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VIDEO: SHM seeks sites to test pediatric transition tool
Would you like to help the Society of Hospital Medicine translate its award-winning Project BOOST® Mentored Implementation Program into the pediatric setting?
“We’re hoping to get six sites to help us implement this project so we can collect data and see how well it works for pediatrics,” James O’Callaghan, MD, medical director, EvergreenHealth, Seattle Children’s, said in an interview.
In this video, recorded during HM17 , Dr. O’Callaghan describes how Pedi-BOOST is intended to work, and what types of pediatric transition concerns it is intended to address.
For more information, please visit the SHM website.
Dr. O’Callaghan had no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Would you like to help the Society of Hospital Medicine translate its award-winning Project BOOST® Mentored Implementation Program into the pediatric setting?
“We’re hoping to get six sites to help us implement this project so we can collect data and see how well it works for pediatrics,” James O’Callaghan, MD, medical director, EvergreenHealth, Seattle Children’s, said in an interview.
In this video, recorded during HM17 , Dr. O’Callaghan describes how Pedi-BOOST is intended to work, and what types of pediatric transition concerns it is intended to address.
For more information, please visit the SHM website.
Dr. O’Callaghan had no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Would you like to help the Society of Hospital Medicine translate its award-winning Project BOOST® Mentored Implementation Program into the pediatric setting?
“We’re hoping to get six sites to help us implement this project so we can collect data and see how well it works for pediatrics,” James O’Callaghan, MD, medical director, EvergreenHealth, Seattle Children’s, said in an interview.
In this video, recorded during HM17 , Dr. O’Callaghan describes how Pedi-BOOST is intended to work, and what types of pediatric transition concerns it is intended to address.
For more information, please visit the SHM website.
Dr. O’Callaghan had no relevant disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Workshop to help hospitalists with patient flow
The “flow” of patients through the hospital can sometimes resemble a 10-lane expressway at gridlock, said Christopher Kim, MD, MBA, SFHM, associate professor of internal medicine and associate medical director of quality and safety at the University of Washington Medical Center in Seattle. That is, there’s no flow at all.
Thursday at HM17, Dr. Kim and a panel of experts will lead small workshops of audience members on how to put the “go” back in the flow. The session, “Hospitalists as Leaders in Patient Flow and Hospital Throughput,” will begin at 10 a.m.
“As hospitalists, we are at the sharp end of this problem and are often asked to be key members of project teams assembled to tackle this challenge of patient flow and capacity management,” said Dr. Kim. “We look forward to an interactive session with our audience members.”
The session will address expedited discharge, the idea of the “hospitalist quarterback,” a kind of in-house controller of patient flow; facilitators of transferring to and from outside hospitals; focused efforts on reducing length of stay; establishing short-stay units to enhance patient flow; and participating in continuous process improvement teams, Dr. Kim said.
There will be several small group workshops interspersed with presentations of background content by the workshop facilitators, who represent a wide range of geographic and care settings. Dr. Kim said they have “all experienced the challenges of patient flow and throughput at their hospitals and health systems and have taken leadership roles to address these issues at their medical centers.”
“We anticipate a highly engaging session, where audience members will be divided into different teams, and each team will be tasked to identify specific interventions and challenges in managing the patient flow and capacity management initiative,” said Dr. Berger, associate medical director for inpatient capacity at the University of Washington. “Audience members will work within their own teams, guided by the workshop facilitators, and after the teams come up with their ideas on each of the topics covered in this workshop, each team will have the opportunity to present their best ideas for sharing and feedback.”
The session comes at a time when hospitals are tapping into hospitalists’ experience.
“Many hospitals across the country are challenged with high-occupancy states, creating pressures and external challenges to serve patients’ needs,” said Dr. Parekh, associate professor of internal medicine at the University of Michigan. “Hospitalists in their daily work have great familiarity with how hospitals run and where the ‘bottlenecks’ are that [block] patient throughput in their organization. Recognizing this experience and talent for enabling patient flow, many hospitals have turned to hospitalists – and in some cases, resident trainees – to lead or contribute to the hospital’s initiatives to enhance patient throughput.”
The importance of patient flow goes beyond efficiency, Dr. Kim said. Hospital staff who work during high-occupancy days feel the brunt of the burden, and this can lead to patient safety problems.
“We will address the importance of optimal communication between providers and staff, both within hospitals and with outside hospitals to ensure patient safety and staff concerns are appropriately addressed,” he said. “This is a topic that affects everyone at the medical center, and so we believe that this topic is applicable to a broad audience. We hope the participants will be able to facilitate a dialogue with a diverse group of leaders at their hospitals.”
Hospitalists as Leaders in Patient Flow and Hospital Throughput
Thursday, 10:00–11:30 a.m.
The “flow” of patients through the hospital can sometimes resemble a 10-lane expressway at gridlock, said Christopher Kim, MD, MBA, SFHM, associate professor of internal medicine and associate medical director of quality and safety at the University of Washington Medical Center in Seattle. That is, there’s no flow at all.
Thursday at HM17, Dr. Kim and a panel of experts will lead small workshops of audience members on how to put the “go” back in the flow. The session, “Hospitalists as Leaders in Patient Flow and Hospital Throughput,” will begin at 10 a.m.
“As hospitalists, we are at the sharp end of this problem and are often asked to be key members of project teams assembled to tackle this challenge of patient flow and capacity management,” said Dr. Kim. “We look forward to an interactive session with our audience members.”
The session will address expedited discharge, the idea of the “hospitalist quarterback,” a kind of in-house controller of patient flow; facilitators of transferring to and from outside hospitals; focused efforts on reducing length of stay; establishing short-stay units to enhance patient flow; and participating in continuous process improvement teams, Dr. Kim said.
There will be several small group workshops interspersed with presentations of background content by the workshop facilitators, who represent a wide range of geographic and care settings. Dr. Kim said they have “all experienced the challenges of patient flow and throughput at their hospitals and health systems and have taken leadership roles to address these issues at their medical centers.”
“We anticipate a highly engaging session, where audience members will be divided into different teams, and each team will be tasked to identify specific interventions and challenges in managing the patient flow and capacity management initiative,” said Dr. Berger, associate medical director for inpatient capacity at the University of Washington. “Audience members will work within their own teams, guided by the workshop facilitators, and after the teams come up with their ideas on each of the topics covered in this workshop, each team will have the opportunity to present their best ideas for sharing and feedback.”
The session comes at a time when hospitals are tapping into hospitalists’ experience.
“Many hospitals across the country are challenged with high-occupancy states, creating pressures and external challenges to serve patients’ needs,” said Dr. Parekh, associate professor of internal medicine at the University of Michigan. “Hospitalists in their daily work have great familiarity with how hospitals run and where the ‘bottlenecks’ are that [block] patient throughput in their organization. Recognizing this experience and talent for enabling patient flow, many hospitals have turned to hospitalists – and in some cases, resident trainees – to lead or contribute to the hospital’s initiatives to enhance patient throughput.”
