The Hospitalist

In early 2014, I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then, I have worked with several telemedicine platforms. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider. Here are my top tips for deciding which telemedicine company to work with.

1. Technology support: Telemedicine is dependent on technology. If it is difficult to get help from tech support, do not credential with the company. Tech support is your lifeline to your patients. Make sure you can get help right away if you are having problems finishing or starting a consult. Companies that send automatic emails saying they will get back to you within 24 hours are the most difficult to work with.
2. Nursing support: All of the telemedicine companies that I have worked with have amazing nurses, but some are overwhelmed with work. Telemedicine nurses are able to connect to your patients via direct callback numbers in a way that you cannot connect. They are able to call in prescriptions to pharmacies if the platform is down or if the patient put in the wrong pharmacy information. Make sure that the company has a nurse that is able to call you back right away. A few telemedicine companies are understaffed with nurses, and it can take hours for a callback. If the key to telemedicine is volume, this is frustrating to deal with.
3. Chief complaints: Many telemedicine companies are moving away from making the “chief complaint” visible to providers before choosing to take the consult. For me, this is a big red flag. It can be as simple as, “I have a cold.” I like this because if I see a patient who says, “I have abdominal pain,” I know to triage them first.
4. Volume: Telemedicine is great for staying connected to outpatient medicine. If you are looking to work on a telemedicine platform for your main source of income, then volume is key. A lot of telemedicine companies will tell you how many calls they get per day; the key question is how many calls they get for the states that you are licensed in and how many providers they have licensed in those states. If you want higher volume, then ask if they will pay for your license in states with higher needs (some will). If you are willing to pay to be licensed in additional states, make sure the volume is high enough to make that extra out-of-pocket cost worth it.
5. Malpractice coverage: Many companies provide malpractice coverage as part of their credentialing package. If they do not, make sure your malpractice coverage covers you for telemedicine.
6. Documentation: Documentation during your telemedicine consult is arguably even more important than in an outpatient visit. Everything is on the phone or by video, so make sure, in the subjective area, that you are quoting what the patient is telling you. You are not able to do a physical exam, so your recommendations will be based on what the patient is saying.

Have fun! Telemedicine has been really enjoyable for me. I like being able to have the time to educate my patients about things like antibiotics. I enjoy the technological aspects and understanding all of the different platforms. Telemedicine gives you a unique opportunity to practice your skills from the comfort of your own home. TH

In early 2014, I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then, I have worked with several telemedicine platforms. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider. Here are my top tips for deciding which telemedicine company to work with.

1. Technology support: Telemedicine is dependent on technology. If it is difficult to get help from tech support, do not credential with the company. Tech support is your lifeline to your patients. Make sure you can get help right away if you are having problems finishing or starting a consult. Companies that send automatic emails saying they will get back to you within 24 hours are the most difficult to work with.
2. Nursing support: All of the telemedicine companies that I have worked with have amazing nurses, but some are overwhelmed with work. Telemedicine nurses are able to connect to your patients via direct callback numbers in a way that you cannot connect. They are able to call in prescriptions to pharmacies if the platform is down or if the patient put in the wrong pharmacy information. Make sure that the company has a nurse that is able to call you back right away. A few telemedicine companies are understaffed with nurses, and it can take hours for a callback. If the key to telemedicine is volume, this is frustrating to deal with.
3. Chief complaints: Many telemedicine companies are moving away from making the “chief complaint” visible to providers before choosing to take the consult. For me, this is a big red flag. It can be as simple as, “I have a cold.” I like this because if I see a patient who says, “I have abdominal pain,” I know to triage them first.
4. Volume: Telemedicine is great for staying connected to outpatient medicine. If you are looking to work on a telemedicine platform for your main source of income, then volume is key. A lot of telemedicine companies will tell you how many calls they get per day; the key question is how many calls they get for the states that you are licensed in and how many providers they have licensed in those states. If you want higher volume, then ask if they will pay for your license in states with higher needs (some will). If you are willing to pay to be licensed in additional states, make sure the volume is high enough to make that extra out-of-pocket cost worth it.
5. Malpractice coverage: Many companies provide malpractice coverage as part of their credentialing package. If they do not, make sure your malpractice coverage covers you for telemedicine.
6. Documentation: Documentation during your telemedicine consult is arguably even more important than in an outpatient visit. Everything is on the phone or by video, so make sure, in the subjective area, that you are quoting what the patient is telling you. You are not able to do a physical exam, so your recommendations will be based on what the patient is saying.

Have fun! Telemedicine has been really enjoyable for me. I like being able to have the time to educate my patients about things like antibiotics. I enjoy the technological aspects and understanding all of the different platforms. Telemedicine gives you a unique opportunity to practice your skills from the comfort of your own home. TH

In early 2014, I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then, I have worked with several telemedicine platforms. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider. Here are my top tips for deciding which telemedicine company to work with.

1. Technology support: Telemedicine is dependent on technology. If it is difficult to get help from tech support, do not credential with the company. Tech support is your lifeline to your patients. Make sure you can get help right away if you are having problems finishing or starting a consult. Companies that send automatic emails saying they will get back to you within 24 hours are the most difficult to work with.
2. Nursing support: All of the telemedicine companies that I have worked with have amazing nurses, but some are overwhelmed with work. Telemedicine nurses are able to connect to your patients via direct callback numbers in a way that you cannot connect. They are able to call in prescriptions to pharmacies if the platform is down or if the patient put in the wrong pharmacy information. Make sure that the company has a nurse that is able to call you back right away. A few telemedicine companies are understaffed with nurses, and it can take hours for a callback. If the key to telemedicine is volume, this is frustrating to deal with.
3. Chief complaints: Many telemedicine companies are moving away from making the “chief complaint” visible to providers before choosing to take the consult. For me, this is a big red flag. It can be as simple as, “I have a cold.” I like this because if I see a patient who says, “I have abdominal pain,” I know to triage them first.
4. Volume: Telemedicine is great for staying connected to outpatient medicine. If you are looking to work on a telemedicine platform for your main source of income, then volume is key. A lot of telemedicine companies will tell you how many calls they get per day; the key question is how many calls they get for the states that you are licensed in and how many providers they have licensed in those states. If you want higher volume, then ask if they will pay for your license in states with higher needs (some will). If you are willing to pay to be licensed in additional states, make sure the volume is high enough to make that extra out-of-pocket cost worth it.
5. Malpractice coverage: Many companies provide malpractice coverage as part of their credentialing package. If they do not, make sure your malpractice coverage covers you for telemedicine.
6. Documentation: Documentation during your telemedicine consult is arguably even more important than in an outpatient visit. Everything is on the phone or by video, so make sure, in the subjective area, that you are quoting what the patient is telling you. You are not able to do a physical exam, so your recommendations will be based on what the patient is saying.

