More than a thousand hospitalists have earned the right to affix “FHM” or “SFHM” alongside their other credentials. Now, you can learn from them about how to apply for Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designations in a first of its kind webinar hosted by SHM (Sept. 24, 1 pm EST). Speakers will include current FHM and Master in Hospital Medicine (MHM) designees. They will talk about the process and how the designation has impacted their careers as hospitalizes.

SHM Fellows Webinar

Sept. 24

1 p.m. (EST)

www.hospitalmedicine.org/fellows

More than a thousand hospitalists have earned the right to affix “FHM” or “SFHM” alongside their other credentials. Now, you can learn from them about how to apply for Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designations in a first of its kind webinar hosted by SHM (Sept. 24, 1 pm EST). Speakers will include current FHM and Master in Hospital Medicine (MHM) designees. They will talk about the process and how the designation has impacted their careers as hospitalizes.

SHM Fellows Webinar

Sept. 24

1 p.m. (EST)

www.hospitalmedicine.org/fellows

More than a thousand hospitalists have earned the right to affix “FHM” or “SFHM” alongside their other credentials. Now, you can learn from them about how to apply for Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designations in a first of its kind webinar hosted by SHM (Sept. 24, 1 pm EST). Speakers will include current FHM and Master in Hospital Medicine (MHM) designees. They will talk about the process and how the designation has impacted their careers as hospitalizes.

SHM Fellows Webinar

Sept. 24

1 p.m. (EST)

www.hospitalmedicine.org/fellows

Academic hospitalists: Now is the time to set your sights on new career goals in 2015. The Academic Hospitalist Academy helps academic hospitalists map out a career in teaching and scholarship while at the same time learning directly from the best academic hospitalists in the field.

Spaces for Academic Hospitalist Academy are limited, and it’s only a month away. Register today.

Academic Hospitalist Academy

October 20-23

Englewood, Colorado

www.academichospitalist.org/

Academic hospitalists: Now is the time to set your sights on new career goals in 2015. The Academic Hospitalist Academy helps academic hospitalists map out a career in teaching and scholarship while at the same time learning directly from the best academic hospitalists in the field.

Spaces for Academic Hospitalist Academy are limited, and it’s only a month away. Register today.

Academic Hospitalist Academy

October 20-23

Englewood, Colorado

www.academichospitalist.org/

Academic hospitalists: Now is the time to set your sights on new career goals in 2015. The Academic Hospitalist Academy helps academic hospitalists map out a career in teaching and scholarship while at the same time learning directly from the best academic hospitalists in the field.

Spaces for Academic Hospitalist Academy are limited, and it’s only a month away. Register today.

Academic Hospitalist Academy

October 20-23

Englewood, Colorado

www.academichospitalist.org/

Medical school and residency are the first steps toward being a first-rate hospitalist, but will they prepare you for the demands of managing a new project in the hospital? Or taking a leadership position within a hospital medicine group? How about making the financial case for changes you’d like to see in your hospital?

SHM established its popular Leadership Academy to help hospitalists take the next steps into leadership positions. The three courses of Leadership Academy teach skills like practicing team and physician engagement, speaking the language of hospital finances, and using your own personal attributes to create an effective and authentic leadership style.

And now, you can demonstrate your experience in Leadership Academy by applying for SHM’s Certificate of Leadership in Hospital Medicine (CLHM). The certificate program requires attending all three Leadership Academy courses and completing a mentored leadership program at your hospital.

A limited number of reservations are still available for the November Leadership Academy in Honolulu. Visit www.hospitalmedicine.org/leadership for more information.

SHM Leadership Academy

November 3-6

Honolulu, Hawaii

www.hospitalmedicine.org/leadership

Medical school and residency are the first steps toward being a first-rate hospitalist, but will they prepare you for the demands of managing a new project in the hospital? Or taking a leadership position within a hospital medicine group? How about making the financial case for changes you’d like to see in your hospital?

SHM established its popular Leadership Academy to help hospitalists take the next steps into leadership positions. The three courses of Leadership Academy teach skills like practicing team and physician engagement, speaking the language of hospital finances, and using your own personal attributes to create an effective and authentic leadership style.

And now, you can demonstrate your experience in Leadership Academy by applying for SHM’s Certificate of Leadership in Hospital Medicine (CLHM). The certificate program requires attending all three Leadership Academy courses and completing a mentored leadership program at your hospital.