The importance of patient flow goes beyond efficiency, Dr. Kim said. Hospital staff who work during high-occupancy days feel the brunt of the burden, and this can lead to patient safety problems.
“We will address the importance of optimal communication between providers and staff, both within hospitals and with outside hospitals to ensure patient safety and staff concerns are appropriately addressed,” he said. “This is a topic that affects everyone at the medical center, and so we believe that this topic is applicable to a broad audience. We hope the participants will be able to facilitate a dialogue with a diverse group of leaders at their hospitals.”
Hospitalists as Leaders in Patient Flow and Hospital Throughput
Thursday, 10:00–11:30 a.m.
The “flow” of patients through the hospital can sometimes resemble a 10-lane expressway at gridlock, said Christopher Kim, MD, MBA, SFHM, associate professor of internal medicine and associate medical director of quality and safety at the University of Washington Medical Center in Seattle. That is, there’s no flow at all.
Thursday at HM17, Dr. Kim and a panel of experts will lead small workshops of audience members on how to put the “go” back in the flow. The session, “Hospitalists as Leaders in Patient Flow and Hospital Throughput,” will begin at 10 a.m.
“As hospitalists, we are at the sharp end of this problem and are often asked to be key members of project teams assembled to tackle this challenge of patient flow and capacity management,” said Dr. Kim. “We look forward to an interactive session with our audience members.”
The session will address expedited discharge, the idea of the “hospitalist quarterback,” a kind of in-house controller of patient flow; facilitators of transferring to and from outside hospitals; focused efforts on reducing length of stay; establishing short-stay units to enhance patient flow; and participating in continuous process improvement teams, Dr. Kim said.
There will be several small group workshops interspersed with presentations of background content by the workshop facilitators, who represent a wide range of geographic and care settings. Dr. Kim said they have “all experienced the challenges of patient flow and throughput at their hospitals and health systems and have taken leadership roles to address these issues at their medical centers.”
“We anticipate a highly engaging session, where audience members will be divided into different teams, and each team will be tasked to identify specific interventions and challenges in managing the patient flow and capacity management initiative,” said Dr. Berger, associate medical director for inpatient capacity at the University of Washington. “Audience members will work within their own teams, guided by the workshop facilitators, and after the teams come up with their ideas on each of the topics covered in this workshop, each team will have the opportunity to present their best ideas for sharing and feedback.”
The session comes at a time when hospitals are tapping into hospitalists’ experience.
“Many hospitals across the country are challenged with high-occupancy states, creating pressures and external challenges to serve patients’ needs,” said Dr. Parekh, associate professor of internal medicine at the University of Michigan. “Hospitalists in their daily work have great familiarity with how hospitals run and where the ‘bottlenecks’ are that [block] patient throughput in their organization. Recognizing this experience and talent for enabling patient flow, many hospitals have turned to hospitalists – and in some cases, resident trainees – to lead or contribute to the hospital’s initiatives to enhance patient throughput.”
The importance of patient flow goes beyond efficiency, Dr. Kim said. Hospital staff who work during high-occupancy days feel the brunt of the burden, and this can lead to patient safety problems.
“We will address the importance of optimal communication between providers and staff, both within hospitals and with outside hospitals to ensure patient safety and staff concerns are appropriately addressed,” he said. “This is a topic that affects everyone at the medical center, and so we believe that this topic is applicable to a broad audience. We hope the participants will be able to facilitate a dialogue with a diverse group of leaders at their hospitals.”
Hospitalists as Leaders in Patient Flow and Hospital Throughput
Thursday, 10:00–11:30 a.m.
Systems engineering in the hospital
Systems-engineering expert James Benneyan, PhD, doesn’t want hospitalists to look at poorly working processes in their institutions and think, “I should try to tweak this process to improve it.”
Instead, he wants them to walk out of his HM17 session at 8 a.m. Thursday – appropriately titled, “Systems Engineering in the Hospital: What Is in Your Toolkit?” – thinking like engineers, which means designing a solution, analyzing how well that process works, and then optimizing it for improvements. If that means not just tweaking a process, but redesigning it from scratch, so be it.
“Systems engineering studies the performance and how to improve the performance of complex systems, particularly sociotechnical systems,” said Dr. Benneyan, who runs the Healthcare Systems Engineering Institute at Northeastern University in Boston, which encompasses four research centers. “Health care is a perfect example … systems engineering can really help to understand and improve complex processes, whether it’s patient flow, safety, on-time discharge [or] better discharge.”
Dr. Benneyan says that systems engineering is, first and foremost, a mindset. It’s an approach to problem solving that’s different, if related, to quality improvement. Both have tremendous value, but they are based on different philosophies, tools, and work styles.
For example, many hospital operating rooms measure how many days the first procedure of the day begins on time. But instead of using that as a yardstick for quality, Dr. Benneyan said a better approach would be designing a system that can adapt to situations when the first case starts late. He compared the process to a delayed flight at an airport. An airline doesn’t back up every plane’s departure when one plane is running behind. Instead, it has systems that adapt to circumstances.
“There are methods and then there are philosophies,” Dr. Benneyan said. “I don’t think people in health care realize what my field did in the airline industry. We didn’t design things that worked and clicked properly. We designed things that … react to daily events and [everything] going on and perform pretty well.”
Dr. Benneyan says that, while health care is an incredibly complex system, other fields with similar levels of technical expertise have used systems engineering much more effectively. Manufacturing, logistics, and global distribution networks are all precise industries requiring hundreds of individual processes to ensure success.
“These are really complicated processes,” he said. “The real barrier is a cultural barrier. Health care is not the most challenging environment to work in. … I think something that people in health care have to have an appreciation for is that the process of doing this work is different from doing their other work. Systems engineering is not the same as quality improvement and can achieve fundamental breakthroughs in cases where QI has not – but also tends to take more work.”
Still, Dr. Benneyan believes his field has lessons that complement quality initiatives. To wit, health care advocates – including the Institute of Medicine, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the National Science Foundation – have all pushed for greater application of systems engineering in medicine with the goal of improving how well health care does its job.
While he hopes hospitalists and other HM17 attendees at his session walk away with a newfound respect for and understanding of what systems engineering can do, he doesn’t want them to think it’s too easy.
“There’s a lack of appreciation of the process of engineering and how it’s different,” he said. “It’s a big challenge, partnering clinician with engineers. … We think differently even though we’re both scientifically trained.
“I hope hospitalists take away an appreciation for how this toolkit can be useful in their world.”
Systems Engineering in the Hospital: What Is in Your Toolkit?
Thursday, 8:00–9:30 a.m.
Systems-engineering expert James Benneyan, PhD, doesn’t want hospitalists to look at poorly working processes in their institutions and think, “I should try to tweak this process to improve it.”
