The Hospitalist

SAN DIEGO – The “holy grail” of thrombosis prevention is the ability to determine the risk of recurrence with or without continuation of anticoagulant treatment, according to Philip S. Wells, MD.

“Very little data exists for the comparison of active treatment to placebo in the acute and long-term phases of treatment,” he said at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “With low molecular weight heparin, vitamin K antagonists, and direct-acting oral anticoagulants, the relative risk reduction is about 90% in the acute phase and 80%-85% in the extended phase. After discontinuing anticoagulants, the absolute risk of recurrence varies depending on VTE category.”

Dr. Wells, chair and chief of the department of medicine at The Ottawa Hospital and the University of Ottawa, said that after 3 months of anticoagulation the chance of recurrence in postsurgical VTE patients is less than 1% per year. After 3 months of anticoagulant use in nonsurgical patients with provoked risk factors, it is around 4%. This includes medical patients, trauma victims, pregnant women, and patients wearing a plaster cast.

In patients who survive an unprovoked VTE, after 3-6 months of anticoagulant therapy their overall recurrence risk is 10% in the first year and 30% after 5 years. The risk of recurrence is 50% higher if a patient experiences a second unprovoked VTE, and the risk of fatality is 50% higher if the initial event was a pulmonary embolism (PE), he said.

According to the ongoing prospective Austrian Study on Recurrent Venous Thromboembolism, the risk of recurrent VTE is 20% in men and 6% in women (N Engl J Med. 2004 Jun 17;350[25]:2558-63). A multicenter prospective study in Canada yielded similar results. It found that the risk of recurrent VTE is 19% in men versus 9% in women (CMAJ 2008;179[5]:417-26).

That Canadian prospective study, led by Marc Rodger, MD, described the development of the HERDOO2 clinical decision rule for determining a patient’s risk for a recurrent VTE. This includes hyperpigmentation, edema, or redness in either leg (signs of postthrombotic syndrome), D-dimer level of 250 mcg/L or greater while on warfarin, body mass index of 30 kg/m² or greater, and age of 65 years or older.

If patients have zero or one risk factor, the annual risk of VTE after 6 months of treatment is 1.6%, while two or more risk factors bumps the annual risk of VTE to 14.1%, according to the researchers.

Doug Brunk/MDedge News

In a separate study of 319 patients with two negative D-dimer results who did not restart anticoagulation therapy, the rate of recurrent VTE was 6.7% per patient-year (Ann Intern Med 2015;162:27-34). It was 9.7% per patient-year in men, compared with 5.4% per patient-year in women.

Dr. Wells emphasized the importance of shared decision-making with the patient when devising a strategy for long-term anticoagulation following a VTE. “We don’t have a lot of good tools, but [trying to elicit] patient preference is the right thing to try and do,” he said. “Physicians should present an unbiased perspective to patients regarding their treatment, including the benefits and harms, effect on quality of life, and cost.”

Dr. Wells also shared his current clinical approach. In women with an unprovoked VTE, he applies the HERDOO2 rule. If there’s a low recurrence risk, he discontinues the anticoagulant. If there’s a non-low recurrence risk he continues with the anticoagulant unless there’s a high risk for bleeding. Men with an unprovoked VTE receive indefinite anticoagulant therapy, but if the index event is a deep vein thrombosis (DVT), Dr. Wells applies a bleeding risk tool to help him determine management going forward. If the patient has a high risk of bleeding, he does not use an anticoagulant.

“If there is a high risk of bleeding it’s best of stay off anticoagulant therapy,” he said. “If there is an intermediate risk of bleeding and the index event was a DVT, the patient could stay off anticoagulants. I think we have a long way to go to developing tools that actually enable us to reach these points with each patient in discussions we have with them about continuing anticoagulants.”

Dr. Wells reported having received research support from BMS/Pfizer and honoraria from Bayer AG, Janssen, Pfizer, and Daiichi Sankyo. He is a member of the scientific advisory board for Bayer AG and Pfizer.

[email protected]

SAN DIEGO – The “holy grail” of thrombosis prevention is the ability to determine the risk of recurrence with or without continuation of anticoagulant treatment, according to Philip S. Wells, MD.

“Very little data exists for the comparison of active treatment to placebo in the acute and long-term phases of treatment,” he said at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “With low molecular weight heparin, vitamin K antagonists, and direct-acting oral anticoagulants, the relative risk reduction is about 90% in the acute phase and 80%-85% in the extended phase. After discontinuing anticoagulants, the absolute risk of recurrence varies depending on VTE category.”

Dr. Wells, chair and chief of the department of medicine at The Ottawa Hospital and the University of Ottawa, said that after 3 months of anticoagulation the chance of recurrence in postsurgical VTE patients is less than 1% per year. After 3 months of anticoagulant use in nonsurgical patients with provoked risk factors, it is around 4%. This includes medical patients, trauma victims, pregnant women, and patients wearing a plaster cast.

In patients who survive an unprovoked VTE, after 3-6 months of anticoagulant therapy their overall recurrence risk is 10% in the first year and 30% after 5 years. The risk of recurrence is 50% higher if a patient experiences a second unprovoked VTE, and the risk of fatality is 50% higher if the initial event was a pulmonary embolism (PE), he said.

According to the ongoing prospective Austrian Study on Recurrent Venous Thromboembolism, the risk of recurrent VTE is 20% in men and 6% in women (N Engl J Med. 2004 Jun 17;350[25]:2558-63). A multicenter prospective study in Canada yielded similar results. It found that the risk of recurrent VTE is 19% in men versus 9% in women (CMAJ 2008;179[5]:417-26).

That Canadian prospective study, led by Marc Rodger, MD, described the development of the HERDOO2 clinical decision rule for determining a patient’s risk for a recurrent VTE. This includes hyperpigmentation, edema, or redness in either leg (signs of postthrombotic syndrome), D-dimer level of 250 mcg/L or greater while on warfarin, body mass index of 30 kg/m² or greater, and age of 65 years or older.

If patients have zero or one risk factor, the annual risk of VTE after 6 months of treatment is 1.6%, while two or more risk factors bumps the annual risk of VTE to 14.1%, according to the researchers.

Doug Brunk/MDedge News

In a separate study of 319 patients with two negative D-dimer results who did not restart anticoagulation therapy, the rate of recurrent VTE was 6.7% per patient-year (Ann Intern Med 2015;162:27-34). It was 9.7% per patient-year in men, compared with 5.4% per patient-year in women.

Dr. Wells emphasized the importance of shared decision-making with the patient when devising a strategy for long-term anticoagulation following a VTE. “We don’t have a lot of good tools, but [trying to elicit] patient preference is the right thing to try and do,” he said. “Physicians should present an unbiased perspective to patients regarding their treatment, including the benefits and harms, effect on quality of life, and cost.”

Dr. Wells also shared his current clinical approach. In women with an unprovoked VTE, he applies the HERDOO2 rule. If there’s a low recurrence risk, he discontinues the anticoagulant. If there’s a non-low recurrence risk he continues with the anticoagulant unless there’s a high risk for bleeding. Men with an unprovoked VTE receive indefinite anticoagulant therapy, but if the index event is a deep vein thrombosis (DVT), Dr. Wells applies a bleeding risk tool to help him determine management going forward. If the patient has a high risk of bleeding, he does not use an anticoagulant.

“If there is a high risk of bleeding it’s best of stay off anticoagulant therapy,” he said. “If there is an intermediate risk of bleeding and the index event was a DVT, the patient could stay off anticoagulants. I think we have a long way to go to developing tools that actually enable us to reach these points with each patient in discussions we have with them about continuing anticoagulants.”

Dr. Wells reported having received research support from BMS/Pfizer and honoraria from Bayer AG, Janssen, Pfizer, and Daiichi Sankyo. He is a member of the scientific advisory board for Bayer AG and Pfizer.

[email protected]

SAN DIEGO – The “holy grail” of thrombosis prevention is the ability to determine the risk of recurrence with or without continuation of anticoagulant treatment, according to Philip S. Wells, MD.

“Very little data exists for the comparison of active treatment to placebo in the acute and long-term phases of treatment,” he said at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “With low molecular weight heparin, vitamin K antagonists, and direct-acting oral anticoagulants, the relative risk reduction is about 90% in the acute phase and 80%-85% in the extended phase. After discontinuing anticoagulants, the absolute risk of recurrence varies depending on VTE category.”

Dr. Wells, chair and chief of the department of medicine at The Ottawa Hospital and the University of Ottawa, said that after 3 months of anticoagulation the chance of recurrence in postsurgical VTE patients is less than 1% per year. After 3 months of anticoagulant use in nonsurgical patients with provoked risk factors, it is around 4%. This includes medical patients, trauma victims, pregnant women, and patients wearing a plaster cast.

In patients who survive an unprovoked VTE, after 3-6 months of anticoagulant therapy their overall recurrence risk is 10% in the first year and 30% after 5 years. The risk of recurrence is 50% higher if a patient experiences a second unprovoked VTE, and the risk of fatality is 50% higher if the initial event was a pulmonary embolism (PE), he said.

According to the ongoing prospective Austrian Study on Recurrent Venous Thromboembolism, the risk of recurrent VTE is 20% in men and 6% in women (N Engl J Med. 2004 Jun 17;350[25]:2558-63). A multicenter prospective study in Canada yielded similar results. It found that the risk of recurrent VTE is 19% in men versus 9% in women (CMAJ 2008;179[5]:417-26).

That Canadian prospective study, led by Marc Rodger, MD, described the development of the HERDOO2 clinical decision rule for determining a patient’s risk for a recurrent VTE. This includes hyperpigmentation, edema, or redness in either leg (signs of postthrombotic syndrome), D-dimer level of 250 mcg/L or greater while on warfarin, body mass index of 30 kg/m² or greater, and age of 65 years or older.

If patients have zero or one risk factor, the annual risk of VTE after 6 months of treatment is 1.6%, while two or more risk factors bumps the annual risk of VTE to 14.1%, according to the researchers.

Doug Brunk/MDedge News

In a separate study of 319 patients with two negative D-dimer results who did not restart anticoagulation therapy, the rate of recurrent VTE was 6.7% per patient-year (Ann Intern Med 2015;162:27-34). It was 9.7% per patient-year in men, compared with 5.4% per patient-year in women.

Dr. Wells emphasized the importance of shared decision-making with the patient when devising a strategy for long-term anticoagulation following a VTE. “We don’t have a lot of good tools, but [trying to elicit] patient preference is the right thing to try and do,” he said. “Physicians should present an unbiased perspective to patients regarding their treatment, including the benefits and harms, effect on quality of life, and cost.”

Dr. Wells also shared his current clinical approach. In women with an unprovoked VTE, he applies the HERDOO2 rule. If there’s a low recurrence risk, he discontinues the anticoagulant. If there’s a non-low recurrence risk he continues with the anticoagulant unless there’s a high risk for bleeding. Men with an unprovoked VTE receive indefinite anticoagulant therapy, but if the index event is a deep vein thrombosis (DVT), Dr. Wells applies a bleeding risk tool to help him determine management going forward. If the patient has a high risk of bleeding, he does not use an anticoagulant.

“If there is a high risk of bleeding it’s best of stay off anticoagulant therapy,” he said. “If there is an intermediate risk of bleeding and the index event was a DVT, the patient could stay off anticoagulants. I think we have a long way to go to developing tools that actually enable us to reach these points with each patient in discussions we have with them about continuing anticoagulants.”

Dr. Wells reported having received research support from BMS/Pfizer and honoraria from Bayer AG, Janssen, Pfizer, and Daiichi Sankyo. He is a member of the scientific advisory board for Bayer AG and Pfizer.

[email protected]

Clinical question: Does switching from a brand name ARB to its generic lead to more ED visits and hospitalizations?

Background: Once a brand name drug’s patent expires, its generic form is commercialized and patients may be switched to the generic version. The drug equivalence of the generic vs. the brand name product may be substantial enough to affect clinically what is happening to the patient. Very few studies exist on the impact of the differences between brand-name and generic ARBs; those that do exist show conflicting results on clinical outcomes for the patient.

Study design: Observational retrospective interrupted time–series analysis.

Setting: Quebec Integrated Chronic Disease Surveillance System in Quebec.

Synopsis: The study analyzed 136,177 patients older than 66 years old with multiple comorbidities during the transition from brand-name to generic versions of losartan, valsartan, and candesartan. The authors compared ER visits or hospitalization of the brand-name users for 24 months before and 12 months after being transitioned from a brand-name ARB to a generic. All three groups were found to have higher rates of adverse events after switching to generics (8% for losartan, 11.7% for valsartan, and 16.6% for candesartan). The study was limited as the authors did not have access to the reason for the ER visits/admissions or the ability to determine which generic version was used (e.g., losartan has eight generic versions). The study highlights the need for further evaluation by risk and survival analysis to control confounders when switching to a generic formulation.

