Richard Quinn

A new report that outlines the potential care delivery improvements and cost savings of telemedicine might also be a road map to increased efficiency for hospitalists, according to one of the study’s authors and a former SHM president.

Telemedicine "simplifies their life," says Mitchell Adams, AB, MBA, executive director of the Massachusetts Technology Collaborative (MTC) in Boston, which coauthored "Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care" with the New England Healthcare Institute (NEHI) in Cambridge. "It means you have you less complications, you have less work. You have an intensivist looking over your shoulder, making sure you’re doing it right."

As the population ages and hospitalists become more entrenched in their institutions, they could end up spending more time on ICU cases. The use of telemedicine—where an intensivist at a remote “command center” oversees the delivery of care—could foster higher-quality and more efficient care, which would subsequently allow HM practitioners to focus on the rest of the census, according to Mary Jo Gorman, MD, MBA, FHM, former SHM president and CEO of St. Louis-based Advanced ICU Care, which provides intensivists to community hospitals using telemedicine.

The study, based on a demonstration project at the University of Massachusetts Memorial Medical Center and two associated community hospitals, reported a 20% drop in ICU mortality at the academic medical center (P=0.01). When adjusted for the severity of ICU illnesses, one community hospital reported a 36% drop in mortality (P=0.83); the other reported a 142% increase (P<0.001). All three centers also reported a reduction in length of stay (LOS) of at least 12 hours.

Dr. Gorman and Adams agree that it will take more evidence-based studies showing the efficacy of telemedicine before the practice becomes widespread, a phenomenon Adams attributes to the "inherent inertia and viscosity in the system to maintain the status quo."

"Everybody might know the right answer," Dr. Gorman adds. "It's still going to take a long time. That’s just the pace at which we move in healthcare."

A new report that outlines the potential care delivery improvements and cost savings of telemedicine might also be a road map to increased efficiency for hospitalists, according to one of the study’s authors and a former SHM president.

Telemedicine "simplifies their life," says Mitchell Adams, AB, MBA, executive director of the Massachusetts Technology Collaborative (MTC) in Boston, which coauthored "Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care" with the New England Healthcare Institute (NEHI) in Cambridge. "It means you have you less complications, you have less work. You have an intensivist looking over your shoulder, making sure you’re doing it right."

As the population ages and hospitalists become more entrenched in their institutions, they could end up spending more time on ICU cases. The use of telemedicine—where an intensivist at a remote “command center” oversees the delivery of care—could foster higher-quality and more efficient care, which would subsequently allow HM practitioners to focus on the rest of the census, according to Mary Jo Gorman, MD, MBA, FHM, former SHM president and CEO of St. Louis-based Advanced ICU Care, which provides intensivists to community hospitals using telemedicine.

The study, based on a demonstration project at the University of Massachusetts Memorial Medical Center and two associated community hospitals, reported a 20% drop in ICU mortality at the academic medical center (P=0.01). When adjusted for the severity of ICU illnesses, one community hospital reported a 36% drop in mortality (P=0.83); the other reported a 142% increase (P<0.001). All three centers also reported a reduction in length of stay (LOS) of at least 12 hours.

Dr. Gorman and Adams agree that it will take more evidence-based studies showing the efficacy of telemedicine before the practice becomes widespread, a phenomenon Adams attributes to the "inherent inertia and viscosity in the system to maintain the status quo."

"Everybody might know the right answer," Dr. Gorman adds. "It's still going to take a long time. That’s just the pace at which we move in healthcare."

A new report that outlines the potential care delivery improvements and cost savings of telemedicine might also be a road map to increased efficiency for hospitalists, according to one of the study’s authors and a former SHM president.

Telemedicine "simplifies their life," says Mitchell Adams, AB, MBA, executive director of the Massachusetts Technology Collaborative (MTC) in Boston, which coauthored "Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care" with the New England Healthcare Institute (NEHI) in Cambridge. "It means you have you less complications, you have less work. You have an intensivist looking over your shoulder, making sure you’re doing it right."

As the population ages and hospitalists become more entrenched in their institutions, they could end up spending more time on ICU cases. The use of telemedicine—where an intensivist at a remote “command center” oversees the delivery of care—could foster higher-quality and more efficient care, which would subsequently allow HM practitioners to focus on the rest of the census, according to Mary Jo Gorman, MD, MBA, FHM, former SHM president and CEO of St. Louis-based Advanced ICU Care, which provides intensivists to community hospitals using telemedicine.

The study, based on a demonstration project at the University of Massachusetts Memorial Medical Center and two associated community hospitals, reported a 20% drop in ICU mortality at the academic medical center (P=0.01). When adjusted for the severity of ICU illnesses, one community hospital reported a 36% drop in mortality (P=0.83); the other reported a 142% increase (P<0.001). All three centers also reported a reduction in length of stay (LOS) of at least 12 hours.

Dr. Gorman and Adams agree that it will take more evidence-based studies showing the efficacy of telemedicine before the practice becomes widespread, a phenomenon Adams attributes to the "inherent inertia and viscosity in the system to maintain the status quo."

"Everybody might know the right answer," Dr. Gorman adds. "It's still going to take a long time. That’s just the pace at which we move in healthcare."

Martin Johns, MD, joined Gifford Medical Center, a 25-bed full access hospital in rural Randolph, Vt., five years ago to launch its HM program. The landmark push toward implementing electronic health records (EHR) now has Dr. Johns and his colleagues scrambling.

Dr. Johns, whose program now has four hospitalists and four physician assistants, recently spoke with The Hospitalist eWire to talk about the technology challenges specifically faced by rural hospitalist programs.

Question: What role did EHR play in your HM group when you began the service?

Answer: Five years ago, I was definitely concerned about that. I came from Geisinger Medical Center (in Danville, Pa.). They had Epic embedded into every aspect of documentation. I was very used to the seamless integration of information in transitions of care. I was somewhat spoiled in that regard, but I also realized a small hospital was going to have different types of systems.

Q: How far has your digital record-keeping in the hospital come to date?

A: We currently have a data repository more than EHR. CPSI is the system we use. One of the difficulties in us making the decision to move to an EHR is a very interesting problem for all small hospitals. Because they require so much augmentation after installation, small hospitals can't afford to have your large Epic system, for example, to put in place. They can't have 10 IT people in house running the service. What ends up happening is that the hospital purchases an EHR based on outpatient clinic interest and said EHR usually doesn't really speak to your inpatient system.