A limited number of reservations are still available for the November Leadership Academy in Honolulu. Visit www.hospitalmedicine.org/leadership for more information.

SHM Leadership Academy

November 3-6

Honolulu, Hawaii

www.hospitalmedicine.org/leadership

Medical school and residency are the first steps toward being a first-rate hospitalist, but will they prepare you for the demands of managing a new project in the hospital? Or taking a leadership position within a hospital medicine group? How about making the financial case for changes you’d like to see in your hospital?

SHM established its popular Leadership Academy to help hospitalists take the next steps into leadership positions. The three courses of Leadership Academy teach skills like practicing team and physician engagement, speaking the language of hospital finances, and using your own personal attributes to create an effective and authentic leadership style.

And now, you can demonstrate your experience in Leadership Academy by applying for SHM’s Certificate of Leadership in Hospital Medicine (CLHM). The certificate program requires attending all three Leadership Academy courses and completing a mentored leadership program at your hospital.

A limited number of reservations are still available for the November Leadership Academy in Honolulu. Visit www.hospitalmedicine.org/leadership for more information.

SHM Leadership Academy

November 3-6

Honolulu, Hawaii

www.hospitalmedicine.org/leadership

If you are a hospitalist working for Kaiser, IPC, or another of the large healthcare systems, you may wonder what the Veterans Health Administration Healthcare System (VA) could possibly have to do with your practice. In many ways, the VA is the prototype, risk-adjusted, capitated accountable care organization (ACO) focused on expanding access to affordable healthcare, lowering costs, and improving quality. We care for complex, diverse, often vulnerable patient populations. We are incented to keep them healthy and out of the hospital. As a highly integrated healthcare system with 152 medical centers and more than 400 hospitalists, the VA has been able to coordinate hospital care, primary care, and post-acute care in a way that many health systems hope to achieve.

VA hospitalists care for veterans with multiple issues, including acute MI, heart failure, pneumonia, and COPD. In short, we care for the same types of patients as hospitalists across the country, with measured outcomes of similar or better quality as non-VA patients.

The VA has utilized an advanced electronic health record (CPRS) since 1997. It allows for effective patient care and is successfully leveraged for large-scale health services research.

The VA has been the site of groundbreaking, Nobel Prize-winning research that has shaped the care of hospitalized patients worldwide: beta blockers for heart failure, steroids for COPD exacerbations, and the invention of implantable cardiac pacemakers and computerized axial tomography (CAT) scans all have as their foundation research performed at VAs.

VA hospitalists educate the next generation of physicians through robust academic affiliations with most of our nation’s most-renowned medical schools and have administered residency training programs for almost 60 years. More than half of all medical students and residents complete part of their training at VAs.

VA hospitalists are also leaders in quality and patient safety.

Over the next year, SHM’s VA Task Force will be sharing 10 of the innovative approaches VA hospitalists are taking to provide care for our nation’s heroes. We will dispel a few myths about the “VA Spa” along the way and, hopefully, share some ideas you can use to better care for your patients.

Many of The Hospitalist’s readers have family members who have served in the military. For all of you, this IS your granddad’s VA—and it’s pretty darn good.

Dr. Odden is a hospitalist at the VA in Ann Arbor, Mich. Dr. Kartha is a hospitalist at the VA in Boston. Both are members of SHM’s VA Task Force.

If you are a hospitalist working for Kaiser, IPC, or another of the large healthcare systems, you may wonder what the Veterans Health Administration Healthcare System (VA) could possibly have to do with your practice. In many ways, the VA is the prototype, risk-adjusted, capitated accountable care organization (ACO) focused on expanding access to affordable healthcare, lowering costs, and improving quality. We care for complex, diverse, often vulnerable patient populations. We are incented to keep them healthy and out of the hospital. As a highly integrated healthcare system with 152 medical centers and more than 400 hospitalists, the VA has been able to coordinate hospital care, primary care, and post-acute care in a way that many health systems hope to achieve.

VA hospitalists care for veterans with multiple issues, including acute MI, heart failure, pneumonia, and COPD. In short, we care for the same types of patients as hospitalists across the country, with measured outcomes of similar or better quality as non-VA patients.

The VA has utilized an advanced electronic health record (CPRS) since 1997. It allows for effective patient care and is successfully leveraged for large-scale health services research.