Bottom line: Switching patients from a brand-name to a generic ARB may lead to more ED consultations and hospital admissions.

Citation: Leclerc J et al. Impact of the commercialization of three generic angiotensin II receptor blockers on adverse events in Quebec Canada. Circ Cardiovasc Qual Outcomes. 2017 Oct 3. pii 10e003891. doi: 10.1161/circoutcomes.117.003891.

Dr. Smith is assistant professor of medicine in the Division of Hospital Medicine, Emory University, Atlanta.

Clinical question: Does switching from a brand name ARB to its generic lead to more ED visits and hospitalizations?

Background: Once a brand name drug’s patent expires, its generic form is commercialized and patients may be switched to the generic version. The drug equivalence of the generic vs. the brand name product may be substantial enough to affect clinically what is happening to the patient. Very few studies exist on the impact of the differences between brand-name and generic ARBs; those that do exist show conflicting results on clinical outcomes for the patient.

Study design: Observational retrospective interrupted time–series analysis.

Setting: Quebec Integrated Chronic Disease Surveillance System in Quebec.

Synopsis: The study analyzed 136,177 patients older than 66 years old with multiple comorbidities during the transition from brand-name to generic versions of losartan, valsartan, and candesartan. The authors compared ER visits or hospitalization of the brand-name users for 24 months before and 12 months after being transitioned from a brand-name ARB to a generic. All three groups were found to have higher rates of adverse events after switching to generics (8% for losartan, 11.7% for valsartan, and 16.6% for candesartan). The study was limited as the authors did not have access to the reason for the ER visits/admissions or the ability to determine which generic version was used (e.g., losartan has eight generic versions). The study highlights the need for further evaluation by risk and survival analysis to control confounders when switching to a generic formulation.

Bottom line: Switching patients from a brand-name to a generic ARB may lead to more ED consultations and hospital admissions.

Citation: Leclerc J et al. Impact of the commercialization of three generic angiotensin II receptor blockers on adverse events in Quebec Canada. Circ Cardiovasc Qual Outcomes. 2017 Oct 3. pii 10e003891. doi: 10.1161/circoutcomes.117.003891.

Dr. Smith is assistant professor of medicine in the Division of Hospital Medicine, Emory University, Atlanta.

Clinical question: Does switching from a brand name ARB to its generic lead to more ED visits and hospitalizations?

Background: Once a brand name drug’s patent expires, its generic form is commercialized and patients may be switched to the generic version. The drug equivalence of the generic vs. the brand name product may be substantial enough to affect clinically what is happening to the patient. Very few studies exist on the impact of the differences between brand-name and generic ARBs; those that do exist show conflicting results on clinical outcomes for the patient.

Study design: Observational retrospective interrupted time–series analysis.

Setting: Quebec Integrated Chronic Disease Surveillance System in Quebec.

Synopsis: The study analyzed 136,177 patients older than 66 years old with multiple comorbidities during the transition from brand-name to generic versions of losartan, valsartan, and candesartan. The authors compared ER visits or hospitalization of the brand-name users for 24 months before and 12 months after being transitioned from a brand-name ARB to a generic. All three groups were found to have higher rates of adverse events after switching to generics (8% for losartan, 11.7% for valsartan, and 16.6% for candesartan). The study was limited as the authors did not have access to the reason for the ER visits/admissions or the ability to determine which generic version was used (e.g., losartan has eight generic versions). The study highlights the need for further evaluation by risk and survival analysis to control confounders when switching to a generic formulation.

Bottom line: Switching patients from a brand-name to a generic ARB may lead to more ED consultations and hospital admissions.

Citation: Leclerc J et al. Impact of the commercialization of three generic angiotensin II receptor blockers on adverse events in Quebec Canada. Circ Cardiovasc Qual Outcomes. 2017 Oct 3. pii 10e003891. doi: 10.1161/circoutcomes.117.003891.

Dr. Smith is assistant professor of medicine in the Division of Hospital Medicine, Emory University, Atlanta.

Background: Patients with saddle PEs can differ in terms of their clinical presentation and may present as hemodynamically stable or unstable. There have been few studies to quantify the presentation, management, and outcome of patients who present with saddle PEs.

Study design: Retrospective cohort study.

Setting: Quaternary care hospital in Minnesota.

Synopsis: Using a localized database, 187 consecutive patients with saddle PEs were matched with 187 nonsaddle PEs using age and the simplified Pulmonary Embolism Severity Index (sPESI). Saddle PE patients had no significant in-hospital mortality differences versus nonsaddle PEs. However, they were more likely to present with massive and submassive hemodynamics (80% vs. 52%; P less than .05), RV dilatation (84% vs. 67%; P less than .001), and troponin elevation (71% vs. 40%; P less than .001). Patients with saddle PEs were more likely to receive thrombolytics, inferior vena cava filter placement, and require mechanical ventilation. They also had increased risk of decompensation after 6 hours (12 patients vs. 6 patients). Limitations of this study include some selection bias and use of a single-center study. Regardless, hospitalists should consider close monitoring for patients with saddle PEs upon admission, independent of hemodynamics given risk of decompensation regardless of presenting vitals.

Bottom line: Saddle PEs have an increased risk of late decompensation, clot burden, and presentation with massive and submassive hemodynamics but not an increased risk of mortality when compared with nonsaddle PEs.

Citation: Alkinj B et al. Saddle vs. nonsaddle pulmonary embolism: Clinical presentation, hemodynamics, management, and outcomes. Mayo Clin Proc. 2017 Oct;92(10):1511-8.

Dr. O’Donnell is assistant professor of medicine in the division of hospital medicine, Emory University, Atlanta.

Background: Patients with saddle PEs can differ in terms of their clinical presentation and may present as hemodynamically stable or unstable. There have been few studies to quantify the presentation, management, and outcome of patients who present with saddle PEs.

Study design: Retrospective cohort study.

Setting: Quaternary care hospital in Minnesota.

Synopsis: Using a localized database, 187 consecutive patients with saddle PEs were matched with 187 nonsaddle PEs using age and the simplified Pulmonary Embolism Severity Index (sPESI). Saddle PE patients had no significant in-hospital mortality differences versus nonsaddle PEs. However, they were more likely to present with massive and submassive hemodynamics (80% vs. 52%; P less than .05), RV dilatation (84% vs. 67%; P less than .001), and troponin elevation (71% vs. 40%; P less than .001). Patients with saddle PEs were more likely to receive thrombolytics, inferior vena cava filter placement, and require mechanical ventilation. They also had increased risk of decompensation after 6 hours (12 patients vs. 6 patients). Limitations of this study include some selection bias and use of a single-center study. Regardless, hospitalists should consider close monitoring for patients with saddle PEs upon admission, independent of hemodynamics given risk of decompensation regardless of presenting vitals.

Bottom line: Saddle PEs have an increased risk of late decompensation, clot burden, and presentation with massive and submassive hemodynamics but not an increased risk of mortality when compared with nonsaddle PEs.

Citation: Alkinj B et al. Saddle vs. nonsaddle pulmonary embolism: Clinical presentation, hemodynamics, management, and outcomes. Mayo Clin Proc. 2017 Oct;92(10):1511-8.

Dr. O’Donnell is assistant professor of medicine in the division of hospital medicine, Emory University, Atlanta.

Background: Patients with saddle PEs can differ in terms of their clinical presentation and may present as hemodynamically stable or unstable. There have been few studies to quantify the presentation, management, and outcome of patients who present with saddle PEs.

Study design: Retrospective cohort study.

Setting: Quaternary care hospital in Minnesota.

Synopsis: Using a localized database, 187 consecutive patients with saddle PEs were matched with 187 nonsaddle PEs using age and the simplified Pulmonary Embolism Severity Index (sPESI). Saddle PE patients had no significant in-hospital mortality differences versus nonsaddle PEs. However, they were more likely to present with massive and submassive hemodynamics (80% vs. 52%; P less than .05), RV dilatation (84% vs. 67%; P less than .001), and troponin elevation (71% vs. 40%; P less than .001). Patients with saddle PEs were more likely to receive thrombolytics, inferior vena cava filter placement, and require mechanical ventilation. They also had increased risk of decompensation after 6 hours (12 patients vs. 6 patients). Limitations of this study include some selection bias and use of a single-center study. Regardless, hospitalists should consider close monitoring for patients with saddle PEs upon admission, independent of hemodynamics given risk of decompensation regardless of presenting vitals.

Bottom line: Saddle PEs have an increased risk of late decompensation, clot burden, and presentation with massive and submassive hemodynamics but not an increased risk of mortality when compared with nonsaddle PEs.

Citation: Alkinj B et al. Saddle vs. nonsaddle pulmonary embolism: Clinical presentation, hemodynamics, management, and outcomes. Mayo Clin Proc. 2017 Oct;92(10):1511-8.

Dr. O’Donnell is assistant professor of medicine in the division of hospital medicine, Emory University, Atlanta.

SHM’s Award of Excellence in Outstanding Service in Hospital Medicine

Dr. Flora Kisuule, MD, SFHM, is an assistant professor at Johns Hopkins School of Medicine and the vice chair for clinical operations for the department of medicine at Johns Hopkins Bayview Medical Center. While at Johns Hopkins University, both in Baltimore, she codeveloped a hospitalist fellowship program that she now directs, as well as a fellowship program specifically for nurse practitioners and physician assistants. Under her leadership as the associate director of the division of hospital medicine, she helped to bring Johns Hopkins Bayview hospitalists’ quality and mortality indicators into the top 5% nationwide and reduced hospital-acquired conditions at Hopkins Bayview to the best of the four regional Hopkins Health System hospitals.

Nationally, she has served on several SHM committees, facilitated at multiple SHM leadership courses, served as vice president of SHM’s Baltimore Chapter, and consulted on hospitalist programs around the country. Internationally, Dr. Kisuule has developed and mentored hospitalist programs in Saudi Arabia, the United Arab Emirates, and Central America. She is currently developing a training program in hospital medicine in Panama and is a Senior Fellow in Hospital Medicine.
 

SHM’s Award of Excellence in Teamwork in Quality Improvement

Since 2011, the Johns Hopkins Health System hospitals have conducted quality improvement projects to increase the value of care for their patients. Their amazing work catalyzed a grass-roots initiative involving faculty and residents at both Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

With a unification of the EHR across the health system, RedondaMiller, MD, MBA, president of Johns Hopkins Hospital, and Renee Demski, MSW, MBA, vice president of quality for Johns Hopkins Health System, created the Johns Hopkins Health System High-Value Care Committee to operationalize initiatives across all six hospitals and Johns Hopkins community physicians. The committee is under the leadership of Trushar Dungarani, DO, FHM, from Howard County General Hospital and Lenny Feldman, MD, SFHM, Amit Pahwa, MD, and Pamela Johnson, MD, from Johns Hopkins Hospital, and comprises provider representatives from each institution and other important contributors from various specialties, including Mike Borowitz, MD, PhD; Dr. Ken Lee, DrPH; Emily Pherson, PharmD; Amy Knight, MD; Tim Niessen, MD, MPH; Keisha Perrin, and Clare Rock.

Initiatives directed by the committee have included reducing inappropriate testing for Clostridium difficile, folate testing for anemia, and duplicative imaging exams, among others. In the 18 months since inception, the committee reduced charges to patients and payers by nearly $4 million and hospital costs by more than $200,000.

Members of this committee joined forces with like-minded institutions to create the High Value Practice Academic Alliance in 2016. Faculty leaders from more than 80 academic centers are now collaborating to increase health care value on a national scale through quality improvement projects, education, and dissemination.

SHM’s Award of Excellence in Teaching

Jennifer O’Toole, MD, MEd, is a med-peds hospitalist at the Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center. She serves as the director of the combined internal medicine and pediatrics residency program and is the director of education for the Children’s Hospital division of hospital medicine. In these roles, Dr. O’Toole has established an acute care track for her med-peds residents interested in careers in hospital medicine and a career development boot camp for early-career faculty members and fellows in the division of hospital medicine.

Perhaps Dr. O’Toole’s most instrumental role as an educator has been her involvement in influential educational programs nationally, including the I-PASS Handoff program. Implementation of I-PASS decreased medical errors by 23% and preventable adverse events by 30% in more than 10,000 patient admissions across nine North American hospitals. She has authored more than 30 peer-reviewed publications related to medical education and has presented more than 50 workshops at national meetings. After serving as a member of the planning committee for the Pediatric Hospital Medicine meeting, she is cochair for the 2018 meeting.