Q: How can a smaller institution transition into a comprehensive system?

A: The biggest barrier is there's just not a really great all-level-of-care product that would take you through that in a small hospital. It's just too difficult and too expensive for someone to create that product, or at least it appears that way. An all-encompassing solution for a small hospital—the market is not just there.

Q: So where does that leave the rural hospitalist?

A: At a smaller place, it sets up all the variables for a communication breakdown. Mrs. Jones comes in for cataract surgery and she gets morphine and she has a reaction. That's on her hospital chart, but doesn't make its way onto her clinic chart. Those are the breakdowns that can happen and that's really challenging. … With this EHR push, if it's not done correctly, the patient can suffer more than they would with paper records.

Martin Johns, MD, joined Gifford Medical Center, a 25-bed full access hospital in rural Randolph, Vt., five years ago to launch its HM program. The landmark push toward implementing electronic health records (EHR) now has Dr. Johns and his colleagues scrambling.

Dr. Johns, whose program now has four hospitalists and four physician assistants, recently spoke with The Hospitalist eWire to talk about the technology challenges specifically faced by rural hospitalist programs.

Question: What role did EHR play in your HM group when you began the service?

Answer: Five years ago, I was definitely concerned about that. I came from Geisinger Medical Center (in Danville, Pa.). They had Epic embedded into every aspect of documentation. I was very used to the seamless integration of information in transitions of care. I was somewhat spoiled in that regard, but I also realized a small hospital was going to have different types of systems.

Q: How far has your digital record-keeping in the hospital come to date?

A: We currently have a data repository more than EHR. CPSI is the system we use. One of the difficulties in us making the decision to move to an EHR is a very interesting problem for all small hospitals. Because they require so much augmentation after installation, small hospitals can't afford to have your large Epic system, for example, to put in place. They can't have 10 IT people in house running the service. What ends up happening is that the hospital purchases an EHR based on outpatient clinic interest and said EHR usually doesn't really speak to your inpatient system.

Q: How can a smaller institution transition into a comprehensive system?

A: The biggest barrier is there's just not a really great all-level-of-care product that would take you through that in a small hospital. It's just too difficult and too expensive for someone to create that product, or at least it appears that way. An all-encompassing solution for a small hospital—the market is not just there.

Q: So where does that leave the rural hospitalist?

A: At a smaller place, it sets up all the variables for a communication breakdown. Mrs. Jones comes in for cataract surgery and she gets morphine and she has a reaction. That's on her hospital chart, but doesn't make its way onto her clinic chart. Those are the breakdowns that can happen and that's really challenging. … With this EHR push, if it's not done correctly, the patient can suffer more than they would with paper records.

Martin Johns, MD, joined Gifford Medical Center, a 25-bed full access hospital in rural Randolph, Vt., five years ago to launch its HM program. The landmark push toward implementing electronic health records (EHR) now has Dr. Johns and his colleagues scrambling.

Dr. Johns, whose program now has four hospitalists and four physician assistants, recently spoke with The Hospitalist eWire to talk about the technology challenges specifically faced by rural hospitalist programs.

Question: What role did EHR play in your HM group when you began the service?

Answer: Five years ago, I was definitely concerned about that. I came from Geisinger Medical Center (in Danville, Pa.). They had Epic embedded into every aspect of documentation. I was very used to the seamless integration of information in transitions of care. I was somewhat spoiled in that regard, but I also realized a small hospital was going to have different types of systems.

Q: How far has your digital record-keeping in the hospital come to date?

A: We currently have a data repository more than EHR. CPSI is the system we use. One of the difficulties in us making the decision to move to an EHR is a very interesting problem for all small hospitals. Because they require so much augmentation after installation, small hospitals can't afford to have your large Epic system, for example, to put in place. They can't have 10 IT people in house running the service. What ends up happening is that the hospital purchases an EHR based on outpatient clinic interest and said EHR usually doesn't really speak to your inpatient system.

Q: How can a smaller institution transition into a comprehensive system?

A: The biggest barrier is there's just not a really great all-level-of-care product that would take you through that in a small hospital. It's just too difficult and too expensive for someone to create that product, or at least it appears that way. An all-encompassing solution for a small hospital—the market is not just there.

Q: So where does that leave the rural hospitalist?

A: At a smaller place, it sets up all the variables for a communication breakdown. Mrs. Jones comes in for cataract surgery and she gets morphine and she has a reaction. That's on her hospital chart, but doesn't make its way onto her clinic chart. Those are the breakdowns that can happen and that's really challenging. … With this EHR push, if it's not done correctly, the patient can suffer more than they would with paper records.

Hospitalists should pay attention to a new study that shows patients with inflammatory bowel disease (IBD) are at increased risk of recurrent VTE, according to a veteran hospitalist who studies the topic. Until research advances to the point it can identify weighted risk, however, it’s difficult to emphasize the results too much, he adds.

Still, Alpesh Amin, MD, MBA, SFHM, FACP, professor and chairman of the Department of Medicine and executive director of the HM program at the University of California at Irvine, says the new research solidifies the idea that HM groups should know whether a patient has IBD when doing a risk assessment.

"Now the question is, 'Which risk factors are most significant?'" Dr. Amin says. "More information needs to come to help define that."

The 14-center cohort study found that the probability of recurrence five years after discontinuation of anticoagulation therapy was higher among patients with IBD than patients without IBD (33.4%; 95% confidence interval [CI]: 21.8–45.0 vs. 21.7%; 95% CI: 18.8–24.6; P=0.01) (Gastroenterology. 2010;139(3):779-787). In addition, after adjustment for potential confounders, IBD also rates as an independent risk factor of recurrence (hazard ratio=2.5; 95% CI: 1.4–4.2; P=0.001).

Dr. Amin would like to see data that delineate the risk differential between hospitalized patients with IBD and hospitalized patients admitted for acute flare-ups of their IBD. For example, an IBD patient admitted with bloody diarrhea is usually steered away from anticoagulants for fear of increased bleeding. In some of those cases, hospitalists may instead use an inferior vena cava (IVC) filter. Those devices recently drew attention after an Archives of Internal Medicine report (PDF) and an FDA advisory questioned their long-term safety implications.

"We don't have strong evidence whether having acute flare-ups makes the risk worse or not," Dr. Amin says. "We need to figure out how to deal with that issue."

