HOSPITALISTS FROM ALL PARTS OF THE COUNTRY—and a few other countries—discussed a wide swath of topics during a community-based HM special-interest forum at HM10. Issues that were discussed included unit-based rounding, changes to Medicare consult codes, strategies for avoiding “dumps,” and working with specialists.

Two established community hospitalists—SHM co-founders John Nelson, MD, MHM, and Winthrop Whitcomb, MD, MHM—moderated the one-hour session.

Much of the debate centered on defining a hospitalist’s role and relationships with others in the hospital. One hospitalist said he’d noticed significant changes in the 15 years since he began HM practice; however, some issues remain unresolved: Primary-care physicians (PCPs) still know the patients better, and medical specialists still want hospitalists to be their “interns.”

“We have two things to sell: your expertise and your availability. It’s up to your group to determine which one you want to sell,” said Tony Lin, MD, FHM, a hospitalist and chief of the Department of Internal Medicine at Kelsey-Seybold Clinic in Houston. “I don’t think you have to pick one. So I think you have to ask yourself: What does our group want to sell to the specialist? Sometimes you might have to turn them down to make that point.”

Dr. Lin also described a phenomena emerging in the Houston area: independent, one-physician HM groups taking root in community hospitals. “A lot of the surgeons are using them because they are willing to work as the interns and residents, the first people the nurses call at 2 a.m.,” he said. “There is a market for them.”

Dr. Nelson advised community hospitalists to avoid doing “the things that make you appear different from everyone else. Build social connections with specialists; call them by their first name; eat lunch in the cafeteria; and dress professionally.”

•

One community hospitalist spoke of an ethical situation she regularly encounters at her hospital, which contracts with multiple HM groups. Anna Rodriguez, MD, of Chesapeake Hospitalists in Chesapeake, Va., explained that her group’s issue is acutely ill patients who are assigned to one of the other HM group services—which, unlike Dr. Rodriguez’s group, are not responsible for codes or 24/7 patient coverage. So what happens when the “other” group’s patient has a sudden deterioration and the hospital staff calls us to run the rapid response? Dr. Rodriguez asked the group.

Dr. Whitcomb suggested Dr. Rodriguez’s group, which is not contracted to run the code, work to iron that situation out. “Then, that is your job and contractually recognized,” he said.

“We get into the exact same situation in our hospital. We created a hospital medicine section and … established expectations for who responds to codes,” said Dennis Kold, MD, medical director of the hospitalist service Tri-Health in Cincinnati. “If the patient is declining, we will respond to code, but we have it set up where the expectation is that the [attending] will be in to take care of the patient in one hour, or if the patient is admitted overnight to the ICU at 10 p.m., that the [admitting] will be in the ICU to take care of the patient within four hours.” Dr. Kold added that when the attending doesn’t show up in time that penalties are enforced (e.g., taken off the ER call schedule, restriction of hospital privileges).

“If you are not dealing with rapid response, then you are just hurting yourself,” added Edward Rosenfeld, MD, a hospitalist with Lehigh Valley Medical Associates in Allentown, Pa. “You need to do it; that’s your code prevention.”

•

Community hospitalists also discussed bundled payments and the recent changes in Medicare consult codes. “As a hospitalist service, I want to be involved in divvying up the money,” said Dan Allen, MD, a group director in Des Moines, Iowa. “I don’t know where it’s going, but I want to have a seat at the table.”

When asked by Dr. Nelson if they had noticed a significant change in reimbursement due to Medicare’s elimination of consultation codes, few in the room raised their hands. In fact, Dr. Nelson explained, “you can bill initial hospital care instead of initial hospital consult.”

“If done right, you might get paid better,” Dr. Rosenfeld added.

—Jason Carris

Health Information Technology on the Hospitalist Radar

Health information technology (HIT) isn’t for geeks anymore. A year after a mostly tech-savvy room discussed the basics of introducing more IT aspects to HM, nearly three dozen hospitalists clamored for SHM to take advocacy positions on everything from best practices to best vendors.

“SHM could help us all speak the language we need to speak,” said Tosha Wetterneck, MD, MS, a hospitalist with the University of Wisconsin Clinic in Madison. “Visibility, transparency—give us the words.”

Participants in last year’s group focused on the technical side of IT. This year’s attendees talked about the need for SHM to create portals for shared information, message boards to spur interinstitution conversations, and, perhaps, a weekend boot-camp-style course to introduce novices to basic IT information.

“SHM needs to take a stand now,” said Damascene Kurukulasuriya, MD, FACP, CMD, CCD, a hospitalist in perioperative medicine at the University of Missouri Health System in Columbia. “We need to be part of the solution.”

To that end, Kendall Rogers, MD, assistant professor at the University of New Mexico School of Medicine and chair of SHM’s IT Task Force, says the society is making progress. More hospitalists have been encouraged to sign up for the BioMedical Informatics course at the Marine Biology Laboratory in Woods Hole, Mass. The weeklong course is an introduction to the use of computer technologies and information science related to biomedicine and health science, according to the program’s Web site (www.courses.mbl.edu/mi/). The cost of travel, housing, and meals are fully paid for by the National Library of Medicine, making the fellowship even more appealing for cash-strapped hospitals and HM groups. “It’s a hidden program,” Dr. Rogers said.

Dr. Rogers and SHM CEO Larry Wellikson have toured the country meeting with top officials from the largest IT vendors, including Cerner and GE Healthcare. An IT committee has formed, with subcommittees dedicated to policy, quality, and leadership/education. But Bob Lineberger, MD, medical information officer at Durham Regional Hospital in North Carolina, says a nuanced message will take time.

“Our focus is just coming into focus,” Dr. Lineberger conceded. “We do need to come up with a position statement.”

—Richard Quinn

Education in HM: How to Grow Rock Stars and Champions

What skills does a hospitalist need to know to practice well that they didn’t learn in residency? That was the question new SHM President Jeff Weise, MD, SFHM, posed to about 20 hospitalists attending the special-interest forum on educational initiatives at HM10. Led by Dr. Wiese and SHM Education Committee co-chair Vikas Parekh, MD, FHM, the discussion focused on what SHM can do—or perhaps do better—in this capacity.