Instead, he wants them to walk out of his HM17 session at 8 a.m. Thursday – appropriately titled, “Systems Engineering in the Hospital: What Is in Your Toolkit?” – thinking like engineers, which means designing a solution, analyzing how well that process works, and then optimizing it for improvements. If that means not just tweaking a process, but redesigning it from scratch, so be it.
“Systems engineering studies the performance and how to improve the performance of complex systems, particularly sociotechnical systems,” said Dr. Benneyan, who runs the Healthcare Systems Engineering Institute at Northeastern University in Boston, which encompasses four research centers. “Health care is a perfect example … systems engineering can really help to understand and improve complex processes, whether it’s patient flow, safety, on-time discharge [or] better discharge.”
Dr. Benneyan says that systems engineering is, first and foremost, a mindset. It’s an approach to problem solving that’s different, if related, to quality improvement. Both have tremendous value, but they are based on different philosophies, tools, and work styles.
For example, many hospital operating rooms measure how many days the first procedure of the day begins on time. But instead of using that as a yardstick for quality, Dr. Benneyan said a better approach would be designing a system that can adapt to situations when the first case starts late. He compared the process to a delayed flight at an airport. An airline doesn’t back up every plane’s departure when one plane is running behind. Instead, it has systems that adapt to circumstances.
“There are methods and then there are philosophies,” Dr. Benneyan said. “I don’t think people in health care realize what my field did in the airline industry. We didn’t design things that worked and clicked properly. We designed things that … react to daily events and [everything] going on and perform pretty well.”
Dr. Benneyan says that, while health care is an incredibly complex system, other fields with similar levels of technical expertise have used systems engineering much more effectively. Manufacturing, logistics, and global distribution networks are all precise industries requiring hundreds of individual processes to ensure success.
“These are really complicated processes,” he said. “The real barrier is a cultural barrier. Health care is not the most challenging environment to work in. … I think something that people in health care have to have an appreciation for is that the process of doing this work is different from doing their other work. Systems engineering is not the same as quality improvement and can achieve fundamental breakthroughs in cases where QI has not – but also tends to take more work.”
Still, Dr. Benneyan believes his field has lessons that complement quality initiatives. To wit, health care advocates – including the Institute of Medicine, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the National Science Foundation – have all pushed for greater application of systems engineering in medicine with the goal of improving how well health care does its job.
While he hopes hospitalists and other HM17 attendees at his session walk away with a newfound respect for and understanding of what systems engineering can do, he doesn’t want them to think it’s too easy.
“There’s a lack of appreciation of the process of engineering and how it’s different,” he said. “It’s a big challenge, partnering clinician with engineers. … We think differently even though we’re both scientifically trained.
“I hope hospitalists take away an appreciation for how this toolkit can be useful in their world.”
Systems Engineering in the Hospital: What Is in Your Toolkit?
Thursday, 8:00–9:30 a.m.
Systems-engineering expert James Benneyan, PhD, doesn’t want hospitalists to look at poorly working processes in their institutions and think, “I should try to tweak this process to improve it.”
Instead, he wants them to walk out of his HM17 session at 8 a.m. Thursday – appropriately titled, “Systems Engineering in the Hospital: What Is in Your Toolkit?” – thinking like engineers, which means designing a solution, analyzing how well that process works, and then optimizing it for improvements. If that means not just tweaking a process, but redesigning it from scratch, so be it.
“Systems engineering studies the performance and how to improve the performance of complex systems, particularly sociotechnical systems,” said Dr. Benneyan, who runs the Healthcare Systems Engineering Institute at Northeastern University in Boston, which encompasses four research centers. “Health care is a perfect example … systems engineering can really help to understand and improve complex processes, whether it’s patient flow, safety, on-time discharge [or] better discharge.”
Dr. Benneyan says that systems engineering is, first and foremost, a mindset. It’s an approach to problem solving that’s different, if related, to quality improvement. Both have tremendous value, but they are based on different philosophies, tools, and work styles.
For example, many hospital operating rooms measure how many days the first procedure of the day begins on time. But instead of using that as a yardstick for quality, Dr. Benneyan said a better approach would be designing a system that can adapt to situations when the first case starts late. He compared the process to a delayed flight at an airport. An airline doesn’t back up every plane’s departure when one plane is running behind. Instead, it has systems that adapt to circumstances.
“There are methods and then there are philosophies,” Dr. Benneyan said. “I don’t think people in health care realize what my field did in the airline industry. We didn’t design things that worked and clicked properly. We designed things that … react to daily events and [everything] going on and perform pretty well.”
Dr. Benneyan says that, while health care is an incredibly complex system, other fields with similar levels of technical expertise have used systems engineering much more effectively. Manufacturing, logistics, and global distribution networks are all precise industries requiring hundreds of individual processes to ensure success.
“These are really complicated processes,” he said. “The real barrier is a cultural barrier. Health care is not the most challenging environment to work in. … I think something that people in health care have to have an appreciation for is that the process of doing this work is different from doing their other work. Systems engineering is not the same as quality improvement and can achieve fundamental breakthroughs in cases where QI has not – but also tends to take more work.”
Still, Dr. Benneyan believes his field has lessons that complement quality initiatives. To wit, health care advocates – including the Institute of Medicine, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the National Science Foundation – have all pushed for greater application of systems engineering in medicine with the goal of improving how well health care does its job.
While he hopes hospitalists and other HM17 attendees at his session walk away with a newfound respect for and understanding of what systems engineering can do, he doesn’t want them to think it’s too easy.
“There’s a lack of appreciation of the process of engineering and how it’s different,” he said. “It’s a big challenge, partnering clinician with engineers. … We think differently even though we’re both scientifically trained.
“I hope hospitalists take away an appreciation for how this toolkit can be useful in their world.”
Systems Engineering in the Hospital: What Is in Your Toolkit?
Thursday, 8:00–9:30 a.m.
Diabetes specialist to offer disease management tips
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Culture change necessary to weed out health care overuse
Chris Moriates, MD, assistant dean for healthcare value and associate professor of medicine at the University of Texas at Austin Dell Medical School, drew insight from writer David Foster Wallace on Tuesday afternoon as he discussed overuse in hospital care.
He cited a story by Wallace: Two young fish are swimming along when they pass an old, wise fish who says, “Mornin’, boys. How’s the water?” One of the young fish asks the other, “What the hell is water?”
For hospitalists, the culture is their water: Even though they’re swimming in it every day, it can be an abstraction that gets little attention. But the culture is what needs to be tended to in order to turn the tide of unnecessary expenses, Dr. Moriates said in his talk, “Overcoming a Culture Overrun with Overuse.”
“How we’re addressing this problem is by making guidelines, algorithms, evidence-based medicine, Choosing Wisely lists,” he said during the well-attended session in the High-Value Care track. “It’s important that we codify our practices in these ways. But it is insufficient, because we must recognize that we are all swimming in that same water.