Hospitalists should pay attention to a new study that shows patients with inflammatory bowel disease (IBD) are at increased risk of recurrent VTE, according to a veteran hospitalist who studies the topic. Until research advances to the point it can identify weighted risk, however, it’s difficult to emphasize the results too much, he adds.

Still, Alpesh Amin, MD, MBA, SFHM, FACP, professor and chairman of the Department of Medicine and executive director of the HM program at the University of California at Irvine, says the new research solidifies the idea that HM groups should know whether a patient has IBD when doing a risk assessment.

"Now the question is, 'Which risk factors are most significant?'" Dr. Amin says. "More information needs to come to help define that."

The 14-center cohort study found that the probability of recurrence five years after discontinuation of anticoagulation therapy was higher among patients with IBD than patients without IBD (33.4%; 95% confidence interval [CI]: 21.8–45.0 vs. 21.7%; 95% CI: 18.8–24.6; P=0.01) (Gastroenterology. 2010;139(3):779-787). In addition, after adjustment for potential confounders, IBD also rates as an independent risk factor of recurrence (hazard ratio=2.5; 95% CI: 1.4–4.2; P=0.001).

Dr. Amin would like to see data that delineate the risk differential between hospitalized patients with IBD and hospitalized patients admitted for acute flare-ups of their IBD. For example, an IBD patient admitted with bloody diarrhea is usually steered away from anticoagulants for fear of increased bleeding. In some of those cases, hospitalists may instead use an inferior vena cava (IVC) filter. Those devices recently drew attention after an Archives of Internal Medicine report (PDF) and an FDA advisory questioned their long-term safety implications.

"We don't have strong evidence whether having acute flare-ups makes the risk worse or not," Dr. Amin says. "We need to figure out how to deal with that issue."

Hospitalists should pay attention to a new study that shows patients with inflammatory bowel disease (IBD) are at increased risk of recurrent VTE, according to a veteran hospitalist who studies the topic. Until research advances to the point it can identify weighted risk, however, it’s difficult to emphasize the results too much, he adds.

Still, Alpesh Amin, MD, MBA, SFHM, FACP, professor and chairman of the Department of Medicine and executive director of the HM program at the University of California at Irvine, says the new research solidifies the idea that HM groups should know whether a patient has IBD when doing a risk assessment.

"Now the question is, 'Which risk factors are most significant?'" Dr. Amin says. "More information needs to come to help define that."

The 14-center cohort study found that the probability of recurrence five years after discontinuation of anticoagulation therapy was higher among patients with IBD than patients without IBD (33.4%; 95% confidence interval [CI]: 21.8–45.0 vs. 21.7%; 95% CI: 18.8–24.6; P=0.01) (Gastroenterology. 2010;139(3):779-787). In addition, after adjustment for potential confounders, IBD also rates as an independent risk factor of recurrence (hazard ratio=2.5; 95% CI: 1.4–4.2; P=0.001).

Dr. Amin would like to see data that delineate the risk differential between hospitalized patients with IBD and hospitalized patients admitted for acute flare-ups of their IBD. For example, an IBD patient admitted with bloody diarrhea is usually steered away from anticoagulants for fear of increased bleeding. In some of those cases, hospitalists may instead use an inferior vena cava (IVC) filter. Those devices recently drew attention after an Archives of Internal Medicine report (PDF) and an FDA advisory questioned their long-term safety implications.

"We don't have strong evidence whether having acute flare-ups makes the risk worse or not," Dr. Amin says. "We need to figure out how to deal with that issue."

The Joint Commission's annual report on quality initiatives in American hospitals could be more valuable to hospitalist groups if they look at where rankings show room for improvement, one hospitalist says.

Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital, says substantial gains in core-measure categories are great in aggregate but do little to spur QI in individual hospitals.

"As a group, we're doing pretty well with these core measures," Dr. Vasilevskis says. "But at an institution, it's critical you understand your individual numbers."

"Improving America’s Hospitals” (PDF), released in September, reported composite 2009 care results of 97.7% for heart attacks and 92.9% for pneumonia. Both were the highest measures since the report began tabulating the data in 2002.

Dr. Vasilevskis sees the news as a great sign for patient care but thinks the value of QI is to apply the techniques that have boosted those measures to other issues, such as interdisciplinary and transitional care. Those areas are more difficult to quantify and study, but that makes them ripe for HM group leaders to tackle, he says.

“This is going to take leadership; we need a quarterback on the team,” he adds. “Hospitalists can step up and be that quarterback.”

Dr. Vasilevskis also advocates for stiffer compliance requirements. For example, he says, while the current report lists a 99.4% compliance rate for physicians giving smoking cessation advice, the report includes no data or follow-up to show how that advice pans out. He notes that approach would be costly and time-consuming but could reap a valuable return on the investment.

"The first step is data," he says. "Then it's going to take leadership."

The Joint Commission's annual report on quality initiatives in American hospitals could be more valuable to hospitalist groups if they look at where rankings show room for improvement, one hospitalist says.

Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital, says substantial gains in core-measure categories are great in aggregate but do little to spur QI in individual hospitals.

"As a group, we're doing pretty well with these core measures," Dr. Vasilevskis says. "But at an institution, it's critical you understand your individual numbers."

"Improving America’s Hospitals” (PDF), released in September, reported composite 2009 care results of 97.7% for heart attacks and 92.9% for pneumonia. Both were the highest measures since the report began tabulating the data in 2002.

Dr. Vasilevskis sees the news as a great sign for patient care but thinks the value of QI is to apply the techniques that have boosted those measures to other issues, such as interdisciplinary and transitional care. Those areas are more difficult to quantify and study, but that makes them ripe for HM group leaders to tackle, he says.

“This is going to take leadership; we need a quarterback on the team,” he adds. “Hospitalists can step up and be that quarterback.”

Dr. Vasilevskis also advocates for stiffer compliance requirements. For example, he says, while the current report lists a 99.4% compliance rate for physicians giving smoking cessation advice, the report includes no data or follow-up to show how that advice pans out. He notes that approach would be costly and time-consuming but could reap a valuable return on the investment.

"The first step is data," he says. "Then it's going to take leadership."

The Joint Commission's annual report on quality initiatives in American hospitals could be more valuable to hospitalist groups if they look at where rankings show room for improvement, one hospitalist says.

Eduard Vasilevskis, MD, assistant professor of medicine in the Section of Hospital Medicine at Vanderbilt University and the Tennessee Valley-Nashville VA Hospital, says substantial gains in core-measure categories are great in aggregate but do little to spur QI in individual hospitals.