The VA has been the site of groundbreaking, Nobel Prize-winning research that has shaped the care of hospitalized patients worldwide: beta blockers for heart failure, steroids for COPD exacerbations, and the invention of implantable cardiac pacemakers and computerized axial tomography (CAT) scans all have as their foundation research performed at VAs.

VA hospitalists educate the next generation of physicians through robust academic affiliations with most of our nation’s most-renowned medical schools and have administered residency training programs for almost 60 years. More than half of all medical students and residents complete part of their training at VAs.

VA hospitalists are also leaders in quality and patient safety.

Over the next year, SHM’s VA Task Force will be sharing 10 of the innovative approaches VA hospitalists are taking to provide care for our nation’s heroes. We will dispel a few myths about the “VA Spa” along the way and, hopefully, share some ideas you can use to better care for your patients.

Many of The Hospitalist’s readers have family members who have served in the military. For all of you, this IS your granddad’s VA—and it’s pretty darn good.

Dr. Odden is a hospitalist at the VA in Ann Arbor, Mich. Dr. Kartha is a hospitalist at the VA in Boston. Both are members of SHM’s VA Task Force.

If you are a hospitalist working for Kaiser, IPC, or another of the large healthcare systems, you may wonder what the Veterans Health Administration Healthcare System (VA) could possibly have to do with your practice. In many ways, the VA is the prototype, risk-adjusted, capitated accountable care organization (ACO) focused on expanding access to affordable healthcare, lowering costs, and improving quality. We care for complex, diverse, often vulnerable patient populations. We are incented to keep them healthy and out of the hospital. As a highly integrated healthcare system with 152 medical centers and more than 400 hospitalists, the VA has been able to coordinate hospital care, primary care, and post-acute care in a way that many health systems hope to achieve.

VA hospitalists care for veterans with multiple issues, including acute MI, heart failure, pneumonia, and COPD. In short, we care for the same types of patients as hospitalists across the country, with measured outcomes of similar or better quality as non-VA patients.

The VA has utilized an advanced electronic health record (CPRS) since 1997. It allows for effective patient care and is successfully leveraged for large-scale health services research.

The VA has been the site of groundbreaking, Nobel Prize-winning research that has shaped the care of hospitalized patients worldwide: beta blockers for heart failure, steroids for COPD exacerbations, and the invention of implantable cardiac pacemakers and computerized axial tomography (CAT) scans all have as their foundation research performed at VAs.

VA hospitalists educate the next generation of physicians through robust academic affiliations with most of our nation’s most-renowned medical schools and have administered residency training programs for almost 60 years. More than half of all medical students and residents complete part of their training at VAs.

VA hospitalists are also leaders in quality and patient safety.

Over the next year, SHM’s VA Task Force will be sharing 10 of the innovative approaches VA hospitalists are taking to provide care for our nation’s heroes. We will dispel a few myths about the “VA Spa” along the way and, hopefully, share some ideas you can use to better care for your patients.

Many of The Hospitalist’s readers have family members who have served in the military. For all of you, this IS your granddad’s VA—and it’s pretty darn good.

Dr. Odden is a hospitalist at the VA in Ann Arbor, Mich. Dr. Kartha is a hospitalist at the VA in Boston. Both are members of SHM’s VA Task Force.

The Hospitalist has grabbed the attention and interest of physicians and industry professionals across the country for 18 years. Now, it has the attention of another type of professional

body—the Awards for Publication Excellence (APEX), which presented the publication with the APEX Grand Award for Magazines, Journals, and Tabloids. [http://www.apexawards.com/A2014_Win.List.pdf].

The annual awards, presented to corporate and nonprofit publications, received 2,075 total applications, including nearly 500 entries to the Magazines, Journals, and Tabloids category. Only 10 Grand Awards were presented in the category.

The Hospitalist also received an Award of Excellence in Health and Medical Writing for writer Bryn Nelson’s special report on the Affordable Care Act in the January 2014 issue.

On the APEX website [www.apexawards.com/apex2014grandawardcomments], category judges complimented The Hospitalist for its “appealing spreads, effective use of sidebars, numbered lists, and a bold headline schedule—all combining to complement the well written copy, which is informative and clearly well researched. The Obamacare special report insert is particularly informative and well designed.”

Published by Wiley Inc., The Hospitalist is the official newsmagazine of the Society of Hospital Medicine. The monthly newsmagazine has a circulation of about 25,000 and provides news, features, and information specific to hospitalists and the healthcare industry.