Have fun! Telemedicine has been really enjoyable for me. I like being able to have the time to educate my patients about things like antibiotics. I enjoy the technological aspects and understanding all of the different platforms. Telemedicine gives you a unique opportunity to practice your skills from the comfort of your own home. TH

The State of Hospital Medicine Report (SoHM) is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity, plus covers practice demographics, staffing levels, staff growth, and compensation models.

Don’t miss out on getting your copy when it becomes available. Order now at www.hospitalmedicine.org/survey and be notified directly when the report is released.

The State of Hospital Medicine Report (SoHM) is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity, plus covers practice demographics, staffing levels, staff growth, and compensation models.

Don’t miss out on getting your copy when it becomes available. Order now at www.hospitalmedicine.org/survey and be notified directly when the report is released.

The State of Hospital Medicine Report (SoHM) is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity, plus covers practice demographics, staffing levels, staff growth, and compensation models.

Don’t miss out on getting your copy when it becomes available. Order now at www.hospitalmedicine.org/survey and be notified directly when the report is released.

One of the most important questions for leaders of hospital medicine groups is, “How can I measure the level of engagement of my hospitalists?” Measuring hospitalist engagement can be difficult, and many leaders are not satisfied with the tools they currently have at their disposal.

SHM developed an Engagement Benchmarking Service that evaluates care quality, autonomy, effective motivation, burnout risk, and more. You can see your standardization scores ranked against national benchmarks to help you determine what’s working well and what needs improvement.

Recruiting ends at the end of September, so register now for the next cohort at www.hospitalmedicine.org/pmad3.

One of the most important questions for leaders of hospital medicine groups is, “How can I measure the level of engagement of my hospitalists?” Measuring hospitalist engagement can be difficult, and many leaders are not satisfied with the tools they currently have at their disposal.

SHM developed an Engagement Benchmarking Service that evaluates care quality, autonomy, effective motivation, burnout risk, and more. You can see your standardization scores ranked against national benchmarks to help you determine what’s working well and what needs improvement.

Recruiting ends at the end of September, so register now for the next cohort at www.hospitalmedicine.org/pmad3.

One of the most important questions for leaders of hospital medicine groups is, “How can I measure the level of engagement of my hospitalists?” Measuring hospitalist engagement can be difficult, and many leaders are not satisfied with the tools they currently have at their disposal.

SHM developed an Engagement Benchmarking Service that evaluates care quality, autonomy, effective motivation, burnout risk, and more. You can see your standardization scores ranked against national benchmarks to help you determine what’s working well and what needs improvement.

Recruiting ends at the end of September, so register now for the next cohort at www.hospitalmedicine.org/pmad3.

Background: Patients with dementia often exhibit behavioral problems, such as agitation and psychosis. The American Psychiatric Association (APA) produced a consensus report on the use of antipsychotics in patients with dementia who also exhibit agitation/psychosis.

Study design: Expert panel review of multiple studies and consensus opinions of experienced clinicians.

Synopsis: While the use of antipsychotics to treat behavioral symptoms in patients with dementia is common, it is important to use these medications judiciously, especially in nonemergency cases. The APA recommends antipsychotics for treatment of agitation in these patients only when symptoms are severe or dangerous or cause significant distress to the patient.

When providers determine that benefits exceed risks, antipsychotic treatment should be initiated at a low dose and carefully titrated up to the minimum effective dose. If there is no significant response after a four-week trial of an adequate dose, tapering and withdrawing antipsychotic medication is recommended. Haloperidol should not be used as a first-line agent. The APA guidelines are not intended to apply to treatment in an urgent context, such as acute delirium.

Bottom line: The APA has provided practical guidelines to direct care of dementia patients. These guidelines are not intended to apply to individuals who are receiving antipsychotics in an urgent context or who receive antipsychotics for other disorders (e.g., chronic psychotic illness).

Citation: Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guidelines on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173(5):543-546.

Short Take

Colistin-Resistant E. coli in the U.S.

The presence of mcr-1, a plasmid-borne colistin resistance gene indicating the presence of a truly pan-drug-resistant bacteria, has been identified for the first time in the United States.

Citation: McGann P, Snesrud E, Maybank R, et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: first report of mcr-1 in the United States. Antimicrob Agents Chemother. 2016;60(7):4420-4421.

Background: Patients with dementia often exhibit behavioral problems, such as agitation and psychosis. The American Psychiatric Association (APA) produced a consensus report on the use of antipsychotics in patients with dementia who also exhibit agitation/psychosis.

Study design: Expert panel review of multiple studies and consensus opinions of experienced clinicians.

Synopsis: While the use of antipsychotics to treat behavioral symptoms in patients with dementia is common, it is important to use these medications judiciously, especially in nonemergency cases. The APA recommends antipsychotics for treatment of agitation in these patients only when symptoms are severe or dangerous or cause significant distress to the patient.

When providers determine that benefits exceed risks, antipsychotic treatment should be initiated at a low dose and carefully titrated up to the minimum effective dose. If there is no significant response after a four-week trial of an adequate dose, tapering and withdrawing antipsychotic medication is recommended. Haloperidol should not be used as a first-line agent. The APA guidelines are not intended to apply to treatment in an urgent context, such as acute delirium.

Bottom line: The APA has provided practical guidelines to direct care of dementia patients. These guidelines are not intended to apply to individuals who are receiving antipsychotics in an urgent context or who receive antipsychotics for other disorders (e.g., chronic psychotic illness).