SHM’s Award of Clinical Excellence for Physicians

Rick Hilger, MD, SFHM, has been a hospitalist with HealthPartners Regions Hospital in St. Paul, Minnesota for 16 years. He is a national expert in the areas of readmission prevention and care delivery for high-utilizer patients. His work in this area was named Best Clinical Innovation at Hospital Medicine 2012. His collaborative approach to solving complex problems is demonstrated by the amount of time he has volunteered to help other organizations improve their care of high utilizers. Over 90 organizations and hospitals have reached out for assistance in starting their own committees, and Dr. Hilger has shared his time and care plan templates with each one. He was one of the first hospitalists asked to participate on a National Quality Forum committee and has improved hospital reimbursement by over 4 million dollars by developing an internal physician advisor program.

Dr. Hilger also has served on the SHM Annual Conference Committee and the Public Policy Committee, where he has worked with other committee members to advocate for policy changes related to observation status and readmission penalties.

SHM’s Award for Excellence in Humanitarian Services

Michelle Morse, MD, MPH, is a hospitalist and the assistant program director for the internal medicine residency at Brigham and Women’s Hospital in Boston. She is also the founding codirector of EqualHealth, an organization that aims to inspire and support the development of Haiti’s next generation of health care leaders. In 2015, Dr. Morse helped to found the Social Medicine Consortium, a global coalition of more than 450 people representing over 50 universities and organizations in 12 countries, which seeks to address the miseducation of health professionals.

In the aftermath of the 2010 earthquake in Haiti, Dr. Morse was compelled to collaborate with colleagues and friends to help build capacity of health care providers committed to social medicine, medical and nursing education, and social justice. She helped to open and operate a new 300-bed teaching hospital in rural Haiti and founded the first three residency training programs at the hospital. Since that time, the hospital has expanded to serve an area of 3 million people with an annual budget of $12 million.
 

SHM’s Award of Excellence in Research

Teryl Nuckols, MD, FHM, is a hospitalist and the director of general internal medicine at Cedars-Sinai Medical Center in Los Angeles. She also serves as associate professor of medicine at the University of California, Los Angeles, and a health services researcher at the RAND Corporation in Santa Monica.

Currently, she is principal investigator and coprincipal investigator on two projects funded by the Agency for Healthcare Research and Quality that are evaluating effects of the Medicare Hospital Readmissions Reduction Program. Dr. Nuckols was previously the principal investigator on two R01 research grants from the Agency for Healthcare Research and Quality and the recipient of a K08 Career Development Award. She has evaluated clinical practice guidelines on behalf of SHM as well as policy makers in California and Australia, and her work has led to more than 30 peer-reviewed publications in NEJM, Journal of Hospital Medicine, and JAMA Internal Medicine among others.
 

SHM’s Award of Clinical Excellence for NPs/PAs

Meredith K. Wold, PA-C, is the supervisor of advanced practice clinicians at HealthPartners Medical Group, which includes 20 nurse practitioners and physician assistants, at Regions Hospital in St. Paul, Minn. She is also the cofounder and co-curriculum director for the HealthPartners Hospital Medicine Physician Assistant Fellowship Program. Under her leadership, the fellowship program offers a clear curriculum that exposes key clinical scenarios and specialties crucial to hospital medicine, preparing new PAs to contribute immediately to team-based care upon completion of the fellowship.

To prevent burnout in a 7-on/7-off schedule, Ms. Wold thought creatively and developed a pooling and “draft” system to give some flexibility and breaks in the block schedule – almost like a fantasy football draft but with patient care shifts for noncontinuity services.
 

Excellence in Management in Hospital Medicine

Maria Lourdes Novelero, MA, MPA, is the associate chair for administration of the department of medicine at the University of California, San Francisco, and has also served as the administrator of the UCSF division of hospital medicine and its associated medical service from 2005 to 2016. In this role, she managed the department’s expansion from a 20-physician division to an 80-physician division. She also led the department’s pioneering efforts in quality, safety, and value.

Ms. Novelero created a structure to build and manage 10 different hospitalist-run services, including cancer, cardiology, neurosurgery, and liver transplant comanagement services; a procedure service; a palliative care service; and a large non–housestaff medicine service. She co-led a multidisciplinary effort to transform the discharge process, and established and cochaired the department of hospital medicine’s high value care committee, which catalyzed value improvement activities throughout UCSF. This committee’s work led to tangible value improvements, such as a 14% reduction in direct costs and a first-ever positive net margin for the medical service.

Ms. Novelero has more than 25 years of experience in management positions in the United States and Japan.
 

Certificate of Leadership in Hospital Medicine

Benji K. Mathews, MD, SFHM, CLHM, graduated from the Institute of Technology at the University of Minnesota and the University of Minnesota Medical School. He completed his internal medicine residency and chief residency through the University of Minnesota, Minneapolis. He joined HealthPartners as an academic hospitalist and holds the titles of section head of hospital medicine at Regions Hospital and director of point of care ultrasound (POCUS) for Hospital Medicine at HealthPartners. He is the president for the Minnesota Chapter of the Society of Hospital Medicine (SHM).

Dr. Mathews has a passion for medical education, care delivery, and quality. He is an assistant professor of medicine at the University of Minnesota. As such, he is core faculty for the internal medicine residency program and chair of the Clinical Competency Committee. Dr. Mathews is an active member of SHM as a member of SHM's annual meeting planning committee, organizing and setting the agenda for SHM's record breaking meetings for the last 4 years. Dr. Mathews also serves on SHM's Quality Improvement and Patient Safety Committee and is the chair of the Diagnostic Error Subcommittee. He has completed the Certificate of Leadership in Hospital Medicine (CLHM) with his area of focus on ultrasound in hospital medicine. His work in diagnostic error and POCUS has been well recognized with multiple workshops and presentations given locally and nationally. He is a Fellow in Diagnostic Safety through the Society to Improve Diagnosis in Medicine.

Dr. Mathews also has a passion for global health, rooted in his commitment to reducing health care disparities both locally and globally. He has worked with medical missions, NGOs, and orphanages in Nepal, India, Bolivia, Honduras, and Costa Rica. This led him to complete the global health course at the University of Minnesota.
 

SHM’s Junior Investigator Award

Christine D. Jones, MD, MS, is an assistant professor of medicine at the University of Colorado's Anschutz medical campus, Aurora, where she is the director of care transitions and director of scholarship for the division of hospital medicine.

University of Colorado Hospital

Dr. Jones’ research is focused on improving care coordination between clinicians in different settings to improve outcomes for patients discharged with home health care. Her research is supported by a K08 career development award from the Agency for Healthcare Research and Quality. Her overall goal is to improve the quality of care transitions for hospitalized patients discharged to post-acute care settings, including home health care. Dr. Jones has presented at every SHM annual conference since she joined in 2013.
 

Chapter Excellence Awards

The Society of Hospital Medicine is proud to recognize outstanding SHM chapters at HM18 for the fifth annual Chapter Excellence Awards. Each year, chapters strive to demonstrate growth, sustenance, and innovation within their chapter activities, which are then applauded for their successes at SHM’s annual conference.

Platinum Chapters: Gulf States, Iowa, Maryland, Michigan, Minnesota, New Mexico, North Carolina Triangle, St. Louis.

Gold Chapters: Hampton Roads, Kentucky, North Jersey, Pacific Northwest.

Silver Chapters: Boston/Eastern Massachusetts, Houston, Los Angeles, Maine, NYC/Westchester, Rocky Mountain, San Francisco Bay Area, South Central PA, Southwest Florida, Wiregrass.
 

Outstanding Chapter of the Year

New Mexico. SHM’s New Mexico Chapter has been nominated to receive the Outstanding Chapter of the Year Award for 2017. Consistently, leadership and members go above and beyond the basic requirements to maintain status by creating and cultivating multiple innovative and dynamic opportunities for attendees to educate and network. The chapter participated in SHM’s pilot program to offer CME for chapters, bringing a CME-accredited educational presentation on the care of diverse patients. Their annual meeting this year featured a poster competition for residents, students, and early-career hospitalists; a didactic on antimicrobial stewardship; and a business meeting with elections, member benefits, and highlights of the chapter’s year, and chapter awards. The chapter initiated breakfast meetings with didactics on DACA and on burnout and wellness, and collaborated with the University of New Mexico, Albuquerque on a grand rounds series on physician wellness that was available via telecast to numerous hospitals and providers off site. The chapter hosted a book club, a networking session at HM17, and an informational meeting on SHM membership and the Fellows Program. They have supported the future of hospital medicine by having a table at the UNM School of Medicine’s student activities fair, a Resident of the Year Award, and a position on our council for a resident representative. They have collaborated with the sole internal medicine residency program in New Mexico so that residents in the hospitalist training track have membership in SHM, and they have expanded our juried poster competition to include students. The chapter’s level of originality is not only a benefit to the chapter, but SHM’s chapter program as a whole.

Rising Star Chapter

Kentucky. SHM’s Kentucky Chapter has been nominated to receive the Rising Star Chapter Award for 2017 for their innovation and growth. The chapter’s leadership was involved with the establishment of the Heartland Hospital Medicine Conference and hosted a hospital medicine career panel and bustling Research, Innovations, and Clinical Vignettes abstract and poster competition. Nearly 50 abstracts were submitted, and the top 40 were invited to present posters at the competition. These posters included a mix of attendings, advanced practice providers, residents, and students interested in participating in the local hospital medicine community. The chapter sponsored the first prize winner’s travel to attend Hospital Medicine 2018 and gave awards to best resident and best student posters. The Kentucky Chapter directly recruited 27 hospitalists to join SHM membership in 2017. The Kentucky Chapter is an active, enthusiastic chapter that is rapidly growing and thriving.

Student Hospitalist Scholarship Recipients

The Society of Hospital Medicine’s Physician in Training Committee launched a Student Hospitalist Scholar Grant program in 2015 for medical students to conduct mentored scholarly projects related to quality improvement and patient safety.

The program was expanded in 2017 and now includes both a summer and longitudinal program for students.

The committee is happy to announce the 4th year of scholar grant recipients to six students based on their ability and interest in hospital medicine, general qualifications, prior educational training, and promise for scholarly activity.

Summer Program

Ilana Scandariato
Cornell University, New York
Project: Understanding the experience of the long-term hospitalized patient with provider fragmentation: A qualitative study
Mentor: Ernie Esquivel, MD, FHM

Maximilian Hemmrich
University of Chicago
Project: Derivation and validation of a COPD readmission risk prediction tool
Mentor: Valerie Press, MD, MPH, SFHM

Sandeep Bala
University of Central Florida, Orlando
Project: The impact of plain language open medical notes on patient activation
Mentor: Marisha Burden, MD, SFHM

Longitudinal Program

Erin Rainosek
University of Texas, San Antonio
Project Title: Design thinking to improve patient experience
Mentor: Luci Leykum, MD, SFHM

Matthew Fallon
Creighton University, Omaha, Neb.
Project: Reducing the hospital readmission rate of congestive heart failure (CHF)
Mentor: Venkata Andukuri, MD, MPH, FHM

Philip Huang
University of Iowa, Iowa City
Project: Expanded patient regionalization to improve care efficiency
Mentor: Ethan Kuperman, MD, FHM


Resident Travel Grant Recipients

The Society of Hospital Medicine’s Physician in Training Committee launched a Resident Travel Grant Program in 2017 for residents to receive funding to attend SHM’s Annual Conference and be recognized for their scholarly work.

The Committee is pleased to announce the first year of Resident Travel Grant Recipients to 10 Residents based on their ability and interest in hospital medicine, research originality, and teaching value, and general qualifications.

Ashley M. Jenkins, MD
Cincinnati Children’s Hospital Medical Center
Poster 41 - Aren’t adults just big kids?: Standardizing care of adults in pediatric hospitals

Brian A. MacDonald Jr., MD, PhD
State University of New York at Buffalo
Poster 135 – Phosphatidylethanol level as a predictor of acute alcohol withdrawal

Christopher S. Bartlett, MD, MPH
University of New Mexico Health Sciences Center, Albuquerque
Poster 47 - Lessons learned from a resident-created experiential quality improvement and patient safety curriculum for medical and nursing students at the University of New Mexico

Christopher T. Su, MD, MPH
Montefiore Medical Center/Albert Einstein College of Medicine, New York
Poster 173 - Concurrent NSAID and warfarin use is associated with increased blood transfusions in hospitalized patients

Madeleine Ivrit Matthiesen, MD
Harvard Medical School/Massachusetts General Hospital Medicine–Pediatrics, Boston
Poster 69 - Resident perceptions of feedback and teaching

Neil Keshvani, MD
University of Texas Southwestern Medical Center, Dallas
Poster 237 - Improving respiratory rate measurement accuracy in the hospital: A quality improvement initiative

Peter N. Barish, MD
University of California, San Francisco
Poster 344 - Costs Related to potential overuse of respiratory viral panel PCRs in general medicine patients

Rachna Rawal, MD
Saint Louis University
Poster 259 - Empowering medicine residents to think before ordering daily labs: A quality improvement study

Yihan Chen, MD
University of California, Los Angeles, Medical Center
Poster 12 - Hospitalist-directed transfers improve emergency room length of stay

Zachary G. Jacobs, MD
University of California, San Francisco
Poster 233 - The prevalence of treating asymptomatic elevated blood pressure with intravenous antihypertensives on the general medicine wards: A potential target for a quality improvement inter-vention
Poster 96 - Factors Impacting time to antibiotic administration in patients with sepsis: A single-center study of electronic health record data

SHM’s Award of Excellence in Outstanding Service in Hospital Medicine

Dr. Flora Kisuule, MD, SFHM, is an assistant professor at Johns Hopkins School of Medicine and the vice chair for clinical operations for the department of medicine at Johns Hopkins Bayview Medical Center. While at Johns Hopkins University, both in Baltimore, she codeveloped a hospitalist fellowship program that she now directs, as well as a fellowship program specifically for nurse practitioners and physician assistants. Under her leadership as the associate director of the division of hospital medicine, she helped to bring Johns Hopkins Bayview hospitalists’ quality and mortality indicators into the top 5% nationwide and reduced hospital-acquired conditions at Hopkins Bayview to the best of the four regional Hopkins Health System hospitals.