SHM President Burke Kealey, MD, SFHM, expressed his pride for the individuals who bring The Hospitalist together.

“SHM constantly strives to bring the very best to our members and other leaders in healthcare. These two APEX awards, especially the Grand Award, are evidence that we are delivering on that goal,” he wrote in an e-mail.

The Hospitalist has garnered seven APEX Awards in the past six years, as well as attaining finalist status for “Best Healthcare Business Publication” from Medical Marketing and Media in 2009.

Physician Editor Danielle Scheurer, MD, MSCR, SFHM, considers the high quality of writing and practical, relevant article topics two of the magazine’s biggest strengths. She thanked the editors for designing a creative repertoire of stories and for thinking of new ways to cover topics.

“A huge part of our success is keeping our finger on the pulse of our customer base and trying to figure out…what kind of information they’re seeking from a magazine like The Hospitalist,” she said. “We are continuously ensuring that we’re hearing the voice of the customer.”

Erin Petenko is a contributing writer for The Hospitalist.

The Hospitalist has grabbed the attention and interest of physicians and industry professionals across the country for 18 years. Now, it has the attention of another type of professional

body—the Awards for Publication Excellence (APEX), which presented the publication with the APEX Grand Award for Magazines, Journals, and Tabloids. [http://www.apexawards.com/A2014_Win.List.pdf].

The annual awards, presented to corporate and nonprofit publications, received 2,075 total applications, including nearly 500 entries to the Magazines, Journals, and Tabloids category. Only 10 Grand Awards were presented in the category.

The Hospitalist also received an Award of Excellence in Health and Medical Writing for writer Bryn Nelson’s special report on the Affordable Care Act in the January 2014 issue.

On the APEX website [www.apexawards.com/apex2014grandawardcomments], category judges complimented The Hospitalist for its “appealing spreads, effective use of sidebars, numbered lists, and a bold headline schedule—all combining to complement the well written copy, which is informative and clearly well researched. The Obamacare special report insert is particularly informative and well designed.”

Published by Wiley Inc., The Hospitalist is the official newsmagazine of the Society of Hospital Medicine. The monthly newsmagazine has a circulation of about 25,000 and provides news, features, and information specific to hospitalists and the healthcare industry.

SHM President Burke Kealey, MD, SFHM, expressed his pride for the individuals who bring The Hospitalist together.

“SHM constantly strives to bring the very best to our members and other leaders in healthcare. These two APEX awards, especially the Grand Award, are evidence that we are delivering on that goal,” he wrote in an e-mail.

The Hospitalist has garnered seven APEX Awards in the past six years, as well as attaining finalist status for “Best Healthcare Business Publication” from Medical Marketing and Media in 2009.

Physician Editor Danielle Scheurer, MD, MSCR, SFHM, considers the high quality of writing and practical, relevant article topics two of the magazine’s biggest strengths. She thanked the editors for designing a creative repertoire of stories and for thinking of new ways to cover topics.

“A huge part of our success is keeping our finger on the pulse of our customer base and trying to figure out…what kind of information they’re seeking from a magazine like The Hospitalist,” she said. “We are continuously ensuring that we’re hearing the voice of the customer.”

Erin Petenko is a contributing writer for The Hospitalist.

The Hospitalist has grabbed the attention and interest of physicians and industry professionals across the country for 18 years. Now, it has the attention of another type of professional

body—the Awards for Publication Excellence (APEX), which presented the publication with the APEX Grand Award for Magazines, Journals, and Tabloids. [http://www.apexawards.com/A2014_Win.List.pdf].

The annual awards, presented to corporate and nonprofit publications, received 2,075 total applications, including nearly 500 entries to the Magazines, Journals, and Tabloids category. Only 10 Grand Awards were presented in the category.

The Hospitalist also received an Award of Excellence in Health and Medical Writing for writer Bryn Nelson’s special report on the Affordable Care Act in the January 2014 issue.

On the APEX website [www.apexawards.com/apex2014grandawardcomments], category judges complimented The Hospitalist for its “appealing spreads, effective use of sidebars, numbered lists, and a bold headline schedule—all combining to complement the well written copy, which is informative and clearly well researched. The Obamacare special report insert is particularly informative and well designed.”

