The Hospitalist

SAN DIEGO — Think beyond your four walls, speakers told hospitalists at HM16. When it comes to public health and public policy, with your experience and knowledge, your input is simply too valuable not to share, they said.

During several sessions at the SHM annual meeting, hospitalists were urged to understand that they could influence the world of healthcare beyond their own patients and their own centers.

“You have more power than you realize,” U.S. Surgeon General Vivek Murthy, MD, MBA, told hospitalists in his opening address. As a hospitalist at Brigham and Women’s Hospital in Boston, Dr. Murthy created the nonprofit organization Doctors for America, which promotes affordable, high-quality healthcare for all Americans.

A member of Congress, he said, once told him that a call from a doctor is listed as “a notable event” and 10 calls from doctors in a day is “a full-blown crisis.” “I’m often struck by how infrequently elected leaders hear from doctors,” Dr. Murthy added. “I’m also struck by how many good ideas I hear from doctors.”

Dr. Murthy suggested that as the HM movement grows, hospitalists should ask themselves questions around issues of leadership, change, and public health.

“Can hospitalists leverage their leadership in the hospital to not only improve systems but also create a culture that supports healing in health?” Dr. Murthy asked. “Can hospitalists be as powerful a force for change outside the hospital as they are inside the hospital, recognizing that critical drivers of illness like nutrition, safety, and physical activity are most often grounded in the community rather than the clinic? As people who often mentor trainees and younger physicians, can we inspire the next generation of physicians with a broader vision of medicine, one where physicians’ sacred duty is to safeguard the health of their community by treating illness but also by preventing it?”

Achieving such goals might be a tall order. When asked about how influential they feel in the world of public health, some hospitalists said they feel they can have some impact in their daily work but, beyond the hospital, not so much.

“I don’t feel very empowered,” said Janna Gelderman-Moffett, DO, a locum tenens physician in Boulder City, Colo. She added, though, that she is “frustrated with how medicine is portrayed.”

Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California, San Francisco Medical Center, who coined the term “hospitalist” 20 years ago, told hospitalists at HM16 that it’s “crucial” for them to take on new roles. But he also waved a caution flag: too much and you may go too far afield.

“We have to be careful about scope creep,” Dr. Wachter said. “And as much as I enjoyed the Surgeon General’s comments, I think we’ve got to be thoughtful about taking on [too much responsibility]. I have people in my group who do a lot of work, for example, in population health. That’s part of their job, but I’m not sure that’s our job, to fix the world of prevention outside of the hospital and SNF. If we begin becoming something for everybody, I think we’ll lose the special focus that made us successful.”

Ron Greeno, MD, FCCP, MHM, chief strategy officer for IPC Healthcare in North Hollywood, Calif., chair of SHM’s Public Policy Committee, and an SHM board member, said the society and hospitalists are “specially suited” to give input to help shape the details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the repealed Sustainable Growth Rate (SGR) formula.

With MACRA, SGR’s threat of broader Medicare payment cuts is eliminated, but it increases the scope of quality measurement, including resource use and clinical-improvement practices. It also uses incentives to push providers toward risk-based models.

With many of MACRA’s specifics now left to the rule-making process, it’s still largely “a creature devoid of form,” Dr. Greeno said. Hospitalists and SHM can make a difference largely because of their roles within systems, he said. “We are trying to actually make things better,” he added. “We’re always looking for a better way to do things.”

Joining SHM’s Grassroots Network, which can involve something as simple as sending a pre-written letter to Washington, D.C.–based legislators, can be a big help. “You know what?” Dr. Greeno said. “This stuff actually has an impact.”

Tresa McNeal, MD, a hospitalist at Baylor Scott & White Health, a not-for-profit healthcare system serving Texas communities, said she was motivated by the speakers’ remarks.

“It’s really good to know that we have people representing us from SHM to [not only] help us learn about these issues but also represent us,” Dr. McNeal said. “I think it makes me want to be part of the grassroots initiative, just realizing that there’s power in numbers.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — Think beyond your four walls, speakers told hospitalists at HM16. When it comes to public health and public policy, with your experience and knowledge, your input is simply too valuable not to share, they said.

During several sessions at the SHM annual meeting, hospitalists were urged to understand that they could influence the world of healthcare beyond their own patients and their own centers.

“You have more power than you realize,” U.S. Surgeon General Vivek Murthy, MD, MBA, told hospitalists in his opening address. As a hospitalist at Brigham and Women’s Hospital in Boston, Dr. Murthy created the nonprofit organization Doctors for America, which promotes affordable, high-quality healthcare for all Americans.

A member of Congress, he said, once told him that a call from a doctor is listed as “a notable event” and 10 calls from doctors in a day is “a full-blown crisis.” “I’m often struck by how infrequently elected leaders hear from doctors,” Dr. Murthy added. “I’m also struck by how many good ideas I hear from doctors.”

Dr. Murthy suggested that as the HM movement grows, hospitalists should ask themselves questions around issues of leadership, change, and public health.

“Can hospitalists leverage their leadership in the hospital to not only improve systems but also create a culture that supports healing in health?” Dr. Murthy asked. “Can hospitalists be as powerful a force for change outside the hospital as they are inside the hospital, recognizing that critical drivers of illness like nutrition, safety, and physical activity are most often grounded in the community rather than the clinic? As people who often mentor trainees and younger physicians, can we inspire the next generation of physicians with a broader vision of medicine, one where physicians’ sacred duty is to safeguard the health of their community by treating illness but also by preventing it?”

Achieving such goals might be a tall order. When asked about how influential they feel in the world of public health, some hospitalists said they feel they can have some impact in their daily work but, beyond the hospital, not so much.

“I don’t feel very empowered,” said Janna Gelderman-Moffett, DO, a locum tenens physician in Boulder City, Colo. She added, though, that she is “frustrated with how medicine is portrayed.”

Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California, San Francisco Medical Center, who coined the term “hospitalist” 20 years ago, told hospitalists at HM16 that it’s “crucial” for them to take on new roles. But he also waved a caution flag: too much and you may go too far afield.

“We have to be careful about scope creep,” Dr. Wachter said. “And as much as I enjoyed the Surgeon General’s comments, I think we’ve got to be thoughtful about taking on [too much responsibility]. I have people in my group who do a lot of work, for example, in population health. That’s part of their job, but I’m not sure that’s our job, to fix the world of prevention outside of the hospital and SNF. If we begin becoming something for everybody, I think we’ll lose the special focus that made us successful.”

Ron Greeno, MD, FCCP, MHM, chief strategy officer for IPC Healthcare in North Hollywood, Calif., chair of SHM’s Public Policy Committee, and an SHM board member, said the society and hospitalists are “specially suited” to give input to help shape the details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the repealed Sustainable Growth Rate (SGR) formula.

With MACRA, SGR’s threat of broader Medicare payment cuts is eliminated, but it increases the scope of quality measurement, including resource use and clinical-improvement practices. It also uses incentives to push providers toward risk-based models.

With many of MACRA’s specifics now left to the rule-making process, it’s still largely “a creature devoid of form,” Dr. Greeno said. Hospitalists and SHM can make a difference largely because of their roles within systems, he said. “We are trying to actually make things better,” he added. “We’re always looking for a better way to do things.”

Joining SHM’s Grassroots Network, which can involve something as simple as sending a pre-written letter to Washington, D.C.–based legislators, can be a big help. “You know what?” Dr. Greeno said. “This stuff actually has an impact.”

Tresa McNeal, MD, a hospitalist at Baylor Scott & White Health, a not-for-profit healthcare system serving Texas communities, said she was motivated by the speakers’ remarks.

“It’s really good to know that we have people representing us from SHM to [not only] help us learn about these issues but also represent us,” Dr. McNeal said. “I think it makes me want to be part of the grassroots initiative, just realizing that there’s power in numbers.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO — Think beyond your four walls, speakers told hospitalists at HM16. When it comes to public health and public policy, with your experience and knowledge, your input is simply too valuable not to share, they said.

During several sessions at the SHM annual meeting, hospitalists were urged to understand that they could influence the world of healthcare beyond their own patients and their own centers.

“You have more power than you realize,” U.S. Surgeon General Vivek Murthy, MD, MBA, told hospitalists in his opening address. As a hospitalist at Brigham and Women’s Hospital in Boston, Dr. Murthy created the nonprofit organization Doctors for America, which promotes affordable, high-quality healthcare for all Americans.

A member of Congress, he said, once told him that a call from a doctor is listed as “a notable event” and 10 calls from doctors in a day is “a full-blown crisis.” “I’m often struck by how infrequently elected leaders hear from doctors,” Dr. Murthy added. “I’m also struck by how many good ideas I hear from doctors.”

Dr. Murthy suggested that as the HM movement grows, hospitalists should ask themselves questions around issues of leadership, change, and public health.

“Can hospitalists leverage their leadership in the hospital to not only improve systems but also create a culture that supports healing in health?” Dr. Murthy asked. “Can hospitalists be as powerful a force for change outside the hospital as they are inside the hospital, recognizing that critical drivers of illness like nutrition, safety, and physical activity are most often grounded in the community rather than the clinic? As people who often mentor trainees and younger physicians, can we inspire the next generation of physicians with a broader vision of medicine, one where physicians’ sacred duty is to safeguard the health of their community by treating illness but also by preventing it?”

Achieving such goals might be a tall order. When asked about how influential they feel in the world of public health, some hospitalists said they feel they can have some impact in their daily work but, beyond the hospital, not so much.

“I don’t feel very empowered,” said Janna Gelderman-Moffett, DO, a locum tenens physician in Boulder City, Colo. She added, though, that she is “frustrated with how medicine is portrayed.”

Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California, San Francisco Medical Center, who coined the term “hospitalist” 20 years ago, told hospitalists at HM16 that it’s “crucial” for them to take on new roles. But he also waved a caution flag: too much and you may go too far afield.

“We have to be careful about scope creep,” Dr. Wachter said. “And as much as I enjoyed the Surgeon General’s comments, I think we’ve got to be thoughtful about taking on [too much responsibility]. I have people in my group who do a lot of work, for example, in population health. That’s part of their job, but I’m not sure that’s our job, to fix the world of prevention outside of the hospital and SNF. If we begin becoming something for everybody, I think we’ll lose the special focus that made us successful.”

Ron Greeno, MD, FCCP, MHM, chief strategy officer for IPC Healthcare in North Hollywood, Calif., chair of SHM’s Public Policy Committee, and an SHM board member, said the society and hospitalists are “specially suited” to give input to help shape the details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the repealed Sustainable Growth Rate (SGR) formula.

With MACRA, SGR’s threat of broader Medicare payment cuts is eliminated, but it increases the scope of quality measurement, including resource use and clinical-improvement practices. It also uses incentives to push providers toward risk-based models.

With many of MACRA’s specifics now left to the rule-making process, it’s still largely “a creature devoid of form,” Dr. Greeno said. Hospitalists and SHM can make a difference largely because of their roles within systems, he said. “We are trying to actually make things better,” he added. “We’re always looking for a better way to do things.”