Nationally, she has served on several SHM committees, facilitated at multiple SHM leadership courses, served as vice president of SHM’s Baltimore Chapter, and consulted on hospitalist programs around the country. Internationally, Dr. Kisuule has developed and mentored hospitalist programs in Saudi Arabia, the United Arab Emirates, and Central America. She is currently developing a training program in hospital medicine in Panama and is a Senior Fellow in Hospital Medicine.
 

SHM’s Award of Excellence in Teamwork in Quality Improvement

Since 2011, the Johns Hopkins Health System hospitals have conducted quality improvement projects to increase the value of care for their patients. Their amazing work catalyzed a grass-roots initiative involving faculty and residents at both Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

With a unification of the EHR across the health system, RedondaMiller, MD, MBA, president of Johns Hopkins Hospital, and Renee Demski, MSW, MBA, vice president of quality for Johns Hopkins Health System, created the Johns Hopkins Health System High-Value Care Committee to operationalize initiatives across all six hospitals and Johns Hopkins community physicians. The committee is under the leadership of Trushar Dungarani, DO, FHM, from Howard County General Hospital and Lenny Feldman, MD, SFHM, Amit Pahwa, MD, and Pamela Johnson, MD, from Johns Hopkins Hospital, and comprises provider representatives from each institution and other important contributors from various specialties, including Mike Borowitz, MD, PhD; Dr. Ken Lee, DrPH; Emily Pherson, PharmD; Amy Knight, MD; Tim Niessen, MD, MPH; Keisha Perrin, and Clare Rock.

Initiatives directed by the committee have included reducing inappropriate testing for Clostridium difficile, folate testing for anemia, and duplicative imaging exams, among others. In the 18 months since inception, the committee reduced charges to patients and payers by nearly $4 million and hospital costs by more than $200,000.

Members of this committee joined forces with like-minded institutions to create the High Value Practice Academic Alliance in 2016. Faculty leaders from more than 80 academic centers are now collaborating to increase health care value on a national scale through quality improvement projects, education, and dissemination.

SHM’s Award of Excellence in Teaching

Jennifer O’Toole, MD, MEd, is a med-peds hospitalist at the Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center. She serves as the director of the combined internal medicine and pediatrics residency program and is the director of education for the Children’s Hospital division of hospital medicine. In these roles, Dr. O’Toole has established an acute care track for her med-peds residents interested in careers in hospital medicine and a career development boot camp for early-career faculty members and fellows in the division of hospital medicine.

Perhaps Dr. O’Toole’s most instrumental role as an educator has been her involvement in influential educational programs nationally, including the I-PASS Handoff program. Implementation of I-PASS decreased medical errors by 23% and preventable adverse events by 30% in more than 10,000 patient admissions across nine North American hospitals. She has authored more than 30 peer-reviewed publications related to medical education and has presented more than 50 workshops at national meetings. After serving as a member of the planning committee for the Pediatric Hospital Medicine meeting, she is cochair for the 2018 meeting.

SHM’s Award of Clinical Excellence for Physicians

Rick Hilger, MD, SFHM, has been a hospitalist with HealthPartners Regions Hospital in St. Paul, Minnesota for 16 years. He is a national expert in the areas of readmission prevention and care delivery for high-utilizer patients. His work in this area was named Best Clinical Innovation at Hospital Medicine 2012. His collaborative approach to solving complex problems is demonstrated by the amount of time he has volunteered to help other organizations improve their care of high utilizers. Over 90 organizations and hospitals have reached out for assistance in starting their own committees, and Dr. Hilger has shared his time and care plan templates with each one. He was one of the first hospitalists asked to participate on a National Quality Forum committee and has improved hospital reimbursement by over 4 million dollars by developing an internal physician advisor program.

Dr. Hilger also has served on the SHM Annual Conference Committee and the Public Policy Committee, where he has worked with other committee members to advocate for policy changes related to observation status and readmission penalties.

SHM’s Award for Excellence in Humanitarian Services

Michelle Morse, MD, MPH, is a hospitalist and the assistant program director for the internal medicine residency at Brigham and Women’s Hospital in Boston. She is also the founding codirector of EqualHealth, an organization that aims to inspire and support the development of Haiti’s next generation of health care leaders. In 2015, Dr. Morse helped to found the Social Medicine Consortium, a global coalition of more than 450 people representing over 50 universities and organizations in 12 countries, which seeks to address the miseducation of health professionals.

In the aftermath of the 2010 earthquake in Haiti, Dr. Morse was compelled to collaborate with colleagues and friends to help build capacity of health care providers committed to social medicine, medical and nursing education, and social justice. She helped to open and operate a new 300-bed teaching hospital in rural Haiti and founded the first three residency training programs at the hospital. Since that time, the hospital has expanded to serve an area of 3 million people with an annual budget of $12 million.
 

SHM’s Award of Excellence in Research

Teryl Nuckols, MD, FHM, is a hospitalist and the director of general internal medicine at Cedars-Sinai Medical Center in Los Angeles. She also serves as associate professor of medicine at the University of California, Los Angeles, and a health services researcher at the RAND Corporation in Santa Monica.

Currently, she is principal investigator and coprincipal investigator on two projects funded by the Agency for Healthcare Research and Quality that are evaluating effects of the Medicare Hospital Readmissions Reduction Program. Dr. Nuckols was previously the principal investigator on two R01 research grants from the Agency for Healthcare Research and Quality and the recipient of a K08 Career Development Award. She has evaluated clinical practice guidelines on behalf of SHM as well as policy makers in California and Australia, and her work has led to more than 30 peer-reviewed publications in NEJM, Journal of Hospital Medicine, and JAMA Internal Medicine among others.
 

SHM’s Award of Clinical Excellence for NPs/PAs

Meredith K. Wold, PA-C, is the supervisor of advanced practice clinicians at HealthPartners Medical Group, which includes 20 nurse practitioners and physician assistants, at Regions Hospital in St. Paul, Minn. She is also the cofounder and co-curriculum director for the HealthPartners Hospital Medicine Physician Assistant Fellowship Program. Under her leadership, the fellowship program offers a clear curriculum that exposes key clinical scenarios and specialties crucial to hospital medicine, preparing new PAs to contribute immediately to team-based care upon completion of the fellowship.

To prevent burnout in a 7-on/7-off schedule, Ms. Wold thought creatively and developed a pooling and “draft” system to give some flexibility and breaks in the block schedule – almost like a fantasy football draft but with patient care shifts for noncontinuity services.
 

Excellence in Management in Hospital Medicine

Maria Lourdes Novelero, MA, MPA, is the associate chair for administration of the department of medicine at the University of California, San Francisco, and has also served as the administrator of the UCSF division of hospital medicine and its associated medical service from 2005 to 2016. In this role, she managed the department’s expansion from a 20-physician division to an 80-physician division. She also led the department’s pioneering efforts in quality, safety, and value.

Ms. Novelero created a structure to build and manage 10 different hospitalist-run services, including cancer, cardiology, neurosurgery, and liver transplant comanagement services; a procedure service; a palliative care service; and a large non–housestaff medicine service. She co-led a multidisciplinary effort to transform the discharge process, and established and cochaired the department of hospital medicine’s high value care committee, which catalyzed value improvement activities throughout UCSF. This committee’s work led to tangible value improvements, such as a 14% reduction in direct costs and a first-ever positive net margin for the medical service.

Ms. Novelero has more than 25 years of experience in management positions in the United States and Japan.
 

Certificate of Leadership in Hospital Medicine

Benji K. Mathews, MD, SFHM, CLHM, graduated from the Institute of Technology at the University of Minnesota and the University of Minnesota Medical School. He completed his internal medicine residency and chief residency through the University of Minnesota, Minneapolis. He joined HealthPartners as an academic hospitalist and holds the titles of section head of hospital medicine at Regions Hospital and director of point of care ultrasound (POCUS) for Hospital Medicine at HealthPartners. He is the president for the Minnesota Chapter of the Society of Hospital Medicine (SHM).

Dr. Mathews has a passion for medical education, care delivery, and quality. He is an assistant professor of medicine at the University of Minnesota. As such, he is core faculty for the internal medicine residency program and chair of the Clinical Competency Committee. Dr. Mathews is an active member of SHM as a member of SHM's annual meeting planning committee, organizing and setting the agenda for SHM's record breaking meetings for the last 4 years. Dr. Mathews also serves on SHM's Quality Improvement and Patient Safety Committee and is the chair of the Diagnostic Error Subcommittee. He has completed the Certificate of Leadership in Hospital Medicine (CLHM) with his area of focus on ultrasound in hospital medicine. His work in diagnostic error and POCUS has been well recognized with multiple workshops and presentations given locally and nationally. He is a Fellow in Diagnostic Safety through the Society to Improve Diagnosis in Medicine.

Dr. Mathews also has a passion for global health, rooted in his commitment to reducing health care disparities both locally and globally. He has worked with medical missions, NGOs, and orphanages in Nepal, India, Bolivia, Honduras, and Costa Rica. This led him to complete the global health course at the University of Minnesota.
 

SHM’s Junior Investigator Award

Christine D. Jones, MD, MS, is an assistant professor of medicine at the University of Colorado's Anschutz medical campus, Aurora, where she is the director of care transitions and director of scholarship for the division of hospital medicine.

University of Colorado Hospital

Dr. Jones’ research is focused on improving care coordination between clinicians in different settings to improve outcomes for patients discharged with home health care. Her research is supported by a K08 career development award from the Agency for Healthcare Research and Quality. Her overall goal is to improve the quality of care transitions for hospitalized patients discharged to post-acute care settings, including home health care. Dr. Jones has presented at every SHM annual conference since she joined in 2013.
 

Chapter Excellence Awards

The Society of Hospital Medicine is proud to recognize outstanding SHM chapters at HM18 for the fifth annual Chapter Excellence Awards. Each year, chapters strive to demonstrate growth, sustenance, and innovation within their chapter activities, which are then applauded for their successes at SHM’s annual conference.

Platinum Chapters: Gulf States, Iowa, Maryland, Michigan, Minnesota, New Mexico, North Carolina Triangle, St. Louis.

Gold Chapters: Hampton Roads, Kentucky, North Jersey, Pacific Northwest.

Silver Chapters: Boston/Eastern Massachusetts, Houston, Los Angeles, Maine, NYC/Westchester, Rocky Mountain, San Francisco Bay Area, South Central PA, Southwest Florida, Wiregrass.
 

Outstanding Chapter of the Year

New Mexico. SHM’s New Mexico Chapter has been nominated to receive the Outstanding Chapter of the Year Award for 2017. Consistently, leadership and members go above and beyond the basic requirements to maintain status by creating and cultivating multiple innovative and dynamic opportunities for attendees to educate and network. The chapter participated in SHM’s pilot program to offer CME for chapters, bringing a CME-accredited educational presentation on the care of diverse patients. Their annual meeting this year featured a poster competition for residents, students, and early-career hospitalists; a didactic on antimicrobial stewardship; and a business meeting with elections, member benefits, and highlights of the chapter’s year, and chapter awards. The chapter initiated breakfast meetings with didactics on DACA and on burnout and wellness, and collaborated with the University of New Mexico, Albuquerque on a grand rounds series on physician wellness that was available via telecast to numerous hospitals and providers off site. The chapter hosted a book club, a networking session at HM17, and an informational meeting on SHM membership and the Fellows Program. They have supported the future of hospital medicine by having a table at the UNM School of Medicine’s student activities fair, a Resident of the Year Award, and a position on our council for a resident representative. They have collaborated with the sole internal medicine residency program in New Mexico so that residents in the hospitalist training track have membership in SHM, and they have expanded our juried poster competition to include students. The chapter’s level of originality is not only a benefit to the chapter, but SHM’s chapter program as a whole.