Citation: Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guidelines on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173(5):543-546.

Short Take

Colistin-Resistant E. coli in the U.S.

The presence of mcr-1, a plasmid-borne colistin resistance gene indicating the presence of a truly pan-drug-resistant bacteria, has been identified for the first time in the United States.

Citation: McGann P, Snesrud E, Maybank R, et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: first report of mcr-1 in the United States. Antimicrob Agents Chemother. 2016;60(7):4420-4421.

Background: Patients with dementia often exhibit behavioral problems, such as agitation and psychosis. The American Psychiatric Association (APA) produced a consensus report on the use of antipsychotics in patients with dementia who also exhibit agitation/psychosis.

Study design: Expert panel review of multiple studies and consensus opinions of experienced clinicians.

Synopsis: While the use of antipsychotics to treat behavioral symptoms in patients with dementia is common, it is important to use these medications judiciously, especially in nonemergency cases. The APA recommends antipsychotics for treatment of agitation in these patients only when symptoms are severe or dangerous or cause significant distress to the patient.

When providers determine that benefits exceed risks, antipsychotic treatment should be initiated at a low dose and carefully titrated up to the minimum effective dose. If there is no significant response after a four-week trial of an adequate dose, tapering and withdrawing antipsychotic medication is recommended. Haloperidol should not be used as a first-line agent. The APA guidelines are not intended to apply to treatment in an urgent context, such as acute delirium.

Bottom line: The APA has provided practical guidelines to direct care of dementia patients. These guidelines are not intended to apply to individuals who are receiving antipsychotics in an urgent context or who receive antipsychotics for other disorders (e.g., chronic psychotic illness).

Citation: Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guidelines on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173(5):543-546.

Short Take

Colistin-Resistant E. coli in the U.S.

The presence of mcr-1, a plasmid-borne colistin resistance gene indicating the presence of a truly pan-drug-resistant bacteria, has been identified for the first time in the United States.

Citation: McGann P, Snesrud E, Maybank R, et al. Escherichia coli harboring mcr-1 and blaCTX-M on a novel IncF plasmid: first report of mcr-1 in the United States. Antimicrob Agents Chemother. 2016;60(7):4420-4421.

Background: Research has shown that frail hospital patients are at increased risk of readmission and death. Although several frailty assessment tools have been developed, few studies have examined the application of such tools to predict post-discharge outcomes of hospitalized patients.

Study design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Synopsis: Researchers enrolled 495 adult patients from general medicine wards in two teaching hospitals. Long-term care residents and patients with limited life expectancy were excluded. Each patient was assessed using three different frailty assessment tools: the Clinical Frailty Scale (CFS), the Fried score, and the Timed Up and Go Test (TUGT). The primary outcomes were 30-day readmission and all-cause mortality. Outcomes were assessed by research personnel blinded to frailty status.

Overall, 211 (43%) patients were classified as frail by at least one tool. In general, frail patients were older, had more comorbidities, and had more frequent hospitalizations than non-frail patients. Agreement among the tools was poor, and only 49 patients met frailty criteria by all three definitions. The CFS was the only tool found to be an independent predictor of adverse 30-day outcomes (23% versus 14% for not frail, P=0.005; adjusted odds ratio, 2.02; 95% CI, 1.19–3.41).

Bottom line: As an independent predictor of adverse post-discharge outcomes, the CFS is a useful tool in both research and clinical settings. The CFS requires little time and no special equipment to administer.

Citation: Belga S, Majumdar SR, Kahlon S, et al. Comparing three different measures of frailty in medical inpatients: multicenter prospective cohort study examining 30-day risk of readmission or death. J Hosp Med. 2016;11(8):556-562.

Short Take

National Program Reduces CAUTI

A national prevention program aimed at reducing catheter-associated urinary tract infections (CAUTIs) has been shown to reduce both catheter use and rates of CAUTI in non-ICU patients.

Citation: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119.

Background: Research has shown that frail hospital patients are at increased risk of readmission and death. Although several frailty assessment tools have been developed, few studies have examined the application of such tools to predict post-discharge outcomes of hospitalized patients.

Study design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Synopsis: Researchers enrolled 495 adult patients from general medicine wards in two teaching hospitals. Long-term care residents and patients with limited life expectancy were excluded. Each patient was assessed using three different frailty assessment tools: the Clinical Frailty Scale (CFS), the Fried score, and the Timed Up and Go Test (TUGT). The primary outcomes were 30-day readmission and all-cause mortality. Outcomes were assessed by research personnel blinded to frailty status.

Overall, 211 (43%) patients were classified as frail by at least one tool. In general, frail patients were older, had more comorbidities, and had more frequent hospitalizations than non-frail patients. Agreement among the tools was poor, and only 49 patients met frailty criteria by all three definitions. The CFS was the only tool found to be an independent predictor of adverse 30-day outcomes (23% versus 14% for not frail, P=0.005; adjusted odds ratio, 2.02; 95% CI, 1.19–3.41).

Bottom line: As an independent predictor of adverse post-discharge outcomes, the CFS is a useful tool in both research and clinical settings. The CFS requires little time and no special equipment to administer.

Citation: Belga S, Majumdar SR, Kahlon S, et al. Comparing three different measures of frailty in medical inpatients: multicenter prospective cohort study examining 30-day risk of readmission or death. J Hosp Med. 2016;11(8):556-562.

Short Take

National Program Reduces CAUTI

A national prevention program aimed at reducing catheter-associated urinary tract infections (CAUTIs) has been shown to reduce both catheter use and rates of CAUTI in non-ICU patients.

Citation: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119.

Background: Research has shown that frail hospital patients are at increased risk of readmission and death. Although several frailty assessment tools have been developed, few studies have examined the application of such tools to predict post-discharge outcomes of hospitalized patients.

Study design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Synopsis: Researchers enrolled 495 adult patients from general medicine wards in two teaching hospitals. Long-term care residents and patients with limited life expectancy were excluded. Each patient was assessed using three different frailty assessment tools: the Clinical Frailty Scale (CFS), the Fried score, and the Timed Up and Go Test (TUGT). The primary outcomes were 30-day readmission and all-cause mortality. Outcomes were assessed by research personnel blinded to frailty status.