Joining SHM’s Grassroots Network, which can involve something as simple as sending a pre-written letter to Washington, D.C.–based legislators, can be a big help. “You know what?” Dr. Greeno said. “This stuff actually has an impact.”

Tresa McNeal, MD, a hospitalist at Baylor Scott & White Health, a not-for-profit healthcare system serving Texas communities, said she was motivated by the speakers’ remarks.

“It’s really good to know that we have people representing us from SHM to [not only] help us learn about these issues but also represent us,” Dr. McNeal said. “I think it makes me want to be part of the grassroots initiative, just realizing that there’s power in numbers.” TH

Thomas R. Collins is a freelance writer in South Florida.

SAN DIEGO—Add three more names to the short list of individuals who’ve reached the peak of the specialty. The Master in Hospital Medicine (MHM) designation, introduced in 2010, honors “highly accomplished individuals” who have made major contributions to HM. Twenty-one people have now attained the designation.

Because Eric Howell, MD, MHM, is an introvert by personality and an engineer by training, he knows full well perfection doesn’t exist. But he tries, as evidenced by a résumé that includes being a past SHM president, current SHM board member, perennial faculty member at the society’s annual meeting, and award-winning professor.

“You’re constantly trying to achieve mastery, but no one ever really reaches it,” says Dr. Howell, director of the collaborative inpatient medicine service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore and chief of its Division of Hospital Medicine. “It’s just good to know that at least I’m viewed by others as being worthy … at least I’m on the right track.

“It’s hard as you become more experienced to find ways to assess your performance, and so getting an award like a Masters is incredibly rewarding because it verifies that your colleagues feel like your work to improve is valid and [has] paid off.”

Tina Budnitz, MPH, MHM, doesn’t see her MHM honorarium as hers alone. Sure, the designation is a nod to accomplishments made over 14 years in multiple leadership roles, including as SHM’s chief strategy and development officer. She helped the nascent specialty craft the “Core Competencies in Hospital Medicine,” design the leadership academies, and launch the now well-established Project BOOST. She developed SHM’s mentored implementation program and the SHM strategic communications plan to help guide the society into 2020.

“As the first non-physician to get this award, I am humbled and honored,” she says. “But what’s most important is the statement being made by SHM that hospital medicine will be propelled forward through the contributions of many professionals including, but not only, physicians. That’s such an important message that I want people to hear.”

Budnitz says SHM is not just a group of individuals.

“The entire team is needed to improve healthcare,” she says.

Gregory Maynard, MD, MSc, MHM, has been a clinician, educator, and quality improvement (QI) pioneer. He helped build and lead mentored-implementation programs to improve transitions of care, upgrade glycemic controls, and prevent venous thromboembolism (VTE).

And now, as chief quality officer at the University of California Davis Medical Center in Sacramento, he is a master.

So why does he still feel like the student and not the teacher?

“What I probably feel best about in hospital medicine is the collaborative approach to mentored implementation, these coaching models to educate broad groups,” he says. “When I’ve had an opportunity to try to work with other hospitalists and mentor them in terms of how to survive as a hospital medicine program or how to attack a problem in quality, be it VTE or something else … they end up teaching me a lot and mentoring me in return.” TH

Richard Quinn is a freelance writer in New Jersey.

SAN DIEGO—Add three more names to the short list of individuals who’ve reached the peak of the specialty. The Master in Hospital Medicine (MHM) designation, introduced in 2010, honors “highly accomplished individuals” who have made major contributions to HM. Twenty-one people have now attained the designation.

Because Eric Howell, MD, MHM, is an introvert by personality and an engineer by training, he knows full well perfection doesn’t exist. But he tries, as evidenced by a résumé that includes being a past SHM president, current SHM board member, perennial faculty member at the society’s annual meeting, and award-winning professor.

“You’re constantly trying to achieve mastery, but no one ever really reaches it,” says Dr. Howell, director of the collaborative inpatient medicine service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore and chief of its Division of Hospital Medicine. “It’s just good to know that at least I’m viewed by others as being worthy … at least I’m on the right track.

“It’s hard as you become more experienced to find ways to assess your performance, and so getting an award like a Masters is incredibly rewarding because it verifies that your colleagues feel like your work to improve is valid and [has] paid off.”

Tina Budnitz, MPH, MHM, doesn’t see her MHM honorarium as hers alone. Sure, the designation is a nod to accomplishments made over 14 years in multiple leadership roles, including as SHM’s chief strategy and development officer. She helped the nascent specialty craft the “Core Competencies in Hospital Medicine,” design the leadership academies, and launch the now well-established Project BOOST. She developed SHM’s mentored implementation program and the SHM strategic communications plan to help guide the society into 2020.

“As the first non-physician to get this award, I am humbled and honored,” she says. “But what’s most important is the statement being made by SHM that hospital medicine will be propelled forward through the contributions of many professionals including, but not only, physicians. That’s such an important message that I want people to hear.”

Budnitz says SHM is not just a group of individuals.

“The entire team is needed to improve healthcare,” she says.

Gregory Maynard, MD, MSc, MHM, has been a clinician, educator, and quality improvement (QI) pioneer. He helped build and lead mentored-implementation programs to improve transitions of care, upgrade glycemic controls, and prevent venous thromboembolism (VTE).

And now, as chief quality officer at the University of California Davis Medical Center in Sacramento, he is a master.

So why does he still feel like the student and not the teacher?

“What I probably feel best about in hospital medicine is the collaborative approach to mentored implementation, these coaching models to educate broad groups,” he says. “When I’ve had an opportunity to try to work with other hospitalists and mentor them in terms of how to survive as a hospital medicine program or how to attack a problem in quality, be it VTE or something else … they end up teaching me a lot and mentoring me in return.” TH

Richard Quinn is a freelance writer in New Jersey.

SAN DIEGO—Add three more names to the short list of individuals who’ve reached the peak of the specialty. The Master in Hospital Medicine (MHM) designation, introduced in 2010, honors “highly accomplished individuals” who have made major contributions to HM. Twenty-one people have now attained the designation.

Because Eric Howell, MD, MHM, is an introvert by personality and an engineer by training, he knows full well perfection doesn’t exist. But he tries, as evidenced by a résumé that includes being a past SHM president, current SHM board member, perennial faculty member at the society’s annual meeting, and award-winning professor.

“You’re constantly trying to achieve mastery, but no one ever really reaches it,” says Dr. Howell, director of the collaborative inpatient medicine service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore and chief of its Division of Hospital Medicine. “It’s just good to know that at least I’m viewed by others as being worthy … at least I’m on the right track.

“It’s hard as you become more experienced to find ways to assess your performance, and so getting an award like a Masters is incredibly rewarding because it verifies that your colleagues feel like your work to improve is valid and [has] paid off.”

Tina Budnitz, MPH, MHM, doesn’t see her MHM honorarium as hers alone. Sure, the designation is a nod to accomplishments made over 14 years in multiple leadership roles, including as SHM’s chief strategy and development officer. She helped the nascent specialty craft the “Core Competencies in Hospital Medicine,” design the leadership academies, and launch the now well-established Project BOOST. She developed SHM’s mentored implementation program and the SHM strategic communications plan to help guide the society into 2020.

“As the first non-physician to get this award, I am humbled and honored,” she says. “But what’s most important is the statement being made by SHM that hospital medicine will be propelled forward through the contributions of many professionals including, but not only, physicians. That’s such an important message that I want people to hear.”

Budnitz says SHM is not just a group of individuals.

“The entire team is needed to improve healthcare,” she says.

Gregory Maynard, MD, MSc, MHM, has been a clinician, educator, and quality improvement (QI) pioneer. He helped build and lead mentored-implementation programs to improve transitions of care, upgrade glycemic controls, and prevent venous thromboembolism (VTE).

And now, as chief quality officer at the University of California Davis Medical Center in Sacramento, he is a master.

So why does he still feel like the student and not the teacher?

“What I probably feel best about in hospital medicine is the collaborative approach to mentored implementation, these coaching models to educate broad groups,” he says. “When I’ve had an opportunity to try to work with other hospitalists and mentor them in terms of how to survive as a hospital medicine program or how to attack a problem in quality, be it VTE or something else … they end up teaching me a lot and mentoring me in return.” TH

Richard Quinn is a freelance writer in New Jersey.

SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.

Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”

“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”

The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.

“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”

Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.

In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.

Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.

Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.

Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.

As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.

“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”

Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.

“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.

Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.

Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.

With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.

Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.

“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH

SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.

Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”

“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”

The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.

“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”

Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.

In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.

Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.

Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.

Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.

As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.

“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”

Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.

“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.

Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.

Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.

With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.

Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.

“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH

SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.

Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”

“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”

The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.

“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”

Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.

In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.

Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.

Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.

Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.

As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.

“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”

Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.

“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.

Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.

Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.

With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.

Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.

“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH

Standing adjacent Poster 391 in a loud, crowded meeting hall, Monika Wells, MD, MPH, a resident in internal medicine at Virginia Mason Medical Center in Seattle, chatted with a colleague. A few feet away, a group of doctors and healthcare professionals huddled dramatically, just barely out of earshot.

The fate of Dr. Wells’ scientific abstract hung in the balance.

Her study, a look at scheduling the start and stop times of hospitalist shifts around expected demand to reduce costs and patient wait times, was a short-list finalist in the Innovations category of HM16’s annual Research, Innovation, and Clinical Vignettes scientific abstract competition. With her work done—she had already made presentations to first a pair of semifinalist judges and then to a herd of all 10 of the category judges—Dr. Wells looked remarkably calm as she waited for the announcement of the winners.

Either way, she said, the competition had been an invigorating, exciting experience.

“I’m a doctor, so I like to compete,” she half-joked. “It definitely has been motivating.”

RIV ribbons this year were handed out to seven winners in four categories. The competition garnered 914 abstracts accepted for presentation.

Dr. Wells ended up being one of them. She was named Innovations’ trainee winner. In her study, researchers found that analyzing the flow of admissions and redistributing hospitalists to better conform to that flow reduced patient wait times and costs as well as improved the subjective experience of hospitalists even as volume increased.

The overall winner in the Innovations category also went to a trainee, Baely Crockett, PharmD, a resident at Eskenazi Health in Indianapolis. Her study looked at a pharmacist-managed rivaroxaban clinic for the treatment of venous thromboembolism (VTE). It was the first time, as far as the judges knew, that an award had gone to a pharmacist.

Dr. Crockett’s abstract showed that patients diagnosed in the ED with low-risk VTE are given a prescription scheduled to be seen in the follow-up clinic within two to five days, at which point the pharmacist sees the patients and reviews their case with them and determines treatment duration.

Dr. Crockett said the pharmacists involved are especially suitable for the role not only because of their expertise in the medication and the handling of time-consuming co-pay issues and other concerns but also because they shadowed ED physicians for six months to get training and experience.

“We’re able to fill in gaps that are true challenges to the patient’s success in finishing therapy,” she said.

One of the Innovations judges, Michael Craig, MD, MPH, FHM, associate professor of medicine at the University of North Carolina in Chapel Hill, said the research hit on an area of growing interest.

“The movement toward outpatient treatment of VTE is a pretty big topic that lots of people are working on,” he said. “It’s very relevant. The whole idea of having a pharmacist-driven intervention is unique; nobody had thought of or heard of before.”

