes the group's efforts in raising awareness about hospital nutrition, such as through info booths at medical meetings and via an online resource center on SHM's Center for Hospital Innovation & Improvement website.

Dr. Parkhurst points to studies that show inpatient malnutrition can lead to higher costs and more complications, as well as make patients more prone to surgical site infections, pressure ulcers, and falls.

"Malnourished patients are more apt to come back to the hospitals and to come in with complications," she says. "That is something we all should be concerned about as clinicians and at the hospital-administration level as well."

Here are Dr. Parkhurst's tips for improving nutrition among your patients:

• Ensure that every patient is getting a nutritional assessment upon admission and that staff is available to follow up with the results;
• Incorporate nutrition into the daily scope of patient care, for example, regularly ask staff whether your patients are eating or not;
• Include information about nutrition in the discharge plan and educate the patient’s family about nutritional interventions; and
• Work with hospital leadership to see how policies and procedures compare with the patient-care models put forth by the Alliance and note areas for improvement.

TH

Visit our website for more information about the importance of inpatient nutrition.

 

How well is your patient eating?

How often you ask this question could improve your hospital's readmission and length-of-stay rates, says Melissa Parkhurst, MD, FHM, medical director of hospital medicine and nutrition support at the University of Kansas Hospital in Kansas City.

A recent report from the Alliance to Advance Patient Nutrition [PDF]—a partnership of four organizations, including SHM, organized to improve nutrition screening and intervention among hospitalized patients—notes that about one in three patients admitted to a hospital meets the criteria for being malnourished. If left untreated, two-thirds of these patients will become more malnourished in the hospital.

"Often patients aren't eating because of testing or because their appetites are depressed because they're ill and not feeling well," says Dr. Parkhurst, an Alliance representative. "Sometimes their medications can alter their tastes, make them nauseated, or give them diarrhea."

Released last month, the findings are included in the partnership's first progress report. It describes the group's efforts in raising awareness about hospital nutrition, such as through info booths at medical meetings and via an online resource center on SHM's Center for Hospital Innovation & Improvement website.

Dr. Parkhurst points to studies that show inpatient malnutrition can lead to higher costs and more complications, as well as make patients more prone to surgical site infections, pressure ulcers, and falls.

"Malnourished patients are more apt to come back to the hospitals and to come in with complications," she says. "That is something we all should be concerned about as clinicians and at the hospital-administration level as well."

Here are Dr. Parkhurst's tips for improving nutrition among your patients:

• Ensure that every patient is getting a nutritional assessment upon admission and that staff is available to follow up with the results;
• Incorporate nutrition into the daily scope of patient care, for example, regularly ask staff whether your patients are eating or not;
• Include information about nutrition in the discharge plan and educate the patient’s family about nutritional interventions; and
• Work with hospital leadership to see how policies and procedures compare with the patient-care models put forth by the Alliance and note areas for improvement.

TH

Visit our website for more information about the importance of inpatient nutrition.

 

How well is your patient eating?

How often you ask this question could improve your hospital's readmission and length-of-stay rates, says Melissa Parkhurst, MD, FHM, medical director of hospital medicine and nutrition support at the University of Kansas Hospital in Kansas City.

A recent report from the Alliance to Advance Patient Nutrition [PDF]—a partnership of four organizations, including SHM, organized to improve nutrition screening and intervention among hospitalized patients—notes that about one in three patients admitted to a hospital meets the criteria for being malnourished. If left untreated, two-thirds of these patients will become more malnourished in the hospital.

"Often patients aren't eating because of testing or because their appetites are depressed because they're ill and not feeling well," says Dr. Parkhurst, an Alliance representative. "Sometimes their medications can alter their tastes, make them nauseated, or give them diarrhea."

Released last month, the findings are included in the partnership's first progress report. It describes the group's efforts in raising awareness about hospital nutrition, such as through info booths at medical meetings and via an online resource center on SHM's Center for Hospital Innovation & Improvement website.

Dr. Parkhurst points to studies that show inpatient malnutrition can lead to higher costs and more complications, as well as make patients more prone to surgical site infections, pressure ulcers, and falls.

"Malnourished patients are more apt to come back to the hospitals and to come in with complications," she says. "That is something we all should be concerned about as clinicians and at the hospital-administration level as well."