Overall, 211 (43%) patients were classified as frail by at least one tool. In general, frail patients were older, had more comorbidities, and had more frequent hospitalizations than non-frail patients. Agreement among the tools was poor, and only 49 patients met frailty criteria by all three definitions. The CFS was the only tool found to be an independent predictor of adverse 30-day outcomes (23% versus 14% for not frail, P=0.005; adjusted odds ratio, 2.02; 95% CI, 1.19–3.41).

Bottom line: As an independent predictor of adverse post-discharge outcomes, the CFS is a useful tool in both research and clinical settings. The CFS requires little time and no special equipment to administer.

Citation: Belga S, Majumdar SR, Kahlon S, et al. Comparing three different measures of frailty in medical inpatients: multicenter prospective cohort study examining 30-day risk of readmission or death. J Hosp Med. 2016;11(8):556-562.

Short Take

National Program Reduces CAUTI

A national prevention program aimed at reducing catheter-associated urinary tract infections (CAUTIs) has been shown to reduce both catheter use and rates of CAUTI in non-ICU patients.

Citation: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119.

It’s a little like giving birth: A nine-month-long process that started last January with the excitement and anticipation of launching the survey and encouraging as many hospital medicine groups (HMGs) as possible to participate. Then the long, drawn-out process of analyzing data, organizing everything into tables and charts, drafting the report, and reviewing it over and over until our eyes crossed. Watching it grow and take shape before our eyes, with a few small hiccups along the way. Then the agonizing process of copyediting, designing (both print and digital versions), and printing—a point at which, like all expectant parents, we said, “Enough already. When will this ever end?”

But we (that is, SHM’s Practice Analysis Committee) finally have a baby, and what proud parents we are! SHM’s 2016 State of Hospital Medicine Report (SoHM) should be available in early October, and the cover story for this issue of The Hospitalist previews some of the key findings.

I want to let you know what’s new and different about this year’s report and to explain why we made some of the changes we did. First, we had an opportunity this year to ask some questions that haven’t appeared in previous surveys, including:

• The percentage of the hospital’s total patient volume the HMG was responsible for caring for
• The presence of hospitalists within the HMG focusing their practice in a specific medical subspecialty, such as critical care, neurology, or oncology
• The annual dollar value of CME allowances for hospitalists
• The utilization of prolonged service codes by hospitalists
• Charge capture methodologies being used by HMGs
• For academic HMGs, the dollar amount of financial support provided for nonclinical work
• Questions regarding non-physician practice administrators that were asked in 2012 but not in 2014

One big change that users of the digital version will see is a much more user-friendly interface with vastly improved search and navigation features. This will be an enormous improvement over the essentially static PDF versions of previous years, and we’re very excited about it.

The other major change that all users will note is that beginning this year, SHM will no longer report findings broken out by employment model (e.g., hospital/IDS-employed versus management companies versus private local hospitalist groups, etc.). We know this will be a disappointment to some, but with the consolidation that has occurred in the management company space over the last couple of years, we found it would be difficult, if not impossible, to protect the confidentiality of information supplied by the largest management companies if the data are reported separately. Because of their sheer size, these mega-companies will be disproportionately represented in the survey results, and their identities and operational details might become apparent.

It’s crucial that management companies continue to be represented in SHM survey data because they represent an important and growing segment of the hospital medicine workforce. SoHM wouldn’t present a true picture of the hospital medicine field without them. We hope to continue to protect the confidentiality of all data and encourage more management companies to participate in future surveys while still providing meaningful information to our users. TH

Leslie Flores is a member of SHM’s Practice Analysis Committee and a partner in Nelson Flores Hospital Medicine Consultants.

It’s a little like giving birth: A nine-month-long process that started last January with the excitement and anticipation of launching the survey and encouraging as many hospital medicine groups (HMGs) as possible to participate. Then the long, drawn-out process of analyzing data, organizing everything into tables and charts, drafting the report, and reviewing it over and over until our eyes crossed. Watching it grow and take shape before our eyes, with a few small hiccups along the way. Then the agonizing process of copyediting, designing (both print and digital versions), and printing—a point at which, like all expectant parents, we said, “Enough already. When will this ever end?”

But we (that is, SHM’s Practice Analysis Committee) finally have a baby, and what proud parents we are! SHM’s 2016 State of Hospital Medicine Report (SoHM) should be available in early October, and the cover story for this issue of The Hospitalist previews some of the key findings.

I want to let you know what’s new and different about this year’s report and to explain why we made some of the changes we did. First, we had an opportunity this year to ask some questions that haven’t appeared in previous surveys, including:

• The percentage of the hospital’s total patient volume the HMG was responsible for caring for
• The presence of hospitalists within the HMG focusing their practice in a specific medical subspecialty, such as critical care, neurology, or oncology
• The annual dollar value of CME allowances for hospitalists
• The utilization of prolonged service codes by hospitalists
• Charge capture methodologies being used by HMGs
• For academic HMGs, the dollar amount of financial support provided for nonclinical work
• Questions regarding non-physician practice administrators that were asked in 2012 but not in 2014

One big change that users of the digital version will see is a much more user-friendly interface with vastly improved search and navigation features. This will be an enormous improvement over the essentially static PDF versions of previous years, and we’re very excited about it.

The other major change that all users will note is that beginning this year, SHM will no longer report findings broken out by employment model (e.g., hospital/IDS-employed versus management companies versus private local hospitalist groups, etc.). We know this will be a disappointment to some, but with the consolidation that has occurred in the management company space over the last couple of years, we found it would be difficult, if not impossible, to protect the confidentiality of information supplied by the largest management companies if the data are reported separately. Because of their sheer size, these mega-companies will be disproportionately represented in the survey results, and their identities and operational details might become apparent.

It’s crucial that management companies continue to be represented in SHM survey data because they represent an important and growing segment of the hospital medicine workforce. SoHM wouldn’t present a true picture of the hospital medicine field without them. We hope to continue to protect the confidentiality of all data and encourage more management companies to participate in future surveys while still providing meaningful information to our users. TH

Leslie Flores is a member of SHM’s Practice Analysis Committee and a partner in Nelson Flores Hospital Medicine Consultants.