The winner in the Research category was Vineet Chopra, MD, MSc, FHM, assistant professor at the University of Michigan in Ann Arbor, whose work set out to quantify how to prevent bloodstream infection and blood clots from the use of peripherally inserted central catheters, or PICC lines. Researchers created a simulation model, based on data from the literature, looking at what would happen to a hospital if the use of certain types of PICCs was increased while use of other types was decreased—the rationale being that PICCs with just one channel, or port, have a lower risk of infection or blood clots than those with multiple ports.

It is a risk that is often unrecognized, and PICC lines with multiple ports are often ordered as a just-in-case measure in the event that the first port gets clogged.

Chopra and colleagues found that, at the average hospital, about 75% of all PICCs used tend to be multichannel and 25% single-channel. They found every 5% increase in single-channel PICC use could prevent almost 1.5 infections per 1,000 patients, and 0.5 blood clots, with a corresponding cost savings of $13,000 per event. That can add up to hundreds of thousands of dollars a year at large hospitals.

And those calculations, Dr. Chopra noted, do not include penalties for infections or the financial effects of having those results publicly reported. Researchers are now creating an online tool— at improvepicc.com—that will allow users to calculate their own costs and potential savings.

“The hope of this is that it will give hospital administrators and hospital leadership and quality officers the momentum, perhaps, to overcome the inertia of not thinking actively,” said Dr. Chopra, who notched his first win after 10 years of participating in the RIV competition. “I think we don’t think actively about the choices we make when it comes to these devices.”

In the Clinical Vignettes category, winner Molly Kantor, MD, assistant clinical professor at the University of California, San Diego, recounted the case of a sickle-cell disease patient whose diagnosis, and hence treatment, was delayed and who ultimately died. She outlined a series of missteps, including taking at face-value a patient-reported past medical disease, which turned out to be wrong; making certain diagnoses based on lab tests and stopping there; and anchoring on the original diagnosis when the thought process was later reevaluated.

Dr. Kantor said the case is a caution flag to hospitalists, reinforcing the need for “a broad differential diagnosis.”

“[Make] sure that the data fits together and that you’re not using just one isolated piece of information to cinch everything, including the past medical history or a certain lab test, when the whole picture doesn’t quite fit together,” she said. “Looking back at this case, it’s pretty clear that the puzzle pieces probably weren’t quite fitting together, but there was enough that the easier thing to do was to make the diagnosis and move on.”

In the Pediatric Clinical Vignettes category, winner Jennifer Ladd, MD, a resident at Duke University, won for a study of a vexing case of a 2-year-old who was irritable and stalled on developmental milestones. At the hospital, the thought was that it could likely be a recurrence of herpes simplex (HSV) encephalitis, but the spinal fluid showed no signs of that and the acyclovir, which nearly always works for the disorder, was having no effect and the symptoms worsened.

The key in the case, said Alyssa Stephany, MD, then assistant professor at Duke University and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, who presented the case in Dr. Ladd’s absence, was that the team reopened the diagnosis and didn’t get ensnared in cognitive bias. A biopsy ultimately showed HSV in the brain tissue; it was a case of recurrence, despite signs to the contrary. Foscarnet was used to effectively treat the child; it is unknown why acyclovir didn’t work in this case.

“It kind of brings to the surface that that’s what a hospitalist is—a hospitalist is that person who sits and thinks, and really thinks, about the patient and doesn’t just do their rote work of input and output of a patient through the hospital system,” Dr. Stephany said. “When you get a case like this, it makes you take pause.”

The trainee winner in the Research category was N. Lance Downing, MD, of Stanford University School of Medicine, for work on an EHR-based severe sepsis alert. The trainee winner in Clinical Vignettes was Bhakti Shah, MD, of North Shore-LIJ Health System, now Northwell Health, on a rare case of autoimmune NMDA receptor encephalitis. TH

Thomas R. Collins is a freelance writer in South Florida.

2016 RIV Finalists, Winners

Research Category

WINNER:

Vineet Chopra, MD, MSc, FHM, LIMITING THE NUMBER OF LUMENS IN PERIPHERALLY INSERTED CENTRAL CATHETERS TO IMPROVE OUTCOMES AND REDUCE COST: A SIMULATION STUDY

TRAINEE WINNER:

N. Downing, MD, AN ELECTRONIC HEALTH RECORD-BASED SEVERE SEPSIS ALERT TO IMPROVE SEPSIS TREATMENT PERFORMANCE: RANDOMIZED EVALUATION

FINALISTS:

Waseem Khaliq, MD, MPH, PREVALENCE AND PREDICTORS OF NON-ADHERENCE TO BREAST CANCER SCREENING: PERSPECTIVE AND PREFERENCES OF HOSPITALIZED WOMEN

Dilli Poudel, MD, SYSTEMIC SCLEROSIS AS A RISK FACTOR OF ACUTE MYOCARDIAL INFARCTION: A US POPULATION BASED STUDY

Aiham Albaeni, MD, REGIONAL VARIATION IN RESOURCES UTILIZATION AND OUTCOMES FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST IN THE UNITED STATES

Poushali Bhattacharjee, MD, DETECTING SEPSIS: ARE TWO OPINIONS BETTER THAN ONE?

Vineet Chopra, MD, MSc, FHM, THE INFLUENCE OF RED BLOOD CELL TRANSFUSION ON VENOUS THROMBOEMBOLISM IN PATIENTS WITH PERIPHERALLY-INSERTED CENTRAL CATHETERS

Shaker Eid, MD, MBA, IMPACT OF HOSPITAL TEACHING STATUS ON OUT-OF-HOSPITAL CARDIAC ARREST OUTCOMES AND RESOURCE UTILIZATION IN THE UNITED STATES: 2000-2012

Tarun Jain, MD, CONTRAST-INDUCED NEPHROPATHY IN STEMI PATIENTS WITH AND WITHOUT CHRONIC KIDNEY DISEASE

Mona Beier, MD, CREATING A PATIENT SAFETY CULTURE ONE INCIDENT REPORT AT A TIME

Charles Pollack, MD, REINITIATION OF ANTITHROMBOTIC THERAPY AFTER EMERGENCY PROCEDURES OR AFTER AN EMERGENT BLEEDING EVENT: ADDITIONAL INTERIM EXPERIENCE FROM THE RE-VERSE AD TRIAL

Robert Boxer, MD, PhD, SAVING TIME: A TIME-MOTION ANALYSIS OF THE IMPACT OF REGIONALIZATION AND DAILY ADMITTING ON INTERN WORKFLOW

Kaleigh Evans, MD, THIRD TROPONIN ORDER OVERUSE IN THE SETTING OF CLINICAL STABILITY

David Paje, MD, SFHM, RISK OF VENOUS THROMBOEMBOLISM IN HOSPITALIZED PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Rehan Qayyum, MD, COMPARISON OF TIME-TRENDS IN PATIENT SATISFACTION BETWEEN TEACHING AND NONTEACHING HOSPITAL

Joshua Rolnick, MD, VALIDATION OF TEST PERFORMANCE AND CLINICAL TIME ZERO FOR AN ELECTRONIC HEALTH RECORD-EMBEDDED SEVERE SEPSIS ALERT

Allison Louis, MD, BLIND SIDED: MISSING POOR VISUAL ACUITY AND DECREASED SELF-EFFICACY IN HOSPITALIZED PATIENTS WITH DIABETES

G. Randy Smith, MD, MS, SFHM, ASSOCIATION OF HOSPITAL ADMISSION SERVICE STRUCTURE WITH EARLY TRANSFER TO CRITICAL CARE, HOSPITAL READMISSION, AND LENGTH OF STAY

Kathleene Wooldridge, MD, R-VA-MARQUIS: IMPLEMENTING BEST PRACTICES IN MEDICATION RECONCILIATION FOR RURAL VETERANS

INNOVATION CATEGORY

WINNER:

Baely Crockett, PharmD, NOVEL PHARMACIST-MANAGED RIVAROXABAN CLINIC FOR OUTPATIENT TREATMENT OF VENOUS THROMBOEMBOLISM

TRAINEE WINNER:

Monika Wells, MD, MPH, DESIGNING HOSPITALIST SHIFTS AROUND ADMISSION DEMAND REDUCES PATIENT WAIT TIMES AND COST

FINALISTS:

Jessica Dong, WHO MOVED MY EHR CHEESE? A NEW APPROACH TO CURATING AND INDIVIDUALIZING COMMUNICATIONS TO PHYSICIANS ABOUT EHR SOFTWARE UPDATES

Stephanie Rennke, MD, MED REC: A SKILLS-BASED CURRICULUM ON MEDICATION SAFETY AND MEDICATION RECONCILIATION FOR MEDICAL STUDENTS

Jens Langsjoen, MD, DEVELOPING AN INPATIENT DELIRIUM PREVENTION PROTOCOL

Mark Goldin, MD, BUILDING PARALLEL CO-MANAGEMENT SERVICES IN A LARGE ACADEMIC HOSPITALIST GROUP

Brian Lichtenstein, MD, IMPROVING RISK-ADJUSTED OUTCOME MEASURES WITH PHYSICIAN-ORIENTED DOCUMENTATION INTERVENTIONS

Matthew Cerasale, MD, REAL-TIME PADUA: AN AUTOMATED EHR INTEGRATED VENOUS THROMBOEMBOLISM RISK ASSESSMENT TOOL

Franziska Jovin, MD, MMM, FHM, IMPLEMENTATION OF A PAY-FOR-PERFOMANCE STRUCTURE FOR HOSPITALIST-LED QUALITY IMPROVEMENT PROJECTS

Arpit Khandelwal, MD, MANAGING CHALLENGING PATIENTS: FROM CONFLICT TO TEACHING OPPORTUNITY

Justin Lotfi, MD, MAKING IT SIMPLE - PROCESS IMPROVEMENT FOR OUTSIDE MEDICAL RECORDS

David McCollum, MD, FIXING WHAT IS BROKEN: QUALITY IMPROVEMENT IN THE CRITICAL LAB VALUE PROCESS

Nidhi Rohatgi, MD, MS, A NOVEL MD-RN COLLABORATIVE PROTOCOL TO PREVENT AND MANAGE ACUTE DELIRIUM IN INPATIENT WARDS

Lesley Schmaltz, MD, UNNECESSARY TRANSFUSIONS: HOSPITAL MEDICINE LEADING INSTITUTION-WIDE CHANGE

Anuj Dalal, MD, FHM, IMPLEMENTATION OF A PATIENT-CENTERED ‘MICROBLOG' MESSAGING PLATFORM TO IMPROVE CARE TEAM COMMUNICATION

Willard Ellis, MD, PhD, FHM, INTENSIVE FOLLOW UP AFTER PALLIATIVE CARE CONSULTATIONS TO REDUCE READMISSIONS

Lakshmi Swaminathan, MD, MHSA, FHM, USING “MAGIC” TO FACILITATE APPROPRIATE PICC USE: RESULTS OF IMPLEMENTATION OF A PICC APPROPRIATENESS ASSESSMENT TOOL