"As a group, we're doing pretty well with these core measures," Dr. Vasilevskis says. "But at an institution, it's critical you understand your individual numbers."

"Improving America’s Hospitals” (PDF), released in September, reported composite 2009 care results of 97.7% for heart attacks and 92.9% for pneumonia. Both were the highest measures since the report began tabulating the data in 2002.

Dr. Vasilevskis sees the news as a great sign for patient care but thinks the value of QI is to apply the techniques that have boosted those measures to other issues, such as interdisciplinary and transitional care. Those areas are more difficult to quantify and study, but that makes them ripe for HM group leaders to tackle, he says.

“This is going to take leadership; we need a quarterback on the team,” he adds. “Hospitalists can step up and be that quarterback.”

Dr. Vasilevskis also advocates for stiffer compliance requirements. For example, he says, while the current report lists a 99.4% compliance rate for physicians giving smoking cessation advice, the report includes no data or follow-up to show how that advice pans out. He notes that approach would be costly and time-consuming but could reap a valuable return on the investment.

"The first step is data," he says. "Then it's going to take leadership."

The FDA's approval of a new oral anticoagulant—the first in 56 years—has sparked conversation in internal-medicine circles, prompting the industry to wonder: Will the new drug unseat warfarin as the go-to therapy?

Warfarin is among the most common prescriptions written by hospitalists, but that is in part due to its status as the lone option for the prevention of strokes and embolisms in atrial fibrillation (AF) patients. But on Oct. 19, the FDA approved dabigatran etexilate (Pradaxa) for AF patients. Several other similar medications are under development.

An FDA announcement on the approval notes that in a trial of 18,000 patients, those taking dabigatran etexilate had fewer strokes than those who took warfarin. The study (N Engl J Med. 361;12:1139-1151) reported primary outcome rates were 1.69% per year in the warfarin group, compared with 1.53% per year in the group that received 110mg of dabigatran (P<0.001).

Marketers for the new drug have suggested that while physicians often are slow to accept new therapies, the elimination of blood monitoring that often increases length of stay could nudge hospitalists to adopt the treatment more quickly.

Kurt Pfeifer, MD, FACP, program director of the Internal Medicine Residency program at Medical College in Milwaukee and a bleeding-risk research follower, is not so sure. He says that until there is clinical evidence, it will be difficult to tout any potential long-term benefits of the new therapy.

"It's not time to have a funeral for warfarin," Dr. Pfeifer says.

He adds that dabigatran's initial trials have not showed him such a compelling efficacy that he would consider removing current warfarin patients from their therapy. He also says that the cost of the new medication—at least double that of warfarin, with no generics available—will be a stumbling block and could prevent it from hospital formularies.

"Even with all these alternative anticoagulants out there, there is still no doubt that warfarin will be a mainstay therapy," Dr. Pfeifer says. "There is a reason these drugs are around a long time. …They are effective and they are cheap."

The FDA's approval of a new oral anticoagulant—the first in 56 years—has sparked conversation in internal-medicine circles, prompting the industry to wonder: Will the new drug unseat warfarin as the go-to therapy?

Warfarin is among the most common prescriptions written by hospitalists, but that is in part due to its status as the lone option for the prevention of strokes and embolisms in atrial fibrillation (AF) patients. But on Oct. 19, the FDA approved dabigatran etexilate (Pradaxa) for AF patients. Several other similar medications are under development.

An FDA announcement on the approval notes that in a trial of 18,000 patients, those taking dabigatran etexilate had fewer strokes than those who took warfarin. The study (N Engl J Med. 361;12:1139-1151) reported primary outcome rates were 1.69% per year in the warfarin group, compared with 1.53% per year in the group that received 110mg of dabigatran (P<0.001).

Marketers for the new drug have suggested that while physicians often are slow to accept new therapies, the elimination of blood monitoring that often increases length of stay could nudge hospitalists to adopt the treatment more quickly.

Kurt Pfeifer, MD, FACP, program director of the Internal Medicine Residency program at Medical College in Milwaukee and a bleeding-risk research follower, is not so sure. He says that until there is clinical evidence, it will be difficult to tout any potential long-term benefits of the new therapy.

"It's not time to have a funeral for warfarin," Dr. Pfeifer says.

He adds that dabigatran's initial trials have not showed him such a compelling efficacy that he would consider removing current warfarin patients from their therapy. He also says that the cost of the new medication—at least double that of warfarin, with no generics available—will be a stumbling block and could prevent it from hospital formularies.

"Even with all these alternative anticoagulants out there, there is still no doubt that warfarin will be a mainstay therapy," Dr. Pfeifer says. "There is a reason these drugs are around a long time. …They are effective and they are cheap."

The FDA's approval of a new oral anticoagulant—the first in 56 years—has sparked conversation in internal-medicine circles, prompting the industry to wonder: Will the new drug unseat warfarin as the go-to therapy?

Warfarin is among the most common prescriptions written by hospitalists, but that is in part due to its status as the lone option for the prevention of strokes and embolisms in atrial fibrillation (AF) patients. But on Oct. 19, the FDA approved dabigatran etexilate (Pradaxa) for AF patients. Several other similar medications are under development.

An FDA announcement on the approval notes that in a trial of 18,000 patients, those taking dabigatran etexilate had fewer strokes than those who took warfarin. The study (N Engl J Med. 361;12:1139-1151) reported primary outcome rates were 1.69% per year in the warfarin group, compared with 1.53% per year in the group that received 110mg of dabigatran (P<0.001).

Marketers for the new drug have suggested that while physicians often are slow to accept new therapies, the elimination of blood monitoring that often increases length of stay could nudge hospitalists to adopt the treatment more quickly.

Kurt Pfeifer, MD, FACP, program director of the Internal Medicine Residency program at Medical College in Milwaukee and a bleeding-risk research follower, is not so sure. He says that until there is clinical evidence, it will be difficult to tout any potential long-term benefits of the new therapy.

"It's not time to have a funeral for warfarin," Dr. Pfeifer says.

He adds that dabigatran's initial trials have not showed him such a compelling efficacy that he would consider removing current warfarin patients from their therapy. He also says that the cost of the new medication—at least double that of warfarin, with no generics available—will be a stumbling block and could prevent it from hospital formularies.

"Even with all these alternative anticoagulants out there, there is still no doubt that warfarin will be a mainstay therapy," Dr. Pfeifer says. "There is a reason these drugs are around a long time. …They are effective and they are cheap."