It’s a little like giving birth: A nine-month-long process that started last January with the excitement and anticipation of launching the survey and encouraging as many hospital medicine groups (HMGs) as possible to participate. Then the long, drawn-out process of analyzing data, organizing everything into tables and charts, drafting the report, and reviewing it over and over until our eyes crossed. Watching it grow and take shape before our eyes, with a few small hiccups along the way. Then the agonizing process of copyediting, designing (both print and digital versions), and printing—a point at which, like all expectant parents, we said, “Enough already. When will this ever end?”

But we (that is, SHM’s Practice Analysis Committee) finally have a baby, and what proud parents we are! SHM’s 2016 State of Hospital Medicine Report (SoHM) should be available in early October, and the cover story for this issue of The Hospitalist previews some of the key findings.

I want to let you know what’s new and different about this year’s report and to explain why we made some of the changes we did. First, we had an opportunity this year to ask some questions that haven’t appeared in previous surveys, including:

• The percentage of the hospital’s total patient volume the HMG was responsible for caring for
• The presence of hospitalists within the HMG focusing their practice in a specific medical subspecialty, such as critical care, neurology, or oncology
• The annual dollar value of CME allowances for hospitalists
• The utilization of prolonged service codes by hospitalists
• Charge capture methodologies being used by HMGs
• For academic HMGs, the dollar amount of financial support provided for nonclinical work
• Questions regarding non-physician practice administrators that were asked in 2012 but not in 2014

One big change that users of the digital version will see is a much more user-friendly interface with vastly improved search and navigation features. This will be an enormous improvement over the essentially static PDF versions of previous years, and we’re very excited about it.

The other major change that all users will note is that beginning this year, SHM will no longer report findings broken out by employment model (e.g., hospital/IDS-employed versus management companies versus private local hospitalist groups, etc.). We know this will be a disappointment to some, but with the consolidation that has occurred in the management company space over the last couple of years, we found it would be difficult, if not impossible, to protect the confidentiality of information supplied by the largest management companies if the data are reported separately. Because of their sheer size, these mega-companies will be disproportionately represented in the survey results, and their identities and operational details might become apparent.

It’s crucial that management companies continue to be represented in SHM survey data because they represent an important and growing segment of the hospital medicine workforce. SoHM wouldn’t present a true picture of the hospital medicine field without them. We hope to continue to protect the confidentiality of all data and encourage more management companies to participate in future surveys while still providing meaningful information to our users. TH

Leslie Flores is a member of SHM’s Practice Analysis Committee and a partner in Nelson Flores Hospital Medicine Consultants.

I’m not exactly a devout follower of women’s college basketball. But having grown up in Knoxville, it was hard not to follow the University of Tennessee Lady Volunteers (“Lady Vols”) and the career of their longtime head coach, Pat Summitt. Summitt recently died from a swift and severe form of early-onset Alzheimer’s disease. In the wake of her death, many have analyzed the impact of her career and the legacy she has left from her lifetime of relentless coaching and developing of athletes. She was an incredible leader who should make us all reflect on the impact we are making in the lives of our patients and their families, our peers, and the next generation of hospitalists.

Early Career

Pat Summitt was born Patricia Sue Head in 1952 in Clarksville, Tenn., the daughter of Richard and Hazel Albright Head and the fourth of five children. When she was in high school, her family moved to another town so she could play basketball (as her local town did not have a girl’s team). Summitt attended the University of Tennessee at the Martin campus and played for its first women’s basketball coach. Although each of Summitt’s three brothers had received an athletic scholarship, at the time there were no athletic scholarships for women, so her parents supported her way through college.1

After college, Summitt started as a graduate assistant at the University of Tennessee. At the start of the 1974 basketball season, the head coach suddenly quit, and she was named the new head coach at the age of 22. (This was before women’s college basketball was even an NCAA-sanctioned sport.) Legend has it she was paid $250 a month and the team had almost no budget. She reportedly washed all the uniforms herself (which were purchased the year before from the proceeds of a doughnut sale) and drove the team van.1

Barely older than most of the players on the team, she coached her first game in December against Mercer University and lost 84–83. From then on, she racked up an incredible number of wins. In her second season, Summitt coached the team to a 16–11 record while working on her master’s degree in physical education.1

By 1978, Summitt recorded her 100th win and coached the Lady Vols in their first Association for Intercollegiate Athletics for Women Final Four. She ended the decade by winning their first-ever Southeastern Conference tournament. A few years later, in 1984, she coached the U.S. women’s team to an Olympic gold medal, becoming the first U.S. Olympian to win a basketball medal and coach a medal-winning team. There were countless other career milestones: She coached the Lady Vols in 16 SEC regular-season championships and 16 SEC tournament titles. She also coached the Lady Vols in 18 NCAA Final Fours.

Legacy

Summitt’s career-win total still stands as the most among NCAA Division I basketball coaches (men or women). Overall, Summitt finished her career with a record of 1,098-208 and a .841 winning percentage.

At the end of her career, there were 78 people mentored directly by her who were coaching basketball or working in administrative positions associated with the sport. Tennessee Athletic Director Dave Hart summarized her legacy:

“Pat Summitt is … truly is a global icon who transcended sports and spent her entire life making a difference in other peoples’ lives. … She was a genuine, humble leader who focused on helping people achieve more than they thought they were capable of accomplishing. … Her legacy will live on through the countless people she touched throughout her career.”2

Every player coached by Summitt finished her undergraduate degree, often with considerable prodding directly from her.

“Across the board with her kids, she also prepared them for life after basketball,” basketball coach Bob Knight said. “Not many people have prepared their players that well for life.”2

You don’t have to be a women’s basketball fan to understand and respect the impact that Summitt had on the lives she touched. She didn’t just win a lot of games—she changed the game. Think about how you will be remembered in your career as a hospitalist. Will you be remembered as someone clocking in and clocking out, just getting by for a paycheck? Or will you be remembered and revered as a “Summitt,” someone who always gave it their all and coached others to their best?