Here are Dr. Parkhurst's tips for improving nutrition among your patients:

• Ensure that every patient is getting a nutritional assessment upon admission and that staff is available to follow up with the results;
• Incorporate nutrition into the daily scope of patient care, for example, regularly ask staff whether your patients are eating or not;
• Include information about nutrition in the discharge plan and educate the patient’s family about nutritional interventions; and
• Work with hospital leadership to see how policies and procedures compare with the patient-care models put forth by the Alliance and note areas for improvement.

TH

Visit our website for more information about the importance of inpatient nutrition.

 

In a Senate subcommittee hearing last month, a panel of patient safety experts and physicians raised concerns about the problem of preventable medical errors, which they say can be linked to more than 1,000 patient deaths per day.

For their part, SHM Public Policy Committee member Bradley Flansbaum, DO, MPH, FHM, says hospitalists should demand that their hospitals report better data on patient outcomes.

"When you talk about a patient death, you're talking about the efforts of an entire hospital going into the death or survival of that patient," says Dr. Flansbaum, a hospitalist at Lenox Hill Hospital in New York. "If you ask, 'Where did something go wrong?' just looking at the mortality rate doesn't help. What service are you inquiring about? How can you get clean data that’s also useful to the clinician?"

In his testimony before the Subcommittee on Primary Health and Aging, hospitalist Ashish Jha, MD, MPH, referenced a landmark 1999 report from the Institute of Medicine (IOM), "To Err Is Human: Building a Safer Health System," [PDF] which estimated that between 44,000 and 98,000 deaths in the U.S. each year can be attributed to preventable medical errors.

Since the IOM report was published, little has been done to change the systems of care delivery that can lead providers to make errors, said Dr. Jha, an internist at the VA Boston Healthcare System and professor of health policy and management at the Harvard School of Public Health in Boston.

"When a physician orders the wrong medication because two drugs might sound alike, or when a patient develops a central-line infection because a rushed surgeon didn't use proper sterile technique, we now understand that we need to focus on the system that produced the errors," Dr. Jha told Senate subcommittee members.

Both Dr. Jha and panelist Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, said the Centers for Disease Control and Prevention should expand its National Nosocomial Infections Surveillance Program to collect and report data on medical errors.

Several other speakers said hospitals should be mandated to publicly report medical errors.

"Public disclosure is a critical element to preventing these events from happening," said panelist Lisa McGiffert, director of the Consumers Union Safe Patient Project in Austin, Texas. "It informs people about healthcare outcomes and motivates healthcare providers to do more to prevent errors." TH

Visit our website for more information on the impact of medical errors.

 

 

In a Senate subcommittee hearing last month, a panel of patient safety experts and physicians raised concerns about the problem of preventable medical errors, which they say can be linked to more than 1,000 patient deaths per day.

For their part, SHM Public Policy Committee member Bradley Flansbaum, DO, MPH, FHM, says hospitalists should demand that their hospitals report better data on patient outcomes.

"When you talk about a patient death, you're talking about the efforts of an entire hospital going into the death or survival of that patient," says Dr. Flansbaum, a hospitalist at Lenox Hill Hospital in New York. "If you ask, 'Where did something go wrong?' just looking at the mortality rate doesn't help. What service are you inquiring about? How can you get clean data that’s also useful to the clinician?"

In his testimony before the Subcommittee on Primary Health and Aging, hospitalist Ashish Jha, MD, MPH, referenced a landmark 1999 report from the Institute of Medicine (IOM), "To Err Is Human: Building a Safer Health System," [PDF] which estimated that between 44,000 and 98,000 deaths in the U.S. each year can be attributed to preventable medical errors.

Since the IOM report was published, little has been done to change the systems of care delivery that can lead providers to make errors, said Dr. Jha, an internist at the VA Boston Healthcare System and professor of health policy and management at the Harvard School of Public Health in Boston.

"When a physician orders the wrong medication because two drugs might sound alike, or when a patient develops a central-line infection because a rushed surgeon didn't use proper sterile technique, we now understand that we need to focus on the system that produced the errors," Dr. Jha told Senate subcommittee members.

Both Dr. Jha and panelist Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, said the Centers for Disease Control and Prevention should expand its National Nosocomial Infections Surveillance Program to collect and report data on medical errors.