“If we don’t change this culture, this water, we will not make any progress.”
A 2013 survey by the Society of Academic Emergency Medicine found that 97% of physicians thought that at least some of the imaging they have personally ordered is medically unnecessary. And a 2011 Annals of Internal Medicine study found that organizational culture was a key factor in distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction.
He pointed to lessons from his previous institution, the University of California San Francisco, where they launched Caring Wisely, a program meant to support front-line clinicians who want to eradicate unnecessary costs. Part of the program involves funding clinicians up to $50,000 for their projects. One such project found that feedback to surgeons about expenses, and a small financial incentive to the department to keep costs down, was associated with reduced operating room costs.
This kind of change can be done anywhere, he said. After all, culture change, he said, can start with something as small as encouraging patient interaction by asking, “What questions do you have?” rather than “Do you have any questions?”
“I don’t want you to leave and think, ‘Well, unless I work somewhere like UCSF, where they’re going to give me $50,000 to do this, or I have an amazing boss like [Dr.] Bob Wachter [the former SHM president from UCSF who coined the term “hospitalist”], there is nothing I can do about this,” Dr. Moriates said. “It turns out that, yes, that is important for changing culture, but each of us has a personal responsibility.”
Chris Moriates, MD, assistant dean for healthcare value and associate professor of medicine at the University of Texas at Austin Dell Medical School, drew insight from writer David Foster Wallace on Tuesday afternoon as he discussed overuse in hospital care.
He cited a story by Wallace: Two young fish are swimming along when they pass an old, wise fish who says, “Mornin’, boys. How’s the water?” One of the young fish asks the other, “What the hell is water?”
For hospitalists, the culture is their water: Even though they’re swimming in it every day, it can be an abstraction that gets little attention. But the culture is what needs to be tended to in order to turn the tide of unnecessary expenses, Dr. Moriates said in his talk, “Overcoming a Culture Overrun with Overuse.”
“How we’re addressing this problem is by making guidelines, algorithms, evidence-based medicine, Choosing Wisely lists,” he said during the well-attended session in the High-Value Care track. “It’s important that we codify our practices in these ways. But it is insufficient, because we must recognize that we are all swimming in that same water.
“If we don’t change this culture, this water, we will not make any progress.”
A 2013 survey by the Society of Academic Emergency Medicine found that 97% of physicians thought that at least some of the imaging they have personally ordered is medically unnecessary. And a 2011 Annals of Internal Medicine study found that organizational culture was a key factor in distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction.
He pointed to lessons from his previous institution, the University of California San Francisco, where they launched Caring Wisely, a program meant to support front-line clinicians who want to eradicate unnecessary costs. Part of the program involves funding clinicians up to $50,000 for their projects. One such project found that feedback to surgeons about expenses, and a small financial incentive to the department to keep costs down, was associated with reduced operating room costs.
This kind of change can be done anywhere, he said. After all, culture change, he said, can start with something as small as encouraging patient interaction by asking, “What questions do you have?” rather than “Do you have any questions?”
“I don’t want you to leave and think, ‘Well, unless I work somewhere like UCSF, where they’re going to give me $50,000 to do this, or I have an amazing boss like [Dr.] Bob Wachter [the former SHM president from UCSF who coined the term “hospitalist”], there is nothing I can do about this,” Dr. Moriates said. “It turns out that, yes, that is important for changing culture, but each of us has a personal responsibility.”
Chris Moriates, MD, assistant dean for healthcare value and associate professor of medicine at the University of Texas at Austin Dell Medical School, drew insight from writer David Foster Wallace on Tuesday afternoon as he discussed overuse in hospital care.
He cited a story by Wallace: Two young fish are swimming along when they pass an old, wise fish who says, “Mornin’, boys. How’s the water?” One of the young fish asks the other, “What the hell is water?”
For hospitalists, the culture is their water: Even though they’re swimming in it every day, it can be an abstraction that gets little attention. But the culture is what needs to be tended to in order to turn the tide of unnecessary expenses, Dr. Moriates said in his talk, “Overcoming a Culture Overrun with Overuse.”
“How we’re addressing this problem is by making guidelines, algorithms, evidence-based medicine, Choosing Wisely lists,” he said during the well-attended session in the High-Value Care track. “It’s important that we codify our practices in these ways. But it is insufficient, because we must recognize that we are all swimming in that same water.
“If we don’t change this culture, this water, we will not make any progress.”
A 2013 survey by the Society of Academic Emergency Medicine found that 97% of physicians thought that at least some of the imaging they have personally ordered is medically unnecessary. And a 2011 Annals of Internal Medicine study found that organizational culture was a key factor in distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction.
He pointed to lessons from his previous institution, the University of California San Francisco, where they launched Caring Wisely, a program meant to support front-line clinicians who want to eradicate unnecessary costs. Part of the program involves funding clinicians up to $50,000 for their projects. One such project found that feedback to surgeons about expenses, and a small financial incentive to the department to keep costs down, was associated with reduced operating room costs.
This kind of change can be done anywhere, he said. After all, culture change, he said, can start with something as small as encouraging patient interaction by asking, “What questions do you have?” rather than “Do you have any questions?”
“I don’t want you to leave and think, ‘Well, unless I work somewhere like UCSF, where they’re going to give me $50,000 to do this, or I have an amazing boss like [Dr.] Bob Wachter [the former SHM president from UCSF who coined the term “hospitalist”], there is nothing I can do about this,” Dr. Moriates said. “It turns out that, yes, that is important for changing culture, but each of us has a personal responsibility.”
On Tap Wednesday
HM17 kicks off today with the presentation of the annual SHM Awards of Excellence, which honor work done in service to HM. A nod to the past, as it were. As those physicians are honored, others will be given their prizes as the winners of the Best of Research and Innovations in 2017, a nod to the present state of HM’s investigative spirit.
“We’re in the midst ... of a lot of change in the health care system,” said HM17 course director Lenny Feldman, MD, FACP, FAAP, SFHM. “To be able to hear from Dr. Conway as to how the priorities of CMS might be changing and what this all means to us in the future is an amazing opportunity. There is no better time to hear from Pat Conway. I’m really looking forward to it.”
A new highlight this year is Wednesday’s track of Repeated Sessions, something organizers added to ensure that some of the most-popular sessions – “Updates and Pearls in Infectious Diseases,” and “Non-Evidence Based Medicine: Things We Do for No Reason” – are available to as many attendees as possible.
“We’ve added that in this year because we know there are sessions that are standing room only on a regular basis,” Dr. Feldman said. “People should not have to stand.
“I’m hoping that these repeated sessions will be well received and will allow folks to be able to go to some other sessions they might not have in fear they were going to miss some of these typically ‘standing room only’ sessions.”