Hospital medicine is still in its relative infancy as a specialty. We all have the potential to pave a positive future for thousands more to come behind us; we all have the potential to be a Summitt. TH

References

1. Gregory S. Q&A: Tennessee Coach Pat Summitt. Time website. Accessed August 7, 2016.

2. Pat Summitt, winningest coach in Division I history, dies at 64. ESPN website. Accessed August 7, 2016.

I’m not exactly a devout follower of women’s college basketball. But having grown up in Knoxville, it was hard not to follow the University of Tennessee Lady Volunteers (“Lady Vols”) and the career of their longtime head coach, Pat Summitt. Summitt recently died from a swift and severe form of early-onset Alzheimer’s disease. In the wake of her death, many have analyzed the impact of her career and the legacy she has left from her lifetime of relentless coaching and developing of athletes. She was an incredible leader who should make us all reflect on the impact we are making in the lives of our patients and their families, our peers, and the next generation of hospitalists.

Early Career

Pat Summitt was born Patricia Sue Head in 1952 in Clarksville, Tenn., the daughter of Richard and Hazel Albright Head and the fourth of five children. When she was in high school, her family moved to another town so she could play basketball (as her local town did not have a girl’s team). Summitt attended the University of Tennessee at the Martin campus and played for its first women’s basketball coach. Although each of Summitt’s three brothers had received an athletic scholarship, at the time there were no athletic scholarships for women, so her parents supported her way through college.1

After college, Summitt started as a graduate assistant at the University of Tennessee. At the start of the 1974 basketball season, the head coach suddenly quit, and she was named the new head coach at the age of 22. (This was before women’s college basketball was even an NCAA-sanctioned sport.) Legend has it she was paid $250 a month and the team had almost no budget. She reportedly washed all the uniforms herself (which were purchased the year before from the proceeds of a doughnut sale) and drove the team van.1

Barely older than most of the players on the team, she coached her first game in December against Mercer University and lost 84–83. From then on, she racked up an incredible number of wins. In her second season, Summitt coached the team to a 16–11 record while working on her master’s degree in physical education.1

By 1978, Summitt recorded her 100th win and coached the Lady Vols in their first Association for Intercollegiate Athletics for Women Final Four. She ended the decade by winning their first-ever Southeastern Conference tournament. A few years later, in 1984, she coached the U.S. women’s team to an Olympic gold medal, becoming the first U.S. Olympian to win a basketball medal and coach a medal-winning team. There were countless other career milestones: She coached the Lady Vols in 16 SEC regular-season championships and 16 SEC tournament titles. She also coached the Lady Vols in 18 NCAA Final Fours.

Legacy

Summitt’s career-win total still stands as the most among NCAA Division I basketball coaches (men or women). Overall, Summitt finished her career with a record of 1,098-208 and a .841 winning percentage.

At the end of her career, there were 78 people mentored directly by her who were coaching basketball or working in administrative positions associated with the sport. Tennessee Athletic Director Dave Hart summarized her legacy:

“Pat Summitt is … truly is a global icon who transcended sports and spent her entire life making a difference in other peoples’ lives. … She was a genuine, humble leader who focused on helping people achieve more than they thought they were capable of accomplishing. … Her legacy will live on through the countless people she touched throughout her career.”2

Every player coached by Summitt finished her undergraduate degree, often with considerable prodding directly from her.

“Across the board with her kids, she also prepared them for life after basketball,” basketball coach Bob Knight said. “Not many people have prepared their players that well for life.”2

You don’t have to be a women’s basketball fan to understand and respect the impact that Summitt had on the lives she touched. She didn’t just win a lot of games—she changed the game. Think about how you will be remembered in your career as a hospitalist. Will you be remembered as someone clocking in and clocking out, just getting by for a paycheck? Or will you be remembered and revered as a “Summitt,” someone who always gave it their all and coached others to their best?

Hospital medicine is still in its relative infancy as a specialty. We all have the potential to pave a positive future for thousands more to come behind us; we all have the potential to be a Summitt. TH

References

1. Gregory S. Q&A: Tennessee Coach Pat Summitt. Time website. Accessed August 7, 2016.

2. Pat Summitt, winningest coach in Division I history, dies at 64. ESPN website. Accessed August 7, 2016.

I’m not exactly a devout follower of women’s college basketball. But having grown up in Knoxville, it was hard not to follow the University of Tennessee Lady Volunteers (“Lady Vols”) and the career of their longtime head coach, Pat Summitt. Summitt recently died from a swift and severe form of early-onset Alzheimer’s disease. In the wake of her death, many have analyzed the impact of her career and the legacy she has left from her lifetime of relentless coaching and developing of athletes. She was an incredible leader who should make us all reflect on the impact we are making in the lives of our patients and their families, our peers, and the next generation of hospitalists.

Early Career

Pat Summitt was born Patricia Sue Head in 1952 in Clarksville, Tenn., the daughter of Richard and Hazel Albright Head and the fourth of five children. When she was in high school, her family moved to another town so she could play basketball (as her local town did not have a girl’s team). Summitt attended the University of Tennessee at the Martin campus and played for its first women’s basketball coach. Although each of Summitt’s three brothers had received an athletic scholarship, at the time there were no athletic scholarships for women, so her parents supported her way through college.1

After college, Summitt started as a graduate assistant at the University of Tennessee. At the start of the 1974 basketball season, the head coach suddenly quit, and she was named the new head coach at the age of 22. (This was before women’s college basketball was even an NCAA-sanctioned sport.) Legend has it she was paid $250 a month and the team had almost no budget. She reportedly washed all the uniforms herself (which were purchased the year before from the proceeds of a doughnut sale) and drove the team van.1

Barely older than most of the players on the team, she coached her first game in December against Mercer University and lost 84–83. From then on, she racked up an incredible number of wins. In her second season, Summitt coached the team to a 16–11 record while working on her master’s degree in physical education.1

By 1978, Summitt recorded her 100th win and coached the Lady Vols in their first Association for Intercollegiate Athletics for Women Final Four. She ended the decade by winning their first-ever Southeastern Conference tournament. A few years later, in 1984, she coached the U.S. women’s team to an Olympic gold medal, becoming the first U.S. Olympian to win a basketball medal and coach a medal-winning team. There were countless other career milestones: She coached the Lady Vols in 16 SEC regular-season championships and 16 SEC tournament titles. She also coached the Lady Vols in 18 NCAA Final Fours.