Dr. Parekh said hospitalists should be experts in quality-improvement (QI) and patient safety, and HM must incorporate that expertise into daily practice. However, he said, SHM’s largest educational focus is the new Focused Practice in Hospital Medicine pathway to American Board of Internal Medicine’s (ABIM) recertification.

In describing the future of this dynamic field, Dr. Weise raised concerns about managing the pipeline of approximately 2,500 new residents turning out each year and the potential for “losing intimacy” among SHM members—which he described as “the curse of being a champion.”

“IT is the only solution,” he added, “and identifying new and better ways of communicating.”

Competency-Based Train-ing (CBT) is critical to the development of new hospitalists, Dr. Wiese explained, as a supplement for what isn’t taught in residency. He posed a question: Should residencies last four or five years to incorporate additional training and career planning? “It’s an MBA paradigm of learning what we do,” he said. “What compels residents to join fellowship programs and earn $50K per year when they can start practicing and earning $150K?”

Educating the membership requires innovation and more than just bench-to-bedside research, Dr. Wiese added. Translational research and best-evidence practices will improve the field. “Five or 10 programs are rock stars,” he said, “but there are 377 that are terrible.”

Future SHM goals include a vision of having hospitalists hold 20% of all Internal Medicine Residency Program Director positions; developing best practices, not unfunded mandates; establishing protected academic time; and encouraging mentorship that positions hospitalists as heroes for the next generation.

An education committee sub-group has been tasked to focus on the recruitment of hospitalists and expose them to the best the society and field have to offer. HM10

—Phaedra Cress

HOSPITALISTS FROM ALL PARTS OF THE COUNTRY—and a few other countries—discussed a wide swath of topics during a community-based HM special-interest forum at HM10. Issues that were discussed included unit-based rounding, changes to Medicare consult codes, strategies for avoiding “dumps,” and working with specialists.

Two established community hospitalists—SHM co-founders John Nelson, MD, MHM, and Winthrop Whitcomb, MD, MHM—moderated the one-hour session.

Much of the debate centered on defining a hospitalist’s role and relationships with others in the hospital. One hospitalist said he’d noticed significant changes in the 15 years since he began HM practice; however, some issues remain unresolved: Primary-care physicians (PCPs) still know the patients better, and medical specialists still want hospitalists to be their “interns.”

“We have two things to sell: your expertise and your availability. It’s up to your group to determine which one you want to sell,” said Tony Lin, MD, FHM, a hospitalist and chief of the Department of Internal Medicine at Kelsey-Seybold Clinic in Houston. “I don’t think you have to pick one. So I think you have to ask yourself: What does our group want to sell to the specialist? Sometimes you might have to turn them down to make that point.”

Dr. Lin also described a phenomena emerging in the Houston area: independent, one-physician HM groups taking root in community hospitals. “A lot of the surgeons are using them because they are willing to work as the interns and residents, the first people the nurses call at 2 a.m.,” he said. “There is a market for them.”

Dr. Nelson advised community hospitalists to avoid doing “the things that make you appear different from everyone else. Build social connections with specialists; call them by their first name; eat lunch in the cafeteria; and dress professionally.”

•

One community hospitalist spoke of an ethical situation she regularly encounters at her hospital, which contracts with multiple HM groups. Anna Rodriguez, MD, of Chesapeake Hospitalists in Chesapeake, Va., explained that her group’s issue is acutely ill patients who are assigned to one of the other HM group services—which, unlike Dr. Rodriguez’s group, are not responsible for codes or 24/7 patient coverage. So what happens when the “other” group’s patient has a sudden deterioration and the hospital staff calls us to run the rapid response? Dr. Rodriguez asked the group.

Dr. Whitcomb suggested Dr. Rodriguez’s group, which is not contracted to run the code, work to iron that situation out. “Then, that is your job and contractually recognized,” he said.

“We get into the exact same situation in our hospital. We created a hospital medicine section and … established expectations for who responds to codes,” said Dennis Kold, MD, medical director of the hospitalist service Tri-Health in Cincinnati. “If the patient is declining, we will respond to code, but we have it set up where the expectation is that the [attending] will be in to take care of the patient in one hour, or if the patient is admitted overnight to the ICU at 10 p.m., that the [admitting] will be in the ICU to take care of the patient within four hours.” Dr. Kold added that when the attending doesn’t show up in time that penalties are enforced (e.g., taken off the ER call schedule, restriction of hospital privileges).

“If you are not dealing with rapid response, then you are just hurting yourself,” added Edward Rosenfeld, MD, a hospitalist with Lehigh Valley Medical Associates in Allentown, Pa. “You need to do it; that’s your code prevention.”

•

Community hospitalists also discussed bundled payments and the recent changes in Medicare consult codes. “As a hospitalist service, I want to be involved in divvying up the money,” said Dan Allen, MD, a group director in Des Moines, Iowa. “I don’t know where it’s going, but I want to have a seat at the table.”

When asked by Dr. Nelson if they had noticed a significant change in reimbursement due to Medicare’s elimination of consultation codes, few in the room raised their hands. In fact, Dr. Nelson explained, “you can bill initial hospital care instead of initial hospital consult.”

“If done right, you might get paid better,” Dr. Rosenfeld added.

—Jason Carris

Health Information Technology on the Hospitalist Radar

Health information technology (HIT) isn’t for geeks anymore. A year after a mostly tech-savvy room discussed the basics of introducing more IT aspects to HM, nearly three dozen hospitalists clamored for SHM to take advocacy positions on everything from best practices to best vendors.

“SHM could help us all speak the language we need to speak,” said Tosha Wetterneck, MD, MS, a hospitalist with the University of Wisconsin Clinic in Madison. “Visibility, transparency—give us the words.”

Participants in last year’s group focused on the technical side of IT. This year’s attendees talked about the need for SHM to create portals for shared information, message boards to spur interinstitution conversations, and, perhaps, a weekend boot-camp-style course to introduce novices to basic IT information.

“SHM needs to take a stand now,” said Damascene Kurukulasuriya, MD, FACP, CMD, CCD, a hospitalist in perioperative medicine at the University of Missouri Health System in Columbia. “We need to be part of the solution.”

To that end, Kendall Rogers, MD, assistant professor at the University of New Mexico School of Medicine and chair of SHM’s IT Task Force, says the society is making progress. More hospitalists have been encouraged to sign up for the BioMedical Informatics course at the Marine Biology Laboratory in Woods Hole, Mass. The weeklong course is an introduction to the use of computer technologies and information science related to biomedicine and health science, according to the program’s Web site (www.courses.mbl.edu/mi/). The cost of travel, housing, and meals are fully paid for by the National Library of Medicine, making the fellowship even more appealing for cash-strapped hospitals and HM groups. “It’s a hidden program,” Dr. Rogers said.

Dr. Rogers and SHM CEO Larry Wellikson have toured the country meeting with top officials from the largest IT vendors, including Cerner and GE Healthcare. An IT committee has formed, with subcommittees dedicated to policy, quality, and leadership/education. But Bob Lineberger, MD, medical information officer at Durham Regional Hospital in North Carolina, says a nuanced message will take time.

“Our focus is just coming into focus,” Dr. Lineberger conceded. “We do need to come up with a position statement.”

—Richard Quinn

Education in HM: How to Grow Rock Stars and Champions

What skills does a hospitalist need to know to practice well that they didn’t learn in residency? That was the question new SHM President Jeff Weise, MD, SFHM, posed to about 20 hospitalists attending the special-interest forum on educational initiatives at HM10. Led by Dr. Wiese and SHM Education Committee co-chair Vikas Parekh, MD, FHM, the discussion focused on what SHM can do—or perhaps do better—in this capacity.

Dr. Parekh said hospitalists should be experts in quality-improvement (QI) and patient safety, and HM must incorporate that expertise into daily practice. However, he said, SHM’s largest educational focus is the new Focused Practice in Hospital Medicine pathway to American Board of Internal Medicine’s (ABIM) recertification.

In describing the future of this dynamic field, Dr. Weise raised concerns about managing the pipeline of approximately 2,500 new residents turning out each year and the potential for “losing intimacy” among SHM members—which he described as “the curse of being a champion.”

“IT is the only solution,” he added, “and identifying new and better ways of communicating.”

Competency-Based Train-ing (CBT) is critical to the development of new hospitalists, Dr. Wiese explained, as a supplement for what isn’t taught in residency. He posed a question: Should residencies last four or five years to incorporate additional training and career planning? “It’s an MBA paradigm of learning what we do,” he said. “What compels residents to join fellowship programs and earn $50K per year when they can start practicing and earning $150K?”

Educating the membership requires innovation and more than just bench-to-bedside research, Dr. Wiese added. Translational research and best-evidence practices will improve the field. “Five or 10 programs are rock stars,” he said, “but there are 377 that are terrible.”

Future SHM goals include a vision of having hospitalists hold 20% of all Internal Medicine Residency Program Director positions; developing best practices, not unfunded mandates; establishing protected academic time; and encouraging mentorship that positions hospitalists as heroes for the next generation.

An education committee sub-group has been tasked to focus on the recruitment of hospitalists and expose them to the best the society and field have to offer. HM10

—Phaedra Cress

HOSPITALISTS FROM ALL PARTS OF THE COUNTRY—and a few other countries—discussed a wide swath of topics during a community-based HM special-interest forum at HM10. Issues that were discussed included unit-based rounding, changes to Medicare consult codes, strategies for avoiding “dumps,” and working with specialists.

Two established community hospitalists—SHM co-founders John Nelson, MD, MHM, and Winthrop Whitcomb, MD, MHM—moderated the one-hour session.

Much of the debate centered on defining a hospitalist’s role and relationships with others in the hospital. One hospitalist said he’d noticed significant changes in the 15 years since he began HM practice; however, some issues remain unresolved: Primary-care physicians (PCPs) still know the patients better, and medical specialists still want hospitalists to be their “interns.”

“We have two things to sell: your expertise and your availability. It’s up to your group to determine which one you want to sell,” said Tony Lin, MD, FHM, a hospitalist and chief of the Department of Internal Medicine at Kelsey-Seybold Clinic in Houston. “I don’t think you have to pick one. So I think you have to ask yourself: What does our group want to sell to the specialist? Sometimes you might have to turn them down to make that point.”

Dr. Lin also described a phenomena emerging in the Houston area: independent, one-physician HM groups taking root in community hospitals. “A lot of the surgeons are using them because they are willing to work as the interns and residents, the first people the nurses call at 2 a.m.,” he said. “There is a market for them.”

Dr. Nelson advised community hospitalists to avoid doing “the things that make you appear different from everyone else. Build social connections with specialists; call them by their first name; eat lunch in the cafeteria; and dress professionally.”

•

One community hospitalist spoke of an ethical situation she regularly encounters at her hospital, which contracts with multiple HM groups. Anna Rodriguez, MD, of Chesapeake Hospitalists in Chesapeake, Va., explained that her group’s issue is acutely ill patients who are assigned to one of the other HM group services—which, unlike Dr. Rodriguez’s group, are not responsible for codes or 24/7 patient coverage. So what happens when the “other” group’s patient has a sudden deterioration and the hospital staff calls us to run the rapid response? Dr. Rodriguez asked the group.

Dr. Whitcomb suggested Dr. Rodriguez’s group, which is not contracted to run the code, work to iron that situation out. “Then, that is your job and contractually recognized,” he said.

“We get into the exact same situation in our hospital. We created a hospital medicine section and … established expectations for who responds to codes,” said Dennis Kold, MD, medical director of the hospitalist service Tri-Health in Cincinnati. “If the patient is declining, we will respond to code, but we have it set up where the expectation is that the [attending] will be in to take care of the patient in one hour, or if the patient is admitted overnight to the ICU at 10 p.m., that the [admitting] will be in the ICU to take care of the patient within four hours.” Dr. Kold added that when the attending doesn’t show up in time that penalties are enforced (e.g., taken off the ER call schedule, restriction of hospital privileges).

“If you are not dealing with rapid response, then you are just hurting yourself,” added Edward Rosenfeld, MD, a hospitalist with Lehigh Valley Medical Associates in Allentown, Pa. “You need to do it; that’s your code prevention.”

•

Community hospitalists also discussed bundled payments and the recent changes in Medicare consult codes. “As a hospitalist service, I want to be involved in divvying up the money,” said Dan Allen, MD, a group director in Des Moines, Iowa. “I don’t know where it’s going, but I want to have a seat at the table.”

When asked by Dr. Nelson if they had noticed a significant change in reimbursement due to Medicare’s elimination of consultation codes, few in the room raised their hands. In fact, Dr. Nelson explained, “you can bill initial hospital care instead of initial hospital consult.”

“If done right, you might get paid better,” Dr. Rosenfeld added.

—Jason Carris

Health Information Technology on the Hospitalist Radar

Health information technology (HIT) isn’t for geeks anymore. A year after a mostly tech-savvy room discussed the basics of introducing more IT aspects to HM, nearly three dozen hospitalists clamored for SHM to take advocacy positions on everything from best practices to best vendors.

“SHM could help us all speak the language we need to speak,” said Tosha Wetterneck, MD, MS, a hospitalist with the University of Wisconsin Clinic in Madison. “Visibility, transparency—give us the words.”

Participants in last year’s group focused on the technical side of IT. This year’s attendees talked about the need for SHM to create portals for shared information, message boards to spur interinstitution conversations, and, perhaps, a weekend boot-camp-style course to introduce novices to basic IT information.

“SHM needs to take a stand now,” said Damascene Kurukulasuriya, MD, FACP, CMD, CCD, a hospitalist in perioperative medicine at the University of Missouri Health System in Columbia. “We need to be part of the solution.”

To that end, Kendall Rogers, MD, assistant professor at the University of New Mexico School of Medicine and chair of SHM’s IT Task Force, says the society is making progress. More hospitalists have been encouraged to sign up for the BioMedical Informatics course at the Marine Biology Laboratory in Woods Hole, Mass. The weeklong course is an introduction to the use of computer technologies and information science related to biomedicine and health science, according to the program’s Web site (www.courses.mbl.edu/mi/). The cost of travel, housing, and meals are fully paid for by the National Library of Medicine, making the fellowship even more appealing for cash-strapped hospitals and HM groups. “It’s a hidden program,” Dr. Rogers said.

Dr. Rogers and SHM CEO Larry Wellikson have toured the country meeting with top officials from the largest IT vendors, including Cerner and GE Healthcare. An IT committee has formed, with subcommittees dedicated to policy, quality, and leadership/education. But Bob Lineberger, MD, medical information officer at Durham Regional Hospital in North Carolina, says a nuanced message will take time.

“Our focus is just coming into focus,” Dr. Lineberger conceded. “We do need to come up with a position statement.”

—Richard Quinn

Education in HM: How to Grow Rock Stars and Champions

What skills does a hospitalist need to know to practice well that they didn’t learn in residency? That was the question new SHM President Jeff Weise, MD, SFHM, posed to about 20 hospitalists attending the special-interest forum on educational initiatives at HM10. Led by Dr. Wiese and SHM Education Committee co-chair Vikas Parekh, MD, FHM, the discussion focused on what SHM can do—or perhaps do better—in this capacity.

Dr. Parekh said hospitalists should be experts in quality-improvement (QI) and patient safety, and HM must incorporate that expertise into daily practice. However, he said, SHM’s largest educational focus is the new Focused Practice in Hospital Medicine pathway to American Board of Internal Medicine’s (ABIM) recertification.

In describing the future of this dynamic field, Dr. Weise raised concerns about managing the pipeline of approximately 2,500 new residents turning out each year and the potential for “losing intimacy” among SHM members—which he described as “the curse of being a champion.”

“IT is the only solution,” he added, “and identifying new and better ways of communicating.”

Competency-Based Train-ing (CBT) is critical to the development of new hospitalists, Dr. Wiese explained, as a supplement for what isn’t taught in residency. He posed a question: Should residencies last four or five years to incorporate additional training and career planning? “It’s an MBA paradigm of learning what we do,” he said. “What compels residents to join fellowship programs and earn $50K per year when they can start practicing and earning $150K?”

Educating the membership requires innovation and more than just bench-to-bedside research, Dr. Wiese added. Translational research and best-evidence practices will improve the field. “Five or 10 programs are rock stars,” he said, “but there are 377 that are terrible.”

Future SHM goals include a vision of having hospitalists hold 20% of all Internal Medicine Residency Program Director positions; developing best practices, not unfunded mandates; establishing protected academic time; and encouraging mentorship that positions hospitalists as heroes for the next generation.

An education committee sub-group has been tasked to focus on the recruitment of hospitalists and expose them to the best the society and field have to offer. HM10

—Phaedra Cress

IT’S 11 MINUTES to 8 o’clock, and the sun is still climbing over the Potomac River just outside the Gaylord National Resort & Convention Center in National Harbor, Md. Day two of SHM’s annual meeting is about to begin.

Hospitalists file into a cavernous ballroom as the day kicks off with a panel discussion on healthcare reform and a speech by that rarest of breed: a popular hospital CEO. The back of the room fills quickly, but front and center, second row—that’s the seat for Nasim Afsarmanesh, MD, director of quality for HM and neurosurgery at Ronald Reagan UCLA Medical Center in Los Angeles.

“If I’m not in the front, I zone out,” she admits.

Dr. Afsarmanesh (who often adds a hyphen to her surname— Afsar-manesh—to help others pronounce it) knows herself and she knows how to plan ahead, from taking notes on her mini-laptop to knowing when to sit up front. And this day in her life is no different. Her schedule is a 12-hour dervish, yet it’s a simple roadmap of how to navigate HM10 and its scores of sessions, speeches, and seminars.

Innovator at Heart

Dr. Afsarmanesh did her residency in 2007 at UCLA. She stayed on to take a faculty position and is now assistant clinical professor of internal medicine (IM) and neurosurgery. Her days are split about 35% clinical practice, 40% on neurology quality issues, and 25% on hospital QI projects. In her free time, she’s an SHM activist and the incoming chair of its Hospital Quality and Patient Safety (HQPS) Committee.

“I get to be an innovator,” she boasts as she picks up a Danish, a chocolate pastry, and a cup of tea following two hours of listening to others talk. “I love that. You can’t really be an innovator when you’re [purely] practicing clinical medicine.”

Innovation requires preparation, though. Dr. Afsarmanesh spends countless hours creating PowerPoint presentations, so she hit a new feature at this year’s meeting: a limited-seating workshop on drawing up effective slides. The presentation is helpful, but she’s partially distracted. “Look up healthcare from talk,” she types as a note to herself for later. She follows that with “Look up Levy’s talk” (a nod to Paul Levy, the well-liked CEO of Beth Israel Deaconess in Boston).

Facial Recognition

The distraction ratchets up as she’s already looking forward to introducing herself to the editorial board of the Journal of Hospital Medicine, where she serves as an assistant editor. There are a few people she’d like to meet in person, so she gracefully sneaks out the side door a few minutes before noon. Handshakes, a box lunch, and a chat with 40 other journal editors ensue for the next hour.

“You can meet people you talk on the phone with for several years,” she says. “You can put a face to the name. That’s important.”

Hobnobbing at a board meeting is only a brief respite, however, before it’s back to professional development. At 1:15, there’s a 60-minute lesson on how to improve care from the patient perspective. Dr. Afsarmanesh, again, is distracted. She’s a first-time presenter in a few minutes, part of a four-woman panel on building a QI educational curriculum for medical students, residents, fellows, faculty, and other healthcare providers.

She scrolls through slides, rehearsing her thoughts. She wonders whether her PowerPoint presentation would have made the grade at this morning’s session.

She is smart enough not to judge her performance too soon—someone in an audience once reached out to her a year later—as she knows the impact of a training session is more than the round of applause at its end.

“You hope that you generate a discussion more than the traditional didactics,” she says. “These meetings are meant to start a discussion and, hopefully, create a network and a community where people can continue to [share ideas and learn from each other]. … I hope that along with some of the content that people take away, the bigger thing is those connections that they make.”

Work Never Ends

It’s 4:30 p.m. and Dr. Afsarmanesh still has a sales pitch to rehearse. This time, it’s self-promotion for her soon-to-begin poster presentation: “The ABCs of Hospitalized Patients: A Multi-Disciplinary Checklist for Improving Quality of Patient Care."

After umpteen repetitions of her spiel, the presentation doesn’t win a prize, but, once again, she showcases her attention to detail: A stack of 8.5”x 11” versions of her poster are available for handouts, a feature few others in the competition have.

Some 12 hours into her tour of this massive convention center, the day is coming to a close. But not before SHM CEO Larry Wellikson, MD, SFHM, drops by to say hello.

He points out how strong her research is. Unfortunately, he uses a pen in the process.

“Don’t poke a hole in my poster,” she jokes.

Moments later, it’s back to working the line queued up at her poster. “Hi, would you like to hear about my poster?” HM2010

Richard Quinn is a freelance writer based in New Jersey.

IT’S 11 MINUTES to 8 o’clock, and the sun is still climbing over the Potomac River just outside the Gaylord National Resort & Convention Center in National Harbor, Md. Day two of SHM’s annual meeting is about to begin.

Hospitalists file into a cavernous ballroom as the day kicks off with a panel discussion on healthcare reform and a speech by that rarest of breed: a popular hospital CEO. The back of the room fills quickly, but front and center, second row—that’s the seat for Nasim Afsarmanesh, MD, director of quality for HM and neurosurgery at Ronald Reagan UCLA Medical Center in Los Angeles.

“If I’m not in the front, I zone out,” she admits.

Dr. Afsarmanesh (who often adds a hyphen to her surname— Afsar-manesh—to help others pronounce it) knows herself and she knows how to plan ahead, from taking notes on her mini-laptop to knowing when to sit up front. And this day in her life is no different. Her schedule is a 12-hour dervish, yet it’s a simple roadmap of how to navigate HM10 and its scores of sessions, speeches, and seminars.

Innovator at Heart

Dr. Afsarmanesh did her residency in 2007 at UCLA. She stayed on to take a faculty position and is now assistant clinical professor of internal medicine (IM) and neurosurgery. Her days are split about 35% clinical practice, 40% on neurology quality issues, and 25% on hospital QI projects. In her free time, she’s an SHM activist and the incoming chair of its Hospital Quality and Patient Safety (HQPS) Committee.

“I get to be an innovator,” she boasts as she picks up a Danish, a chocolate pastry, and a cup of tea following two hours of listening to others talk. “I love that. You can’t really be an innovator when you’re [purely] practicing clinical medicine.”

Innovation requires preparation, though. Dr. Afsarmanesh spends countless hours creating PowerPoint presentations, so she hit a new feature at this year’s meeting: a limited-seating workshop on drawing up effective slides. The presentation is helpful, but she’s partially distracted. “Look up healthcare from talk,” she types as a note to herself for later. She follows that with “Look up Levy’s talk” (a nod to Paul Levy, the well-liked CEO of Beth Israel Deaconess in Boston).

Facial Recognition

The distraction ratchets up as she’s already looking forward to introducing herself to the editorial board of the Journal of Hospital Medicine, where she serves as an assistant editor. There are a few people she’d like to meet in person, so she gracefully sneaks out the side door a few minutes before noon. Handshakes, a box lunch, and a chat with 40 other journal editors ensue for the next hour.

“You can meet people you talk on the phone with for several years,” she says. “You can put a face to the name. That’s important.”

Hobnobbing at a board meeting is only a brief respite, however, before it’s back to professional development. At 1:15, there’s a 60-minute lesson on how to improve care from the patient perspective. Dr. Afsarmanesh, again, is distracted. She’s a first-time presenter in a few minutes, part of a four-woman panel on building a QI educational curriculum for medical students, residents, fellows, faculty, and other healthcare providers.

She scrolls through slides, rehearsing her thoughts. She wonders whether her PowerPoint presentation would have made the grade at this morning’s session.

She is smart enough not to judge her performance too soon—someone in an audience once reached out to her a year later—as she knows the impact of a training session is more than the round of applause at its end.

“You hope that you generate a discussion more than the traditional didactics,” she says. “These meetings are meant to start a discussion and, hopefully, create a network and a community where people can continue to [share ideas and learn from each other]. … I hope that along with some of the content that people take away, the bigger thing is those connections that they make.”

Work Never Ends

It’s 4:30 p.m. and Dr. Afsarmanesh still has a sales pitch to rehearse. This time, it’s self-promotion for her soon-to-begin poster presentation: “The ABCs of Hospitalized Patients: A Multi-Disciplinary Checklist for Improving Quality of Patient Care."

After umpteen repetitions of her spiel, the presentation doesn’t win a prize, but, once again, she showcases her attention to detail: A stack of 8.5”x 11” versions of her poster are available for handouts, a feature few others in the competition have.

Some 12 hours into her tour of this massive convention center, the day is coming to a close. But not before SHM CEO Larry Wellikson, MD, SFHM, drops by to say hello.

He points out how strong her research is. Unfortunately, he uses a pen in the process.

“Don’t poke a hole in my poster,” she jokes.

Moments later, it’s back to working the line queued up at her poster. “Hi, would you like to hear about my poster?” HM2010

Richard Quinn is a freelance writer based in New Jersey.

IT’S 11 MINUTES to 8 o’clock, and the sun is still climbing over the Potomac River just outside the Gaylord National Resort & Convention Center in National Harbor, Md. Day two of SHM’s annual meeting is about to begin.

Hospitalists file into a cavernous ballroom as the day kicks off with a panel discussion on healthcare reform and a speech by that rarest of breed: a popular hospital CEO. The back of the room fills quickly, but front and center, second row—that’s the seat for Nasim Afsarmanesh, MD, director of quality for HM and neurosurgery at Ronald Reagan UCLA Medical Center in Los Angeles.

“If I’m not in the front, I zone out,” she admits.

Dr. Afsarmanesh (who often adds a hyphen to her surname— Afsar-manesh—to help others pronounce it) knows herself and she knows how to plan ahead, from taking notes on her mini-laptop to knowing when to sit up front. And this day in her life is no different. Her schedule is a 12-hour dervish, yet it’s a simple roadmap of how to navigate HM10 and its scores of sessions, speeches, and seminars.

Innovator at Heart

Dr. Afsarmanesh did her residency in 2007 at UCLA. She stayed on to take a faculty position and is now assistant clinical professor of internal medicine (IM) and neurosurgery. Her days are split about 35% clinical practice, 40% on neurology quality issues, and 25% on hospital QI projects. In her free time, she’s an SHM activist and the incoming chair of its Hospital Quality and Patient Safety (HQPS) Committee.

“I get to be an innovator,” she boasts as she picks up a Danish, a chocolate pastry, and a cup of tea following two hours of listening to others talk. “I love that. You can’t really be an innovator when you’re [purely] practicing clinical medicine.”

Innovation requires preparation, though. Dr. Afsarmanesh spends countless hours creating PowerPoint presentations, so she hit a new feature at this year’s meeting: a limited-seating workshop on drawing up effective slides. The presentation is helpful, but she’s partially distracted. “Look up healthcare from talk,” she types as a note to herself for later. She follows that with “Look up Levy’s talk” (a nod to Paul Levy, the well-liked CEO of Beth Israel Deaconess in Boston).

Facial Recognition

The distraction ratchets up as she’s already looking forward to introducing herself to the editorial board of the Journal of Hospital Medicine, where she serves as an assistant editor. There are a few people she’d like to meet in person, so she gracefully sneaks out the side door a few minutes before noon. Handshakes, a box lunch, and a chat with 40 other journal editors ensue for the next hour.

“You can meet people you talk on the phone with for several years,” she says. “You can put a face to the name. That’s important.”

Hobnobbing at a board meeting is only a brief respite, however, before it’s back to professional development. At 1:15, there’s a 60-minute lesson on how to improve care from the patient perspective. Dr. Afsarmanesh, again, is distracted. She’s a first-time presenter in a few minutes, part of a four-woman panel on building a QI educational curriculum for medical students, residents, fellows, faculty, and other healthcare providers.

She scrolls through slides, rehearsing her thoughts. She wonders whether her PowerPoint presentation would have made the grade at this morning’s session.

She is smart enough not to judge her performance too soon—someone in an audience once reached out to her a year later—as she knows the impact of a training session is more than the round of applause at its end.

“You hope that you generate a discussion more than the traditional didactics,” she says. “These meetings are meant to start a discussion and, hopefully, create a network and a community where people can continue to [share ideas and learn from each other]. … I hope that along with some of the content that people take away, the bigger thing is those connections that they make.”

Work Never Ends

It’s 4:30 p.m. and Dr. Afsarmanesh still has a sales pitch to rehearse. This time, it’s self-promotion for her soon-to-begin poster presentation: “The ABCs of Hospitalized Patients: A Multi-Disciplinary Checklist for Improving Quality of Patient Care."

After umpteen repetitions of her spiel, the presentation doesn’t win a prize, but, once again, she showcases her attention to detail: A stack of 8.5”x 11” versions of her poster are available for handouts, a feature few others in the competition have.

Some 12 hours into her tour of this massive convention center, the day is coming to a close. But not before SHM CEO Larry Wellikson, MD, SFHM, drops by to say hello.

He points out how strong her research is. Unfortunately, he uses a pen in the process.

“Don’t poke a hole in my poster,” she jokes.

Moments later, it’s back to working the line queued up at her poster. “Hi, would you like to hear about my poster?” HM2010

Richard Quinn is a freelance writer based in New Jersey.

NATIONAL HARBOR, Md. HM10 kicked off with a pediatric hospitalist leading the way. Patrick Conway, MD, MSc, a chief medical officer with the U.S. Department of Health and Human Services, and one of pediatric HM’s own, was a part of the opening panel discussion that reviewed the implications of healthcare reform. And as the pediatric track coursed over the next two days, amidst the hustle and bustle of value-laden content, the final pediatric presentation just might have escaped routine notice.