HM17 kicks off today with the presentation of the annual SHM Awards of Excellence, which honor work done in service to HM. A nod to the past, as it were. As those physicians are honored, others will be given their prizes as the winners of the Best of Research and Innovations in 2017, a nod to the present state of HM’s investigative spirit.
“We’re in the midst ... of a lot of change in the health care system,” said HM17 course director Lenny Feldman, MD, FACP, FAAP, SFHM. “To be able to hear from Dr. Conway as to how the priorities of CMS might be changing and what this all means to us in the future is an amazing opportunity. There is no better time to hear from Pat Conway. I’m really looking forward to it.”
A new highlight this year is Wednesday’s track of Repeated Sessions, something organizers added to ensure that some of the most-popular sessions – “Updates and Pearls in Infectious Diseases,” and “Non-Evidence Based Medicine: Things We Do for No Reason” – are available to as many attendees as possible.
“We’ve added that in this year because we know there are sessions that are standing room only on a regular basis,” Dr. Feldman said. “People should not have to stand.
“I’m hoping that these repeated sessions will be well received and will allow folks to be able to go to some other sessions they might not have in fear they were going to miss some of these typically ‘standing room only’ sessions.”
HM17 kicks off today with the presentation of the annual SHM Awards of Excellence, which honor work done in service to HM. A nod to the past, as it were. As those physicians are honored, others will be given their prizes as the winners of the Best of Research and Innovations in 2017, a nod to the present state of HM’s investigative spirit.
“We’re in the midst ... of a lot of change in the health care system,” said HM17 course director Lenny Feldman, MD, FACP, FAAP, SFHM. “To be able to hear from Dr. Conway as to how the priorities of CMS might be changing and what this all means to us in the future is an amazing opportunity. There is no better time to hear from Pat Conway. I’m really looking forward to it.”
A new highlight this year is Wednesday’s track of Repeated Sessions, something organizers added to ensure that some of the most-popular sessions – “Updates and Pearls in Infectious Diseases,” and “Non-Evidence Based Medicine: Things We Do for No Reason” – are available to as many attendees as possible.
“We’ve added that in this year because we know there are sessions that are standing room only on a regular basis,” Dr. Feldman said. “People should not have to stand.
“I’m hoping that these repeated sessions will be well received and will allow folks to be able to go to some other sessions they might not have in fear they were going to miss some of these typically ‘standing room only’ sessions.”
Experts to review ‘hot topics’ in pediatric hospital medicine research
Pediatric hospital medicine (PHM) is a fast-moving field, so having the best information is part of being a good doctor. But try going through all the relevant journals every month and pulling out the relevant findings. It’s a tall task.
Never fear! Akshata Hopkins, MD, an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., and Amit Singh, MD, of Stanford (Calif.) Children’s Health, have done the work for you. They reviewed every issue from 18 relevant journals over the last year and chose studies that are “hot topics” and involve important, evolving clinical questions that any physician caring for hospitalized children should know about.
As pediatric hospitalists, “we’re looking at articles from a pediatric hospital medicine standpoint, but the way that we chose the articles was based on topics that are prevalent to not only academic centers but community centers – and so it’s more broad,” Dr. Hopkins said. “The topics themselves are not necessarily new, but there are nuances to management [for which] every year there is new data that’s coming out. So what we’ve done is digest it for them.”
[[{"fid":"195832","view_mode":"medstat_image_flush_right","attributes":{"alt":"Dr. Akshata Hopkins","height":"220","width":"146","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":""}}}]]Their session at 5:30 p.m. today, “Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016,” will touch on both clinical and systems issues, often with a case used as a way to introduce topics, followed by a review of findings from a recent article. Dr. Hopkins said that questions will be answered throughout the session. Topics will include the management of young febrile infants, nasogastric feeding in bronchiolitis, prediction of severe pneumonia outcomes in children, and a review of quality measures that include patient experience and antibiotic stewardship.
“With the rise of more PCR testing and discussions of Choosing Wisely and high-value care, there’s more testing available,” Dr. Hopkins said. “But what is that going to cost versus what are the benefits that it brings? Are these tests valuable and in what way? And that’s kind of a hot topic. It depends on the age of the child and actually the results of [testing] are a little surprising.”
Dr. Singh said he hopes the session appeals to hospitalists in a wide array of care settings. “You want to make sure you are covering the breadth and scope of practice we might find ourselves in, whether it is in an adult hospital as the only hospital-based pediatrician covering ED consults, a NICU, a delivery room, and a small pediatric ward, or whether it is a pediatric hospitalist leading a team of medical students and residents in a large, free-standing, university-affiliated, children’s hospital,” he said.
Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016
Wednesday, 5:30–6:20 p.m.
Pediatric hospital medicine (PHM) is a fast-moving field, so having the best information is part of being a good doctor. But try going through all the relevant journals every month and pulling out the relevant findings. It’s a tall task.
Never fear! Akshata Hopkins, MD, an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., and Amit Singh, MD, of Stanford (Calif.) Children’s Health, have done the work for you. They reviewed every issue from 18 relevant journals over the last year and chose studies that are “hot topics” and involve important, evolving clinical questions that any physician caring for hospitalized children should know about.
As pediatric hospitalists, “we’re looking at articles from a pediatric hospital medicine standpoint, but the way that we chose the articles was based on topics that are prevalent to not only academic centers but community centers – and so it’s more broad,” Dr. Hopkins said. “The topics themselves are not necessarily new, but there are nuances to management [for which] every year there is new data that’s coming out. So what we’ve done is digest it for them.”
[[{"fid":"195832","view_mode":"medstat_image_flush_right","attributes":{"alt":"Dr. Akshata Hopkins","height":"220","width":"146","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":""}}}]]Their session at 5:30 p.m. today, “Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016,” will touch on both clinical and systems issues, often with a case used as a way to introduce topics, followed by a review of findings from a recent article. Dr. Hopkins said that questions will be answered throughout the session. Topics will include the management of young febrile infants, nasogastric feeding in bronchiolitis, prediction of severe pneumonia outcomes in children, and a review of quality measures that include patient experience and antibiotic stewardship.
“With the rise of more PCR testing and discussions of Choosing Wisely and high-value care, there’s more testing available,” Dr. Hopkins said. “But what is that going to cost versus what are the benefits that it brings? Are these tests valuable and in what way? And that’s kind of a hot topic. It depends on the age of the child and actually the results of [testing] are a little surprising.”
Dr. Singh said he hopes the session appeals to hospitalists in a wide array of care settings. “You want to make sure you are covering the breadth and scope of practice we might find ourselves in, whether it is in an adult hospital as the only hospital-based pediatrician covering ED consults, a NICU, a delivery room, and a small pediatric ward, or whether it is a pediatric hospitalist leading a team of medical students and residents in a large, free-standing, university-affiliated, children’s hospital,” he said.
Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016
Wednesday, 5:30–6:20 p.m.
Pediatric hospital medicine (PHM) is a fast-moving field, so having the best information is part of being a good doctor. But try going through all the relevant journals every month and pulling out the relevant findings. It’s a tall task.
Never fear! Akshata Hopkins, MD, an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., and Amit Singh, MD, of Stanford (Calif.) Children’s Health, have done the work for you. They reviewed every issue from 18 relevant journals over the last year and chose studies that are “hot topics” and involve important, evolving clinical questions that any physician caring for hospitalized children should know about.
As pediatric hospitalists, “we’re looking at articles from a pediatric hospital medicine standpoint, but the way that we chose the articles was based on topics that are prevalent to not only academic centers but community centers – and so it’s more broad,” Dr. Hopkins said. “The topics themselves are not necessarily new, but there are nuances to management [for which] every year there is new data that’s coming out. So what we’ve done is digest it for them.”
[[{"fid":"195832","view_mode":"medstat_image_flush_right","attributes":{"alt":"Dr. Akshata Hopkins","height":"220","width":"146","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":""}}}]]Their session at 5:30 p.m. today, “Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016,” will touch on both clinical and systems issues, often with a case used as a way to introduce topics, followed by a review of findings from a recent article. Dr. Hopkins said that questions will be answered throughout the session. Topics will include the management of young febrile infants, nasogastric feeding in bronchiolitis, prediction of severe pneumonia outcomes in children, and a review of quality measures that include patient experience and antibiotic stewardship.
“With the rise of more PCR testing and discussions of Choosing Wisely and high-value care, there’s more testing available,” Dr. Hopkins said. “But what is that going to cost versus what are the benefits that it brings? Are these tests valuable and in what way? And that’s kind of a hot topic. It depends on the age of the child and actually the results of [testing] are a little surprising.”
Dr. Singh said he hopes the session appeals to hospitalists in a wide array of care settings. “You want to make sure you are covering the breadth and scope of practice we might find ourselves in, whether it is in an adult hospital as the only hospital-based pediatrician covering ED consults, a NICU, a delivery room, and a small pediatric ward, or whether it is a pediatric hospitalist leading a team of medical students and residents in a large, free-standing, university-affiliated, children’s hospital,” he said.
Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016
Wednesday, 5:30–6:20 p.m.
Telehospitalists can expand capability, capacity
The cost of health care is on the lips of everyone, from the thousands of HM17 attendees to congressional leaders to President Donald Trump. Yet, one long-promoted answer – telemedicine practiced by telehospitalists – is not as widely adopted as its proponents say it should be. After Wednesday’s session, “Foundations of a Hospital Medicine Telemedicine Program,” which begins at 4:15 p.m., at least a few more physicians will see it as an option.
“The timing is there,” said copresenter Talbot “Mac” McCormick, MD, president and chief executive officer of Eagle Telemedicine of Atlanta. “Telemedicine has come of age.”
[[{"fid":"194482","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Talbot \\\u0022Mac\u0022 McCormick, Eagle telemedicine, Atlanta","height":"220","width":"157","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":""}}}]]Copresenter Shannon Carpenter, BS, MBA, vice president at Charlotte, N.C.–based Carolinas Healthcare System, said telemedicine is a “relevancy issue.”
“We are hearing so much about a need for an alternative care model, [and] the virtual-care model is incredibly relevant in today’s environment,” Ms. Carpenter said. Adding to telemedicine’s basic advantage is its ability to help alleviate staffing issues.
“Telemedicine and telehospitalists can support and fill out gaps [and] can expand capability and capacity,” Dr. McCormick added. “Then, the other part is economy of scale. You can share a telehospitalist amongst a couple of small hospitals ... an advantage over each one trying to do it themselves.”
For example, individual institutions might not be able to keep a hospitalist busy 12 hours a night, but a nocturnist is still a requirement.
“When they need somebody, they sure need them,” Dr. McCormick said. “So, you get an economy of scale that several small hospitals effectively can share one physician because the space continuum – not necessarily the time continuum – but the space continuum and the geographic continuum is different engaging telemedicine versus people physically on the ground.”
Ms. Carpenter said that one of the obstacles to telemedicine is simply getting physicians to change habits.
“The biggest hurdles that we experienced were with buy-in for the care-delivery model,” she said. “Surprisingly, it’s not from the patients’ perspectives. It’s from either from the physicians who should be providing the service and/or from the staff in the hospital who aren’t used to the technology or the method of care delivery. To avoid this, it’s just like anything else: over-communication, education, and an ability to explain why and how care will be delivered.”
In addition to the difficulty of changing the culture, integration failures are another potential pitfall, according to Dr. McCormick.
“I think that communication gets to part of that,” he said. “I think [telemedicine should be viewed] ... not [as] a segmented silo of a hospitalist team – to be functional and to work well, it has to be integrated with the team so that it’s just a seamless part of the care team of the doctors, the nurses, the nurse practitioners.”
Both presenters agree that, as value-based payments and alternative payment models proliferate in the coming years, telemedicine will only grow as hospitals and hospitalist group leaders look for cost efficiencies. It will also be broader than just nocturnist services.
Ms. Carpenter said future uses could include expansion to ambulatory clinics for transitioning patients from acute care back to their medical home environment or to telehospitalists supporting paramedics on home visits.
“The use of tools and technology like this can allow care to bridge across these multiple geographic locations of care and do it in a way that provides continuity, economy of scale, consistent and high quality care,” Dr. McCormick said.
Foundations of a Hospital Medicine Telemedicine Program
Wednesday, 4:15–5:20 p.m.
Available via HM17 On Demand
The cost of health care is on the lips of everyone, from the thousands of HM17 attendees to congressional leaders to President Donald Trump. Yet, one long-promoted answer – telemedicine practiced by telehospitalists – is not as widely adopted as its proponents say it should be. After Wednesday’s session, “Foundations of a Hospital Medicine Telemedicine Program,” which begins at 4:15 p.m., at least a few more physicians will see it as an option.
“The timing is there,” said copresenter Talbot “Mac” McCormick, MD, president and chief executive officer of Eagle Telemedicine of Atlanta. “Telemedicine has come of age.”
[[{"fid":"194482","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Talbot \\\u0022Mac\u0022 McCormick, Eagle telemedicine, Atlanta","height":"220","width":"157","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":""}}}]]Copresenter Shannon Carpenter, BS, MBA, vice president at Charlotte, N.C.–based Carolinas Healthcare System, said telemedicine is a “relevancy issue.”
“We are hearing so much about a need for an alternative care model, [and] the virtual-care model is incredibly relevant in today’s environment,” Ms. Carpenter said. Adding to telemedicine’s basic advantage is its ability to help alleviate staffing issues.