Hospitalists who encounter the occasional late-stage colorectal cancer patient might be perplexed as to why the patient refuses to remove food from their in-room refrigerator and often are wearing mittens. But it would be immediately clear to them once they knew that the patient was on oxaliplatin—a less-than-decade-old medication delivered via the chemotherapy regimen known as FOLFOX—and that a common side effect is neuropathy resulting in extreme sensitivity to cold.

Why wouldn’t hospitalists know this? Because, according to a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, oncologists traditionally have tried to holistically manage the care of cancer patients. In today’s age of new treatments and increased inpatient care for patients with aggressive cancers, though, Jason Konner, MD, says it’s time for hospitalists to take a greater role in the management of cancer patients.

The upshot: Dr. Konner envisions a new breed of oncologist-hospitalists. (Check out this in-depth look at specialty physicians adopting the HM model of care.)

“Universally, the hospitalist is going to have to be part of a team with the oncologist,” says Dr. Konner, assistant professor with the Gynecological Medical Oncology Service and Developmental Therapeutic Services. “We’re going to complement each other. There are definitely things that we can do that they can’t and definitely things they can do that we can’t. Right now, it’s just being part of the team to address the diverse medical complications of cancer. But I think that increasingly, [hospitalists] are going to be the primary caregivers, sometimes solely the caregivers, of patients with cancer complications.”

The concept, which was raised during an “Oncology for the Hospitalist” presentation at the fifth annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York City, is not new, but it is particularly relevant as cancer mortality and incidence rates continue to drop. Dr. Konner counters that while improved screening techniques—mammographies and prostate-specific antigen (PSA) tests, to note a pair—have reduced incidences, the majority of “aggressive cancers and cancers that kill people” still require intensive inpatient care.

To wit, a pilot program at Mount Sinai several years ago dedicated a hospitalist to the oncology service in the hopes of developing a staffer with a new expertise. The brief program, which yielded little data because of its small sample size, was aimed at determining the efficacy of an oncology hospitalist.

Richard Quinn is a freelance writer based in New Jersey.

Hospitalists who encounter the occasional late-stage colorectal cancer patient might be perplexed as to why the patient refuses to remove food from their in-room refrigerator and often are wearing mittens. But it would be immediately clear to them once they knew that the patient was on oxaliplatin—a less-than-decade-old medication delivered via the chemotherapy regimen known as FOLFOX—and that a common side effect is neuropathy resulting in extreme sensitivity to cold.

Why wouldn’t hospitalists know this? Because, according to a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, oncologists traditionally have tried to holistically manage the care of cancer patients. In today’s age of new treatments and increased inpatient care for patients with aggressive cancers, though, Jason Konner, MD, says it’s time for hospitalists to take a greater role in the management of cancer patients.

The upshot: Dr. Konner envisions a new breed of oncologist-hospitalists. (Check out this in-depth look at specialty physicians adopting the HM model of care.)

“Universally, the hospitalist is going to have to be part of a team with the oncologist,” says Dr. Konner, assistant professor with the Gynecological Medical Oncology Service and Developmental Therapeutic Services. “We’re going to complement each other. There are definitely things that we can do that they can’t and definitely things they can do that we can’t. Right now, it’s just being part of the team to address the diverse medical complications of cancer. But I think that increasingly, [hospitalists] are going to be the primary caregivers, sometimes solely the caregivers, of patients with cancer complications.”

The concept, which was raised during an “Oncology for the Hospitalist” presentation at the fifth annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York City, is not new, but it is particularly relevant as cancer mortality and incidence rates continue to drop. Dr. Konner counters that while improved screening techniques—mammographies and prostate-specific antigen (PSA) tests, to note a pair—have reduced incidences, the majority of “aggressive cancers and cancers that kill people” still require intensive inpatient care.

To wit, a pilot program at Mount Sinai several years ago dedicated a hospitalist to the oncology service in the hopes of developing a staffer with a new expertise. The brief program, which yielded little data because of its small sample size, was aimed at determining the efficacy of an oncology hospitalist.

Richard Quinn is a freelance writer based in New Jersey.

Hospitalists who encounter the occasional late-stage colorectal cancer patient might be perplexed as to why the patient refuses to remove food from their in-room refrigerator and often are wearing mittens. But it would be immediately clear to them once they knew that the patient was on oxaliplatin—a less-than-decade-old medication delivered via the chemotherapy regimen known as FOLFOX—and that a common side effect is neuropathy resulting in extreme sensitivity to cold.

Why wouldn’t hospitalists know this? Because, according to a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, oncologists traditionally have tried to holistically manage the care of cancer patients. In today’s age of new treatments and increased inpatient care for patients with aggressive cancers, though, Jason Konner, MD, says it’s time for hospitalists to take a greater role in the management of cancer patients.

The upshot: Dr. Konner envisions a new breed of oncologist-hospitalists. (Check out this in-depth look at specialty physicians adopting the HM model of care.)

“Universally, the hospitalist is going to have to be part of a team with the oncologist,” says Dr. Konner, assistant professor with the Gynecological Medical Oncology Service and Developmental Therapeutic Services. “We’re going to complement each other. There are definitely things that we can do that they can’t and definitely things they can do that we can’t. Right now, it’s just being part of the team to address the diverse medical complications of cancer. But I think that increasingly, [hospitalists] are going to be the primary caregivers, sometimes solely the caregivers, of patients with cancer complications.”

The concept, which was raised during an “Oncology for the Hospitalist” presentation at the fifth annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York City, is not new, but it is particularly relevant as cancer mortality and incidence rates continue to drop. Dr. Konner counters that while improved screening techniques—mammographies and prostate-specific antigen (PSA) tests, to note a pair—have reduced incidences, the majority of “aggressive cancers and cancers that kill people” still require intensive inpatient care.

To wit, a pilot program at Mount Sinai several years ago dedicated a hospitalist to the oncology service in the hopes of developing a staffer with a new expertise. The brief program, which yielded little data because of its small sample size, was aimed at determining the efficacy of an oncology hospitalist.

Richard Quinn is a freelance writer based in New Jersey.

Hospitalist Jeffrey Schnipper, MD, MPH, FHM, estimated last year that a full third of his current patient census was either diabetic or hypoglycemic, a figure that might seem out of place for someone who isn’t a diabetologist.