Charles Coffey, MD, MSc, FHM, IMPLEMENTING GUIDELINE-BASED INDICATIONS FOR CARDIAC MONITORING AT CEDARS-SINAI MEDICAL CENTER

Erik Hoyer, MD, USE OF A HOSPITALIST CLINICAL COMMUNITY TO FACILITATE DISSEMINATION OF AN EARLY MOBILITY QUALITY IMPROVEMENT PROGRAM

Elizabeth Stewart, MD, A MULTIDISCIPLINARY APPROACH TO HIGH VALUE CARDIAC BIOMARKER

CLINICAL VIGNETTES CATEGORY

WINNER (ADULT):

Molly Kantor, MD, THE TIP OF THE ICEBERG: A RARE CAUSE OF ACUTE LIVER FAILURE

WINNER (PEDIATRIC):

Jennifer Ladd, MD, MORE THAN JUST THE “TERRIBLE TWOS”: A CASE OF RESISTANT HSV ENCEPHALITIS

TRAINEE WINNER:

Bhakti Shah, MD, UNMASKING THE TERATOMA

FINALISTS:

Weijen Chang, MD, SFHM, UNCOILING A PROBLEMATIC TICKLE IN THE THROAT

Kenton Dover, MD, KEEPING AN EYE OUT FOR THE DIAGNOSIS

Stephanie Royer, MD, THE YOUNGEST REPORTED CASE OF EOSINOPHILIC CHOLANGITIS

Oluremi Ajala, MD, ANGINA OF ABDOMINAL ORIGIN

Asana Anderson, MBBS, A PARATHYROID CRISIS BURIED IN A SEPTIC OTOMASTOIDITIS

Kyle Bennett, DO, BULLS-EYE MARKS THE SPOT: LYME CARDITIS PRESENTING AS RASH AND PRESYNCOPE

John Biebelhausen, MD, MBA, CROSSFIT CATASTROPHE: CHEST PAIN IN A HEALTHY YOUNG WOMAN

Xuan Gao, MD, A CASE OF THE UNSEEN: KLEBSIELLA PNEUMONIA PYOGENIC LIVER ABSCESS WITH PNEUMONIA AND SEPTIC ENDOPHTHALMITIS IN A NON-ASIAN U.S. RESIDENT

Sana Grover, MBBS, 'ABSTINENT AND INTOXICATED'. A RARE CASE OF AUTO-BREWERY SYNDROME

Andrew Hawrylak, MD, WHEN IT'S NOT AN ALLERGIC REACTION: AN UNUSUAL CASE OF ECTHYEMA GANGRENOSUM ASSOCIATED WITH PROTEUS BACTEREMIA

Rasheen Imtiaz, MD, LACTIC ACIDOSIS IN ASTHMA

Jessie King, MD, PhD, THE SMOKING WOMAN

Bradley Manning, MD, A SUPER-ANTIGEN-MEDIATED MIMIC OF ACUTE APPENDICITIS

Hiroki Matsuura, IMPAIRED CONSCIOUSNESS WITH INDOLENT BREAST MASS

Niharika Singh, MD, LOWER EXTREMITY NECROTIZING FASCIITIS: AN UNUSUAL PRESENTATION OF PERFORATED SIGMOID DIVERTICULITIS

Vivan Tran, DO, PUTTING THE PEE IN PREGNANCY: A CASE OF GESTATIONAL DIABETES INSIPIDUS YOU DON'T WANT TO MISS

Kristen Welch, THE MYSTERIOUS DANCE: A RARE CASE OF DELAYED ONSET DIABETIC STRIATOPATHY

Standing adjacent Poster 391 in a loud, crowded meeting hall, Monika Wells, MD, MPH, a resident in internal medicine at Virginia Mason Medical Center in Seattle, chatted with a colleague. A few feet away, a group of doctors and healthcare professionals huddled dramatically, just barely out of earshot.

The fate of Dr. Wells’ scientific abstract hung in the balance.

Her study, a look at scheduling the start and stop times of hospitalist shifts around expected demand to reduce costs and patient wait times, was a short-list finalist in the Innovations category of HM16’s annual Research, Innovation, and Clinical Vignettes scientific abstract competition. With her work done—she had already made presentations to first a pair of semifinalist judges and then to a herd of all 10 of the category judges—Dr. Wells looked remarkably calm as she waited for the announcement of the winners.

Either way, she said, the competition had been an invigorating, exciting experience.

“I’m a doctor, so I like to compete,” she half-joked. “It definitely has been motivating.”

RIV ribbons this year were handed out to seven winners in four categories. The competition garnered 914 abstracts accepted for presentation.

Dr. Wells ended up being one of them. She was named Innovations’ trainee winner. In her study, researchers found that analyzing the flow of admissions and redistributing hospitalists to better conform to that flow reduced patient wait times and costs as well as improved the subjective experience of hospitalists even as volume increased.

The overall winner in the Innovations category also went to a trainee, Baely Crockett, PharmD, a resident at Eskenazi Health in Indianapolis. Her study looked at a pharmacist-managed rivaroxaban clinic for the treatment of venous thromboembolism (VTE). It was the first time, as far as the judges knew, that an award had gone to a pharmacist.

Dr. Crockett’s abstract showed that patients diagnosed in the ED with low-risk VTE are given a prescription scheduled to be seen in the follow-up clinic within two to five days, at which point the pharmacist sees the patients and reviews their case with them and determines treatment duration.

Dr. Crockett said the pharmacists involved are especially suitable for the role not only because of their expertise in the medication and the handling of time-consuming co-pay issues and other concerns but also because they shadowed ED physicians for six months to get training and experience.

“We’re able to fill in gaps that are true challenges to the patient’s success in finishing therapy,” she said.

One of the Innovations judges, Michael Craig, MD, MPH, FHM, associate professor of medicine at the University of North Carolina in Chapel Hill, said the research hit on an area of growing interest.

“The movement toward outpatient treatment of VTE is a pretty big topic that lots of people are working on,” he said. “It’s very relevant. The whole idea of having a pharmacist-driven intervention is unique; nobody had thought of or heard of before.”

The winner in the Research category was Vineet Chopra, MD, MSc, FHM, assistant professor at the University of Michigan in Ann Arbor, whose work set out to quantify how to prevent bloodstream infection and blood clots from the use of peripherally inserted central catheters, or PICC lines. Researchers created a simulation model, based on data from the literature, looking at what would happen to a hospital if the use of certain types of PICCs was increased while use of other types was decreased—the rationale being that PICCs with just one channel, or port, have a lower risk of infection or blood clots than those with multiple ports.

It is a risk that is often unrecognized, and PICC lines with multiple ports are often ordered as a just-in-case measure in the event that the first port gets clogged.

Chopra and colleagues found that, at the average hospital, about 75% of all PICCs used tend to be multichannel and 25% single-channel. They found every 5% increase in single-channel PICC use could prevent almost 1.5 infections per 1,000 patients, and 0.5 blood clots, with a corresponding cost savings of $13,000 per event. That can add up to hundreds of thousands of dollars a year at large hospitals.

And those calculations, Dr. Chopra noted, do not include penalties for infections or the financial effects of having those results publicly reported. Researchers are now creating an online tool— at improvepicc.com—that will allow users to calculate their own costs and potential savings.

“The hope of this is that it will give hospital administrators and hospital leadership and quality officers the momentum, perhaps, to overcome the inertia of not thinking actively,” said Dr. Chopra, who notched his first win after 10 years of participating in the RIV competition. “I think we don’t think actively about the choices we make when it comes to these devices.”

In the Clinical Vignettes category, winner Molly Kantor, MD, assistant clinical professor at the University of California, San Diego, recounted the case of a sickle-cell disease patient whose diagnosis, and hence treatment, was delayed and who ultimately died. She outlined a series of missteps, including taking at face-value a patient-reported past medical disease, which turned out to be wrong; making certain diagnoses based on lab tests and stopping there; and anchoring on the original diagnosis when the thought process was later reevaluated.

Dr. Kantor said the case is a caution flag to hospitalists, reinforcing the need for “a broad differential diagnosis.”

“[Make] sure that the data fits together and that you’re not using just one isolated piece of information to cinch everything, including the past medical history or a certain lab test, when the whole picture doesn’t quite fit together,” she said. “Looking back at this case, it’s pretty clear that the puzzle pieces probably weren’t quite fitting together, but there was enough that the easier thing to do was to make the diagnosis and move on.”

In the Pediatric Clinical Vignettes category, winner Jennifer Ladd, MD, a resident at Duke University, won for a study of a vexing case of a 2-year-old who was irritable and stalled on developmental milestones. At the hospital, the thought was that it could likely be a recurrence of herpes simplex (HSV) encephalitis, but the spinal fluid showed no signs of that and the acyclovir, which nearly always works for the disorder, was having no effect and the symptoms worsened.

The key in the case, said Alyssa Stephany, MD, then assistant professor at Duke University and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, who presented the case in Dr. Ladd’s absence, was that the team reopened the diagnosis and didn’t get ensnared in cognitive bias. A biopsy ultimately showed HSV in the brain tissue; it was a case of recurrence, despite signs to the contrary. Foscarnet was used to effectively treat the child; it is unknown why acyclovir didn’t work in this case.

“It kind of brings to the surface that that’s what a hospitalist is—a hospitalist is that person who sits and thinks, and really thinks, about the patient and doesn’t just do their rote work of input and output of a patient through the hospital system,” Dr. Stephany said. “When you get a case like this, it makes you take pause.”

The trainee winner in the Research category was N. Lance Downing, MD, of Stanford University School of Medicine, for work on an EHR-based severe sepsis alert. The trainee winner in Clinical Vignettes was Bhakti Shah, MD, of North Shore-LIJ Health System, now Northwell Health, on a rare case of autoimmune NMDA receptor encephalitis. TH

Thomas R. Collins is a freelance writer in South Florida.

2016 RIV Finalists, Winners

Research Category

WINNER:

Vineet Chopra, MD, MSc, FHM, LIMITING THE NUMBER OF LUMENS IN PERIPHERALLY INSERTED CENTRAL CATHETERS TO IMPROVE OUTCOMES AND REDUCE COST: A SIMULATION STUDY

TRAINEE WINNER:

N. Downing, MD, AN ELECTRONIC HEALTH RECORD-BASED SEVERE SEPSIS ALERT TO IMPROVE SEPSIS TREATMENT PERFORMANCE: RANDOMIZED EVALUATION

FINALISTS:

Waseem Khaliq, MD, MPH, PREVALENCE AND PREDICTORS OF NON-ADHERENCE TO BREAST CANCER SCREENING: PERSPECTIVE AND PREFERENCES OF HOSPITALIZED WOMEN

Dilli Poudel, MD, SYSTEMIC SCLEROSIS AS A RISK FACTOR OF ACUTE MYOCARDIAL INFARCTION: A US POPULATION BASED STUDY

Aiham Albaeni, MD, REGIONAL VARIATION IN RESOURCES UTILIZATION AND OUTCOMES FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST IN THE UNITED STATES

Poushali Bhattacharjee, MD, DETECTING SEPSIS: ARE TWO OPINIONS BETTER THAN ONE?