“Telemedicine and telehospitalists can support and fill out gaps [and] can expand capability and capacity,” Dr. McCormick added. “Then, the other part is economy of scale. You can share a telehospitalist amongst a couple of small hospitals ... an advantage over each one trying to do it themselves.”
For example, individual institutions might not be able to keep a hospitalist busy 12 hours a night, but a nocturnist is still a requirement.
“When they need somebody, they sure need them,” Dr. McCormick said. “So, you get an economy of scale that several small hospitals effectively can share one physician because the space continuum – not necessarily the time continuum – but the space continuum and the geographic continuum is different engaging telemedicine versus people physically on the ground.”
Ms. Carpenter said that one of the obstacles to telemedicine is simply getting physicians to change habits.
“The biggest hurdles that we experienced were with buy-in for the care-delivery model,” she said. “Surprisingly, it’s not from the patients’ perspectives. It’s from either from the physicians who should be providing the service and/or from the staff in the hospital who aren’t used to the technology or the method of care delivery. To avoid this, it’s just like anything else: over-communication, education, and an ability to explain why and how care will be delivered.”
In addition to the difficulty of changing the culture, integration failures are another potential pitfall, according to Dr. McCormick.
“I think that communication gets to part of that,” he said. “I think [telemedicine should be viewed] ... not [as] a segmented silo of a hospitalist team – to be functional and to work well, it has to be integrated with the team so that it’s just a seamless part of the care team of the doctors, the nurses, the nurse practitioners.”
Both presenters agree that, as value-based payments and alternative payment models proliferate in the coming years, telemedicine will only grow as hospitals and hospitalist group leaders look for cost efficiencies. It will also be broader than just nocturnist services.
Ms. Carpenter said future uses could include expansion to ambulatory clinics for transitioning patients from acute care back to their medical home environment or to telehospitalists supporting paramedics on home visits.
“The use of tools and technology like this can allow care to bridge across these multiple geographic locations of care and do it in a way that provides continuity, economy of scale, consistent and high quality care,” Dr. McCormick said.
Foundations of a Hospital Medicine Telemedicine Program
Wednesday, 4:15–5:20 p.m.
Available via HM17 On Demand
The cost of health care is on the lips of everyone, from the thousands of HM17 attendees to congressional leaders to President Donald Trump. Yet, one long-promoted answer – telemedicine practiced by telehospitalists – is not as widely adopted as its proponents say it should be. After Wednesday’s session, “Foundations of a Hospital Medicine Telemedicine Program,” which begins at 4:15 p.m., at least a few more physicians will see it as an option.
“The timing is there,” said copresenter Talbot “Mac” McCormick, MD, president and chief executive officer of Eagle Telemedicine of Atlanta. “Telemedicine has come of age.”
[[{"fid":"194482","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Talbot \\\u0022Mac\u0022 McCormick, Eagle telemedicine, Atlanta","height":"220","width":"157","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":""}}}]]Copresenter Shannon Carpenter, BS, MBA, vice president at Charlotte, N.C.–based Carolinas Healthcare System, said telemedicine is a “relevancy issue.”
“We are hearing so much about a need for an alternative care model, [and] the virtual-care model is incredibly relevant in today’s environment,” Ms. Carpenter said. Adding to telemedicine’s basic advantage is its ability to help alleviate staffing issues.
“Telemedicine and telehospitalists can support and fill out gaps [and] can expand capability and capacity,” Dr. McCormick added. “Then, the other part is economy of scale. You can share a telehospitalist amongst a couple of small hospitals ... an advantage over each one trying to do it themselves.”
For example, individual institutions might not be able to keep a hospitalist busy 12 hours a night, but a nocturnist is still a requirement.
“When they need somebody, they sure need them,” Dr. McCormick said. “So, you get an economy of scale that several small hospitals effectively can share one physician because the space continuum – not necessarily the time continuum – but the space continuum and the geographic continuum is different engaging telemedicine versus people physically on the ground.”
Ms. Carpenter said that one of the obstacles to telemedicine is simply getting physicians to change habits.
“The biggest hurdles that we experienced were with buy-in for the care-delivery model,” she said. “Surprisingly, it’s not from the patients’ perspectives. It’s from either from the physicians who should be providing the service and/or from the staff in the hospital who aren’t used to the technology or the method of care delivery. To avoid this, it’s just like anything else: over-communication, education, and an ability to explain why and how care will be delivered.”
In addition to the difficulty of changing the culture, integration failures are another potential pitfall, according to Dr. McCormick.
“I think that communication gets to part of that,” he said. “I think [telemedicine should be viewed] ... not [as] a segmented silo of a hospitalist team – to be functional and to work well, it has to be integrated with the team so that it’s just a seamless part of the care team of the doctors, the nurses, the nurse practitioners.”
Both presenters agree that, as value-based payments and alternative payment models proliferate in the coming years, telemedicine will only grow as hospitals and hospitalist group leaders look for cost efficiencies. It will also be broader than just nocturnist services.
Ms. Carpenter said future uses could include expansion to ambulatory clinics for transitioning patients from acute care back to their medical home environment or to telehospitalists supporting paramedics on home visits.
“The use of tools and technology like this can allow care to bridge across these multiple geographic locations of care and do it in a way that provides continuity, economy of scale, consistent and high quality care,” Dr. McCormick said.
Foundations of a Hospital Medicine Telemedicine Program
Wednesday, 4:15–5:20 p.m.
Available via HM17 On Demand
Welcome to Annual Meeting Day 2
Day 1 has already raised the bar for the SHM Annual Meeting. Day 2, Wednesday, will set a whole new standard with courses, speakers, content, and perspective.
Leading off the day will be the presentation of the best of Research and Innovations. This year, we had hundreds of submissions, and the kickoff of Day 2 will showcase the very best of the best! Following immediately, we will recognize the winners of the SHM Awards of Excellence.
Then, off to the main meeting!
This year, we anticipated that some sessions would be so hot that we would have to hold them twice to meet the demand. These sessions are labeled with their own track and include my own personal favorite – and ironically named – series at SHM, “Things We Do for No Reason.” So if you missed this or any of the other talks – heart failure, pulmonary embolism, infectious diseases, delirium, and syncope – here’s your second chance!
But wait – there’s more! This year, for the first time, we have Maintenance of Certification credit available for attendees of the MOC-Clinical Updates sessions and the Rapid Fire Sessions. So, go right ahead and get the MOC credits while you catch up on the latest evidence.
Every year, hospitalists, residents, and students from all over submit hundreds of insightful clinical vignettes posters. Lunch and learn in the Exhibit Hall and peruse the great cases while the judges debate over the absolute best. Afterward is the can’t- miss feature at every Annual Meeting: the Update in Hospital Medicine – this year being delivered by a pair of hospitalist leaders from the heartland, Rachel Thompson, MD, MPH, SFHM and Chad Miller, MD, FHM. Come for Rachel and Chad’s interpretation of the most important and relevant recent literature in adult hospital medicine.