Rising Star Chapter

Kentucky. SHM’s Kentucky Chapter has been nominated to receive the Rising Star Chapter Award for 2017 for their innovation and growth. The chapter’s leadership was involved with the establishment of the Heartland Hospital Medicine Conference and hosted a hospital medicine career panel and bustling Research, Innovations, and Clinical Vignettes abstract and poster competition. Nearly 50 abstracts were submitted, and the top 40 were invited to present posters at the competition. These posters included a mix of attendings, advanced practice providers, residents, and students interested in participating in the local hospital medicine community. The chapter sponsored the first prize winner’s travel to attend Hospital Medicine 2018 and gave awards to best resident and best student posters. The Kentucky Chapter directly recruited 27 hospitalists to join SHM membership in 2017. The Kentucky Chapter is an active, enthusiastic chapter that is rapidly growing and thriving.

Student Hospitalist Scholarship Recipients

The Society of Hospital Medicine’s Physician in Training Committee launched a Student Hospitalist Scholar Grant program in 2015 for medical students to conduct mentored scholarly projects related to quality improvement and patient safety.

The program was expanded in 2017 and now includes both a summer and longitudinal program for students.

The committee is happy to announce the 4th year of scholar grant recipients to six students based on their ability and interest in hospital medicine, general qualifications, prior educational training, and promise for scholarly activity.

Summer Program

Ilana Scandariato
Cornell University, New York
Project: Understanding the experience of the long-term hospitalized patient with provider fragmentation: A qualitative study
Mentor: Ernie Esquivel, MD, FHM

Maximilian Hemmrich
University of Chicago
Project: Derivation and validation of a COPD readmission risk prediction tool
Mentor: Valerie Press, MD, MPH, SFHM

Sandeep Bala
University of Central Florida, Orlando
Project: The impact of plain language open medical notes on patient activation
Mentor: Marisha Burden, MD, SFHM

Longitudinal Program

Erin Rainosek
University of Texas, San Antonio
Project Title: Design thinking to improve patient experience
Mentor: Luci Leykum, MD, SFHM

Matthew Fallon
Creighton University, Omaha, Neb.
Project: Reducing the hospital readmission rate of congestive heart failure (CHF)
Mentor: Venkata Andukuri, MD, MPH, FHM

Philip Huang
University of Iowa, Iowa City
Project: Expanded patient regionalization to improve care efficiency
Mentor: Ethan Kuperman, MD, FHM


Resident Travel Grant Recipients

The Society of Hospital Medicine’s Physician in Training Committee launched a Resident Travel Grant Program in 2017 for residents to receive funding to attend SHM’s Annual Conference and be recognized for their scholarly work.

The Committee is pleased to announce the first year of Resident Travel Grant Recipients to 10 Residents based on their ability and interest in hospital medicine, research originality, and teaching value, and general qualifications.

Ashley M. Jenkins, MD
Cincinnati Children’s Hospital Medical Center
Poster 41 - Aren’t adults just big kids?: Standardizing care of adults in pediatric hospitals

Brian A. MacDonald Jr., MD, PhD
State University of New York at Buffalo
Poster 135 – Phosphatidylethanol level as a predictor of acute alcohol withdrawal

Christopher S. Bartlett, MD, MPH
University of New Mexico Health Sciences Center, Albuquerque
Poster 47 - Lessons learned from a resident-created experiential quality improvement and patient safety curriculum for medical and nursing students at the University of New Mexico

Christopher T. Su, MD, MPH
Montefiore Medical Center/Albert Einstein College of Medicine, New York
Poster 173 - Concurrent NSAID and warfarin use is associated with increased blood transfusions in hospitalized patients

Madeleine Ivrit Matthiesen, MD
Harvard Medical School/Massachusetts General Hospital Medicine–Pediatrics, Boston
Poster 69 - Resident perceptions of feedback and teaching

Neil Keshvani, MD
University of Texas Southwestern Medical Center, Dallas
Poster 237 - Improving respiratory rate measurement accuracy in the hospital: A quality improvement initiative

Peter N. Barish, MD
University of California, San Francisco
Poster 344 - Costs Related to potential overuse of respiratory viral panel PCRs in general medicine patients

Rachna Rawal, MD
Saint Louis University
Poster 259 - Empowering medicine residents to think before ordering daily labs: A quality improvement study

Yihan Chen, MD
University of California, Los Angeles, Medical Center
Poster 12 - Hospitalist-directed transfers improve emergency room length of stay

Zachary G. Jacobs, MD
University of California, San Francisco
Poster 233 - The prevalence of treating asymptomatic elevated blood pressure with intravenous antihypertensives on the general medicine wards: A potential target for a quality improvement inter-vention
Poster 96 - Factors Impacting time to antibiotic administration in patients with sepsis: A single-center study of electronic health record data

SHM’s Award of Excellence in Outstanding Service in Hospital Medicine

Dr. Flora Kisuule, MD, SFHM, is an assistant professor at Johns Hopkins School of Medicine and the vice chair for clinical operations for the department of medicine at Johns Hopkins Bayview Medical Center. While at Johns Hopkins University, both in Baltimore, she codeveloped a hospitalist fellowship program that she now directs, as well as a fellowship program specifically for nurse practitioners and physician assistants. Under her leadership as the associate director of the division of hospital medicine, she helped to bring Johns Hopkins Bayview hospitalists’ quality and mortality indicators into the top 5% nationwide and reduced hospital-acquired conditions at Hopkins Bayview to the best of the four regional Hopkins Health System hospitals.

Nationally, she has served on several SHM committees, facilitated at multiple SHM leadership courses, served as vice president of SHM’s Baltimore Chapter, and consulted on hospitalist programs around the country. Internationally, Dr. Kisuule has developed and mentored hospitalist programs in Saudi Arabia, the United Arab Emirates, and Central America. She is currently developing a training program in hospital medicine in Panama and is a Senior Fellow in Hospital Medicine.
 

SHM’s Award of Excellence in Teamwork in Quality Improvement

Since 2011, the Johns Hopkins Health System hospitals have conducted quality improvement projects to increase the value of care for their patients. Their amazing work catalyzed a grass-roots initiative involving faculty and residents at both Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

With a unification of the EHR across the health system, RedondaMiller, MD, MBA, president of Johns Hopkins Hospital, and Renee Demski, MSW, MBA, vice president of quality for Johns Hopkins Health System, created the Johns Hopkins Health System High-Value Care Committee to operationalize initiatives across all six hospitals and Johns Hopkins community physicians. The committee is under the leadership of Trushar Dungarani, DO, FHM, from Howard County General Hospital and Lenny Feldman, MD, SFHM, Amit Pahwa, MD, and Pamela Johnson, MD, from Johns Hopkins Hospital, and comprises provider representatives from each institution and other important contributors from various specialties, including Mike Borowitz, MD, PhD; Dr. Ken Lee, DrPH; Emily Pherson, PharmD; Amy Knight, MD; Tim Niessen, MD, MPH; Keisha Perrin, and Clare Rock.

Initiatives directed by the committee have included reducing inappropriate testing for Clostridium difficile, folate testing for anemia, and duplicative imaging exams, among others. In the 18 months since inception, the committee reduced charges to patients and payers by nearly $4 million and hospital costs by more than $200,000.

Members of this committee joined forces with like-minded institutions to create the High Value Practice Academic Alliance in 2016. Faculty leaders from more than 80 academic centers are now collaborating to increase health care value on a national scale through quality improvement projects, education, and dissemination.

SHM’s Award of Excellence in Teaching

Jennifer O’Toole, MD, MEd, is a med-peds hospitalist at the Cincinnati Children’s Hospital Medical Center and University of Cincinnati Medical Center. She serves as the director of the combined internal medicine and pediatrics residency program and is the director of education for the Children’s Hospital division of hospital medicine. In these roles, Dr. O’Toole has established an acute care track for her med-peds residents interested in careers in hospital medicine and a career development boot camp for early-career faculty members and fellows in the division of hospital medicine.

Perhaps Dr. O’Toole’s most instrumental role as an educator has been her involvement in influential educational programs nationally, including the I-PASS Handoff program. Implementation of I-PASS decreased medical errors by 23% and preventable adverse events by 30% in more than 10,000 patient admissions across nine North American hospitals. She has authored more than 30 peer-reviewed publications related to medical education and has presented more than 50 workshops at national meetings. After serving as a member of the planning committee for the Pediatric Hospital Medicine meeting, she is cochair for the 2018 meeting.

SHM’s Award of Clinical Excellence for Physicians

Rick Hilger, MD, SFHM, has been a hospitalist with HealthPartners Regions Hospital in St. Paul, Minnesota for 16 years. He is a national expert in the areas of readmission prevention and care delivery for high-utilizer patients. His work in this area was named Best Clinical Innovation at Hospital Medicine 2012. His collaborative approach to solving complex problems is demonstrated by the amount of time he has volunteered to help other organizations improve their care of high utilizers. Over 90 organizations and hospitals have reached out for assistance in starting their own committees, and Dr. Hilger has shared his time and care plan templates with each one. He was one of the first hospitalists asked to participate on a National Quality Forum committee and has improved hospital reimbursement by over 4 million dollars by developing an internal physician advisor program.

Dr. Hilger also has served on the SHM Annual Conference Committee and the Public Policy Committee, where he has worked with other committee members to advocate for policy changes related to observation status and readmission penalties.

SHM’s Award for Excellence in Humanitarian Services

Michelle Morse, MD, MPH, is a hospitalist and the assistant program director for the internal medicine residency at Brigham and Women’s Hospital in Boston. She is also the founding codirector of EqualHealth, an organization that aims to inspire and support the development of Haiti’s next generation of health care leaders. In 2015, Dr. Morse helped to found the Social Medicine Consortium, a global coalition of more than 450 people representing over 50 universities and organizations in 12 countries, which seeks to address the miseducation of health professionals.

In the aftermath of the 2010 earthquake in Haiti, Dr. Morse was compelled to collaborate with colleagues and friends to help build capacity of health care providers committed to social medicine, medical and nursing education, and social justice. She helped to open and operate a new 300-bed teaching hospital in rural Haiti and founded the first three residency training programs at the hospital. Since that time, the hospital has expanded to serve an area of 3 million people with an annual budget of $12 million.
 

SHM’s Award of Excellence in Research

Teryl Nuckols, MD, FHM, is a hospitalist and the director of general internal medicine at Cedars-Sinai Medical Center in Los Angeles. She also serves as associate professor of medicine at the University of California, Los Angeles, and a health services researcher at the RAND Corporation in Santa Monica.

Currently, she is principal investigator and coprincipal investigator on two projects funded by the Agency for Healthcare Research and Quality that are evaluating effects of the Medicare Hospital Readmissions Reduction Program. Dr. Nuckols was previously the principal investigator on two R01 research grants from the Agency for Healthcare Research and Quality and the recipient of a K08 Career Development Award. She has evaluated clinical practice guidelines on behalf of SHM as well as policy makers in California and Australia, and her work has led to more than 30 peer-reviewed publications in NEJM, Journal of Hospital Medicine, and JAMA Internal Medicine among others.
 

SHM’s Award of Clinical Excellence for NPs/PAs

Meredith K. Wold, PA-C, is the supervisor of advanced practice clinicians at HealthPartners Medical Group, which includes 20 nurse practitioners and physician assistants, at Regions Hospital in St. Paul, Minn. She is also the cofounder and co-curriculum director for the HealthPartners Hospital Medicine Physician Assistant Fellowship Program. Under her leadership, the fellowship program offers a clear curriculum that exposes key clinical scenarios and specialties crucial to hospital medicine, preparing new PAs to contribute immediately to team-based care upon completion of the fellowship.

To prevent burnout in a 7-on/7-off schedule, Ms. Wold thought creatively and developed a pooling and “draft” system to give some flexibility and breaks in the block schedule – almost like a fantasy football draft but with patient care shifts for noncontinuity services.
 

Excellence in Management in Hospital Medicine

Maria Lourdes Novelero, MA, MPA, is the associate chair for administration of the department of medicine at the University of California, San Francisco, and has also served as the administrator of the UCSF division of hospital medicine and its associated medical service from 2005 to 2016. In this role, she managed the department’s expansion from a 20-physician division to an 80-physician division. She also led the department’s pioneering efforts in quality, safety, and value.

Ms. Novelero created a structure to build and manage 10 different hospitalist-run services, including cancer, cardiology, neurosurgery, and liver transplant comanagement services; a procedure service; a palliative care service; and a large non–housestaff medicine service. She co-led a multidisciplinary effort to transform the discharge process, and established and cochaired the department of hospital medicine’s high value care committee, which catalyzed value improvement activities throughout UCSF. This committee’s work led to tangible value improvements, such as a 14% reduction in direct costs and a first-ever positive net margin for the medical service.