Vineet Chopra, MD, MSc, FHM, THE INFLUENCE OF RED BLOOD CELL TRANSFUSION ON VENOUS THROMBOEMBOLISM IN PATIENTS WITH PERIPHERALLY-INSERTED CENTRAL CATHETERS

Shaker Eid, MD, MBA, IMPACT OF HOSPITAL TEACHING STATUS ON OUT-OF-HOSPITAL CARDIAC ARREST OUTCOMES AND RESOURCE UTILIZATION IN THE UNITED STATES: 2000-2012

Tarun Jain, MD, CONTRAST-INDUCED NEPHROPATHY IN STEMI PATIENTS WITH AND WITHOUT CHRONIC KIDNEY DISEASE

Mona Beier, MD, CREATING A PATIENT SAFETY CULTURE ONE INCIDENT REPORT AT A TIME

Charles Pollack, MD, REINITIATION OF ANTITHROMBOTIC THERAPY AFTER EMERGENCY PROCEDURES OR AFTER AN EMERGENT BLEEDING EVENT: ADDITIONAL INTERIM EXPERIENCE FROM THE RE-VERSE AD TRIAL

Robert Boxer, MD, PhD, SAVING TIME: A TIME-MOTION ANALYSIS OF THE IMPACT OF REGIONALIZATION AND DAILY ADMITTING ON INTERN WORKFLOW

Kaleigh Evans, MD, THIRD TROPONIN ORDER OVERUSE IN THE SETTING OF CLINICAL STABILITY

David Paje, MD, SFHM, RISK OF VENOUS THROMBOEMBOLISM IN HOSPITALIZED PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Rehan Qayyum, MD, COMPARISON OF TIME-TRENDS IN PATIENT SATISFACTION BETWEEN TEACHING AND NONTEACHING HOSPITAL

Joshua Rolnick, MD, VALIDATION OF TEST PERFORMANCE AND CLINICAL TIME ZERO FOR AN ELECTRONIC HEALTH RECORD-EMBEDDED SEVERE SEPSIS ALERT

Allison Louis, MD, BLIND SIDED: MISSING POOR VISUAL ACUITY AND DECREASED SELF-EFFICACY IN HOSPITALIZED PATIENTS WITH DIABETES

G. Randy Smith, MD, MS, SFHM, ASSOCIATION OF HOSPITAL ADMISSION SERVICE STRUCTURE WITH EARLY TRANSFER TO CRITICAL CARE, HOSPITAL READMISSION, AND LENGTH OF STAY

Kathleene Wooldridge, MD, R-VA-MARQUIS: IMPLEMENTING BEST PRACTICES IN MEDICATION RECONCILIATION FOR RURAL VETERANS

INNOVATION CATEGORY

WINNER:

Baely Crockett, PharmD, NOVEL PHARMACIST-MANAGED RIVAROXABAN CLINIC FOR OUTPATIENT TREATMENT OF VENOUS THROMBOEMBOLISM

TRAINEE WINNER:

Monika Wells, MD, MPH, DESIGNING HOSPITALIST SHIFTS AROUND ADMISSION DEMAND REDUCES PATIENT WAIT TIMES AND COST

FINALISTS:

Jessica Dong, WHO MOVED MY EHR CHEESE? A NEW APPROACH TO CURATING AND INDIVIDUALIZING COMMUNICATIONS TO PHYSICIANS ABOUT EHR SOFTWARE UPDATES

Stephanie Rennke, MD, MED REC: A SKILLS-BASED CURRICULUM ON MEDICATION SAFETY AND MEDICATION RECONCILIATION FOR MEDICAL STUDENTS

Jens Langsjoen, MD, DEVELOPING AN INPATIENT DELIRIUM PREVENTION PROTOCOL

Mark Goldin, MD, BUILDING PARALLEL CO-MANAGEMENT SERVICES IN A LARGE ACADEMIC HOSPITALIST GROUP

Brian Lichtenstein, MD, IMPROVING RISK-ADJUSTED OUTCOME MEASURES WITH PHYSICIAN-ORIENTED DOCUMENTATION INTERVENTIONS

Matthew Cerasale, MD, REAL-TIME PADUA: AN AUTOMATED EHR INTEGRATED VENOUS THROMBOEMBOLISM RISK ASSESSMENT TOOL

Franziska Jovin, MD, MMM, FHM, IMPLEMENTATION OF A PAY-FOR-PERFOMANCE STRUCTURE FOR HOSPITALIST-LED QUALITY IMPROVEMENT PROJECTS

Arpit Khandelwal, MD, MANAGING CHALLENGING PATIENTS: FROM CONFLICT TO TEACHING OPPORTUNITY

Justin Lotfi, MD, MAKING IT SIMPLE - PROCESS IMPROVEMENT FOR OUTSIDE MEDICAL RECORDS

David McCollum, MD, FIXING WHAT IS BROKEN: QUALITY IMPROVEMENT IN THE CRITICAL LAB VALUE PROCESS

Nidhi Rohatgi, MD, MS, A NOVEL MD-RN COLLABORATIVE PROTOCOL TO PREVENT AND MANAGE ACUTE DELIRIUM IN INPATIENT WARDS

Lesley Schmaltz, MD, UNNECESSARY TRANSFUSIONS: HOSPITAL MEDICINE LEADING INSTITUTION-WIDE CHANGE

Anuj Dalal, MD, FHM, IMPLEMENTATION OF A PATIENT-CENTERED ‘MICROBLOG' MESSAGING PLATFORM TO IMPROVE CARE TEAM COMMUNICATION

Willard Ellis, MD, PhD, FHM, INTENSIVE FOLLOW UP AFTER PALLIATIVE CARE CONSULTATIONS TO REDUCE READMISSIONS

Lakshmi Swaminathan, MD, MHSA, FHM, USING “MAGIC” TO FACILITATE APPROPRIATE PICC USE: RESULTS OF IMPLEMENTATION OF A PICC APPROPRIATENESS ASSESSMENT TOOL

Charles Coffey, MD, MSc, FHM, IMPLEMENTING GUIDELINE-BASED INDICATIONS FOR CARDIAC MONITORING AT CEDARS-SINAI MEDICAL CENTER

Erik Hoyer, MD, USE OF A HOSPITALIST CLINICAL COMMUNITY TO FACILITATE DISSEMINATION OF AN EARLY MOBILITY QUALITY IMPROVEMENT PROGRAM

Elizabeth Stewart, MD, A MULTIDISCIPLINARY APPROACH TO HIGH VALUE CARDIAC BIOMARKER

CLINICAL VIGNETTES CATEGORY

WINNER (ADULT):

Molly Kantor, MD, THE TIP OF THE ICEBERG: A RARE CAUSE OF ACUTE LIVER FAILURE

WINNER (PEDIATRIC):

Jennifer Ladd, MD, MORE THAN JUST THE “TERRIBLE TWOS”: A CASE OF RESISTANT HSV ENCEPHALITIS

TRAINEE WINNER:

Bhakti Shah, MD, UNMASKING THE TERATOMA

FINALISTS:

Weijen Chang, MD, SFHM, UNCOILING A PROBLEMATIC TICKLE IN THE THROAT

Kenton Dover, MD, KEEPING AN EYE OUT FOR THE DIAGNOSIS

Stephanie Royer, MD, THE YOUNGEST REPORTED CASE OF EOSINOPHILIC CHOLANGITIS

Oluremi Ajala, MD, ANGINA OF ABDOMINAL ORIGIN

Asana Anderson, MBBS, A PARATHYROID CRISIS BURIED IN A SEPTIC OTOMASTOIDITIS

Kyle Bennett, DO, BULLS-EYE MARKS THE SPOT: LYME CARDITIS PRESENTING AS RASH AND PRESYNCOPE

John Biebelhausen, MD, MBA, CROSSFIT CATASTROPHE: CHEST PAIN IN A HEALTHY YOUNG WOMAN

Xuan Gao, MD, A CASE OF THE UNSEEN: KLEBSIELLA PNEUMONIA PYOGENIC LIVER ABSCESS WITH PNEUMONIA AND SEPTIC ENDOPHTHALMITIS IN A NON-ASIAN U.S. RESIDENT

Sana Grover, MBBS, 'ABSTINENT AND INTOXICATED'. A RARE CASE OF AUTO-BREWERY SYNDROME

Andrew Hawrylak, MD, WHEN IT'S NOT AN ALLERGIC REACTION: AN UNUSUAL CASE OF ECTHYEMA GANGRENOSUM ASSOCIATED WITH PROTEUS BACTEREMIA

Rasheen Imtiaz, MD, LACTIC ACIDOSIS IN ASTHMA

Jessie King, MD, PhD, THE SMOKING WOMAN

Bradley Manning, MD, A SUPER-ANTIGEN-MEDIATED MIMIC OF ACUTE APPENDICITIS

Hiroki Matsuura, IMPAIRED CONSCIOUSNESS WITH INDOLENT BREAST MASS

Niharika Singh, MD, LOWER EXTREMITY NECROTIZING FASCIITIS: AN UNUSUAL PRESENTATION OF PERFORATED SIGMOID DIVERTICULITIS

Vivan Tran, DO, PUTTING THE PEE IN PREGNANCY: A CASE OF GESTATIONAL DIABETES INSIPIDUS YOU DON'T WANT TO MISS

Kristen Welch, THE MYSTERIOUS DANCE: A RARE CASE OF DELAYED ONSET DIABETIC STRIATOPATHY

Standing adjacent Poster 391 in a loud, crowded meeting hall, Monika Wells, MD, MPH, a resident in internal medicine at Virginia Mason Medical Center in Seattle, chatted with a colleague. A few feet away, a group of doctors and healthcare professionals huddled dramatically, just barely out of earshot.

The fate of Dr. Wells’ scientific abstract hung in the balance.

Her study, a look at scheduling the start and stop times of hospitalist shifts around expected demand to reduce costs and patient wait times, was a short-list finalist in the Innovations category of HM16’s annual Research, Innovation, and Clinical Vignettes scientific abstract competition. With her work done—she had already made presentations to first a pair of semifinalist judges and then to a herd of all 10 of the category judges—Dr. Wells looked remarkably calm as she waited for the announcement of the winners.

Either way, she said, the competition had been an invigorating, exciting experience.

“I’m a doctor, so I like to compete,” she half-joked. “It definitely has been motivating.”

RIV ribbons this year were handed out to seven winners in four categories. The competition garnered 914 abstracts accepted for presentation.

Dr. Wells ended up being one of them. She was named Innovations’ trainee winner. In her study, researchers found that analyzing the flow of admissions and redistributing hospitalists to better conform to that flow reduced patient wait times and costs as well as improved the subjective experience of hospitalists even as volume increased.

The overall winner in the Innovations category also went to a trainee, Baely Crockett, PharmD, a resident at Eskenazi Health in Indianapolis. Her study looked at a pharmacist-managed rivaroxaban clinic for the treatment of venous thromboembolism (VTE). It was the first time, as far as the judges knew, that an award had gone to a pharmacist.