Resident or medical student? You’re in good company at HM17. We have more trainees here than ever before. At 5:30 p.m., we’re holding a special session for you: A skills workshop on “Mastering the Job Interview.” We don’t learn these things in medical or residency – learn them at HM17!
A few other key sessions close out Day 2: Ron Greeno, MD, FCCP, MHM, and Nasim Afsar, MD, SFHM, present on the role hospitalists can (and must) play in the rollout and management of Alternative Payment Models. Then, there’s the mysteriously titled “Myths, Misunderstandings, Medicare & Money: PA/NP and Physician Teams in Hospital Medicine.”
Finally, wind down and see what’s new in the pediatrics world with the Pediatric Hospital Medicine Update with Akshata Hopkins, MD, and Amit Singh, MD.
If yesterday set the tone and tomorrow is the wrap up, Day 2 – today – is the middle act of HM17 and is sure to be educational, provocative, exciting, and an exceptional learning experience. Be sure to take time to walk through the exhibit hall. Please also stop by the SHM Booth to meet the hardworking SHM staff who have made this meeting a great success and introduce yourself to members of the Board who will be present in the booth during the course of the meeting!
Dr. Harte is outgoing president of SHM and president of Cleveland Clinic Akron General and Southern Region.
Day 1 has already raised the bar for the SHM Annual Meeting. Day 2, Wednesday, will set a whole new standard with courses, speakers, content, and perspective.
Leading off the day will be the presentation of the best of Research and Innovations. This year, we had hundreds of submissions, and the kickoff of Day 2 will showcase the very best of the best! Following immediately, we will recognize the winners of the SHM Awards of Excellence.
Then, off to the main meeting!
This year, we anticipated that some sessions would be so hot that we would have to hold them twice to meet the demand. These sessions are labeled with their own track and include my own personal favorite – and ironically named – series at SHM, “Things We Do for No Reason.” So if you missed this or any of the other talks – heart failure, pulmonary embolism, infectious diseases, delirium, and syncope – here’s your second chance!
But wait – there’s more! This year, for the first time, we have Maintenance of Certification credit available for attendees of the MOC-Clinical Updates sessions and the Rapid Fire Sessions. So, go right ahead and get the MOC credits while you catch up on the latest evidence.
Every year, hospitalists, residents, and students from all over submit hundreds of insightful clinical vignettes posters. Lunch and learn in the Exhibit Hall and peruse the great cases while the judges debate over the absolute best. Afterward is the can’t- miss feature at every Annual Meeting: the Update in Hospital Medicine – this year being delivered by a pair of hospitalist leaders from the heartland, Rachel Thompson, MD, MPH, SFHM and Chad Miller, MD, FHM. Come for Rachel and Chad’s interpretation of the most important and relevant recent literature in adult hospital medicine.
Resident or medical student? You’re in good company at HM17. We have more trainees here than ever before. At 5:30 p.m., we’re holding a special session for you: A skills workshop on “Mastering the Job Interview.” We don’t learn these things in medical or residency – learn them at HM17!
A few other key sessions close out Day 2: Ron Greeno, MD, FCCP, MHM, and Nasim Afsar, MD, SFHM, present on the role hospitalists can (and must) play in the rollout and management of Alternative Payment Models. Then, there’s the mysteriously titled “Myths, Misunderstandings, Medicare & Money: PA/NP and Physician Teams in Hospital Medicine.”
Finally, wind down and see what’s new in the pediatrics world with the Pediatric Hospital Medicine Update with Akshata Hopkins, MD, and Amit Singh, MD.
If yesterday set the tone and tomorrow is the wrap up, Day 2 – today – is the middle act of HM17 and is sure to be educational, provocative, exciting, and an exceptional learning experience. Be sure to take time to walk through the exhibit hall. Please also stop by the SHM Booth to meet the hardworking SHM staff who have made this meeting a great success and introduce yourself to members of the Board who will be present in the booth during the course of the meeting!
Dr. Harte is outgoing president of SHM and president of Cleveland Clinic Akron General and Southern Region.
Day 1 has already raised the bar for the SHM Annual Meeting. Day 2, Wednesday, will set a whole new standard with courses, speakers, content, and perspective.
Leading off the day will be the presentation of the best of Research and Innovations. This year, we had hundreds of submissions, and the kickoff of Day 2 will showcase the very best of the best! Following immediately, we will recognize the winners of the SHM Awards of Excellence.
Then, off to the main meeting!
This year, we anticipated that some sessions would be so hot that we would have to hold them twice to meet the demand. These sessions are labeled with their own track and include my own personal favorite – and ironically named – series at SHM, “Things We Do for No Reason.” So if you missed this or any of the other talks – heart failure, pulmonary embolism, infectious diseases, delirium, and syncope – here’s your second chance!
But wait – there’s more! This year, for the first time, we have Maintenance of Certification credit available for attendees of the MOC-Clinical Updates sessions and the Rapid Fire Sessions. So, go right ahead and get the MOC credits while you catch up on the latest evidence.
Every year, hospitalists, residents, and students from all over submit hundreds of insightful clinical vignettes posters. Lunch and learn in the Exhibit Hall and peruse the great cases while the judges debate over the absolute best. Afterward is the can’t- miss feature at every Annual Meeting: the Update in Hospital Medicine – this year being delivered by a pair of hospitalist leaders from the heartland, Rachel Thompson, MD, MPH, SFHM and Chad Miller, MD, FHM. Come for Rachel and Chad’s interpretation of the most important and relevant recent literature in adult hospital medicine.
Resident or medical student? You’re in good company at HM17. We have more trainees here than ever before. At 5:30 p.m., we’re holding a special session for you: A skills workshop on “Mastering the Job Interview.” We don’t learn these things in medical or residency – learn them at HM17!
A few other key sessions close out Day 2: Ron Greeno, MD, FCCP, MHM, and Nasim Afsar, MD, SFHM, present on the role hospitalists can (and must) play in the rollout and management of Alternative Payment Models. Then, there’s the mysteriously titled “Myths, Misunderstandings, Medicare & Money: PA/NP and Physician Teams in Hospital Medicine.”
Finally, wind down and see what’s new in the pediatrics world with the Pediatric Hospital Medicine Update with Akshata Hopkins, MD, and Amit Singh, MD.
If yesterday set the tone and tomorrow is the wrap up, Day 2 – today – is the middle act of HM17 and is sure to be educational, provocative, exciting, and an exceptional learning experience. Be sure to take time to walk through the exhibit hall. Please also stop by the SHM Booth to meet the hardworking SHM staff who have made this meeting a great success and introduce yourself to members of the Board who will be present in the booth during the course of the meeting!
Dr. Harte is outgoing president of SHM and president of Cleveland Clinic Akron General and Southern Region.
Hospitalists can do better at end-of-life care, expert says
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.