Legacy

Summitt’s career-win total still stands as the most among NCAA Division I basketball coaches (men or women). Overall, Summitt finished her career with a record of 1,098-208 and a .841 winning percentage.

At the end of her career, there were 78 people mentored directly by her who were coaching basketball or working in administrative positions associated with the sport. Tennessee Athletic Director Dave Hart summarized her legacy:

“Pat Summitt is … truly is a global icon who transcended sports and spent her entire life making a difference in other peoples’ lives. … She was a genuine, humble leader who focused on helping people achieve more than they thought they were capable of accomplishing. … Her legacy will live on through the countless people she touched throughout her career.”2

Every player coached by Summitt finished her undergraduate degree, often with considerable prodding directly from her.

“Across the board with her kids, she also prepared them for life after basketball,” basketball coach Bob Knight said. “Not many people have prepared their players that well for life.”2

You don’t have to be a women’s basketball fan to understand and respect the impact that Summitt had on the lives she touched. She didn’t just win a lot of games—she changed the game. Think about how you will be remembered in your career as a hospitalist. Will you be remembered as someone clocking in and clocking out, just getting by for a paycheck? Or will you be remembered and revered as a “Summitt,” someone who always gave it their all and coached others to their best?

Hospital medicine is still in its relative infancy as a specialty. We all have the potential to pave a positive future for thousands more to come behind us; we all have the potential to be a Summitt. TH

References

1. Gregory S. Q&A: Tennessee Coach Pat Summitt. Time website. Accessed August 7, 2016.

2. Pat Summitt, winningest coach in Division I history, dies at 64. ESPN website. Accessed August 7, 2016.

Dr. Scott Krugman, Chair of Pediatrics and Director of Medical Education at MedStar Franklin Square Medical Center in Baltimore, and Dr. Miguel Villagra, Medical Director of the Hospitalist Department at White River Medical Center in Batesville, AR talk about how residents and early career MDs process that decision.

Dr. Scott Krugman, Chair of Pediatrics and Director of Medical Education at MedStar Franklin Square Medical Center in Baltimore, and Dr. Miguel Villagra, Medical Director of the Hospitalist Department at White River Medical Center in Batesville, AR talk about how residents and early career MDs process that decision.

Dr. Scott Krugman, Chair of Pediatrics and Director of Medical Education at MedStar Franklin Square Medical Center in Baltimore, and Dr. Miguel Villagra, Medical Director of the Hospitalist Department at White River Medical Center in Batesville, AR talk about how residents and early career MDs process that decision.

Background: The Centers for Medicare & Medicaid Services (CMS) tracks 30-day all-cause readmission rates as a quality measure. Prior studies have looked at various hospital factors associated with lower readmission rates but have not looked at hospitalist staffing levels, level of physician integration with the hospital, and the adoption of a medical home model.

Study design: Retrospective cohort study.

Setting: Private hospitals.

Synopsis: Using the American Hospital Association Annual Survey of Hospitals, CMS Hospital Compare, and Area Health Resources File of private hospitals with no missing data, the study reviewed data from 1,756 hospitals and found the median 30-day all-cause readmission rate to be 16%, with the middle 50% of hospitals’ readmission rate between 15.2% and 16.5%. All hospitals used hospitalists to provide care. Fifty-one percent of hospitals reported fully integrated, or employed, physicians. Twenty-nine percent reported establishment of a medical home.

The study found that higher hospitalist staffing levels were associated with significantly lower readmission rates. Fully integrated hospitals had a lower readmission rate than not fully integrated (15.86% versus 15.93%). Also, physician-owned hospitals had a lower readmission rate than non-physician-owned hospitals, and hospitals that had adopted a medical home model had significantly lower readmission rates. Readmission rates were significantly higher for major teaching hospitals (16.9% versus 15.76% minor teaching versus 15.83% nonteaching).

Bottom line: High hospitalist staffing levels, full integration of the hospitalists, and physician-owned hospitals were associated with lower 30-day all-cause readmission rates for private hospitals.

Citation: Al-Amin M. Hospital characteristics and 30-day all-cause readmission rates [published online ahead of print May 17, 2016]. J Hosp Med. doi:10.1002/jhm.2606

Background: The Centers for Medicare & Medicaid Services (CMS) tracks 30-day all-cause readmission rates as a quality measure. Prior studies have looked at various hospital factors associated with lower readmission rates but have not looked at hospitalist staffing levels, level of physician integration with the hospital, and the adoption of a medical home model.

Study design: Retrospective cohort study.

Setting: Private hospitals.

Synopsis: Using the American Hospital Association Annual Survey of Hospitals, CMS Hospital Compare, and Area Health Resources File of private hospitals with no missing data, the study reviewed data from 1,756 hospitals and found the median 30-day all-cause readmission rate to be 16%, with the middle 50% of hospitals’ readmission rate between 15.2% and 16.5%. All hospitals used hospitalists to provide care. Fifty-one percent of hospitals reported fully integrated, or employed, physicians. Twenty-nine percent reported establishment of a medical home.

The study found that higher hospitalist staffing levels were associated with significantly lower readmission rates. Fully integrated hospitals had a lower readmission rate than not fully integrated (15.86% versus 15.93%). Also, physician-owned hospitals had a lower readmission rate than non-physician-owned hospitals, and hospitals that had adopted a medical home model had significantly lower readmission rates. Readmission rates were significantly higher for major teaching hospitals (16.9% versus 15.76% minor teaching versus 15.83% nonteaching).

Bottom line: High hospitalist staffing levels, full integration of the hospitalists, and physician-owned hospitals were associated with lower 30-day all-cause readmission rates for private hospitals.