Dr. Crockett’s abstract showed that patients diagnosed in the ED with low-risk VTE are given a prescription scheduled to be seen in the follow-up clinic within two to five days, at which point the pharmacist sees the patients and reviews their case with them and determines treatment duration.

Dr. Crockett said the pharmacists involved are especially suitable for the role not only because of their expertise in the medication and the handling of time-consuming co-pay issues and other concerns but also because they shadowed ED physicians for six months to get training and experience.

“We’re able to fill in gaps that are true challenges to the patient’s success in finishing therapy,” she said.

One of the Innovations judges, Michael Craig, MD, MPH, FHM, associate professor of medicine at the University of North Carolina in Chapel Hill, said the research hit on an area of growing interest.

“The movement toward outpatient treatment of VTE is a pretty big topic that lots of people are working on,” he said. “It’s very relevant. The whole idea of having a pharmacist-driven intervention is unique; nobody had thought of or heard of before.”

The winner in the Research category was Vineet Chopra, MD, MSc, FHM, assistant professor at the University of Michigan in Ann Arbor, whose work set out to quantify how to prevent bloodstream infection and blood clots from the use of peripherally inserted central catheters, or PICC lines. Researchers created a simulation model, based on data from the literature, looking at what would happen to a hospital if the use of certain types of PICCs was increased while use of other types was decreased—the rationale being that PICCs with just one channel, or port, have a lower risk of infection or blood clots than those with multiple ports.

It is a risk that is often unrecognized, and PICC lines with multiple ports are often ordered as a just-in-case measure in the event that the first port gets clogged.

Chopra and colleagues found that, at the average hospital, about 75% of all PICCs used tend to be multichannel and 25% single-channel. They found every 5% increase in single-channel PICC use could prevent almost 1.5 infections per 1,000 patients, and 0.5 blood clots, with a corresponding cost savings of $13,000 per event. That can add up to hundreds of thousands of dollars a year at large hospitals.

And those calculations, Dr. Chopra noted, do not include penalties for infections or the financial effects of having those results publicly reported. Researchers are now creating an online tool— at improvepicc.com—that will allow users to calculate their own costs and potential savings.

“The hope of this is that it will give hospital administrators and hospital leadership and quality officers the momentum, perhaps, to overcome the inertia of not thinking actively,” said Dr. Chopra, who notched his first win after 10 years of participating in the RIV competition. “I think we don’t think actively about the choices we make when it comes to these devices.”

In the Clinical Vignettes category, winner Molly Kantor, MD, assistant clinical professor at the University of California, San Diego, recounted the case of a sickle-cell disease patient whose diagnosis, and hence treatment, was delayed and who ultimately died. She outlined a series of missteps, including taking at face-value a patient-reported past medical disease, which turned out to be wrong; making certain diagnoses based on lab tests and stopping there; and anchoring on the original diagnosis when the thought process was later reevaluated.

Dr. Kantor said the case is a caution flag to hospitalists, reinforcing the need for “a broad differential diagnosis.”

“[Make] sure that the data fits together and that you’re not using just one isolated piece of information to cinch everything, including the past medical history or a certain lab test, when the whole picture doesn’t quite fit together,” she said. “Looking back at this case, it’s pretty clear that the puzzle pieces probably weren’t quite fitting together, but there was enough that the easier thing to do was to make the diagnosis and move on.”

In the Pediatric Clinical Vignettes category, winner Jennifer Ladd, MD, a resident at Duke University, won for a study of a vexing case of a 2-year-old who was irritable and stalled on developmental milestones. At the hospital, the thought was that it could likely be a recurrence of herpes simplex (HSV) encephalitis, but the spinal fluid showed no signs of that and the acyclovir, which nearly always works for the disorder, was having no effect and the symptoms worsened.

The key in the case, said Alyssa Stephany, MD, then assistant professor at Duke University and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, who presented the case in Dr. Ladd’s absence, was that the team reopened the diagnosis and didn’t get ensnared in cognitive bias. A biopsy ultimately showed HSV in the brain tissue; it was a case of recurrence, despite signs to the contrary. Foscarnet was used to effectively treat the child; it is unknown why acyclovir didn’t work in this case.

“It kind of brings to the surface that that’s what a hospitalist is—a hospitalist is that person who sits and thinks, and really thinks, about the patient and doesn’t just do their rote work of input and output of a patient through the hospital system,” Dr. Stephany said. “When you get a case like this, it makes you take pause.”

The trainee winner in the Research category was N. Lance Downing, MD, of Stanford University School of Medicine, for work on an EHR-based severe sepsis alert. The trainee winner in Clinical Vignettes was Bhakti Shah, MD, of North Shore-LIJ Health System, now Northwell Health, on a rare case of autoimmune NMDA receptor encephalitis. TH

Thomas R. Collins is a freelance writer in South Florida.

2016 RIV Finalists, Winners

Research Category

WINNER:

Vineet Chopra, MD, MSc, FHM, LIMITING THE NUMBER OF LUMENS IN PERIPHERALLY INSERTED CENTRAL CATHETERS TO IMPROVE OUTCOMES AND REDUCE COST: A SIMULATION STUDY

TRAINEE WINNER:

N. Downing, MD, AN ELECTRONIC HEALTH RECORD-BASED SEVERE SEPSIS ALERT TO IMPROVE SEPSIS TREATMENT PERFORMANCE: RANDOMIZED EVALUATION

FINALISTS:

Waseem Khaliq, MD, MPH, PREVALENCE AND PREDICTORS OF NON-ADHERENCE TO BREAST CANCER SCREENING: PERSPECTIVE AND PREFERENCES OF HOSPITALIZED WOMEN

Dilli Poudel, MD, SYSTEMIC SCLEROSIS AS A RISK FACTOR OF ACUTE MYOCARDIAL INFARCTION: A US POPULATION BASED STUDY

Aiham Albaeni, MD, REGIONAL VARIATION IN RESOURCES UTILIZATION AND OUTCOMES FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST IN THE UNITED STATES

Poushali Bhattacharjee, MD, DETECTING SEPSIS: ARE TWO OPINIONS BETTER THAN ONE?

Vineet Chopra, MD, MSc, FHM, THE INFLUENCE OF RED BLOOD CELL TRANSFUSION ON VENOUS THROMBOEMBOLISM IN PATIENTS WITH PERIPHERALLY-INSERTED CENTRAL CATHETERS

Shaker Eid, MD, MBA, IMPACT OF HOSPITAL TEACHING STATUS ON OUT-OF-HOSPITAL CARDIAC ARREST OUTCOMES AND RESOURCE UTILIZATION IN THE UNITED STATES: 2000-2012

Tarun Jain, MD, CONTRAST-INDUCED NEPHROPATHY IN STEMI PATIENTS WITH AND WITHOUT CHRONIC KIDNEY DISEASE

Mona Beier, MD, CREATING A PATIENT SAFETY CULTURE ONE INCIDENT REPORT AT A TIME

Charles Pollack, MD, REINITIATION OF ANTITHROMBOTIC THERAPY AFTER EMERGENCY PROCEDURES OR AFTER AN EMERGENT BLEEDING EVENT: ADDITIONAL INTERIM EXPERIENCE FROM THE RE-VERSE AD TRIAL

Robert Boxer, MD, PhD, SAVING TIME: A TIME-MOTION ANALYSIS OF THE IMPACT OF REGIONALIZATION AND DAILY ADMITTING ON INTERN WORKFLOW

Kaleigh Evans, MD, THIRD TROPONIN ORDER OVERUSE IN THE SETTING OF CLINICAL STABILITY

David Paje, MD, SFHM, RISK OF VENOUS THROMBOEMBOLISM IN HOSPITALIZED PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Rehan Qayyum, MD, COMPARISON OF TIME-TRENDS IN PATIENT SATISFACTION BETWEEN TEACHING AND NONTEACHING HOSPITAL

Joshua Rolnick, MD, VALIDATION OF TEST PERFORMANCE AND CLINICAL TIME ZERO FOR AN ELECTRONIC HEALTH RECORD-EMBEDDED SEVERE SEPSIS ALERT

Allison Louis, MD, BLIND SIDED: MISSING POOR VISUAL ACUITY AND DECREASED SELF-EFFICACY IN HOSPITALIZED PATIENTS WITH DIABETES

G. Randy Smith, MD, MS, SFHM, ASSOCIATION OF HOSPITAL ADMISSION SERVICE STRUCTURE WITH EARLY TRANSFER TO CRITICAL CARE, HOSPITAL READMISSION, AND LENGTH OF STAY

Kathleene Wooldridge, MD, R-VA-MARQUIS: IMPLEMENTING BEST PRACTICES IN MEDICATION RECONCILIATION FOR RURAL VETERANS

INNOVATION CATEGORY

WINNER:

Baely Crockett, PharmD, NOVEL PHARMACIST-MANAGED RIVAROXABAN CLINIC FOR OUTPATIENT TREATMENT OF VENOUS THROMBOEMBOLISM

TRAINEE WINNER:

Monika Wells, MD, MPH, DESIGNING HOSPITALIST SHIFTS AROUND ADMISSION DEMAND REDUCES PATIENT WAIT TIMES AND COST

FINALISTS:

Jessica Dong, WHO MOVED MY EHR CHEESE? A NEW APPROACH TO CURATING AND INDIVIDUALIZING COMMUNICATIONS TO PHYSICIANS ABOUT EHR SOFTWARE UPDATES

Stephanie Rennke, MD, MED REC: A SKILLS-BASED CURRICULUM ON MEDICATION SAFETY AND MEDICATION RECONCILIATION FOR MEDICAL STUDENTS

Jens Langsjoen, MD, DEVELOPING AN INPATIENT DELIRIUM PREVENTION PROTOCOL

Mark Goldin, MD, BUILDING PARALLEL CO-MANAGEMENT SERVICES IN A LARGE ACADEMIC HOSPITALIST GROUP

Brian Lichtenstein, MD, IMPROVING RISK-ADJUSTED OUTCOME MEASURES WITH PHYSICIAN-ORIENTED DOCUMENTATION INTERVENTIONS

Matthew Cerasale, MD, REAL-TIME PADUA: AN AUTOMATED EHR INTEGRATED VENOUS THROMBOEMBOLISM RISK ASSESSMENT TOOL

Franziska Jovin, MD, MMM, FHM, IMPLEMENTATION OF A PAY-FOR-PERFOMANCE STRUCTURE FOR HOSPITALIST-LED QUALITY IMPROVEMENT PROJECTS

Arpit Khandelwal, MD, MANAGING CHALLENGING PATIENTS: FROM CONFLICT TO TEACHING OPPORTUNITY

Justin Lotfi, MD, MAKING IT SIMPLE - PROCESS IMPROVEMENT FOR OUTSIDE MEDICAL RECORDS

David McCollum, MD, FIXING WHAT IS BROKEN: QUALITY IMPROVEMENT IN THE CRITICAL LAB VALUE PROCESS

Nidhi Rohatgi, MD, MS, A NOVEL MD-RN COLLABORATIVE PROTOCOL TO PREVENT AND MANAGE ACUTE DELIRIUM IN INPATIENT WARDS

Lesley Schmaltz, MD, UNNECESSARY TRANSFUSIONS: HOSPITAL MEDICINE LEADING INSTITUTION-WIDE CHANGE

Anuj Dalal, MD, FHM, IMPLEMENTATION OF A PATIENT-CENTERED ‘MICROBLOG' MESSAGING PLATFORM TO IMPROVE CARE TEAM COMMUNICATION