Last week, Dr. Schnipper's estimation made perfect sense with the release of a new report from the Centers for Disease Control and Prevention (CDC) that forecasts a near-doubling of diabetic incidences in the next 40 years.

"I won't be surprised when there's a day where half of my patients have diabetes or hypoglycemia," says Dr. Schnipper, director of clinical research and associate physician in the general medicine division at Brigham and Women's Hospitalist Service in Boston. "We all have to become experts in how to comanage these patients."

The CDC data, published in Population Health Metrics on Oct. 22, state that "annual diagnosed diabetes incidence [new cases] will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050" (doi: 10.1186/1478-7954-8-29). The authors note that intervention can reduce that prevalence, but won't eliminate it.

Dr. Schnipper says the exponential growth of diabetes incidence will not directly correlate to growth in patient counts, as many diabetics will be able to control their disease without admission to the hospital. However, he says, a large percentage of new cases are likely to end up as hospitalized patients heaped on HM groups' already full plates.

He suggests one response to the looming surge in diabetics might be to administer an A1c test to nearly all of your admitted patients to determine blood-glucose levels, or develop new protocols for how, who, and when to screen for diabetes.

One obvious patient group to be concerned about is the obese population, which Dr. Schnipper says is a direct cause of the diabetic incidence increase. "What we're seeing is an epidemic of obesity causing an epidemic of diabetes," he adds. "We already need to know how to manage these patients."

Hospitalist Jeffrey Schnipper, MD, MPH, FHM, estimated last year that a full third of his current patient census was either diabetic or hypoglycemic, a figure that might seem out of place for someone who isn’t a diabetologist.

Last week, Dr. Schnipper's estimation made perfect sense with the release of a new report from the Centers for Disease Control and Prevention (CDC) that forecasts a near-doubling of diabetic incidences in the next 40 years.

"I won't be surprised when there's a day where half of my patients have diabetes or hypoglycemia," says Dr. Schnipper, director of clinical research and associate physician in the general medicine division at Brigham and Women's Hospitalist Service in Boston. "We all have to become experts in how to comanage these patients."

The CDC data, published in Population Health Metrics on Oct. 22, state that "annual diagnosed diabetes incidence [new cases] will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050" (doi: 10.1186/1478-7954-8-29). The authors note that intervention can reduce that prevalence, but won't eliminate it.

Dr. Schnipper says the exponential growth of diabetes incidence will not directly correlate to growth in patient counts, as many diabetics will be able to control their disease without admission to the hospital. However, he says, a large percentage of new cases are likely to end up as hospitalized patients heaped on HM groups' already full plates.

He suggests one response to the looming surge in diabetics might be to administer an A1c test to nearly all of your admitted patients to determine blood-glucose levels, or develop new protocols for how, who, and when to screen for diabetes.

One obvious patient group to be concerned about is the obese population, which Dr. Schnipper says is a direct cause of the diabetic incidence increase. "What we're seeing is an epidemic of obesity causing an epidemic of diabetes," he adds. "We already need to know how to manage these patients."

Hospitalist Jeffrey Schnipper, MD, MPH, FHM, estimated last year that a full third of his current patient census was either diabetic or hypoglycemic, a figure that might seem out of place for someone who isn’t a diabetologist.

Last week, Dr. Schnipper's estimation made perfect sense with the release of a new report from the Centers for Disease Control and Prevention (CDC) that forecasts a near-doubling of diabetic incidences in the next 40 years.

"I won't be surprised when there's a day where half of my patients have diabetes or hypoglycemia," says Dr. Schnipper, director of clinical research and associate physician in the general medicine division at Brigham and Women's Hospitalist Service in Boston. "We all have to become experts in how to comanage these patients."

The CDC data, published in Population Health Metrics on Oct. 22, state that "annual diagnosed diabetes incidence [new cases] will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050" (doi: 10.1186/1478-7954-8-29). The authors note that intervention can reduce that prevalence, but won't eliminate it.

Dr. Schnipper says the exponential growth of diabetes incidence will not directly correlate to growth in patient counts, as many diabetics will be able to control their disease without admission to the hospital. However, he says, a large percentage of new cases are likely to end up as hospitalized patients heaped on HM groups' already full plates.

He suggests one response to the looming surge in diabetics might be to administer an A1c test to nearly all of your admitted patients to determine blood-glucose levels, or develop new protocols for how, who, and when to screen for diabetes.

One obvious patient group to be concerned about is the obese population, which Dr. Schnipper says is a direct cause of the diabetic incidence increase. "What we're seeing is an epidemic of obesity causing an epidemic of diabetes," he adds. "We already need to know how to manage these patients."

The phenomenon of physician presenteeism, doctors coming to work even if they themselves are sick, is an opportunity for residency directors to pull back on how they schedule physicians in training, one program head says.

A study last month found that 57.9% of residents reported working while sick at least once and 31.3% had done so in the previous year (JAMA 2010;304(11);1166-1168). In one outlier hospital, every resident surveyed reported working when sick.

"Hospitals have to learn not to schedule their people to the max," says Ethan Fried, MD, MS, FACP, assistant professor of clinical medicine at Columbia University, vice chair for education in the department of medicine and director of Graduate Medical Education at St. Luke's-Roosevelt in New York City. "Just because you can go 80 hours a week and take care of 10 patients doesn't mean you should go 80 hours a week and take care of 10 patients."

Dr. Fried, president of the Association of Program Directors in Internal Medicine (APDIM), says creating schedules with little or no flexibility can hamper a program's ability to handle inevitable sick calls. Larger programs might have "sick-call pools," which are used to cover staffing shortfalls, but smaller programs might not have that luxury, he adds.

Jack Percelay, MD, MPH, SFHM, FAAP, pediatric hospitalist with ELMO Pediatrics in New York City, says the culture of residencies is to "suck it up," and some physicians carry that attitude into private practice.

"The decision of whether or not to work sick is really related to the institutions' culture," Dr. Percelay, an SHM board member, writes in an e-mail interview. "If we are to discourage physicians from working when sick, some sort of sick leave benefit or backup system needs to be in place. ... It's a real Pandora's box. I don't want my colleagues to stay home with a runny nose, nor do I want them to come in and get IV fluids in the back room."

Dr. Fried notes that the issue is further complicated by rules on how much training time residents need to be considered competent. He says the American Board of Internal Medicine (ABIM) recently gave program directors discretion in "granting credit for up to one month of missed time in a three-year period."