Published by Wiley Inc., The Hospitalist is the official newsmagazine of the Society of Hospital Medicine. The monthly newsmagazine has a circulation of about 25,000 and provides news, features, and information specific to hospitalists and the healthcare industry.

SHM President Burke Kealey, MD, SFHM, expressed his pride for the individuals who bring The Hospitalist together.

“SHM constantly strives to bring the very best to our members and other leaders in healthcare. These two APEX awards, especially the Grand Award, are evidence that we are delivering on that goal,” he wrote in an e-mail.

The Hospitalist has garnered seven APEX Awards in the past six years, as well as attaining finalist status for “Best Healthcare Business Publication” from Medical Marketing and Media in 2009.

Physician Editor Danielle Scheurer, MD, MSCR, SFHM, considers the high quality of writing and practical, relevant article topics two of the magazine’s biggest strengths. She thanked the editors for designing a creative repertoire of stories and for thinking of new ways to cover topics.

“A huge part of our success is keeping our finger on the pulse of our customer base and trying to figure out…what kind of information they’re seeking from a magazine like The Hospitalist,” she said. “We are continuously ensuring that we’re hearing the voice of the customer.”

Erin Petenko is a contributing writer for The Hospitalist.

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Summary

Behavioral emergencies occur when a patient is physically aggressive or potentially harmful to himself/herself or others. Although they may be rare, behavioral emergencies are high-risk situations, and untrained staff might be uncomfortable dealing with these events.

Patients with underlying psychiatric or developmental disorders, those who have ingested substances, or those who have a medication side effect are at the highest risk for becoming violent. Triggers for these events could be pain, hunger, isolation, change in routine, or even the hospital’s physical environment. Early warning signs for a behavioral emergency can include verbal threats, yelling, or silence. Physical signs may include pacing, crossed arms, furrowed brow, or throwing objects.

The first response to a potential behavioral emergency is to try to de-escalate the situation. Speak in a quiet, calm voice; back off and give personal space. Try to reduce a source of discomfort, and use distractions or rewards. If de-escalation is not successful and a patient becomes violent, the provider’s first role is to be safe: Get away and get help. Hospitals should have—or should develop—a violent patient response team, which may then physically restrain the patient. Medications can be used to treat medical issues but should not be used solely for chemical restraint.

Once a patient is safely restrained, a number of Joint Commission on Accreditation of Healthcare Organizations-mandated actions must occur. The legal guardian and attending of record must be notified. A debrief must occur regarding the events; this must be documented in the medical record. Finally, a strategy must be formulated to enable the patient to be safely removed from restraints as soon as it is safe.

The presenters demonstrated various personal safety techniques to escape from a violent patient, as well as the use of physical restraints. Participants engaged in a mock behavioral emergency to experience the chaos of these events.

Summary

Behavioral emergencies occur when a patient is physically aggressive or potentially harmful to himself/herself or others. Although they may be rare, behavioral emergencies are high-risk situations, and untrained staff might be uncomfortable dealing with these events.

Patients with underlying psychiatric or developmental disorders, those who have ingested substances, or those who have a medication side effect are at the highest risk for becoming violent. Triggers for these events could be pain, hunger, isolation, change in routine, or even the hospital’s physical environment. Early warning signs for a behavioral emergency can include verbal threats, yelling, or silence. Physical signs may include pacing, crossed arms, furrowed brow, or throwing objects.

The first response to a potential behavioral emergency is to try to de-escalate the situation. Speak in a quiet, calm voice; back off and give personal space. Try to reduce a source of discomfort, and use distractions or rewards. If de-escalation is not successful and a patient becomes violent, the provider’s first role is to be safe: Get away and get help. Hospitals should have—or should develop—a violent patient response team, which may then physically restrain the patient. Medications can be used to treat medical issues but should not be used solely for chemical restraint.

Once a patient is safely restrained, a number of Joint Commission on Accreditation of Healthcare Organizations-mandated actions must occur. The legal guardian and attending of record must be notified. A debrief must occur regarding the events; this must be documented in the medical record. Finally, a strategy must be formulated to enable the patient to be safely removed from restraints as soon as it is safe.

The presenters demonstrated various personal safety techniques to escape from a violent patient, as well as the use of physical restraints. Participants engaged in a mock behavioral emergency to experience the chaos of these events.

Summary

Behavioral emergencies occur when a patient is physically aggressive or potentially harmful to himself/herself or others. Although they may be rare, behavioral emergencies are high-risk situations, and untrained staff might be uncomfortable dealing with these events.