Willard Ellis, MD, PhD, FHM, INTENSIVE FOLLOW UP AFTER PALLIATIVE CARE CONSULTATIONS TO REDUCE READMISSIONS

Lakshmi Swaminathan, MD, MHSA, FHM, USING “MAGIC” TO FACILITATE APPROPRIATE PICC USE: RESULTS OF IMPLEMENTATION OF A PICC APPROPRIATENESS ASSESSMENT TOOL

Charles Coffey, MD, MSc, FHM, IMPLEMENTING GUIDELINE-BASED INDICATIONS FOR CARDIAC MONITORING AT CEDARS-SINAI MEDICAL CENTER

Erik Hoyer, MD, USE OF A HOSPITALIST CLINICAL COMMUNITY TO FACILITATE DISSEMINATION OF AN EARLY MOBILITY QUALITY IMPROVEMENT PROGRAM

Elizabeth Stewart, MD, A MULTIDISCIPLINARY APPROACH TO HIGH VALUE CARDIAC BIOMARKER

CLINICAL VIGNETTES CATEGORY

WINNER (ADULT):

Molly Kantor, MD, THE TIP OF THE ICEBERG: A RARE CAUSE OF ACUTE LIVER FAILURE

WINNER (PEDIATRIC):

Jennifer Ladd, MD, MORE THAN JUST THE “TERRIBLE TWOS”: A CASE OF RESISTANT HSV ENCEPHALITIS

TRAINEE WINNER:

Bhakti Shah, MD, UNMASKING THE TERATOMA

FINALISTS:

Weijen Chang, MD, SFHM, UNCOILING A PROBLEMATIC TICKLE IN THE THROAT

Kenton Dover, MD, KEEPING AN EYE OUT FOR THE DIAGNOSIS

Stephanie Royer, MD, THE YOUNGEST REPORTED CASE OF EOSINOPHILIC CHOLANGITIS

Oluremi Ajala, MD, ANGINA OF ABDOMINAL ORIGIN

Asana Anderson, MBBS, A PARATHYROID CRISIS BURIED IN A SEPTIC OTOMASTOIDITIS

Kyle Bennett, DO, BULLS-EYE MARKS THE SPOT: LYME CARDITIS PRESENTING AS RASH AND PRESYNCOPE

John Biebelhausen, MD, MBA, CROSSFIT CATASTROPHE: CHEST PAIN IN A HEALTHY YOUNG WOMAN

Xuan Gao, MD, A CASE OF THE UNSEEN: KLEBSIELLA PNEUMONIA PYOGENIC LIVER ABSCESS WITH PNEUMONIA AND SEPTIC ENDOPHTHALMITIS IN A NON-ASIAN U.S. RESIDENT

Sana Grover, MBBS, 'ABSTINENT AND INTOXICATED'. A RARE CASE OF AUTO-BREWERY SYNDROME

Andrew Hawrylak, MD, WHEN IT'S NOT AN ALLERGIC REACTION: AN UNUSUAL CASE OF ECTHYEMA GANGRENOSUM ASSOCIATED WITH PROTEUS BACTEREMIA

Rasheen Imtiaz, MD, LACTIC ACIDOSIS IN ASTHMA

Jessie King, MD, PhD, THE SMOKING WOMAN

Bradley Manning, MD, A SUPER-ANTIGEN-MEDIATED MIMIC OF ACUTE APPENDICITIS

Hiroki Matsuura, IMPAIRED CONSCIOUSNESS WITH INDOLENT BREAST MASS

Niharika Singh, MD, LOWER EXTREMITY NECROTIZING FASCIITIS: AN UNUSUAL PRESENTATION OF PERFORATED SIGMOID DIVERTICULITIS

Vivan Tran, DO, PUTTING THE PEE IN PREGNANCY: A CASE OF GESTATIONAL DIABETES INSIPIDUS YOU DON'T WANT TO MISS

Kristen Welch, THE MYSTERIOUS DANCE: A RARE CASE OF DELAYED ONSET DIABETIC STRIATOPATHY

Two academic hospitalists talk about why they teach, what they're learning from their students, and what they see as the future of hospital medicine. Since academic HM is the new-hospitalist pipeline, hearing what they're seeing in their student and resident trainee corps is a snapshot of HM's sustainability.

Two academic hospitalists talk about why they teach, what they're learning from their students, and what they see as the future of hospital medicine. Since academic HM is the new-hospitalist pipeline, hearing what they're seeing in their student and resident trainee corps is a snapshot of HM's sustainability.

Two academic hospitalists talk about why they teach, what they're learning from their students, and what they see as the future of hospital medicine. Since academic HM is the new-hospitalist pipeline, hearing what they're seeing in their student and resident trainee corps is a snapshot of HM's sustainability.

Clinical question: What are the factors that increase risk of Clostridium difficile infection (CDI) in postoperative patients?

Background: CDI has become an important infectious etiology for morbidity, lengthy and costly hospital admissions, and mortality. This study focused on the risks for postoperative patients to be infected with C. diff. Awareness of the risk factors for CDI allows for processes to be implemented that can decrease the rate of infection.

Study design: Retrospective, observational study.

Setting: Multiple Veterans Health Administration surgery programs.

Synopsis: The study investigated 468,386 surgical procedures in 134 surgical programs in 12 subspecialties over a four-year period. Overall, the postoperative CDI rate was 0.4% per year. Rates were higher in emergency or complex procedures, older patients, patients with longer preoperative hospital stays, and those who received three or more classes of antibiotics. CDI in postoperative patients was associated with five times higher risk of mortality, a 12 times higher risk of morbidity, and longer hospital stays (17.9 versus 3.6 days) compared with those without CDI. Further studies with a larger population size will confirm the findings of this study.

The study was conducted on middle-aged to elderly male veterans, and it can only be assumed that these results will translate to other populations. Nevertheless, CDI can lead to significant morbidity and mortality, and the study reinforces the importance of infection control and prevention to reduce CDI incidence and disease severity.

Bottom line: Postoperative CDI is significantly associated with the number of postoperative antibiotics, surgical procedure complexity, preoperative length of stay, and patient comorbidities.

Citation: Li X, Wilson M, Nylander W, Smith T, Lynn M, Gunnar W. Analysis of morbidity and mortality outcomes in postoperative Clostridium difficile infection in the Veterans Health Administration. JAMA Surg. 2015;25:1-9.

Clinical question: What are the factors that increase risk of Clostridium difficile infection (CDI) in postoperative patients?

Background: CDI has become an important infectious etiology for morbidity, lengthy and costly hospital admissions, and mortality. This study focused on the risks for postoperative patients to be infected with C. diff. Awareness of the risk factors for CDI allows for processes to be implemented that can decrease the rate of infection.

Study design: Retrospective, observational study.

Setting: Multiple Veterans Health Administration surgery programs.

Synopsis: The study investigated 468,386 surgical procedures in 134 surgical programs in 12 subspecialties over a four-year period. Overall, the postoperative CDI rate was 0.4% per year. Rates were higher in emergency or complex procedures, older patients, patients with longer preoperative hospital stays, and those who received three or more classes of antibiotics. CDI in postoperative patients was associated with five times higher risk of mortality, a 12 times higher risk of morbidity, and longer hospital stays (17.9 versus 3.6 days) compared with those without CDI. Further studies with a larger population size will confirm the findings of this study.

The study was conducted on middle-aged to elderly male veterans, and it can only be assumed that these results will translate to other populations. Nevertheless, CDI can lead to significant morbidity and mortality, and the study reinforces the importance of infection control and prevention to reduce CDI incidence and disease severity.

Bottom line: Postoperative CDI is significantly associated with the number of postoperative antibiotics, surgical procedure complexity, preoperative length of stay, and patient comorbidities.

Citation: Li X, Wilson M, Nylander W, Smith T, Lynn M, Gunnar W. Analysis of morbidity and mortality outcomes in postoperative Clostridium difficile infection in the Veterans Health Administration. JAMA Surg. 2015;25:1-9.

Clinical question: What are the factors that increase risk of Clostridium difficile infection (CDI) in postoperative patients?

Background: CDI has become an important infectious etiology for morbidity, lengthy and costly hospital admissions, and mortality. This study focused on the risks for postoperative patients to be infected with C. diff. Awareness of the risk factors for CDI allows for processes to be implemented that can decrease the rate of infection.

Study design: Retrospective, observational study.

Setting: Multiple Veterans Health Administration surgery programs.

Synopsis: The study investigated 468,386 surgical procedures in 134 surgical programs in 12 subspecialties over a four-year period. Overall, the postoperative CDI rate was 0.4% per year. Rates were higher in emergency or complex procedures, older patients, patients with longer preoperative hospital stays, and those who received three or more classes of antibiotics. CDI in postoperative patients was associated with five times higher risk of mortality, a 12 times higher risk of morbidity, and longer hospital stays (17.9 versus 3.6 days) compared with those without CDI. Further studies with a larger population size will confirm the findings of this study.

The study was conducted on middle-aged to elderly male veterans, and it can only be assumed that these results will translate to other populations. Nevertheless, CDI can lead to significant morbidity and mortality, and the study reinforces the importance of infection control and prevention to reduce CDI incidence and disease severity.

Bottom line: Postoperative CDI is significantly associated with the number of postoperative antibiotics, surgical procedure complexity, preoperative length of stay, and patient comorbidities.

Citation: Li X, Wilson M, Nylander W, Smith T, Lynn M, Gunnar W. Analysis of morbidity and mortality outcomes in postoperative Clostridium difficile infection in the Veterans Health Administration. JAMA Surg. 2015;25:1-9.

Clinical question: What is the etiology of 30-day readmissions in postoperative patients?

Background: As the focus of healthcare changes to a quality-focused model, readmissions impact physicians, reimbursements, and patients. Understanding the cause of readmissions becomes essential to preventing them. The etiology of 30-day readmissions in postoperative patients has not specifically been studied.

Study design: Retrospective analysis.

Setting: Academic tertiary-care center.

Synopsis: Using administrative claims data, an analysis of 22,559 patients who underwent a major surgical procedure between 2009 and 2013 was performed. A total of 56 surgeons within eight surgical subspecialties were analyzed, showing that variation in 30-day readmissions was largely due to patient-specific factors (82.8%) while only a minority were attributable to surgical subspecialty (14.5%) and individual surgeon levels (2.8%). Factors associated with readmission included race/ethnicity, comorbidities, postoperative complications, and extended length of stay.

Further studies within this area will need to be conducted focusing on one specific subspecialty and one surgeon to exclude confounding factors. Additional meta-analysis can then compare these individual studies. A larger population and multiple care centers will also further validate the findings. Understanding the cause of the readmissions in postoperative patients can prevent further readmissions, improve quality of care, and decrease healthcare costs. If patient factors are identified as a major cause for readmissions in postoperative patients, changes in preoperative management may need to be made.