Still, presenteeism may be less of a problem with the current generation of residents than in the past because of culture changes tied to duty-hour rules. "We make such a big deal about working while fatigued, and that's now considered completely inappropriate," Dr. Fried says. "The trainees ... are much more willing to admit when they under the weather."

The phenomenon of physician presenteeism, doctors coming to work even if they themselves are sick, is an opportunity for residency directors to pull back on how they schedule physicians in training, one program head says.

A study last month found that 57.9% of residents reported working while sick at least once and 31.3% had done so in the previous year (JAMA 2010;304(11);1166-1168). In one outlier hospital, every resident surveyed reported working when sick.

"Hospitals have to learn not to schedule their people to the max," says Ethan Fried, MD, MS, FACP, assistant professor of clinical medicine at Columbia University, vice chair for education in the department of medicine and director of Graduate Medical Education at St. Luke's-Roosevelt in New York City. "Just because you can go 80 hours a week and take care of 10 patients doesn't mean you should go 80 hours a week and take care of 10 patients."

Dr. Fried, president of the Association of Program Directors in Internal Medicine (APDIM), says creating schedules with little or no flexibility can hamper a program's ability to handle inevitable sick calls. Larger programs might have "sick-call pools," which are used to cover staffing shortfalls, but smaller programs might not have that luxury, he adds.

Jack Percelay, MD, MPH, SFHM, FAAP, pediatric hospitalist with ELMO Pediatrics in New York City, says the culture of residencies is to "suck it up," and some physicians carry that attitude into private practice.

"The decision of whether or not to work sick is really related to the institutions' culture," Dr. Percelay, an SHM board member, writes in an e-mail interview. "If we are to discourage physicians from working when sick, some sort of sick leave benefit or backup system needs to be in place. ... It's a real Pandora's box. I don't want my colleagues to stay home with a runny nose, nor do I want them to come in and get IV fluids in the back room."

Dr. Fried notes that the issue is further complicated by rules on how much training time residents need to be considered competent. He says the American Board of Internal Medicine (ABIM) recently gave program directors discretion in "granting credit for up to one month of missed time in a three-year period."

Still, presenteeism may be less of a problem with the current generation of residents than in the past because of culture changes tied to duty-hour rules. "We make such a big deal about working while fatigued, and that's now considered completely inappropriate," Dr. Fried says. "The trainees ... are much more willing to admit when they under the weather."

The phenomenon of physician presenteeism, doctors coming to work even if they themselves are sick, is an opportunity for residency directors to pull back on how they schedule physicians in training, one program head says.

A study last month found that 57.9% of residents reported working while sick at least once and 31.3% had done so in the previous year (JAMA 2010;304(11);1166-1168). In one outlier hospital, every resident surveyed reported working when sick.

"Hospitals have to learn not to schedule their people to the max," says Ethan Fried, MD, MS, FACP, assistant professor of clinical medicine at Columbia University, vice chair for education in the department of medicine and director of Graduate Medical Education at St. Luke's-Roosevelt in New York City. "Just because you can go 80 hours a week and take care of 10 patients doesn't mean you should go 80 hours a week and take care of 10 patients."

Dr. Fried, president of the Association of Program Directors in Internal Medicine (APDIM), says creating schedules with little or no flexibility can hamper a program's ability to handle inevitable sick calls. Larger programs might have "sick-call pools," which are used to cover staffing shortfalls, but smaller programs might not have that luxury, he adds.

Jack Percelay, MD, MPH, SFHM, FAAP, pediatric hospitalist with ELMO Pediatrics in New York City, says the culture of residencies is to "suck it up," and some physicians carry that attitude into private practice.

"The decision of whether or not to work sick is really related to the institutions' culture," Dr. Percelay, an SHM board member, writes in an e-mail interview. "If we are to discourage physicians from working when sick, some sort of sick leave benefit or backup system needs to be in place. ... It's a real Pandora's box. I don't want my colleagues to stay home with a runny nose, nor do I want them to come in and get IV fluids in the back room."

Dr. Fried notes that the issue is further complicated by rules on how much training time residents need to be considered competent. He says the American Board of Internal Medicine (ABIM) recently gave program directors discretion in "granting credit for up to one month of missed time in a three-year period."

Still, presenteeism may be less of a problem with the current generation of residents than in the past because of culture changes tied to duty-hour rules. "We make such a big deal about working while fatigued, and that's now considered completely inappropriate," Dr. Fried says. "The trainees ... are much more willing to admit when they under the weather."

Advances in treatment and ever-growing life expectancies for patients diagnosed with human immunodeficiency virus (HIV) are likely to push more HIV-positive patients into the censuses of HM groups, according to a specialist at Mount Sinai School of Medicine in New York City.

“Hospitalists … are going to be doing more and more of the HIV care because we have a growing population of aging patients who are in care or identify as being HIV-positive, and they’re not coming in with exotic or unusual opportunistic infections,” says Rich MacKay, MD, director of the inpatient HIV service at Mount Sinai Medial Center in New York. “They are coming in with the things that other 50-, 60-, 70-year-olds are coming in with, though they may have more of those.”

Dr. MacKay, who is an assistant professor and splits his time between admitted patients and an outpatient clinic, spoke to more than 100 attendees at the fifth annual Mid-Atlantic Hospital Medicine Symposium last weekend in New York. He says hospitalists who familiarize themselves with HIV indicators could press for earlier identification of HIV in patients.

“If you screen people and you’re testing them on the day of their hospitalization, I think that’s huge,” Dr. MacKay says. “Finding somebody who is early in the disease and linking them in to care, so that they don’t fall off the cliff, so that they don’t come in five years later with PCP [pneumocystis pneumonia] and die from it—I think that’s a huge part for the hospitalist.”

Dr. MacKay further notes that just being aware of HIV symptoms can provide the cognizance necessary to consider alternative diagnoses. That can be particularly relevant for cases in which standard treatments might be effective for a few days (e.g. a steroid regimen) but not actually resolve the underlying problem, he adds.

“Maybe [a patient] is coming in with what looks like an exacerbation of COPD, but they’ve only got 50 T-cells and in fact what you’re seeing is PCP,” he says. “It’s not always clear.”

Advances in treatment and ever-growing life expectancies for patients diagnosed with human immunodeficiency virus (HIV) are likely to push more HIV-positive patients into the censuses of HM groups, according to a specialist at Mount Sinai School of Medicine in New York City.

“Hospitalists … are going to be doing more and more of the HIV care because we have a growing population of aging patients who are in care or identify as being HIV-positive, and they’re not coming in with exotic or unusual opportunistic infections,” says Rich MacKay, MD, director of the inpatient HIV service at Mount Sinai Medial Center in New York. “They are coming in with the things that other 50-, 60-, 70-year-olds are coming in with, though they may have more of those.”

Dr. MacKay, who is an assistant professor and splits his time between admitted patients and an outpatient clinic, spoke to more than 100 attendees at the fifth annual Mid-Atlantic Hospital Medicine Symposium last weekend in New York. He says hospitalists who familiarize themselves with HIV indicators could press for earlier identification of HIV in patients.

“If you screen people and you’re testing them on the day of their hospitalization, I think that’s huge,” Dr. MacKay says. “Finding somebody who is early in the disease and linking them in to care, so that they don’t fall off the cliff, so that they don’t come in five years later with PCP [pneumocystis pneumonia] and die from it—I think that’s a huge part for the hospitalist.”

Dr. MacKay further notes that just being aware of HIV symptoms can provide the cognizance necessary to consider alternative diagnoses. That can be particularly relevant for cases in which standard treatments might be effective for a few days (e.g. a steroid regimen) but not actually resolve the underlying problem, he adds.

“Maybe [a patient] is coming in with what looks like an exacerbation of COPD, but they’ve only got 50 T-cells and in fact what you’re seeing is PCP,” he says. “It’s not always clear.”

Advances in treatment and ever-growing life expectancies for patients diagnosed with human immunodeficiency virus (HIV) are likely to push more HIV-positive patients into the censuses of HM groups, according to a specialist at Mount Sinai School of Medicine in New York City.

“Hospitalists … are going to be doing more and more of the HIV care because we have a growing population of aging patients who are in care or identify as being HIV-positive, and they’re not coming in with exotic or unusual opportunistic infections,” says Rich MacKay, MD, director of the inpatient HIV service at Mount Sinai Medial Center in New York. “They are coming in with the things that other 50-, 60-, 70-year-olds are coming in with, though they may have more of those.”

Dr. MacKay, who is an assistant professor and splits his time between admitted patients and an outpatient clinic, spoke to more than 100 attendees at the fifth annual Mid-Atlantic Hospital Medicine Symposium last weekend in New York. He says hospitalists who familiarize themselves with HIV indicators could press for earlier identification of HIV in patients.

“If you screen people and you’re testing them on the day of their hospitalization, I think that’s huge,” Dr. MacKay says. “Finding somebody who is early in the disease and linking them in to care, so that they don’t fall off the cliff, so that they don’t come in five years later with PCP [pneumocystis pneumonia] and die from it—I think that’s a huge part for the hospitalist.”

Dr. MacKay further notes that just being aware of HIV symptoms can provide the cognizance necessary to consider alternative diagnoses. That can be particularly relevant for cases in which standard treatments might be effective for a few days (e.g. a steroid regimen) but not actually resolve the underlying problem, he adds.

“Maybe [a patient] is coming in with what looks like an exacerbation of COPD, but they’ve only got 50 T-cells and in fact what you’re seeing is PCP,” he says. “It’s not always clear.”

A new study that found tighter glycemic control in ICU patients who received continuous insulin infusion (CII) via computer-guided algorithms versus paper-based protocols might not be enough to ditch paper forms just yet, one of the report's authors says.

While the review in this month's multicenter, randomized trial also reported no differences between groups in length of stay (P=0.704), ICU stay (P=0.145), or in-hospital mortality (P=0.561).

"It leaves it up to the individual physician to decide," Dr. Newton says. "'Is what we're doing working good enough to do what we need to do? Or do we need to make a change?'"

Nationwide, glycemic control is a quality initiative frequently tackled by HM groups. To wit, SHM this year enrolled the first sites into its Glycemic Control Mentored Implementation program. The pilot program addresses subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

And while those institutions and hospitalists focusing on glycemic control will be keen to see the data comparing computer-based and standard column-based algorithms, Dr. Newton says, it will require continued research to determine how each protocol performs in patient safety measures before hospitalists change their habits.

"Honestly, I don't know if [the current research] is [enough]," Dr. Newton says. "If their approach is working … then it's probably not worth making a large investment to cause an upheaval of their whole system at this time."

A new study that found tighter glycemic control in ICU patients who received continuous insulin infusion (CII) via computer-guided algorithms versus paper-based protocols might not be enough to ditch paper forms just yet, one of the report's authors says.

While the review in this month's multicenter, randomized trial also reported no differences between groups in length of stay (P=0.704), ICU stay (P=0.145), or in-hospital mortality (P=0.561).

"It leaves it up to the individual physician to decide," Dr. Newton says. "'Is what we're doing working good enough to do what we need to do? Or do we need to make a change?'"

Nationwide, glycemic control is a quality initiative frequently tackled by HM groups. To wit, SHM this year enrolled the first sites into its Glycemic Control Mentored Implementation program. The pilot program addresses subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

And while those institutions and hospitalists focusing on glycemic control will be keen to see the data comparing computer-based and standard column-based algorithms, Dr. Newton says, it will require continued research to determine how each protocol performs in patient safety measures before hospitalists change their habits.

"Honestly, I don't know if [the current research] is [enough]," Dr. Newton says. "If their approach is working … then it's probably not worth making a large investment to cause an upheaval of their whole system at this time."

A new study that found tighter glycemic control in ICU patients who received continuous insulin infusion (CII) via computer-guided algorithms versus paper-based protocols might not be enough to ditch paper forms just yet, one of the report's authors says.

While the review in this month's multicenter, randomized trial also reported no differences between groups in length of stay (P=0.704), ICU stay (P=0.145), or in-hospital mortality (P=0.561).

"It leaves it up to the individual physician to decide," Dr. Newton says. "'Is what we're doing working good enough to do what we need to do? Or do we need to make a change?'"

Nationwide, glycemic control is a quality initiative frequently tackled by HM groups. To wit, SHM this year enrolled the first sites into its Glycemic Control Mentored Implementation program. The pilot program addresses subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

And while those institutions and hospitalists focusing on glycemic control will be keen to see the data comparing computer-based and standard column-based algorithms, Dr. Newton says, it will require continued research to determine how each protocol performs in patient safety measures before hospitalists change their habits.

"Honestly, I don't know if [the current research] is [enough]," Dr. Newton says. "If their approach is working … then it's probably not worth making a large investment to cause an upheaval of their whole system at this time."