Patients with underlying psychiatric or developmental disorders, those who have ingested substances, or those who have a medication side effect are at the highest risk for becoming violent. Triggers for these events could be pain, hunger, isolation, change in routine, or even the hospital’s physical environment. Early warning signs for a behavioral emergency can include verbal threats, yelling, or silence. Physical signs may include pacing, crossed arms, furrowed brow, or throwing objects.

The first response to a potential behavioral emergency is to try to de-escalate the situation. Speak in a quiet, calm voice; back off and give personal space. Try to reduce a source of discomfort, and use distractions or rewards. If de-escalation is not successful and a patient becomes violent, the provider’s first role is to be safe: Get away and get help. Hospitals should have—or should develop—a violent patient response team, which may then physically restrain the patient. Medications can be used to treat medical issues but should not be used solely for chemical restraint.

Once a patient is safely restrained, a number of Joint Commission on Accreditation of Healthcare Organizations-mandated actions must occur. The legal guardian and attending of record must be notified. A debrief must occur regarding the events; this must be documented in the medical record. Finally, a strategy must be formulated to enable the patient to be safely removed from restraints as soon as it is safe.

The presenters demonstrated various personal safety techniques to escape from a violent patient, as well as the use of physical restraints. Participants engaged in a mock behavioral emergency to experience the chaos of these events.

Summary

“Master the basics of a good hospitalist program and keep revisiting your core values, and you will continue to have a high quality and sustainable program,” says Dr. Dan Hale at the PHM14 workshop “Building Blocks in the Evolution of a Successful Distributed Hospitalist Program.”

Dr. Elisabeth Schainker, chief of pediatric hospitalist medicine at The Floating Hospital for Children at Tufts Medical Center in Boston, and Dr. Hale, a hospitalist at The Floating Hospital and site director of the Lawrence General Hospital affiliated pediatric hospitalist program, allowed participants to share their experiences in program development.

This workshop reviewed the fundamentals programs should review before starting and also, periodically, after they’ve been established. Program changes should be made as needed. The workshop used an assessment tool to evaluate the basic elements of the participants’ programs. The February 2014 article “Key Principles and Characteristics of an Effective Hospital Medicine Group” in the Journal of Hospital Medicine was used as a starting point for program self-evaluation.

These “building blocks” include the following:

• Establish the rationale for the program and include all stakeholders;
• Determine financial expectations;
• Define scope of practice;
• Organize nursing and referral physician collaboration;
• Assess staffing and workload expectations;
• Establish referral base; and
• Ensure basic code and emergency preparedness.

Ongoing development elements of a program were discussed as well. These components help further integrate a hospitalist program with the hospital as a whole and help add value. These ongoing “building blocks” include:

• Communication and collaboration with other hospital departments (e.g. emergency, radiology, surgery);
• Newborn medicine care;
• Internal group clinical practice guidelines;
• Co-management of surgical or specialty patients;
• Transfers from other hospitals or continuing care from tertiary care centers;
• Pediatric code teams and rapid response teams;
• Advanced code and emergency preparedness and mock code training; and
• Nursing education.

These additive features may be different at each program. Not all of these components are applicable or needed at all hospitals. Thoughtful approaches and thorough planning can create synergy with other components of a program.

The essentials of a successful distributed network of multiple hospitalist program sites were also described.

After assuring that the fundamentals are present at each site, transparency and institutional alignment are imperative.

Summary

“Master the basics of a good hospitalist program and keep revisiting your core values, and you will continue to have a high quality and sustainable program,” says Dr. Dan Hale at the PHM14 workshop “Building Blocks in the Evolution of a Successful Distributed Hospitalist Program.”

Dr. Elisabeth Schainker, chief of pediatric hospitalist medicine at The Floating Hospital for Children at Tufts Medical Center in Boston, and Dr. Hale, a hospitalist at The Floating Hospital and site director of the Lawrence General Hospital affiliated pediatric hospitalist program, allowed participants to share their experiences in program development.

This workshop reviewed the fundamentals programs should review before starting and also, periodically, after they’ve been established. Program changes should be made as needed. The workshop used an assessment tool to evaluate the basic elements of the participants’ programs. The February 2014 article “Key Principles and Characteristics of an Effective Hospital Medicine Group” in the Journal of Hospital Medicine was used as a starting point for program self-evaluation.