Ms. Novelero has more than 25 years of experience in management positions in the United States and Japan.
 

Certificate of Leadership in Hospital Medicine

Benji K. Mathews, MD, SFHM, CLHM, graduated from the Institute of Technology at the University of Minnesota and the University of Minnesota Medical School. He completed his internal medicine residency and chief residency through the University of Minnesota, Minneapolis. He joined HealthPartners as an academic hospitalist and holds the titles of section head of hospital medicine at Regions Hospital and director of point of care ultrasound (POCUS) for Hospital Medicine at HealthPartners. He is the president for the Minnesota Chapter of the Society of Hospital Medicine (SHM).

Dr. Mathews has a passion for medical education, care delivery, and quality. He is an assistant professor of medicine at the University of Minnesota. As such, he is core faculty for the internal medicine residency program and chair of the Clinical Competency Committee. Dr. Mathews is an active member of SHM as a member of SHM's annual meeting planning committee, organizing and setting the agenda for SHM's record breaking meetings for the last 4 years. Dr. Mathews also serves on SHM's Quality Improvement and Patient Safety Committee and is the chair of the Diagnostic Error Subcommittee. He has completed the Certificate of Leadership in Hospital Medicine (CLHM) with his area of focus on ultrasound in hospital medicine. His work in diagnostic error and POCUS has been well recognized with multiple workshops and presentations given locally and nationally. He is a Fellow in Diagnostic Safety through the Society to Improve Diagnosis in Medicine.

Dr. Mathews also has a passion for global health, rooted in his commitment to reducing health care disparities both locally and globally. He has worked with medical missions, NGOs, and orphanages in Nepal, India, Bolivia, Honduras, and Costa Rica. This led him to complete the global health course at the University of Minnesota.
 

SHM’s Junior Investigator Award

Christine D. Jones, MD, MS, is an assistant professor of medicine at the University of Colorado's Anschutz medical campus, Aurora, where she is the director of care transitions and director of scholarship for the division of hospital medicine.

University of Colorado Hospital

Dr. Jones’ research is focused on improving care coordination between clinicians in different settings to improve outcomes for patients discharged with home health care. Her research is supported by a K08 career development award from the Agency for Healthcare Research and Quality. Her overall goal is to improve the quality of care transitions for hospitalized patients discharged to post-acute care settings, including home health care. Dr. Jones has presented at every SHM annual conference since she joined in 2013.
 

Chapter Excellence Awards

The Society of Hospital Medicine is proud to recognize outstanding SHM chapters at HM18 for the fifth annual Chapter Excellence Awards. Each year, chapters strive to demonstrate growth, sustenance, and innovation within their chapter activities, which are then applauded for their successes at SHM’s annual conference.

Platinum Chapters: Gulf States, Iowa, Maryland, Michigan, Minnesota, New Mexico, North Carolina Triangle, St. Louis.

Gold Chapters: Hampton Roads, Kentucky, North Jersey, Pacific Northwest.

Silver Chapters: Boston/Eastern Massachusetts, Houston, Los Angeles, Maine, NYC/Westchester, Rocky Mountain, San Francisco Bay Area, South Central PA, Southwest Florida, Wiregrass.
 

Outstanding Chapter of the Year

New Mexico. SHM’s New Mexico Chapter has been nominated to receive the Outstanding Chapter of the Year Award for 2017. Consistently, leadership and members go above and beyond the basic requirements to maintain status by creating and cultivating multiple innovative and dynamic opportunities for attendees to educate and network. The chapter participated in SHM’s pilot program to offer CME for chapters, bringing a CME-accredited educational presentation on the care of diverse patients. Their annual meeting this year featured a poster competition for residents, students, and early-career hospitalists; a didactic on antimicrobial stewardship; and a business meeting with elections, member benefits, and highlights of the chapter’s year, and chapter awards. The chapter initiated breakfast meetings with didactics on DACA and on burnout and wellness, and collaborated with the University of New Mexico, Albuquerque on a grand rounds series on physician wellness that was available via telecast to numerous hospitals and providers off site. The chapter hosted a book club, a networking session at HM17, and an informational meeting on SHM membership and the Fellows Program. They have supported the future of hospital medicine by having a table at the UNM School of Medicine’s student activities fair, a Resident of the Year Award, and a position on our council for a resident representative. They have collaborated with the sole internal medicine residency program in New Mexico so that residents in the hospitalist training track have membership in SHM, and they have expanded our juried poster competition to include students. The chapter’s level of originality is not only a benefit to the chapter, but SHM’s chapter program as a whole.

Rising Star Chapter

Kentucky. SHM’s Kentucky Chapter has been nominated to receive the Rising Star Chapter Award for 2017 for their innovation and growth. The chapter’s leadership was involved with the establishment of the Heartland Hospital Medicine Conference and hosted a hospital medicine career panel and bustling Research, Innovations, and Clinical Vignettes abstract and poster competition. Nearly 50 abstracts were submitted, and the top 40 were invited to present posters at the competition. These posters included a mix of attendings, advanced practice providers, residents, and students interested in participating in the local hospital medicine community. The chapter sponsored the first prize winner’s travel to attend Hospital Medicine 2018 and gave awards to best resident and best student posters. The Kentucky Chapter directly recruited 27 hospitalists to join SHM membership in 2017. The Kentucky Chapter is an active, enthusiastic chapter that is rapidly growing and thriving.

Student Hospitalist Scholarship Recipients

The Society of Hospital Medicine’s Physician in Training Committee launched a Student Hospitalist Scholar Grant program in 2015 for medical students to conduct mentored scholarly projects related to quality improvement and patient safety.

The program was expanded in 2017 and now includes both a summer and longitudinal program for students.

The committee is happy to announce the 4th year of scholar grant recipients to six students based on their ability and interest in hospital medicine, general qualifications, prior educational training, and promise for scholarly activity.

Summer Program

Ilana Scandariato
Cornell University, New York
Project: Understanding the experience of the long-term hospitalized patient with provider fragmentation: A qualitative study
Mentor: Ernie Esquivel, MD, FHM

Maximilian Hemmrich
University of Chicago
Project: Derivation and validation of a COPD readmission risk prediction tool
Mentor: Valerie Press, MD, MPH, SFHM

Sandeep Bala
University of Central Florida, Orlando
Project: The impact of plain language open medical notes on patient activation
Mentor: Marisha Burden, MD, SFHM

Longitudinal Program

Erin Rainosek
University of Texas, San Antonio
Project Title: Design thinking to improve patient experience
Mentor: Luci Leykum, MD, SFHM

Matthew Fallon
Creighton University, Omaha, Neb.
Project: Reducing the hospital readmission rate of congestive heart failure (CHF)
Mentor: Venkata Andukuri, MD, MPH, FHM

Philip Huang
University of Iowa, Iowa City
Project: Expanded patient regionalization to improve care efficiency
Mentor: Ethan Kuperman, MD, FHM


Resident Travel Grant Recipients

The Society of Hospital Medicine’s Physician in Training Committee launched a Resident Travel Grant Program in 2017 for residents to receive funding to attend SHM’s Annual Conference and be recognized for their scholarly work.

The Committee is pleased to announce the first year of Resident Travel Grant Recipients to 10 Residents based on their ability and interest in hospital medicine, research originality, and teaching value, and general qualifications.

Ashley M. Jenkins, MD
Cincinnati Children’s Hospital Medical Center
Poster 41 - Aren’t adults just big kids?: Standardizing care of adults in pediatric hospitals

Brian A. MacDonald Jr., MD, PhD
State University of New York at Buffalo
Poster 135 – Phosphatidylethanol level as a predictor of acute alcohol withdrawal

Christopher S. Bartlett, MD, MPH
University of New Mexico Health Sciences Center, Albuquerque
Poster 47 - Lessons learned from a resident-created experiential quality improvement and patient safety curriculum for medical and nursing students at the University of New Mexico

Christopher T. Su, MD, MPH
Montefiore Medical Center/Albert Einstein College of Medicine, New York
Poster 173 - Concurrent NSAID and warfarin use is associated with increased blood transfusions in hospitalized patients

Madeleine Ivrit Matthiesen, MD
Harvard Medical School/Massachusetts General Hospital Medicine–Pediatrics, Boston
Poster 69 - Resident perceptions of feedback and teaching

Neil Keshvani, MD
University of Texas Southwestern Medical Center, Dallas
Poster 237 - Improving respiratory rate measurement accuracy in the hospital: A quality improvement initiative

Peter N. Barish, MD
University of California, San Francisco
Poster 344 - Costs Related to potential overuse of respiratory viral panel PCRs in general medicine patients

Rachna Rawal, MD
Saint Louis University
Poster 259 - Empowering medicine residents to think before ordering daily labs: A quality improvement study

Yihan Chen, MD
University of California, Los Angeles, Medical Center
Poster 12 - Hospitalist-directed transfers improve emergency room length of stay

Zachary G. Jacobs, MD
University of California, San Francisco
Poster 233 - The prevalence of treating asymptomatic elevated blood pressure with intravenous antihypertensives on the general medicine wards: A potential target for a quality improvement inter-vention
Poster 96 - Factors Impacting time to antibiotic administration in patients with sepsis: A single-center study of electronic health record data

The Call for Content for HM19 – open to both Society of Hospital Medicine members and nonmembers – is being expanded from solely workshop submissions to include speaker and topic proposals.

“The open call for workshops has been in place for a number of years,” said Dustin T. Smith, MD, FHM, an associate professor of medicine at Emory University in Atlanta. Dr. Smith is an HM18 assistant course director and will be the primary course director for HM19. “In the past, we used a targeted survey method to get speaker/topic suggestions for the didactic sessions. The change was made, in part, based on member and annual meeting feedback along with strong SHM leadership support and guidance.”

This change, for both workshops and sessions, will allow for more speaker diversity, as well as open the door for new presenters. “We really feel this ability to propose content and speakers will resonate with our members and nonmembers alike, giving them a voice in annual conference planning,” he continued. “Our overall goal is to create new and exciting meeting formats each year that spark interest and promote overall attendee learning.”

Dr. Smith hosted an informational presentation on the process as part of the MEDTalks session on Monday.

When asked about themes for next year’s conference, Dr. Smith stated, “I anticipate that some of the areas of focus will center around health policy, advocacy for patients, and the latest in hospital medicine.” The SHM Annual Meeting Committee is responsible for HM19’s didactic content, the foundation of which will be rooted in hot topics and subject areas in the field. Planning also will take into account momentum and feedback from HM18.

“We have a few innovative and exciting educational tracks at HM18, including The Great Debate and Seasoning Your Career. If they are successful, we hope to offer similar ones next year,” Dr. Smith explained. “Some already popular tracks such as Rapid Fire clinical topics and Clinical Updates will likely remain meeting staples, although their content will certainly change.

“I am a working member of a talented group of incredibly knowledgeable hospitalists who form the Annual Conference Committee for both HM18 and HM19. With amazing SHM leadership and staff liaison guidance and support, we will be planning content for the bulk of the educational portion of next year’s conference,” he noted.

The Call for Content for HM19 – open to both Society of Hospital Medicine members and nonmembers – is being expanded from solely workshop submissions to include speaker and topic proposals.

“The open call for workshops has been in place for a number of years,” said Dustin T. Smith, MD, FHM, an associate professor of medicine at Emory University in Atlanta. Dr. Smith is an HM18 assistant course director and will be the primary course director for HM19. “In the past, we used a targeted survey method to get speaker/topic suggestions for the didactic sessions. The change was made, in part, based on member and annual meeting feedback along with strong SHM leadership support and guidance.”

This change, for both workshops and sessions, will allow for more speaker diversity, as well as open the door for new presenters. “We really feel this ability to propose content and speakers will resonate with our members and nonmembers alike, giving them a voice in annual conference planning,” he continued. “Our overall goal is to create new and exciting meeting formats each year that spark interest and promote overall attendee learning.”

Dr. Smith hosted an informational presentation on the process as part of the MEDTalks session on Monday.

When asked about themes for next year’s conference, Dr. Smith stated, “I anticipate that some of the areas of focus will center around health policy, advocacy for patients, and the latest in hospital medicine.” The SHM Annual Meeting Committee is responsible for HM19’s didactic content, the foundation of which will be rooted in hot topics and subject areas in the field. Planning also will take into account momentum and feedback from HM18.

“We have a few innovative and exciting educational tracks at HM18, including The Great Debate and Seasoning Your Career. If they are successful, we hope to offer similar ones next year,” Dr. Smith explained. “Some already popular tracks such as Rapid Fire clinical topics and Clinical Updates will likely remain meeting staples, although their content will certainly change.