Bottom line: Postoperative readmissions are more dependent on patient factors than surgeon- or surgical subspecialty-specific factors.

Citation: Gani F, Lucas DJ, Kim Y, Schneider EB, Pawlik TM. Understanding variation in 30-day surgical readmission in the era of accountable care: effect of the patient, surgeon, and surgical subspecialties. JAMA Surg. 2015;150(11):1042-1049.

Clinical question: What is the etiology of 30-day readmissions in postoperative patients?

Background: As the focus of healthcare changes to a quality-focused model, readmissions impact physicians, reimbursements, and patients. Understanding the cause of readmissions becomes essential to preventing them. The etiology of 30-day readmissions in postoperative patients has not specifically been studied.

Study design: Retrospective analysis.

Setting: Academic tertiary-care center.

Synopsis: Using administrative claims data, an analysis of 22,559 patients who underwent a major surgical procedure between 2009 and 2013 was performed. A total of 56 surgeons within eight surgical subspecialties were analyzed, showing that variation in 30-day readmissions was largely due to patient-specific factors (82.8%) while only a minority were attributable to surgical subspecialty (14.5%) and individual surgeon levels (2.8%). Factors associated with readmission included race/ethnicity, comorbidities, postoperative complications, and extended length of stay.

Further studies within this area will need to be conducted focusing on one specific subspecialty and one surgeon to exclude confounding factors. Additional meta-analysis can then compare these individual studies. A larger population and multiple care centers will also further validate the findings. Understanding the cause of the readmissions in postoperative patients can prevent further readmissions, improve quality of care, and decrease healthcare costs. If patient factors are identified as a major cause for readmissions in postoperative patients, changes in preoperative management may need to be made.

Bottom line: Postoperative readmissions are more dependent on patient factors than surgeon- or surgical subspecialty-specific factors.

Citation: Gani F, Lucas DJ, Kim Y, Schneider EB, Pawlik TM. Understanding variation in 30-day surgical readmission in the era of accountable care: effect of the patient, surgeon, and surgical subspecialties. JAMA Surg. 2015;150(11):1042-1049.

Clinical question: What is the etiology of 30-day readmissions in postoperative patients?

Background: As the focus of healthcare changes to a quality-focused model, readmissions impact physicians, reimbursements, and patients. Understanding the cause of readmissions becomes essential to preventing them. The etiology of 30-day readmissions in postoperative patients has not specifically been studied.

Study design: Retrospective analysis.

Setting: Academic tertiary-care center.

Synopsis: Using administrative claims data, an analysis of 22,559 patients who underwent a major surgical procedure between 2009 and 2013 was performed. A total of 56 surgeons within eight surgical subspecialties were analyzed, showing that variation in 30-day readmissions was largely due to patient-specific factors (82.8%) while only a minority were attributable to surgical subspecialty (14.5%) and individual surgeon levels (2.8%). Factors associated with readmission included race/ethnicity, comorbidities, postoperative complications, and extended length of stay.

Further studies within this area will need to be conducted focusing on one specific subspecialty and one surgeon to exclude confounding factors. Additional meta-analysis can then compare these individual studies. A larger population and multiple care centers will also further validate the findings. Understanding the cause of the readmissions in postoperative patients can prevent further readmissions, improve quality of care, and decrease healthcare costs. If patient factors are identified as a major cause for readmissions in postoperative patients, changes in preoperative management may need to be made.

Bottom line: Postoperative readmissions are more dependent on patient factors than surgeon- or surgical subspecialty-specific factors.

Citation: Gani F, Lucas DJ, Kim Y, Schneider EB, Pawlik TM. Understanding variation in 30-day surgical readmission in the era of accountable care: effect of the patient, surgeon, and surgical subspecialties. JAMA Surg. 2015;150(11):1042-1049.

(Reuters) - U.S. hospitals should brace for a surge in "ransomware" attacks by cyber criminals who infect and shut down computer networks, then demand payment in return for unlocking them, a non-profit healthcare group warned on Friday.

The Health Information Trust Alliance conducted a study of some 30 mid-sized U.S. hospitals late last year and found that 52 percent of them were infected with malicious software, HITRUST Chief Executive Daniel Nutkis told Reuters.

The most common type of malware was ransomware, Nutkis said, which was present in 35 percent of the hospitals included in the study of network traffic conducted by security software maker Trend Micro Inc.

Ransomware is malicious software that locks up data in computers and leaves messages demanding payment to recover the data. Last month, Hollywood Presbyterian Hospital in Los Angeles paid a ransom of $17,000 to regain access to its systems.

This week, an attack on MedStar Health forced the largest healthcare provider in Washington, D.C., to shut down much of its computer network. The Baltimore Sun reported a ransom of $18,500 was sought. MedStar declined to comment.

HITRUST said it expects such attacks to become more frequent because ransomware has turned into a profitable business for cyber criminals.

The results of the study, which HITRUST has yet to share with the public, demonstrate that hackers have moved away from focusing on stealing patient data, Nutkis said.

"If stuff isn't working, they move on. If stuff is working, they keep doing it," said Nutkis. "Organizations that are paying have considered their options, and unfortunately they don't have a lot of options."

Extortion has become more popular with cyber criminals because it is seen as a way to generate fast money, said Larry Whiteside, a healthcare expert with cyber security firm Optiv.

Stealing healthcare data is far more labour intensive, requiring attackers to keep their presence in a victim's network undetected for months as they steal data, then they need to find buyers, he added.

"With ransomware I'm going to get paid immediately," Whiteside said.

Frisco, Texas-based HITRUST's board includes executives from Anthem, Health Care Services, Humana, UnitedHealth and Walgreens.

(Reuters) - U.S. hospitals should brace for a surge in "ransomware" attacks by cyber criminals who infect and shut down computer networks, then demand payment in return for unlocking them, a non-profit healthcare group warned on Friday.

The Health Information Trust Alliance conducted a study of some 30 mid-sized U.S. hospitals late last year and found that 52 percent of them were infected with malicious software, HITRUST Chief Executive Daniel Nutkis told Reuters.

The most common type of malware was ransomware, Nutkis said, which was present in 35 percent of the hospitals included in the study of network traffic conducted by security software maker Trend Micro Inc.

Ransomware is malicious software that locks up data in computers and leaves messages demanding payment to recover the data. Last month, Hollywood Presbyterian Hospital in Los Angeles paid a ransom of $17,000 to regain access to its systems.

This week, an attack on MedStar Health forced the largest healthcare provider in Washington, D.C., to shut down much of its computer network. The Baltimore Sun reported a ransom of $18,500 was sought. MedStar declined to comment.

HITRUST said it expects such attacks to become more frequent because ransomware has turned into a profitable business for cyber criminals.

The results of the study, which HITRUST has yet to share with the public, demonstrate that hackers have moved away from focusing on stealing patient data, Nutkis said.

"If stuff isn't working, they move on. If stuff is working, they keep doing it," said Nutkis. "Organizations that are paying have considered their options, and unfortunately they don't have a lot of options."

Extortion has become more popular with cyber criminals because it is seen as a way to generate fast money, said Larry Whiteside, a healthcare expert with cyber security firm Optiv.

Stealing healthcare data is far more labour intensive, requiring attackers to keep their presence in a victim's network undetected for months as they steal data, then they need to find buyers, he added.

"With ransomware I'm going to get paid immediately," Whiteside said.

Frisco, Texas-based HITRUST's board includes executives from Anthem, Health Care Services, Humana, UnitedHealth and Walgreens.

(Reuters) - U.S. hospitals should brace for a surge in "ransomware" attacks by cyber criminals who infect and shut down computer networks, then demand payment in return for unlocking them, a non-profit healthcare group warned on Friday.

The Health Information Trust Alliance conducted a study of some 30 mid-sized U.S. hospitals late last year and found that 52 percent of them were infected with malicious software, HITRUST Chief Executive Daniel Nutkis told Reuters.

The most common type of malware was ransomware, Nutkis said, which was present in 35 percent of the hospitals included in the study of network traffic conducted by security software maker Trend Micro Inc.

Ransomware is malicious software that locks up data in computers and leaves messages demanding payment to recover the data. Last month, Hollywood Presbyterian Hospital in Los Angeles paid a ransom of $17,000 to regain access to its systems.

This week, an attack on MedStar Health forced the largest healthcare provider in Washington, D.C., to shut down much of its computer network. The Baltimore Sun reported a ransom of $18,500 was sought. MedStar declined to comment.

HITRUST said it expects such attacks to become more frequent because ransomware has turned into a profitable business for cyber criminals.

The results of the study, which HITRUST has yet to share with the public, demonstrate that hackers have moved away from focusing on stealing patient data, Nutkis said.

"If stuff isn't working, they move on. If stuff is working, they keep doing it," said Nutkis. "Organizations that are paying have considered their options, and unfortunately they don't have a lot of options."

Extortion has become more popular with cyber criminals because it is seen as a way to generate fast money, said Larry Whiteside, a healthcare expert with cyber security firm Optiv.

Stealing healthcare data is far more labour intensive, requiring attackers to keep their presence in a victim's network undetected for months as they steal data, then they need to find buyers, he added.

"With ransomware I'm going to get paid immediately," Whiteside said.

Frisco, Texas-based HITRUST's board includes executives from Anthem, Health Care Services, Humana, UnitedHealth and Walgreens.

Are you interested in growing professionally and getting involved in work that you are excited about with colleagues across the country? You are in the driver’s seat as a hospitalist. You are in a position to lead, initiate quality improvement, impact patient outcomes, and advocate for your patients and your specialty in healthcare legislation.

SHM offers a wealth of volunteer experiences that will grow your strengths and interests, sharpen your professional acumen, and enhance your profile. New engagement opportunities are added regularly and represent unique ways to make a difference in hospital medicine. Check out some highlights:

These are just a few potential opportunities available from SHM. To learn more and find one that fits your interests, visit hospitalmedicine.org/professionalgrowth.

Are you interested in growing professionally and getting involved in work that you are excited about with colleagues across the country? You are in the driver’s seat as a hospitalist. You are in a position to lead, initiate quality improvement, impact patient outcomes, and advocate for your patients and your specialty in healthcare legislation.

SHM offers a wealth of volunteer experiences that will grow your strengths and interests, sharpen your professional acumen, and enhance your profile. New engagement opportunities are added regularly and represent unique ways to make a difference in hospital medicine. Check out some highlights:

These are just a few potential opportunities available from SHM. To learn more and find one that fits your interests, visit hospitalmedicine.org/professionalgrowth.

Are you interested in growing professionally and getting involved in work that you are excited about with colleagues across the country? You are in the driver’s seat as a hospitalist. You are in a position to lead, initiate quality improvement, impact patient outcomes, and advocate for your patients and your specialty in healthcare legislation.

SHM offers a wealth of volunteer experiences that will grow your strengths and interests, sharpen your professional acumen, and enhance your profile. New engagement opportunities are added regularly and represent unique ways to make a difference in hospital medicine. Check out some highlights:

These are just a few potential opportunities available from SHM. To learn more and find one that fits your interests, visit hospitalmedicine.org/professionalgrowth.

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH