NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

 

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

 

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

 

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

Scott Flanders, MD, SFHM, director of the hospitalist program at the University of Michigan in Ann Arbor set out to answer three key questions in “rapid-fire” format during the “Pneumonia Update” at HM13.

1. Is procalcitonin ready for “prime time” in determining community-acquired pneumonia (CAP) treatment duration?
2. What is the utility of diagnostic testing in CAP patients?
3. How do you decide which pneumonia patients need broad-spectrum antibiotic coverage?

It turns out that lots of other countries follow procalcitonin levels as a marker of inflammation during CAP treatment. A 2012 Archives of Internal Medicine article notes that U.S. compliance with measuring procalcitonin levels is less than 40%, and monitoring these levels can help diagnosis and guide treatment and the duration of treatment. Procalcitonin is released in the blood in response to bacterial infection. It rises within four hours of infection (earlier than other markers such as CRP and ESR.) The degree and rate of rise is associated with severity; the rate of decline is associated with resolution. Numerous studies show that when providers correlate CAP treatment with procalcitonin levels there is a safe reduction in antibiotic days.

Dr. Flanders also examined the utility of diagnostic tests. In general, CAP outcomes are unchanged and management rarely is impacted by sputum collection. Within the ICU setting it is recommended to get sputum cultures, as it may have a role in healthcare-associated pneumonia, especially if a patient has a history of drug-resistant organisms.

With regard to blood culture analysis, only 4% to 7% of blood cultures are positive in CAP, with many of them being false positives. False positive cultures lead to a 50% increase in charges, and increase length of stay by 65%. A 2004 American Journal of Respiratory and Critical Care Medicine article recommends targeted blood culture screen that correctly detect 90% of bacteremia with 40% fewer cultures. It recommends that patients who are at risk for bacteremia (those with prior antibiotics, WBC count greater than 20, systolic BP less than 90, history of liver disease, temperature greater than 40 degrees or less than 35 degrees celsius, elevated BUN greater than 30, sodium less than 130, pulse greater than 125) be given a point for each risk factor. Those with no risk and no prior antibiotics were deemed safe to forgo cultures. Those with one risk factor, with prior antibiotics were recommended to get one set of cultures. Those with more than one risk factor were recommended to receive two sets of cultures.

Pneumococcal urinary antigen was evaluated. It is noted to have great specificity, but lousy sensitivity. Patients with bacteremia might have false negative results. In general, the antigen might be appropriate in non-severe cases if it will help you narrow therapy. But it shouldn’t be ordered if it is not going to change therapy.

Dr. Flanders also noted that urinary legionella antigen is 80% sensitive for legionella.

Answering the question about the need for broad-spectrum antibiotics, it was thought that any patient receiving home care or home wound care, goes to a dialysis center, lives in a NH or LTC facility would need broad-spectrum antibiotics for HCAP. But Dr. Flanders states it may be a case of doing too much too fast. He recommends patients that reside in nursing homes or who receive home care be treated as a CAP, as the risk of drug-resistant organisms isn’t actually that high in that group. But if a patient had previous admission to the hospital, he recommends treatment for HCAP.

Strong risk factors for resistant organisms include prior hospitalization in past 90 days, LTAC/SNF patients if they have had prior antibiotics and have poor functional status, critically-ill patients, or those with prior MRSA/pseudomonal infections. The data for nursing home patients, home health or home wound care or dialysis patients is less clear. TH

 

Tracy Cardin is a nurse practitioner in the section of hospital medicine at University of Chicago.

Scott Flanders, MD, SFHM, director of the hospitalist program at the University of Michigan in Ann Arbor set out to answer three key questions in “rapid-fire” format during the “Pneumonia Update” at HM13.

1. Is procalcitonin ready for “prime time” in determining community-acquired pneumonia (CAP) treatment duration?
2. What is the utility of diagnostic testing in CAP patients?
3. How do you decide which pneumonia patients need broad-spectrum antibiotic coverage?

It turns out that lots of other countries follow procalcitonin levels as a marker of inflammation during CAP treatment. A 2012 Archives of Internal Medicine article notes that U.S. compliance with measuring procalcitonin levels is less than 40%, and monitoring these levels can help diagnosis and guide treatment and the duration of treatment. Procalcitonin is released in the blood in response to bacterial infection. It rises within four hours of infection (earlier than other markers such as CRP and ESR.) The degree and rate of rise is associated with severity; the rate of decline is associated with resolution. Numerous studies show that when providers correlate CAP treatment with procalcitonin levels there is a safe reduction in antibiotic days.

Dr. Flanders also examined the utility of diagnostic tests. In general, CAP outcomes are unchanged and management rarely is impacted by sputum collection. Within the ICU setting it is recommended to get sputum cultures, as it may have a role in healthcare-associated pneumonia, especially if a patient has a history of drug-resistant organisms.

With regard to blood culture analysis, only 4% to 7% of blood cultures are positive in CAP, with many of them being false positives. False positive cultures lead to a 50% increase in charges, and increase length of stay by 65%. A 2004 American Journal of Respiratory and Critical Care Medicine article recommends targeted blood culture screen that correctly detect 90% of bacteremia with 40% fewer cultures. It recommends that patients who are at risk for bacteremia (those with prior antibiotics, WBC count greater than 20, systolic BP less than 90, history of liver disease, temperature greater than 40 degrees or less than 35 degrees celsius, elevated BUN greater than 30, sodium less than 130, pulse greater than 125) be given a point for each risk factor. Those with no risk and no prior antibiotics were deemed safe to forgo cultures. Those with one risk factor, with prior antibiotics were recommended to get one set of cultures. Those with more than one risk factor were recommended to receive two sets of cultures.

Pneumococcal urinary antigen was evaluated. It is noted to have great specificity, but lousy sensitivity. Patients with bacteremia might have false negative results. In general, the antigen might be appropriate in non-severe cases if it will help you narrow therapy. But it shouldn’t be ordered if it is not going to change therapy.

Dr. Flanders also noted that urinary legionella antigen is 80% sensitive for legionella.

Answering the question about the need for broad-spectrum antibiotics, it was thought that any patient receiving home care or home wound care, goes to a dialysis center, lives in a NH or LTC facility would need broad-spectrum antibiotics for HCAP. But Dr. Flanders states it may be a case of doing too much too fast. He recommends patients that reside in nursing homes or who receive home care be treated as a CAP, as the risk of drug-resistant organisms isn’t actually that high in that group. But if a patient had previous admission to the hospital, he recommends treatment for HCAP.

Strong risk factors for resistant organisms include prior hospitalization in past 90 days, LTAC/SNF patients if they have had prior antibiotics and have poor functional status, critically-ill patients, or those with prior MRSA/pseudomonal infections. The data for nursing home patients, home health or home wound care or dialysis patients is less clear. TH

 

Tracy Cardin is a nurse practitioner in the section of hospital medicine at University of Chicago.

Scott Flanders, MD, SFHM, director of the hospitalist program at the University of Michigan in Ann Arbor set out to answer three key questions in “rapid-fire” format during the “Pneumonia Update” at HM13.

1. Is procalcitonin ready for “prime time” in determining community-acquired pneumonia (CAP) treatment duration?
2. What is the utility of diagnostic testing in CAP patients?
3. How do you decide which pneumonia patients need broad-spectrum antibiotic coverage?

It turns out that lots of other countries follow procalcitonin levels as a marker of inflammation during CAP treatment. A 2012 Archives of Internal Medicine article notes that U.S. compliance with measuring procalcitonin levels is less than 40%, and monitoring these levels can help diagnosis and guide treatment and the duration of treatment. Procalcitonin is released in the blood in response to bacterial infection. It rises within four hours of infection (earlier than other markers such as CRP and ESR.) The degree and rate of rise is associated with severity; the rate of decline is associated with resolution. Numerous studies show that when providers correlate CAP treatment with procalcitonin levels there is a safe reduction in antibiotic days.

Dr. Flanders also examined the utility of diagnostic tests. In general, CAP outcomes are unchanged and management rarely is impacted by sputum collection. Within the ICU setting it is recommended to get sputum cultures, as it may have a role in healthcare-associated pneumonia, especially if a patient has a history of drug-resistant organisms.

With regard to blood culture analysis, only 4% to 7% of blood cultures are positive in CAP, with many of them being false positives. False positive cultures lead to a 50% increase in charges, and increase length of stay by 65%. A 2004 American Journal of Respiratory and Critical Care Medicine article recommends targeted blood culture screen that correctly detect 90% of bacteremia with 40% fewer cultures. It recommends that patients who are at risk for bacteremia (those with prior antibiotics, WBC count greater than 20, systolic BP less than 90, history of liver disease, temperature greater than 40 degrees or less than 35 degrees celsius, elevated BUN greater than 30, sodium less than 130, pulse greater than 125) be given a point for each risk factor. Those with no risk and no prior antibiotics were deemed safe to forgo cultures. Those with one risk factor, with prior antibiotics were recommended to get one set of cultures. Those with more than one risk factor were recommended to receive two sets of cultures.

Pneumococcal urinary antigen was evaluated. It is noted to have great specificity, but lousy sensitivity. Patients with bacteremia might have false negative results. In general, the antigen might be appropriate in non-severe cases if it will help you narrow therapy. But it shouldn’t be ordered if it is not going to change therapy.

Dr. Flanders also noted that urinary legionella antigen is 80% sensitive for legionella.

Answering the question about the need for broad-spectrum antibiotics, it was thought that any patient receiving home care or home wound care, goes to a dialysis center, lives in a NH or LTC facility would need broad-spectrum antibiotics for HCAP. But Dr. Flanders states it may be a case of doing too much too fast. He recommends patients that reside in nursing homes or who receive home care be treated as a CAP, as the risk of drug-resistant organisms isn’t actually that high in that group. But if a patient had previous admission to the hospital, he recommends treatment for HCAP.

Strong risk factors for resistant organisms include prior hospitalization in past 90 days, LTAC/SNF patients if they have had prior antibiotics and have poor functional status, critically-ill patients, or those with prior MRSA/pseudomonal infections. The data for nursing home patients, home health or home wound care or dialysis patients is less clear. TH

 

Tracy Cardin is a nurse practitioner in the section of hospital medicine at University of Chicago.

The practice management session titled, “Improving Patient Satisfaction—Two Success Stories,” was presented by Steven Deiteizweig, MD, system chairman, Department of Hospital Medicine and medical director, regional business development from Ochsner Health System in New Orleans, Peter Short, MD, CMO for Addison Gilbert and Beverly Hospitals in Massachusetts, and Richard Slataper, MD, medical director for the HM service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Optimizing the patient experience and overall satisfaction continues to be a focus of all hospitals and hospitalists. Presenters examined realistic expectations and tactics to improve patient satisfaction scores, as well as leverage the hospitalists’ role with hospital administration. Additionally, key considerations in reporting and benchmarking patient satisfaction were discussed.

One of the key messages was not to attempt to implement all of the suggestions but to pick three tactics, perfect them, and move on to another three tactics.

Dr. Short stressed patience in implementing the approach. He also emphasized that in order to make a difference, all stakeholders need to be committed to enhancing the patient experience and no one person can change the outcome. It has to be the complete patient experience team—physicians, nursing, administration, environmental services, transportation, etc.

Drs. Short and Slataper discussed the Studer group application of the mnemonic AIDET (Acknowledge, Introduce, Duration, Explain, and Thank), as well as the importance of sitting down to discuss a patients’ care and consistent utilization of a white board in every patient room. Dr. Short implemented hourly rounding in his hospitals, which faced initial resistance from nursing but over time experienced a 50% reduction in call lights.

Dr. Short also discussed making sure to take the time to celebrate success when the patient experience improvement has been improved.

Another key message was to insure the right hospitalists are hired to be part of the team. Without engaged and enthusiastic providers, how can anyone expect the patients to be engaged in their care?

Dr. Slataper took some time to talk about his program’s efforts to keep the caseload to 16 patients per day, which coincided with benchmarks presented in another practice management session. Slataper’s program has grown and they have recruited to keep the average encounters per day to around 16, which he says helps prevent provider burnout and is supported by research.

A number of the tactics to improve the patient experience are common sense to how we would want ourselves, or one of your family members, treated. However, it really comes down to communication. For example:

• Mentality of all care-team members who will interact with the patient during their stay;
• Time with the patient and their family to make them perceive as though they are the only patient in the hospital;
• Alignment of goals from the board of trustees/directors to the environmental staff; and
• Communication with the PCP or sub-acute facility during and post-discharge.

Each hospitalist program needs to define what success will look like for their program with all of the stakeholders and then execute on those tactics. Additionally, consistent feedback in the forms of dashboards and feedback assist in moving the needle. TH

Bryan Weiss is managing director of MedSynergies, Inc., in Irving, Texas.

 

The practice management session titled, “Improving Patient Satisfaction—Two Success Stories,” was presented by Steven Deiteizweig, MD, system chairman, Department of Hospital Medicine and medical director, regional business development from Ochsner Health System in New Orleans, Peter Short, MD, CMO for Addison Gilbert and Beverly Hospitals in Massachusetts, and Richard Slataper, MD, medical director for the HM service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Optimizing the patient experience and overall satisfaction continues to be a focus of all hospitals and hospitalists. Presenters examined realistic expectations and tactics to improve patient satisfaction scores, as well as leverage the hospitalists’ role with hospital administration. Additionally, key considerations in reporting and benchmarking patient satisfaction were discussed.

One of the key messages was not to attempt to implement all of the suggestions but to pick three tactics, perfect them, and move on to another three tactics.

Dr. Short stressed patience in implementing the approach. He also emphasized that in order to make a difference, all stakeholders need to be committed to enhancing the patient experience and no one person can change the outcome. It has to be the complete patient experience team—physicians, nursing, administration, environmental services, transportation, etc.

Drs. Short and Slataper discussed the Studer group application of the mnemonic AIDET (Acknowledge, Introduce, Duration, Explain, and Thank), as well as the importance of sitting down to discuss a patients’ care and consistent utilization of a white board in every patient room. Dr. Short implemented hourly rounding in his hospitals, which faced initial resistance from nursing but over time experienced a 50% reduction in call lights.

Dr. Short also discussed making sure to take the time to celebrate success when the patient experience improvement has been improved.

Another key message was to insure the right hospitalists are hired to be part of the team. Without engaged and enthusiastic providers, how can anyone expect the patients to be engaged in their care?

Dr. Slataper took some time to talk about his program’s efforts to keep the caseload to 16 patients per day, which coincided with benchmarks presented in another practice management session. Slataper’s program has grown and they have recruited to keep the average encounters per day to around 16, which he says helps prevent provider burnout and is supported by research.

A number of the tactics to improve the patient experience are common sense to how we would want ourselves, or one of your family members, treated. However, it really comes down to communication. For example:

• Mentality of all care-team members who will interact with the patient during their stay;
• Time with the patient and their family to make them perceive as though they are the only patient in the hospital;
• Alignment of goals from the board of trustees/directors to the environmental staff; and
• Communication with the PCP or sub-acute facility during and post-discharge.

Each hospitalist program needs to define what success will look like for their program with all of the stakeholders and then execute on those tactics. Additionally, consistent feedback in the forms of dashboards and feedback assist in moving the needle. TH

Bryan Weiss is managing director of MedSynergies, Inc., in Irving, Texas.

 

The practice management session titled, “Improving Patient Satisfaction—Two Success Stories,” was presented by Steven Deiteizweig, MD, system chairman, Department of Hospital Medicine and medical director, regional business development from Ochsner Health System in New Orleans, Peter Short, MD, CMO for Addison Gilbert and Beverly Hospitals in Massachusetts, and Richard Slataper, MD, medical director for the HM service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Optimizing the patient experience and overall satisfaction continues to be a focus of all hospitals and hospitalists. Presenters examined realistic expectations and tactics to improve patient satisfaction scores, as well as leverage the hospitalists’ role with hospital administration. Additionally, key considerations in reporting and benchmarking patient satisfaction were discussed.

One of the key messages was not to attempt to implement all of the suggestions but to pick three tactics, perfect them, and move on to another three tactics.

Dr. Short stressed patience in implementing the approach. He also emphasized that in order to make a difference, all stakeholders need to be committed to enhancing the patient experience and no one person can change the outcome. It has to be the complete patient experience team—physicians, nursing, administration, environmental services, transportation, etc.

Drs. Short and Slataper discussed the Studer group application of the mnemonic AIDET (Acknowledge, Introduce, Duration, Explain, and Thank), as well as the importance of sitting down to discuss a patients’ care and consistent utilization of a white board in every patient room. Dr. Short implemented hourly rounding in his hospitals, which faced initial resistance from nursing but over time experienced a 50% reduction in call lights.

Dr. Short also discussed making sure to take the time to celebrate success when the patient experience improvement has been improved.

Another key message was to insure the right hospitalists are hired to be part of the team. Without engaged and enthusiastic providers, how can anyone expect the patients to be engaged in their care?

Dr. Slataper took some time to talk about his program’s efforts to keep the caseload to 16 patients per day, which coincided with benchmarks presented in another practice management session. Slataper’s program has grown and they have recruited to keep the average encounters per day to around 16, which he says helps prevent provider burnout and is supported by research.

A number of the tactics to improve the patient experience are common sense to how we would want ourselves, or one of your family members, treated. However, it really comes down to communication. For example:

• Mentality of all care-team members who will interact with the patient during their stay;
• Time with the patient and their family to make them perceive as though they are the only patient in the hospital;
• Alignment of goals from the board of trustees/directors to the environmental staff; and
• Communication with the PCP or sub-acute facility during and post-discharge.

Each hospitalist program needs to define what success will look like for their program with all of the stakeholders and then execute on those tactics. Additionally, consistent feedback in the forms of dashboards and feedback assist in moving the needle. TH

Bryan Weiss is managing director of MedSynergies, Inc., in Irving, Texas.

 

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

This presentation was a playful banter between two experts—Steven Cohn of Miller School of Medicine in Miami and Lenny Feldman of Johns Hopkins in Baltimore—who showed us the evidence (and lack thereof) for several perioperative matters.

Issue No. 1: Timing of non-cardiac surgery after cardiac stent placement. The AHA/ACC guidelines suggest waiting 12 months after placement of a drug-eluting stent and 30-45 days for bare -metal stents. The speakers suggested that, based on limited data, waiting only 6 months might be sufficient time for patients to undergo non cardiac surgery. They were in support of the 30-45 day waiting period for bare-metal stents.

Issue No. 2: Care approach for hip fracture patients. Current models include admission to the hospitalist or orthopaedic service, with varying thresholds for medical consultations and subsequent follow ups. Other systems utilize true comanagement models. Experience suggests higher satisfaction from nurses and surgeons when patients are comanaged by hospitalists, but do we as a specialty have enough resources in terms of manpower to be involved in comanaging all ortho and other surgical patients? Is it professionally satisfying for hospitalists to comanage and, ultimately, how are patient outcomes impacted when patients are comanaged by hospitalists?

Dr. Cohn suggested there is limited benefit in hospitalist comanagement of low-risk, straightforward cases. There is data suggesting decrease in time to surgery, decrease in uti,DVT, and pressure ulcers with medical comanagement.

Issue No. 3: Routine, post-operative troponin monitoring for silent myocardial infarcts. Data showed 65% of patients with post-op MIs will not have symptoms. They may have a troponin leak or ECG changes. The controversy is that even if we detect a post-op MI, there is no good data that any interventions (eg, aspirin and statins, transferring to CCU or telemetry, performing cardiac catherization) would improve the patient mortality. There is data that shows the higher the troponin leak in post-operative patients, the higher the mortality except in low risk patients.

Issue No. 4: Preoperative dosing of glargine insulin. There are no guidelines in the U.S. In the U.K., the National Health Services recommends continuing glargine at 100%, which is what Dr. Cohn recommends for patients with sugars greater than 120 and without kidney disease. Dr. Lenny Feldman was more inclined to reduce the glargine dosing for patients, taking it the night before or the morning of surgery. Reduction could be anywhere from 50% to 80% of the patient's usual dose. Certainly it is more safe to deal with hyperglycemia than it is to deal with hypoglycemia. However, we need to be mindful still of the complications associated with perioperative hypergylcemia. Ultimately, the dosing needs to be individualized and we can find the right balance to minimize both hypo and hyperglycemia in the perioperative period.

Dr. Ma is a member of Team Hospitalist.

This presentation was a playful banter between two experts—Steven Cohn of Miller School of Medicine in Miami and Lenny Feldman of Johns Hopkins in Baltimore—who showed us the evidence (and lack thereof) for several perioperative matters.

Issue No. 1: Timing of non-cardiac surgery after cardiac stent placement. The AHA/ACC guidelines suggest waiting 12 months after placement of a drug-eluting stent and 30-45 days for bare -metal stents. The speakers suggested that, based on limited data, waiting only 6 months might be sufficient time for patients to undergo non cardiac surgery. They were in support of the 30-45 day waiting period for bare-metal stents.

Issue No. 2: Care approach for hip fracture patients. Current models include admission to the hospitalist or orthopaedic service, with varying thresholds for medical consultations and subsequent follow ups. Other systems utilize true comanagement models. Experience suggests higher satisfaction from nurses and surgeons when patients are comanaged by hospitalists, but do we as a specialty have enough resources in terms of manpower to be involved in comanaging all ortho and other surgical patients? Is it professionally satisfying for hospitalists to comanage and, ultimately, how are patient outcomes impacted when patients are comanaged by hospitalists?

Dr. Cohn suggested there is limited benefit in hospitalist comanagement of low-risk, straightforward cases. There is data suggesting decrease in time to surgery, decrease in uti,DVT, and pressure ulcers with medical comanagement.

Issue No. 3: Routine, post-operative troponin monitoring for silent myocardial infarcts. Data showed 65% of patients with post-op MIs will not have symptoms. They may have a troponin leak or ECG changes. The controversy is that even if we detect a post-op MI, there is no good data that any interventions (eg, aspirin and statins, transferring to CCU or telemetry, performing cardiac catherization) would improve the patient mortality. There is data that shows the higher the troponin leak in post-operative patients, the higher the mortality except in low risk patients.

Issue No. 4: Preoperative dosing of glargine insulin. There are no guidelines in the U.S. In the U.K., the National Health Services recommends continuing glargine at 100%, which is what Dr. Cohn recommends for patients with sugars greater than 120 and without kidney disease. Dr. Lenny Feldman was more inclined to reduce the glargine dosing for patients, taking it the night before or the morning of surgery. Reduction could be anywhere from 50% to 80% of the patient's usual dose. Certainly it is more safe to deal with hyperglycemia than it is to deal with hypoglycemia. However, we need to be mindful still of the complications associated with perioperative hypergylcemia. Ultimately, the dosing needs to be individualized and we can find the right balance to minimize both hypo and hyperglycemia in the perioperative period.

Dr. Ma is a member of Team Hospitalist.

This presentation was a playful banter between two experts—Steven Cohn of Miller School of Medicine in Miami and Lenny Feldman of Johns Hopkins in Baltimore—who showed us the evidence (and lack thereof) for several perioperative matters.

Issue No. 1: Timing of non-cardiac surgery after cardiac stent placement. The AHA/ACC guidelines suggest waiting 12 months after placement of a drug-eluting stent and 30-45 days for bare -metal stents. The speakers suggested that, based on limited data, waiting only 6 months might be sufficient time for patients to undergo non cardiac surgery. They were in support of the 30-45 day waiting period for bare-metal stents.

Issue No. 2: Care approach for hip fracture patients. Current models include admission to the hospitalist or orthopaedic service, with varying thresholds for medical consultations and subsequent follow ups. Other systems utilize true comanagement models. Experience suggests higher satisfaction from nurses and surgeons when patients are comanaged by hospitalists, but do we as a specialty have enough resources in terms of manpower to be involved in comanaging all ortho and other surgical patients? Is it professionally satisfying for hospitalists to comanage and, ultimately, how are patient outcomes impacted when patients are comanaged by hospitalists?

Dr. Cohn suggested there is limited benefit in hospitalist comanagement of low-risk, straightforward cases. There is data suggesting decrease in time to surgery, decrease in uti,DVT, and pressure ulcers with medical comanagement.

Issue No. 3: Routine, post-operative troponin monitoring for silent myocardial infarcts. Data showed 65% of patients with post-op MIs will not have symptoms. They may have a troponin leak or ECG changes. The controversy is that even if we detect a post-op MI, there is no good data that any interventions (eg, aspirin and statins, transferring to CCU or telemetry, performing cardiac catherization) would improve the patient mortality. There is data that shows the higher the troponin leak in post-operative patients, the higher the mortality except in low risk patients.

Issue No. 4: Preoperative dosing of glargine insulin. There are no guidelines in the U.S. In the U.K., the National Health Services recommends continuing glargine at 100%, which is what Dr. Cohn recommends for patients with sugars greater than 120 and without kidney disease. Dr. Lenny Feldman was more inclined to reduce the glargine dosing for patients, taking it the night before or the morning of surgery. Reduction could be anywhere from 50% to 80% of the patient's usual dose. Certainly it is more safe to deal with hyperglycemia than it is to deal with hypoglycemia. However, we need to be mindful still of the complications associated with perioperative hypergylcemia. Ultimately, the dosing needs to be individualized and we can find the right balance to minimize both hypo and hyperglycemia in the perioperative period.

Dr. Ma is a member of Team Hospitalist.

I had the pleasure of attending the Hm13 workshop, “e-information Management 101,” a panel discussion led by Vineet Arora, MD, MAPP, FHM, of the University of Chicago, Anuj Dalal, MD, FHM, of Brigham and Women's Hospital in Boston, Cheng-Kai Kao, University of Chicago, and Roger Yu, MD, of Beth Israel Deaconess Medical Center. This very useful presentation was filled with specific tips and techniques that physicians can use to control and organize the constant, daily stream of e-information.

Here is a summary of key information from the panelists:

• Many people are starting to find success using the GTD Method, based on David Allen’s “Getting Things Done.” The basic premise is to learn to touch an item once and act on it once. If an item requires action, either do it, delegate it or defer it. If an item does not require action, either file it, delete it or incubate it for possible later action.
• Learn to reduce email volume. For example, unsubscribe from listservs you no longer use or need. Learn to reduce the “perception” of email volume by keeping personal email separate from work email, and using rules and filters to reduce the volume of email to your main email inbox.
• The use of mobile devices in the hospital setting offers many opportunities for integration into your daily workflow. These devices can be used to look up drug databases, access formularies, show patients radiographs or CT scan images, or read articles for CME credit.

Key Takeaways

• We need to learn to pull information when we need it, rather than having it pushed to us. We should “push” information when it is high priority, high awareness, such as emails from your boss. We should “pull” information when it is low priority, low awareness, such as journal alerts or table of contents.
• Physicians should start to embrace cloud computing. These applications allow you to access and store files on a distant storage server from any device, such as desktop, laptop, smartphone, or tablet. Cloud computing helps to prevent multiple copies of files from existing in multiple sites. It also allows collaboration on presentations or papers from multiple users who can be physically located anywhere in the country. TH

Dr. O'Callaghan is a member of Team Hospitalist, and clinical assistant professor of pediatrics at University of Washington and Seattle Children’s Hospital

I had the pleasure of attending the Hm13 workshop, “e-information Management 101,” a panel discussion led by Vineet Arora, MD, MAPP, FHM, of the University of Chicago, Anuj Dalal, MD, FHM, of Brigham and Women's Hospital in Boston, Cheng-Kai Kao, University of Chicago, and Roger Yu, MD, of Beth Israel Deaconess Medical Center. This very useful presentation was filled with specific tips and techniques that physicians can use to control and organize the constant, daily stream of e-information.

Here is a summary of key information from the panelists:

• Many people are starting to find success using the GTD Method, based on David Allen’s “Getting Things Done.” The basic premise is to learn to touch an item once and act on it once. If an item requires action, either do it, delegate it or defer it. If an item does not require action, either file it, delete it or incubate it for possible later action.
• Learn to reduce email volume. For example, unsubscribe from listservs you no longer use or need. Learn to reduce the “perception” of email volume by keeping personal email separate from work email, and using rules and filters to reduce the volume of email to your main email inbox.
• The use of mobile devices in the hospital setting offers many opportunities for integration into your daily workflow. These devices can be used to look up drug databases, access formularies, show patients radiographs or CT scan images, or read articles for CME credit.

Key Takeaways

• We need to learn to pull information when we need it, rather than having it pushed to us. We should “push” information when it is high priority, high awareness, such as emails from your boss. We should “pull” information when it is low priority, low awareness, such as journal alerts or table of contents.
• Physicians should start to embrace cloud computing. These applications allow you to access and store files on a distant storage server from any device, such as desktop, laptop, smartphone, or tablet. Cloud computing helps to prevent multiple copies of files from existing in multiple sites. It also allows collaboration on presentations or papers from multiple users who can be physically located anywhere in the country. TH

Dr. O'Callaghan is a member of Team Hospitalist, and clinical assistant professor of pediatrics at University of Washington and Seattle Children’s Hospital

I had the pleasure of attending the Hm13 workshop, “e-information Management 101,” a panel discussion led by Vineet Arora, MD, MAPP, FHM, of the University of Chicago, Anuj Dalal, MD, FHM, of Brigham and Women's Hospital in Boston, Cheng-Kai Kao, University of Chicago, and Roger Yu, MD, of Beth Israel Deaconess Medical Center. This very useful presentation was filled with specific tips and techniques that physicians can use to control and organize the constant, daily stream of e-information.

Here is a summary of key information from the panelists:

• Many people are starting to find success using the GTD Method, based on David Allen’s “Getting Things Done.” The basic premise is to learn to touch an item once and act on it once. If an item requires action, either do it, delegate it or defer it. If an item does not require action, either file it, delete it or incubate it for possible later action.
• Learn to reduce email volume. For example, unsubscribe from listservs you no longer use or need. Learn to reduce the “perception” of email volume by keeping personal email separate from work email, and using rules and filters to reduce the volume of email to your main email inbox.
• The use of mobile devices in the hospital setting offers many opportunities for integration into your daily workflow. These devices can be used to look up drug databases, access formularies, show patients radiographs or CT scan images, or read articles for CME credit.

Key Takeaways

• We need to learn to pull information when we need it, rather than having it pushed to us. We should “push” information when it is high priority, high awareness, such as emails from your boss. We should “pull” information when it is low priority, low awareness, such as journal alerts or table of contents.
• Physicians should start to embrace cloud computing. These applications allow you to access and store files on a distant storage server from any device, such as desktop, laptop, smartphone, or tablet. Cloud computing helps to prevent multiple copies of files from existing in multiple sites. It also allows collaboration on presentations or papers from multiple users who can be physically located anywhere in the country. TH

Dr. O'Callaghan is a member of Team Hospitalist, and clinical assistant professor of pediatrics at University of Washington and Seattle Children’s Hospital