Two days after its electronic release, a live preview of the “Pediatric Hospital Medicine Core Competencies” debuted at HM 2010.¹ (The core competencies were printed as a supplement in the April issue of the Journal of Hospital Medicine.)

Mary Ottolini, MD, of Children’s National Medical Center in Washington, D.C., graciously thanked Erin Stucky, MD, Rady Children’s Hospital in San Diego, and Jennifer Maniscalco, MD, Children’s Hospital in Los Angeles, for their collaboration in the core competencies effort, which represented the culmination of years of perseverance and dedication. The core competencies underwent a rigorous development and review process; notably, draft copies were sent to more than 30 academic and certifying societies and stakeholder agencies for input. Vibrant discussion ensued as pediatric, family practice, and med-ped hospitalists engaged in both thoughtful reflection and optimistic forecasts of the relevance and utility of a practical framework to define the field.

These guidelines, however, are just the beginning. Much dialogue centered on the future role of the core competencies in such arenas as education and professional development. It became clear that work remains if pediatric hospitalists are to make the best use of this sentinel publication.

Nonetheless, this journey that is the advancement of a vibrant—and now well-defined—field of medicine has a stellar launching pad from which to take flight. HM10

Dr. Shen is a pediatric hospitalist and director of the hospital medicine program at Dell Children’s Hospital in Austin, Texas.

Reference

1. Stucky ER, Maniscalco J, Ottolini MC, et al. The pediatric hospital medicine core competencies. J Hosp Med. 2010;5(S2):1-82.

NATIONAL HARBOR, Md. HM10 kicked off with a pediatric hospitalist leading the way. Patrick Conway, MD, MSc, a chief medical officer with the U.S. Department of Health and Human Services, and one of pediatric HM’s own, was a part of the opening panel discussion that reviewed the implications of healthcare reform. And as the pediatric track coursed over the next two days, amidst the hustle and bustle of value-laden content, the final pediatric presentation just might have escaped routine notice.

Two days after its electronic release, a live preview of the “Pediatric Hospital Medicine Core Competencies” debuted at HM 2010.¹ (The core competencies were printed as a supplement in the April issue of the Journal of Hospital Medicine.)

Mary Ottolini, MD, of Children’s National Medical Center in Washington, D.C., graciously thanked Erin Stucky, MD, Rady Children’s Hospital in San Diego, and Jennifer Maniscalco, MD, Children’s Hospital in Los Angeles, for their collaboration in the core competencies effort, which represented the culmination of years of perseverance and dedication. The core competencies underwent a rigorous development and review process; notably, draft copies were sent to more than 30 academic and certifying societies and stakeholder agencies for input. Vibrant discussion ensued as pediatric, family practice, and med-ped hospitalists engaged in both thoughtful reflection and optimistic forecasts of the relevance and utility of a practical framework to define the field.

These guidelines, however, are just the beginning. Much dialogue centered on the future role of the core competencies in such arenas as education and professional development. It became clear that work remains if pediatric hospitalists are to make the best use of this sentinel publication.

Nonetheless, this journey that is the advancement of a vibrant—and now well-defined—field of medicine has a stellar launching pad from which to take flight. HM10

Dr. Shen is a pediatric hospitalist and director of the hospital medicine program at Dell Children’s Hospital in Austin, Texas.

Reference

1. Stucky ER, Maniscalco J, Ottolini MC, et al. The pediatric hospital medicine core competencies. J Hosp Med. 2010;5(S2):1-82.

NATIONAL HARBOR, Md. HM10 kicked off with a pediatric hospitalist leading the way. Patrick Conway, MD, MSc, a chief medical officer with the U.S. Department of Health and Human Services, and one of pediatric HM’s own, was a part of the opening panel discussion that reviewed the implications of healthcare reform. And as the pediatric track coursed over the next two days, amidst the hustle and bustle of value-laden content, the final pediatric presentation just might have escaped routine notice.

Two days after its electronic release, a live preview of the “Pediatric Hospital Medicine Core Competencies” debuted at HM 2010.¹ (The core competencies were printed as a supplement in the April issue of the Journal of Hospital Medicine.)

Mary Ottolini, MD, of Children’s National Medical Center in Washington, D.C., graciously thanked Erin Stucky, MD, Rady Children’s Hospital in San Diego, and Jennifer Maniscalco, MD, Children’s Hospital in Los Angeles, for their collaboration in the core competencies effort, which represented the culmination of years of perseverance and dedication. The core competencies underwent a rigorous development and review process; notably, draft copies were sent to more than 30 academic and certifying societies and stakeholder agencies for input. Vibrant discussion ensued as pediatric, family practice, and med-ped hospitalists engaged in both thoughtful reflection and optimistic forecasts of the relevance and utility of a practical framework to define the field.

These guidelines, however, are just the beginning. Much dialogue centered on the future role of the core competencies in such arenas as education and professional development. It became clear that work remains if pediatric hospitalists are to make the best use of this sentinel publication.

Nonetheless, this journey that is the advancement of a vibrant—and now well-defined—field of medicine has a stellar launching pad from which to take flight. HM10

Dr. Shen is a pediatric hospitalist and director of the hospital medicine program at Dell Children’s Hospital in Austin, Texas.

Reference

1. Stucky ER, Maniscalco J, Ottolini MC, et al. The pediatric hospital medicine core competencies. J Hosp Med. 2010;5(S2):1-82.

JOHN G. BARTLETT, MD, professor of medicine in the Department of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, mesmerized a standing-room-only crowd of more than 500 at his lecture about the increase of Clostridium difficile in U.S. hospitals.

C. diff incidence has more than doubled since the mid-1990s, to more than 160 cases per 100,000 patients, and currently outnumbers the annual total of MRSA cases in the U.S., according to Dr. Bartlett, one of the foremost scholars on the subject. For hospitalists encountering patients with questions about the disease and where it comes from, Dr. Bartlett encouraged providers to punt that question: “The fact is, we don’t know most of the time.”

Most patients acquire C. diff during a hospital stay (74%) or a previous hospital stay (21%), and research shows the longer patients stay in the hospital, the more likely they are to acquire the disease.