Citation: Al-Amin M. Hospital characteristics and 30-day all-cause readmission rates [published online ahead of print May 17, 2016]. J Hosp Med. doi:10.1002/jhm.2606

Background: The Centers for Medicare & Medicaid Services (CMS) tracks 30-day all-cause readmission rates as a quality measure. Prior studies have looked at various hospital factors associated with lower readmission rates but have not looked at hospitalist staffing levels, level of physician integration with the hospital, and the adoption of a medical home model.

Study design: Retrospective cohort study.

Setting: Private hospitals.

Synopsis: Using the American Hospital Association Annual Survey of Hospitals, CMS Hospital Compare, and Area Health Resources File of private hospitals with no missing data, the study reviewed data from 1,756 hospitals and found the median 30-day all-cause readmission rate to be 16%, with the middle 50% of hospitals’ readmission rate between 15.2% and 16.5%. All hospitals used hospitalists to provide care. Fifty-one percent of hospitals reported fully integrated, or employed, physicians. Twenty-nine percent reported establishment of a medical home.

The study found that higher hospitalist staffing levels were associated with significantly lower readmission rates. Fully integrated hospitals had a lower readmission rate than not fully integrated (15.86% versus 15.93%). Also, physician-owned hospitals had a lower readmission rate than non-physician-owned hospitals, and hospitals that had adopted a medical home model had significantly lower readmission rates. Readmission rates were significantly higher for major teaching hospitals (16.9% versus 15.76% minor teaching versus 15.83% nonteaching).

Bottom line: High hospitalist staffing levels, full integration of the hospitalists, and physician-owned hospitals were associated with lower 30-day all-cause readmission rates for private hospitals.

Citation: Al-Amin M. Hospital characteristics and 30-day all-cause readmission rates [published online ahead of print May 17, 2016]. J Hosp Med. doi:10.1002/jhm.2606

Background: Treating infective endocarditis with four to six weeks of intravenous antibiotics carries a high cost. There are data to support oral antibiotics for right-sided endocarditis due to methicillin-sensitive Staphylococcus aureus (with ciprofloxacin and rifampicin), but experience in using oral antibiotics for infective endocarditis is limited.

Study design: Cohort study.

Setting: Large academic hospital in France.

Synopsis: The researchers included 426 patients with definitive or probable endocarditis by Duke criteria. After an initial period of treatment with intravenous (IV) antibiotics, 50% of the identified group was transitioned to oral antibiotics (amoxicillin alone in 50% and combinations of fluoroquinolones, rifampicin, amoxicillin, and clindamycin in the others).

The risk of death was not increased in the group treated with oral antibiotics when adjusted for the four biggest predictors of death (age >65, type 1 diabetes mellitus, disinsertion of prosthetic valve, and endocarditis due to S. aureus). Nine patients treated with IV antibiotics experienced relapsed endocarditis compared to two patients treated with oral antibiotics.

Patients selected for treatment with oral antibiotics were less likely to have severe disease, significant comorbidities, or infection with S. aureus. The length of treatment with IV antibiotics before switching to oral antibiotics varied widely.

Bottom line: It’s possible low-risk patients with infective endocarditis may be treated with oral antibiotics, but more data are needed.

Citation: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi, JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients [published online ahead of print April 16, 2016]. Clin Microbiol Infect. doi:10.1016/j.cmi.2016.04.003.

Background: Treating infective endocarditis with four to six weeks of intravenous antibiotics carries a high cost. There are data to support oral antibiotics for right-sided endocarditis due to methicillin-sensitive Staphylococcus aureus (with ciprofloxacin and rifampicin), but experience in using oral antibiotics for infective endocarditis is limited.

Study design: Cohort study.

Setting: Large academic hospital in France.

Synopsis: The researchers included 426 patients with definitive or probable endocarditis by Duke criteria. After an initial period of treatment with intravenous (IV) antibiotics, 50% of the identified group was transitioned to oral antibiotics (amoxicillin alone in 50% and combinations of fluoroquinolones, rifampicin, amoxicillin, and clindamycin in the others).

The risk of death was not increased in the group treated with oral antibiotics when adjusted for the four biggest predictors of death (age >65, type 1 diabetes mellitus, disinsertion of prosthetic valve, and endocarditis due to S. aureus). Nine patients treated with IV antibiotics experienced relapsed endocarditis compared to two patients treated with oral antibiotics.

Patients selected for treatment with oral antibiotics were less likely to have severe disease, significant comorbidities, or infection with S. aureus. The length of treatment with IV antibiotics before switching to oral antibiotics varied widely.

Bottom line: It’s possible low-risk patients with infective endocarditis may be treated with oral antibiotics, but more data are needed.

Citation: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi, JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients [published online ahead of print April 16, 2016]. Clin Microbiol Infect. doi:10.1016/j.cmi.2016.04.003.

Background: Treating infective endocarditis with four to six weeks of intravenous antibiotics carries a high cost. There are data to support oral antibiotics for right-sided endocarditis due to methicillin-sensitive Staphylococcus aureus (with ciprofloxacin and rifampicin), but experience in using oral antibiotics for infective endocarditis is limited.

Study design: Cohort study.

Setting: Large academic hospital in France.

Synopsis: The researchers included 426 patients with definitive or probable endocarditis by Duke criteria. After an initial period of treatment with intravenous (IV) antibiotics, 50% of the identified group was transitioned to oral antibiotics (amoxicillin alone in 50% and combinations of fluoroquinolones, rifampicin, amoxicillin, and clindamycin in the others).

The risk of death was not increased in the group treated with oral antibiotics when adjusted for the four biggest predictors of death (age >65, type 1 diabetes mellitus, disinsertion of prosthetic valve, and endocarditis due to S. aureus). Nine patients treated with IV antibiotics experienced relapsed endocarditis compared to two patients treated with oral antibiotics.

Patients selected for treatment with oral antibiotics were less likely to have severe disease, significant comorbidities, or infection with S. aureus. The length of treatment with IV antibiotics before switching to oral antibiotics varied widely.

Bottom line: It’s possible low-risk patients with infective endocarditis may be treated with oral antibiotics, but more data are needed.

Citation: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi, JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients [published online ahead of print April 16, 2016]. Clin Microbiol Infect. doi:10.1016/j.cmi.2016.04.003.