Several other speakers said hospitals should be mandated to publicly report medical errors.

"Public disclosure is a critical element to preventing these events from happening," said panelist Lisa McGiffert, director of the Consumers Union Safe Patient Project in Austin, Texas. "It informs people about healthcare outcomes and motivates healthcare providers to do more to prevent errors." TH

Visit our website for more information on the impact of medical errors.

 

 

In a Senate subcommittee hearing last month, a panel of patient safety experts and physicians raised concerns about the problem of preventable medical errors, which they say can be linked to more than 1,000 patient deaths per day.

For their part, SHM Public Policy Committee member Bradley Flansbaum, DO, MPH, FHM, says hospitalists should demand that their hospitals report better data on patient outcomes.

"When you talk about a patient death, you're talking about the efforts of an entire hospital going into the death or survival of that patient," says Dr. Flansbaum, a hospitalist at Lenox Hill Hospital in New York. "If you ask, 'Where did something go wrong?' just looking at the mortality rate doesn't help. What service are you inquiring about? How can you get clean data that’s also useful to the clinician?"

In his testimony before the Subcommittee on Primary Health and Aging, hospitalist Ashish Jha, MD, MPH, referenced a landmark 1999 report from the Institute of Medicine (IOM), "To Err Is Human: Building a Safer Health System," [PDF] which estimated that between 44,000 and 98,000 deaths in the U.S. each year can be attributed to preventable medical errors.

Since the IOM report was published, little has been done to change the systems of care delivery that can lead providers to make errors, said Dr. Jha, an internist at the VA Boston Healthcare System and professor of health policy and management at the Harvard School of Public Health in Boston.

"When a physician orders the wrong medication because two drugs might sound alike, or when a patient develops a central-line infection because a rushed surgeon didn't use proper sterile technique, we now understand that we need to focus on the system that produced the errors," Dr. Jha told Senate subcommittee members.

Both Dr. Jha and panelist Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, said the Centers for Disease Control and Prevention should expand its National Nosocomial Infections Surveillance Program to collect and report data on medical errors.

Several other speakers said hospitals should be mandated to publicly report medical errors.

"Public disclosure is a critical element to preventing these events from happening," said panelist Lisa McGiffert, director of the Consumers Union Safe Patient Project in Austin, Texas. "It informs people about healthcare outcomes and motivates healthcare providers to do more to prevent errors." TH

Visit our website for more information on the impact of medical errors.

 

 

A new report that shows efforts to prevent central-line-associated bloodstream infections (CLABSIs) saved the government at least $640 million over nearly 20 years is an example of how effective prevention campaigns can be, a veteran hospitalist says.

"The major idea of this report was to show us that complications like bloodstream infections are preventable," says Ketino Kobaidze MD, PhD, FHM, assistant professor of medicine and associate site director of the division of hospital medicine at the Emory University School of Medicine in Atlanta. "When you prevent these things, you can locate other things. That's what the major message is to any kind of healthcare provider."

Published in the June issue of Health Affairs, the report examines the results of CDC programs from 1990 to 2008 to prevent CLABSIs in critical care units and how prevention helped the Centers for Medicaid & Medicare Services (CMS) reduce the amount of reimbursement paid to hospitals for treating such infections.

The authors reported that from 1990 to 2008, between 40,556 and 75,067 CLABSIs were avoided in Medicare and Medicaid patients treated in critical care units. This resulted in:

• Net savings ranging from $640 million to $1.8 billion;

• Net savings per case ranging from $15,780 to $24,391; and

• Per dollar rate of return on CDC investments between $3.88 and $23.85.

"Now, you're basically expected for it to not happen at all," says Dr. Kobaidze, referring to a rule implemented by CMS in 2008 that ended reimbursements to hospitals for treating CLABSIs that weren't present upon admission.

With that rule, CMS included 10 categories of hospital-acquired conditions (HACs) for the payment provision rule, including stage III and IV pressure ulcers and falls that occur while the patient is in the hospital. The rule was updated in 2013 to include HACs related to surgical site infection with cardiac implantable electronic devices and iatrogenic pneumothorax with venous catheterization. TH 

Visit our website for more information on bloodstream infection prevention.

 

A new report that shows efforts to prevent central-line-associated bloodstream infections (CLABSIs) saved the government at least $640 million over nearly 20 years is an example of how effective prevention campaigns can be, a veteran hospitalist says.