“I am a working member of a talented group of incredibly knowledgeable hospitalists who form the Annual Conference Committee for both HM18 and HM19. With amazing SHM leadership and staff liaison guidance and support, we will be planning content for the bulk of the educational portion of next year’s conference,” he noted.

The Call for Content for HM19 – open to both Society of Hospital Medicine members and nonmembers – is being expanded from solely workshop submissions to include speaker and topic proposals.

“The open call for workshops has been in place for a number of years,” said Dustin T. Smith, MD, FHM, an associate professor of medicine at Emory University in Atlanta. Dr. Smith is an HM18 assistant course director and will be the primary course director for HM19. “In the past, we used a targeted survey method to get speaker/topic suggestions for the didactic sessions. The change was made, in part, based on member and annual meeting feedback along with strong SHM leadership support and guidance.”

This change, for both workshops and sessions, will allow for more speaker diversity, as well as open the door for new presenters. “We really feel this ability to propose content and speakers will resonate with our members and nonmembers alike, giving them a voice in annual conference planning,” he continued. “Our overall goal is to create new and exciting meeting formats each year that spark interest and promote overall attendee learning.”

Dr. Smith hosted an informational presentation on the process as part of the MEDTalks session on Monday.

When asked about themes for next year’s conference, Dr. Smith stated, “I anticipate that some of the areas of focus will center around health policy, advocacy for patients, and the latest in hospital medicine.” The SHM Annual Meeting Committee is responsible for HM19’s didactic content, the foundation of which will be rooted in hot topics and subject areas in the field. Planning also will take into account momentum and feedback from HM18.

“We have a few innovative and exciting educational tracks at HM18, including The Great Debate and Seasoning Your Career. If they are successful, we hope to offer similar ones next year,” Dr. Smith explained. “Some already popular tracks such as Rapid Fire clinical topics and Clinical Updates will likely remain meeting staples, although their content will certainly change.

“I am a working member of a talented group of incredibly knowledgeable hospitalists who form the Annual Conference Committee for both HM18 and HM19. With amazing SHM leadership and staff liaison guidance and support, we will be planning content for the bulk of the educational portion of next year’s conference,” he noted.

This morning’s “Primary Palliative Care – What Every Hospitalist Should Know” is an introductory session on primary palliative care to help define the concept, illustrate the problem, and help troubleshoot barriers to practicing high-quality primary palliative care, according to Brett Hendel-Paterson, MD, FHM, a hospitalist at Region’s Hospital in St. Paul, Minn. and a presenter for this session.

Dr. Hendel-Paterson, Jeffrey L. Greenwald, MD, SFHM, of Massachusetts General Hospital, Boston, and Jeffrey Frank, MD, MBA, of Vituity, will each present on the topic of administering palliative care as a hospitalist and why it is important for hospitalists to better understand this area of medicine.

A common misunderstanding about palliative care is that it is end-of-life care only, a misconception within both the medical and patient community. Most people believe that palliative care is associated with the “angel of death,” as Dr. Greenwald stated. Palliative care does encompass end-of-life care but is also associated with life-limiting illness. Both areas of palliative can be improved with better patient communication and symptom management.

As frontline providers at times of critical illness, and throughout illness, hospitalists are ideally positioned to provide palliative care services, Dr. Greenwald stated during an interview.

With hospitalists in such a prominent role in providing palliative care, Dr. Hendel-Paterson offered a detailed explanation about why the information from this session is important for hospitalists.

“The majority of Americans who die in this country die in hospitals. We see and we know that patients sometimes get more aggressive care leading to greater suffering in their final days,” he said. “As hospitalists, we are expected to be the primary physicians in the hospital caring for patients with a variety of health conditions. We are expected to have a basic expertise and be able to independently manage health conditions. For example, we are expected to be able to diagnose and treat pneumonia without consulting infectious disease or pulmonology specialists for basic care. In the same way, we must be able to communicate well with our patients and families and help lead them through discussions of prognosis and advance care planning. Primary palliative care refers to the skill set that includes communications about serious illness and basic symptom management.”

Dr. Greenwald expanded on Dr. Hendel-Paterson’s point concerning the growing need for hospitalists who are competent in palliative care.

“As the population ages, this issue is going to become more and more important for our field, because there isn’t a sufficient pipeline, current state – or predicted future state – of palliative care providers in hospitals to meet the need. So there’s a gap in the need, and that need is increasing.”

Primary Palliative Care – What Every Hospitalist Should Know
Wednesday, 10:00-10:40 a.m.
Crystal Ballroom J1

This morning’s “Primary Palliative Care – What Every Hospitalist Should Know” is an introductory session on primary palliative care to help define the concept, illustrate the problem, and help troubleshoot barriers to practicing high-quality primary palliative care, according to Brett Hendel-Paterson, MD, FHM, a hospitalist at Region’s Hospital in St. Paul, Minn. and a presenter for this session.

Dr. Hendel-Paterson, Jeffrey L. Greenwald, MD, SFHM, of Massachusetts General Hospital, Boston, and Jeffrey Frank, MD, MBA, of Vituity, will each present on the topic of administering palliative care as a hospitalist and why it is important for hospitalists to better understand this area of medicine.

A common misunderstanding about palliative care is that it is end-of-life care only, a misconception within both the medical and patient community. Most people believe that palliative care is associated with the “angel of death,” as Dr. Greenwald stated. Palliative care does encompass end-of-life care but is also associated with life-limiting illness. Both areas of palliative can be improved with better patient communication and symptom management.

As frontline providers at times of critical illness, and throughout illness, hospitalists are ideally positioned to provide palliative care services, Dr. Greenwald stated during an interview.

With hospitalists in such a prominent role in providing palliative care, Dr. Hendel-Paterson offered a detailed explanation about why the information from this session is important for hospitalists.

“The majority of Americans who die in this country die in hospitals. We see and we know that patients sometimes get more aggressive care leading to greater suffering in their final days,” he said. “As hospitalists, we are expected to be the primary physicians in the hospital caring for patients with a variety of health conditions. We are expected to have a basic expertise and be able to independently manage health conditions. For example, we are expected to be able to diagnose and treat pneumonia without consulting infectious disease or pulmonology specialists for basic care. In the same way, we must be able to communicate well with our patients and families and help lead them through discussions of prognosis and advance care planning. Primary palliative care refers to the skill set that includes communications about serious illness and basic symptom management.”

Dr. Greenwald expanded on Dr. Hendel-Paterson’s point concerning the growing need for hospitalists who are competent in palliative care.

“As the population ages, this issue is going to become more and more important for our field, because there isn’t a sufficient pipeline, current state – or predicted future state – of palliative care providers in hospitals to meet the need. So there’s a gap in the need, and that need is increasing.”

Primary Palliative Care – What Every Hospitalist Should Know
Wednesday, 10:00-10:40 a.m.
Crystal Ballroom J1

This morning’s “Primary Palliative Care – What Every Hospitalist Should Know” is an introductory session on primary palliative care to help define the concept, illustrate the problem, and help troubleshoot barriers to practicing high-quality primary palliative care, according to Brett Hendel-Paterson, MD, FHM, a hospitalist at Region’s Hospital in St. Paul, Minn. and a presenter for this session.

Dr. Hendel-Paterson, Jeffrey L. Greenwald, MD, SFHM, of Massachusetts General Hospital, Boston, and Jeffrey Frank, MD, MBA, of Vituity, will each present on the topic of administering palliative care as a hospitalist and why it is important for hospitalists to better understand this area of medicine.

A common misunderstanding about palliative care is that it is end-of-life care only, a misconception within both the medical and patient community. Most people believe that palliative care is associated with the “angel of death,” as Dr. Greenwald stated. Palliative care does encompass end-of-life care but is also associated with life-limiting illness. Both areas of palliative can be improved with better patient communication and symptom management.

As frontline providers at times of critical illness, and throughout illness, hospitalists are ideally positioned to provide palliative care services, Dr. Greenwald stated during an interview.

With hospitalists in such a prominent role in providing palliative care, Dr. Hendel-Paterson offered a detailed explanation about why the information from this session is important for hospitalists.

“The majority of Americans who die in this country die in hospitals. We see and we know that patients sometimes get more aggressive care leading to greater suffering in their final days,” he said. “As hospitalists, we are expected to be the primary physicians in the hospital caring for patients with a variety of health conditions. We are expected to have a basic expertise and be able to independently manage health conditions. For example, we are expected to be able to diagnose and treat pneumonia without consulting infectious disease or pulmonology specialists for basic care. In the same way, we must be able to communicate well with our patients and families and help lead them through discussions of prognosis and advance care planning. Primary palliative care refers to the skill set that includes communications about serious illness and basic symptom management.”

Dr. Greenwald expanded on Dr. Hendel-Paterson’s point concerning the growing need for hospitalists who are competent in palliative care.

“As the population ages, this issue is going to become more and more important for our field, because there isn’t a sufficient pipeline, current state – or predicted future state – of palliative care providers in hospitals to meet the need. So there’s a gap in the need, and that need is increasing.”

Primary Palliative Care – What Every Hospitalist Should Know
Wednesday, 10:00-10:40 a.m.
Crystal Ballroom J1

Measuring and analyzing data is essential for any quality improvement project. Data can validate whether an anecdotal assumption indicates the need for a quality improvement initiative and can help showcase the success of any intervention.

At today’s session, “Using Data to Inform Quality Improvement,” attendees will learn how to develop balanced metrics for quality improvement projects, understand distinctions between quality improvement and traditional research projects, and identify how different measures of the same data can tell vastly different stories.

The session will be divided into three 20-minute sections. Ethan Kuperman, MD, MSc, FHM, clinical assistant professor, University of Iowa Health Care, Iowa City, will begin by discussing how to develop balanced metrics by exploring a venous thromboembolism prophylaxis quality improvement project.

Next, Aparna Kamath, MD, MS, SFHM, assistant professor and academic hospitalist, Duke University Health System, Durham, N.C., will demonstrate the distinction between quality improvement and research by exploring medication reconciliation. “I will also emphasize the need for feasibility and rigor in data gathering and analysis in addition to accuracy when doing a quality improvement project,” she said. “Our workshop will make these tasks less daunting for hospitalists doing quality improvement projects.”

Finally, Justin Glasgow, MD, PhD, inpatient medicine faculty and Value Institute senior clinical scholar, Christiana Care Health System, Newark, Del., will explore how improper data definitions led to differing interpretations while developing and deploying an early warning system. “Attendees will learn how to design a quality improvement project to ensure that they measure interventions in a manner that ensures they have had true success, while not creating any unintended consequences,” Dr. Glasgow said.

“The session is important as it will help attendees develop successful projects that their colleagues will respect and that their bosses will admire,” added Dr. Glasgow. “They will gain confidence to turn their experience into distributable scholarship.”

“Hospitalists at all stages of their careers can benefit from this presentation,” Dr. Kuperman said. “Whether you’re preparing for your first quality improvement project or getting ready for a systemwide redesign, collecting the wrong data or misusing collected data can ruin your results or lead you to the wrong conclusions.”

Using Data to Inform Quality Improvement
Wednesday, 8:40-9:40 a.m.
Crystal Ballroom G1/A&B

Measuring and analyzing data is essential for any quality improvement project. Data can validate whether an anecdotal assumption indicates the need for a quality improvement initiative and can help showcase the success of any intervention.

At today’s session, “Using Data to Inform Quality Improvement,” attendees will learn how to develop balanced metrics for quality improvement projects, understand distinctions between quality improvement and traditional research projects, and identify how different measures of the same data can tell vastly different stories.

The session will be divided into three 20-minute sections. Ethan Kuperman, MD, MSc, FHM, clinical assistant professor, University of Iowa Health Care, Iowa City, will begin by discussing how to develop balanced metrics by exploring a venous thromboembolism prophylaxis quality improvement project.

Next, Aparna Kamath, MD, MS, SFHM, assistant professor and academic hospitalist, Duke University Health System, Durham, N.C., will demonstrate the distinction between quality improvement and research by exploring medication reconciliation. “I will also emphasize the need for feasibility and rigor in data gathering and analysis in addition to accuracy when doing a quality improvement project,” she said. “Our workshop will make these tasks less daunting for hospitalists doing quality improvement projects.”

Finally, Justin Glasgow, MD, PhD, inpatient medicine faculty and Value Institute senior clinical scholar, Christiana Care Health System, Newark, Del., will explore how improper data definitions led to differing interpretations while developing and deploying an early warning system. “Attendees will learn how to design a quality improvement project to ensure that they measure interventions in a manner that ensures they have had true success, while not creating any unintended consequences,” Dr. Glasgow said.

“The session is important as it will help attendees develop successful projects that their colleagues will respect and that their bosses will admire,” added Dr. Glasgow. “They will gain confidence to turn their experience into distributable scholarship.”