These “building blocks” include the following:

• Establish the rationale for the program and include all stakeholders;
• Determine financial expectations;
• Define scope of practice;
• Organize nursing and referral physician collaboration;
• Assess staffing and workload expectations;
• Establish referral base; and
• Ensure basic code and emergency preparedness.

Ongoing development elements of a program were discussed as well. These components help further integrate a hospitalist program with the hospital as a whole and help add value. These ongoing “building blocks” include:

• Communication and collaboration with other hospital departments (e.g. emergency, radiology, surgery);
• Newborn medicine care;
• Internal group clinical practice guidelines;
• Co-management of surgical or specialty patients;
• Transfers from other hospitals or continuing care from tertiary care centers;
• Pediatric code teams and rapid response teams;
• Advanced code and emergency preparedness and mock code training; and
• Nursing education.

These additive features may be different at each program. Not all of these components are applicable or needed at all hospitals. Thoughtful approaches and thorough planning can create synergy with other components of a program.

The essentials of a successful distributed network of multiple hospitalist program sites were also described.

After assuring that the fundamentals are present at each site, transparency and institutional alignment are imperative.

Summary

“Master the basics of a good hospitalist program and keep revisiting your core values, and you will continue to have a high quality and sustainable program,” says Dr. Dan Hale at the PHM14 workshop “Building Blocks in the Evolution of a Successful Distributed Hospitalist Program.”

Dr. Elisabeth Schainker, chief of pediatric hospitalist medicine at The Floating Hospital for Children at Tufts Medical Center in Boston, and Dr. Hale, a hospitalist at The Floating Hospital and site director of the Lawrence General Hospital affiliated pediatric hospitalist program, allowed participants to share their experiences in program development.

This workshop reviewed the fundamentals programs should review before starting and also, periodically, after they’ve been established. Program changes should be made as needed. The workshop used an assessment tool to evaluate the basic elements of the participants’ programs. The February 2014 article “Key Principles and Characteristics of an Effective Hospital Medicine Group” in the Journal of Hospital Medicine was used as a starting point for program self-evaluation.

These “building blocks” include the following:

• Establish the rationale for the program and include all stakeholders;
• Determine financial expectations;
• Define scope of practice;
• Organize nursing and referral physician collaboration;
• Assess staffing and workload expectations;
• Establish referral base; and
• Ensure basic code and emergency preparedness.

Ongoing development elements of a program were discussed as well. These components help further integrate a hospitalist program with the hospital as a whole and help add value. These ongoing “building blocks” include:

• Communication and collaboration with other hospital departments (e.g. emergency, radiology, surgery);
• Newborn medicine care;
• Internal group clinical practice guidelines;
• Co-management of surgical or specialty patients;
• Transfers from other hospitals or continuing care from tertiary care centers;
• Pediatric code teams and rapid response teams;
• Advanced code and emergency preparedness and mock code training; and
• Nursing education.

These additive features may be different at each program. Not all of these components are applicable or needed at all hospitals. Thoughtful approaches and thorough planning can create synergy with other components of a program.

The essentials of a successful distributed network of multiple hospitalist program sites were also described.

After assuring that the fundamentals are present at each site, transparency and institutional alignment are imperative.

Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.

The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.

“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.

Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”

While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.

Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.

Questions were wide-ranging.

Q: How did you become a CEO?

“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.

Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?

“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.

Q: If PHM fellowship becomes a requirement, will your hospital fund them?

“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.

Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?

“Know where your organization wants to go,” Dr. Sperring said.

The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.

“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”

Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.

Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.

The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.

After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.

The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.

Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.

Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.

Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.

The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.

“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.

Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”

While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.

Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.

Questions were wide-ranging.

Q: How did you become a CEO?

“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.

Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?

“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.

Q: If PHM fellowship becomes a requirement, will your hospital fund them?

“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.

Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?

“Know where your organization wants to go,” Dr. Sperring said.

The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.

“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”

Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.

Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.

The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.

After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.

The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.

Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.

Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.

Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.

The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.

“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.

Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”

While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.

Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.

Questions were wide-ranging.

Q: How did you become a CEO?

“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.

Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?

“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.

Q: If PHM fellowship becomes a requirement, will your hospital fund them?

“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.

Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?

“Know where your organization wants to go,” Dr. Sperring said.

The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.

“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”

Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.

Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.

The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.

After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.

The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.

Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.

Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.

Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.