"The major idea of this report was to show us that complications like bloodstream infections are preventable," says Ketino Kobaidze MD, PhD, FHM, assistant professor of medicine and associate site director of the division of hospital medicine at the Emory University School of Medicine in Atlanta. "When you prevent these things, you can locate other things. That's what the major message is to any kind of healthcare provider."

Published in the June issue of Health Affairs, the report examines the results of CDC programs from 1990 to 2008 to prevent CLABSIs in critical care units and how prevention helped the Centers for Medicaid & Medicare Services (CMS) reduce the amount of reimbursement paid to hospitals for treating such infections.

The authors reported that from 1990 to 2008, between 40,556 and 75,067 CLABSIs were avoided in Medicare and Medicaid patients treated in critical care units. This resulted in:

• Net savings ranging from $640 million to $1.8 billion;

• Net savings per case ranging from $15,780 to $24,391; and

• Per dollar rate of return on CDC investments between $3.88 and $23.85.

"Now, you're basically expected for it to not happen at all," says Dr. Kobaidze, referring to a rule implemented by CMS in 2008 that ended reimbursements to hospitals for treating CLABSIs that weren't present upon admission.

With that rule, CMS included 10 categories of hospital-acquired conditions (HACs) for the payment provision rule, including stage III and IV pressure ulcers and falls that occur while the patient is in the hospital. The rule was updated in 2013 to include HACs related to surgical site infection with cardiac implantable electronic devices and iatrogenic pneumothorax with venous catheterization. TH 

Visit our website for more information on bloodstream infection prevention.

 

A new report that shows efforts to prevent central-line-associated bloodstream infections (CLABSIs) saved the government at least $640 million over nearly 20 years is an example of how effective prevention campaigns can be, a veteran hospitalist says.

"The major idea of this report was to show us that complications like bloodstream infections are preventable," says Ketino Kobaidze MD, PhD, FHM, assistant professor of medicine and associate site director of the division of hospital medicine at the Emory University School of Medicine in Atlanta. "When you prevent these things, you can locate other things. That's what the major message is to any kind of healthcare provider."

Published in the June issue of Health Affairs, the report examines the results of CDC programs from 1990 to 2008 to prevent CLABSIs in critical care units and how prevention helped the Centers for Medicaid & Medicare Services (CMS) reduce the amount of reimbursement paid to hospitals for treating such infections.

The authors reported that from 1990 to 2008, between 40,556 and 75,067 CLABSIs were avoided in Medicare and Medicaid patients treated in critical care units. This resulted in:

• Net savings ranging from $640 million to $1.8 billion;

• Net savings per case ranging from $15,780 to $24,391; and

• Per dollar rate of return on CDC investments between $3.88 and $23.85.

"Now, you're basically expected for it to not happen at all," says Dr. Kobaidze, referring to a rule implemented by CMS in 2008 that ended reimbursements to hospitals for treating CLABSIs that weren't present upon admission.

With that rule, CMS included 10 categories of hospital-acquired conditions (HACs) for the payment provision rule, including stage III and IV pressure ulcers and falls that occur while the patient is in the hospital. The rule was updated in 2013 to include HACs related to surgical site infection with cardiac implantable electronic devices and iatrogenic pneumothorax with venous catheterization. TH 

Visit our website for more information on bloodstream infection prevention.

 

As hospitalist workloads increase, so do hospital costs and patients' lengths of stay (LOS), according to findings in a recent study.

Those results, says SHM President Burke T. Kealey, MD, SFHM, provide a good starting point to determine an ideal patient census for hospitalists.

"Pushing hospitalist workloads ever higher to meet the demands of patient-care needs or flawed payment models has costs associated with it," says Dr. Kealey, associate medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. "The costs may be borne by the system or by patients, but there are costs."

For the study published in JAMA Internal Medicine, researchers analyzed data from 20,241 hospitalizations involving 13,916 patients seen by hospitalists at the Christiana Care Health System in Newark, Del., between February 2008 and January 2011.

For hospital occupancies less than 75%, they found that LOS increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, LOS increased to about 8 days with higher workloads. For occupancies greater than 85%, the LOS decreased slightly and then increased significantly with higher workloads, with this change occurring at about 15 patients or more per hospitalist.