“Hospitalists at all stages of their careers can benefit from this presentation,” Dr. Kuperman said. “Whether you’re preparing for your first quality improvement project or getting ready for a systemwide redesign, collecting the wrong data or misusing collected data can ruin your results or lead you to the wrong conclusions.”

Using Data to Inform Quality Improvement
Wednesday, 8:40-9:40 a.m.
Crystal Ballroom G1/A&B

Measuring and analyzing data is essential for any quality improvement project. Data can validate whether an anecdotal assumption indicates the need for a quality improvement initiative and can help showcase the success of any intervention.

At today’s session, “Using Data to Inform Quality Improvement,” attendees will learn how to develop balanced metrics for quality improvement projects, understand distinctions between quality improvement and traditional research projects, and identify how different measures of the same data can tell vastly different stories.

The session will be divided into three 20-minute sections. Ethan Kuperman, MD, MSc, FHM, clinical assistant professor, University of Iowa Health Care, Iowa City, will begin by discussing how to develop balanced metrics by exploring a venous thromboembolism prophylaxis quality improvement project.

Next, Aparna Kamath, MD, MS, SFHM, assistant professor and academic hospitalist, Duke University Health System, Durham, N.C., will demonstrate the distinction between quality improvement and research by exploring medication reconciliation. “I will also emphasize the need for feasibility and rigor in data gathering and analysis in addition to accuracy when doing a quality improvement project,” she said. “Our workshop will make these tasks less daunting for hospitalists doing quality improvement projects.”

Finally, Justin Glasgow, MD, PhD, inpatient medicine faculty and Value Institute senior clinical scholar, Christiana Care Health System, Newark, Del., will explore how improper data definitions led to differing interpretations while developing and deploying an early warning system. “Attendees will learn how to design a quality improvement project to ensure that they measure interventions in a manner that ensures they have had true success, while not creating any unintended consequences,” Dr. Glasgow said.

“The session is important as it will help attendees develop successful projects that their colleagues will respect and that their bosses will admire,” added Dr. Glasgow. “They will gain confidence to turn their experience into distributable scholarship.”

“Hospitalists at all stages of their careers can benefit from this presentation,” Dr. Kuperman said. “Whether you’re preparing for your first quality improvement project or getting ready for a systemwide redesign, collecting the wrong data or misusing collected data can ruin your results or lead you to the wrong conclusions.”

Using Data to Inform Quality Improvement
Wednesday, 8:40-9:40 a.m.
Crystal Ballroom G1/A&B

As has become tradition, Robert Wachter, MD, MHM, of the University of California, San Francisco, will close the conference today and will focus on the broader changes that must happen as the role of the hospitalist continues to evolve.

“I am going to talk about the changes in the world of hospital care and the importance of the field to innovate,” Dr. Wachter said. “To me, there are gravitational forces in the health care world that are making … patients who are in hospitals sicker than they were before. More and more patients are going to be cared for in outpatient settings and at home. We are going start to ... see things like sensors and telemedicine to enable more care outside of the hospital.”

Dr. Wachter said hospital medicine must evolve and mature to continue to prove that hospitalists are indispensable staff members within the hospital.

“That was why the field became the fastest-growing profession in medical history. We can’t sit on our laurels. We have to continue to innovate,” he said. “Even as the system changes around us, I am confident that we will innovate. My talk will be a pep talk and will include reflections on how the world of health care is changing and what those changes will mean to hospitalists.”

Dr. Wachter noted that the trend of steering patients who are less sick to the outpatient setting, as well as other economic factors, would change the nature of hospitalist practice.

“It will be more acuity, more intensity, more complex relationships with your own hospital and often with partner hospitals,” he said. “More of the work will be digitally enabled than it would have been 5 or 10 years ago.”

As has become tradition, Robert Wachter, MD, MHM, of the University of California, San Francisco, will close the conference today and will focus on the broader changes that must happen as the role of the hospitalist continues to evolve.

“I am going to talk about the changes in the world of hospital care and the importance of the field to innovate,” Dr. Wachter said. “To me, there are gravitational forces in the health care world that are making … patients who are in hospitals sicker than they were before. More and more patients are going to be cared for in outpatient settings and at home. We are going start to ... see things like sensors and telemedicine to enable more care outside of the hospital.”

Dr. Wachter said hospital medicine must evolve and mature to continue to prove that hospitalists are indispensable staff members within the hospital.

“That was why the field became the fastest-growing profession in medical history. We can’t sit on our laurels. We have to continue to innovate,” he said. “Even as the system changes around us, I am confident that we will innovate. My talk will be a pep talk and will include reflections on how the world of health care is changing and what those changes will mean to hospitalists.”

Dr. Wachter noted that the trend of steering patients who are less sick to the outpatient setting, as well as other economic factors, would change the nature of hospitalist practice.

“It will be more acuity, more intensity, more complex relationships with your own hospital and often with partner hospitals,” he said. “More of the work will be digitally enabled than it would have been 5 or 10 years ago.”

As has become tradition, Robert Wachter, MD, MHM, of the University of California, San Francisco, will close the conference today and will focus on the broader changes that must happen as the role of the hospitalist continues to evolve.

“I am going to talk about the changes in the world of hospital care and the importance of the field to innovate,” Dr. Wachter said. “To me, there are gravitational forces in the health care world that are making … patients who are in hospitals sicker than they were before. More and more patients are going to be cared for in outpatient settings and at home. We are going start to ... see things like sensors and telemedicine to enable more care outside of the hospital.”

Dr. Wachter said hospital medicine must evolve and mature to continue to prove that hospitalists are indispensable staff members within the hospital.

“That was why the field became the fastest-growing profession in medical history. We can’t sit on our laurels. We have to continue to innovate,” he said. “Even as the system changes around us, I am confident that we will innovate. My talk will be a pep talk and will include reflections on how the world of health care is changing and what those changes will mean to hospitalists.”

Dr. Wachter noted that the trend of steering patients who are less sick to the outpatient setting, as well as other economic factors, would change the nature of hospitalist practice.

“It will be more acuity, more intensity, more complex relationships with your own hospital and often with partner hospitals,” he said. “More of the work will be digitally enabled than it would have been 5 or 10 years ago.”

Many health care providers are guilty of having implicit or unconscious biases against patients, which can negatively affect the care they give. “Once providers come to this realization, they can make a conscious effort to neutralize these biases from manifesting throughout a practice,” said Aziz Ansari, DO, SFHM, associate chief medical officer, Clinical Optimization and Revenue Integrity, and associate professor of medicine, Loyola University Medical Center, Maywood, Ill., who will present today’s session “Winning Hearts and Minds at the Bedside: Battling Unconscious Bias Through Cultural Humility.”

By practicing cultural humility, hospitalists can gain trust from patients and their families, whom they do not know in their everyday practice. This encourages providers to be humble, ascertain what is important to the patient, and learn from every patient encounter.

The session will begin with a case study involving bias, followed by a self-reflection exercise. To determine whether you may be biased against some patient groups, Dr. Ansari recommends taking the online implicit association test at Implicit.harvard.edu.

As a palliative care specialist, Dr. Ansari has repeatedly faced situations in which a lack of cultural humility caused patients or their family member to foster mistrust toward a provider. Consequently, patients and family members may choose aggressive measures that providers might consider futile.

Dr. Ansari also will define what implicit or unconscious biases entail in greater detail. The discussion will then circle back to the original case and reveal how providers can improve their mindset when facing difficult situations by employing a tool called “The 5 Rs of Cultural Humility,” which include reflection, respect, regard, relevance, and resiliency.

Dr. Ansari spearheaded the development of the 5 Rs tool when he chaired the Cultural Humility Workgroup of SHM’s Practice Management Committee. “The goal is to use the tool to attain cultural humility and transform a potentially negative encounter into a gratifying one,” he said.

At a minimum, attendees should take time during the session to reflect on their own thoughts and biases. “This introspection can bring to light practices that providers may have been unaware of and, ultimately, can change their behaviors so every patient and their family feels that they are being seen and heard,” Dr. Ansari said. “In today’s current climate it is more important than ever for providers to self-reflect on their attitudes and perceptions because an increasing number of groups in our diverse society are feeling more marginalized.”

Winning Hearts and Minds at the Bedside: Battling Unconscious Bias Through Cultural Humility
Wednesday, 9:10-9:50 a.m.
​Crystal Ballroom G2/C-F

Many health care providers are guilty of having implicit or unconscious biases against patients, which can negatively affect the care they give. “Once providers come to this realization, they can make a conscious effort to neutralize these biases from manifesting throughout a practice,” said Aziz Ansari, DO, SFHM, associate chief medical officer, Clinical Optimization and Revenue Integrity, and associate professor of medicine, Loyola University Medical Center, Maywood, Ill., who will present today’s session “Winning Hearts and Minds at the Bedside: Battling Unconscious Bias Through Cultural Humility.”

By practicing cultural humility, hospitalists can gain trust from patients and their families, whom they do not know in their everyday practice. This encourages providers to be humble, ascertain what is important to the patient, and learn from every patient encounter.

The session will begin with a case study involving bias, followed by a self-reflection exercise. To determine whether you may be biased against some patient groups, Dr. Ansari recommends taking the online implicit association test at Implicit.harvard.edu.

As a palliative care specialist, Dr. Ansari has repeatedly faced situations in which a lack of cultural humility caused patients or their family member to foster mistrust toward a provider. Consequently, patients and family members may choose aggressive measures that providers might consider futile.

Dr. Ansari also will define what implicit or unconscious biases entail in greater detail. The discussion will then circle back to the original case and reveal how providers can improve their mindset when facing difficult situations by employing a tool called “The 5 Rs of Cultural Humility,” which include reflection, respect, regard, relevance, and resiliency.

Dr. Ansari spearheaded the development of the 5 Rs tool when he chaired the Cultural Humility Workgroup of SHM’s Practice Management Committee. “The goal is to use the tool to attain cultural humility and transform a potentially negative encounter into a gratifying one,” he said.

At a minimum, attendees should take time during the session to reflect on their own thoughts and biases. “This introspection can bring to light practices that providers may have been unaware of and, ultimately, can change their behaviors so every patient and their family feels that they are being seen and heard,” Dr. Ansari said. “In today’s current climate it is more important than ever for providers to self-reflect on their attitudes and perceptions because an increasing number of groups in our diverse society are feeling more marginalized.”

Winning Hearts and Minds at the Bedside: Battling Unconscious Bias Through Cultural Humility
Wednesday, 9:10-9:50 a.m.
​Crystal Ballroom G2/C-F

Many health care providers are guilty of having implicit or unconscious biases against patients, which can negatively affect the care they give. “Once providers come to this realization, they can make a conscious effort to neutralize these biases from manifesting throughout a practice,” said Aziz Ansari, DO, SFHM, associate chief medical officer, Clinical Optimization and Revenue Integrity, and associate professor of medicine, Loyola University Medical Center, Maywood, Ill., who will present today’s session “Winning Hearts and Minds at the Bedside: Battling Unconscious Bias Through Cultural Humility.”

By practicing cultural humility, hospitalists can gain trust from patients and their families, whom they do not know in their everyday practice. This encourages providers to be humble, ascertain what is important to the patient, and learn from every patient encounter.

The session will begin with a case study involving bias, followed by a self-reflection exercise. To determine whether you may be biased against some patient groups, Dr. Ansari recommends taking the online implicit association test at Implicit.harvard.edu.

As a palliative care specialist, Dr. Ansari has repeatedly faced situations in which a lack of cultural humility caused patients or their family member to foster mistrust toward a provider. Consequently, patients and family members may choose aggressive measures that providers might consider futile.

Dr. Ansari also will define what implicit or unconscious biases entail in greater detail. The discussion will then circle back to the original case and reveal how providers can improve their mindset when facing difficult situations by employing a tool called “The 5 Rs of Cultural Humility,” which include reflection, respect, regard, relevance, and resiliency.

Dr. Ansari spearheaded the development of the 5 Rs tool when he chaired the Cultural Humility Workgroup of SHM’s Practice Management Committee. “The goal is to use the tool to attain cultural humility and transform a potentially negative encounter into a gratifying one,” he said.

At a minimum, attendees should take time during the session to reflect on their own thoughts and biases. “This introspection can bring to light practices that providers may have been unaware of and, ultimately, can change their behaviors so every patient and their family feels that they are being seen and heard,” Dr. Ansari said. “In today’s current climate it is more important than ever for providers to self-reflect on their attitudes and perceptions because an increasing number of groups in our diverse society are feeling more marginalized.”

Winning Hearts and Minds at the Bedside: Battling Unconscious Bias Through Cultural Humility
Wednesday, 9:10-9:50 a.m.
​Crystal Ballroom G2/C-F