Costs were also significantly associated with an increase in workload. As the study notes, benchmark recommendations for an individual hospitalist’s workload range from 10 to 15 patient encounters per day.

Dr. Kealey says the findings seem to support the conventional wisdom that hospitalists should ideally see no more than 15 patients a day. He notes, however, that deciding the optimal number of cases for a given practice depends on several factors, including duration of shift, the availability of physician extenders, and the addition of surgical or cardiology cases.

"We won't be able as a specialty to fully realize our potential until we understand and apply the learnings about workload into our practices to ensure hospitalist career sustainability, system health, and best patient care," Dr. Kealey says. "This paper really gets the discussion going."

For more from Dr. Kealey on hospitalist workloads, read his recent blog post on "The Hospital Leader." TH

Visit our website for more information about hospitalist workloads.

 

 

As hospitalist workloads increase, so do hospital costs and patients' lengths of stay (LOS), according to findings in a recent study.

Those results, says SHM President Burke T. Kealey, MD, SFHM, provide a good starting point to determine an ideal patient census for hospitalists.

"Pushing hospitalist workloads ever higher to meet the demands of patient-care needs or flawed payment models has costs associated with it," says Dr. Kealey, associate medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. "The costs may be borne by the system or by patients, but there are costs."

For the study published in JAMA Internal Medicine, researchers analyzed data from 20,241 hospitalizations involving 13,916 patients seen by hospitalists at the Christiana Care Health System in Newark, Del., between February 2008 and January 2011.

For hospital occupancies less than 75%, they found that LOS increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, LOS increased to about 8 days with higher workloads. For occupancies greater than 85%, the LOS decreased slightly and then increased significantly with higher workloads, with this change occurring at about 15 patients or more per hospitalist.

Costs were also significantly associated with an increase in workload. As the study notes, benchmark recommendations for an individual hospitalist’s workload range from 10 to 15 patient encounters per day.

Dr. Kealey says the findings seem to support the conventional wisdom that hospitalists should ideally see no more than 15 patients a day. He notes, however, that deciding the optimal number of cases for a given practice depends on several factors, including duration of shift, the availability of physician extenders, and the addition of surgical or cardiology cases.

"We won't be able as a specialty to fully realize our potential until we understand and apply the learnings about workload into our practices to ensure hospitalist career sustainability, system health, and best patient care," Dr. Kealey says. "This paper really gets the discussion going."

For more from Dr. Kealey on hospitalist workloads, read his recent blog post on "The Hospital Leader." TH

Visit our website for more information about hospitalist workloads.

 

 

As hospitalist workloads increase, so do hospital costs and patients' lengths of stay (LOS), according to findings in a recent study.

Those results, says SHM President Burke T. Kealey, MD, SFHM, provide a good starting point to determine an ideal patient census for hospitalists.

"Pushing hospitalist workloads ever higher to meet the demands of patient-care needs or flawed payment models has costs associated with it," says Dr. Kealey, associate medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. "The costs may be borne by the system or by patients, but there are costs."

For the study published in JAMA Internal Medicine, researchers analyzed data from 20,241 hospitalizations involving 13,916 patients seen by hospitalists at the Christiana Care Health System in Newark, Del., between February 2008 and January 2011.

For hospital occupancies less than 75%, they found that LOS increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, LOS increased to about 8 days with higher workloads. For occupancies greater than 85%, the LOS decreased slightly and then increased significantly with higher workloads, with this change occurring at about 15 patients or more per hospitalist.

Costs were also significantly associated with an increase in workload. As the study notes, benchmark recommendations for an individual hospitalist’s workload range from 10 to 15 patient encounters per day.

Dr. Kealey says the findings seem to support the conventional wisdom that hospitalists should ideally see no more than 15 patients a day. He notes, however, that deciding the optimal number of cases for a given practice depends on several factors, including duration of shift, the availability of physician extenders, and the addition of surgical or cardiology cases.

"We won't be able as a specialty to fully realize our potential until we understand and apply the learnings about workload into our practices to ensure hospitalist career sustainability, system health, and best patient care," Dr. Kealey says. "This paper really gets the discussion going."

For more from Dr. Kealey on hospitalist workloads, read his recent blog post on "The Hospital Leader." TH

Visit our website for more information about hospitalist workloads.