“It’s embedded in the fabric of hospitals,” Dr. Bartlett said. “The longer you are in the hospital, the more likely you are to get colonized.”

Prevention guidelines include:

• Hand hygiene;
• Advocate gloves and gowns;
• Patients with C. diff should be in single rooms;
• Maintain precautions until diarrhea resolves; and
• Clean with chlorine antiseptic.

Dr. Bartlett was excited to share his experience with RT-PCR testing, which he termed the “new, slick, fast” testing option for C. diff. In trials, it has been shown to be 99% sensitive and 98% specific. “If your lab does PCR, it is the best test currently available,” Dr. Bartlett said, although he cautioned that “this test detects the bug, not the toxin.”

Treatment of C. diff disease happens in the colon, and medications must make it there to be effective. The most common treatments, vancomycin and metronidazole, have pluses and minuses, Dr. Bartlett explained. Vancomycin is FDA-approved and unbeaten in clinical trials; however, it is the more expensive choice. Metronidazole is cheaper ($5 per day) and proven to be effective in mild to moderate cases, but is not FDA-approved and is unproven in severe cases.

Dr. Bartlett’s guidelines for C. diff treatment:

• Mild cases: no treatment;
• Moderate: metronidazole 250 mg four times a day for 10 to 14 days; and
• Serious: vancomycin 125 mg four times a day for 10 to 14 days.

“If metro doesn’t work, switch to oral vanco,” Dr. Bartlett said. HM10

JOHN G. BARTLETT, MD, professor of medicine in the Department of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, mesmerized a standing-room-only crowd of more than 500 at his lecture about the increase of Clostridium difficile in U.S. hospitals.

C. diff incidence has more than doubled since the mid-1990s, to more than 160 cases per 100,000 patients, and currently outnumbers the annual total of MRSA cases in the U.S., according to Dr. Bartlett, one of the foremost scholars on the subject. For hospitalists encountering patients with questions about the disease and where it comes from, Dr. Bartlett encouraged providers to punt that question: “The fact is, we don’t know most of the time.”

Most patients acquire C. diff during a hospital stay (74%) or a previous hospital stay (21%), and research shows the longer patients stay in the hospital, the more likely they are to acquire the disease.

“It’s embedded in the fabric of hospitals,” Dr. Bartlett said. “The longer you are in the hospital, the more likely you are to get colonized.”

Prevention guidelines include:

• Hand hygiene;
• Advocate gloves and gowns;
• Patients with C. diff should be in single rooms;
• Maintain precautions until diarrhea resolves; and
• Clean with chlorine antiseptic.

Dr. Bartlett was excited to share his experience with RT-PCR testing, which he termed the “new, slick, fast” testing option for C. diff. In trials, it has been shown to be 99% sensitive and 98% specific. “If your lab does PCR, it is the best test currently available,” Dr. Bartlett said, although he cautioned that “this test detects the bug, not the toxin.”

Treatment of C. diff disease happens in the colon, and medications must make it there to be effective. The most common treatments, vancomycin and metronidazole, have pluses and minuses, Dr. Bartlett explained. Vancomycin is FDA-approved and unbeaten in clinical trials; however, it is the more expensive choice. Metronidazole is cheaper ($5 per day) and proven to be effective in mild to moderate cases, but is not FDA-approved and is unproven in severe cases.

Dr. Bartlett’s guidelines for C. diff treatment:

• Mild cases: no treatment;
• Moderate: metronidazole 250 mg four times a day for 10 to 14 days; and
• Serious: vancomycin 125 mg four times a day for 10 to 14 days.

“If metro doesn’t work, switch to oral vanco,” Dr. Bartlett said. HM10

JOHN G. BARTLETT, MD, professor of medicine in the Department of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, mesmerized a standing-room-only crowd of more than 500 at his lecture about the increase of Clostridium difficile in U.S. hospitals.

C. diff incidence has more than doubled since the mid-1990s, to more than 160 cases per 100,000 patients, and currently outnumbers the annual total of MRSA cases in the U.S., according to Dr. Bartlett, one of the foremost scholars on the subject. For hospitalists encountering patients with questions about the disease and where it comes from, Dr. Bartlett encouraged providers to punt that question: “The fact is, we don’t know most of the time.”

Most patients acquire C. diff during a hospital stay (74%) or a previous hospital stay (21%), and research shows the longer patients stay in the hospital, the more likely they are to acquire the disease.

“It’s embedded in the fabric of hospitals,” Dr. Bartlett said. “The longer you are in the hospital, the more likely you are to get colonized.”

Prevention guidelines include:

• Hand hygiene;
• Advocate gloves and gowns;
• Patients with C. diff should be in single rooms;
• Maintain precautions until diarrhea resolves; and
• Clean with chlorine antiseptic.

Dr. Bartlett was excited to share his experience with RT-PCR testing, which he termed the “new, slick, fast” testing option for C. diff. In trials, it has been shown to be 99% sensitive and 98% specific. “If your lab does PCR, it is the best test currently available,” Dr. Bartlett said, although he cautioned that “this test detects the bug, not the toxin.”

Treatment of C. diff disease happens in the colon, and medications must make it there to be effective. The most common treatments, vancomycin and metronidazole, have pluses and minuses, Dr. Bartlett explained. Vancomycin is FDA-approved and unbeaten in clinical trials; however, it is the more expensive choice. Metronidazole is cheaper ($5 per day) and proven to be effective in mild to moderate cases, but is not FDA-approved and is unproven in severe cases.

Dr. Bartlett’s guidelines for C. diff treatment:

• Mild cases: no treatment;
• Moderate: metronidazole 250 mg four times a day for 10 to 14 days; and
• Serious: vancomycin 125 mg four times a day for 10 to 14 days.

“If metro doesn’t work, switch to oral vanco,” Dr. Bartlett said. HM10

PHYSICIAN ASSISTANTS (PAs) and nurse practitioners can do almost anything a physician can do, and many have skill sets physicians lack, according to David Friar, MD, FHM, president of Hospitalists of Northwest Michigan based in Traverse City.

“As we go forward, with continued physician shortages and with the growing responsibilities of the hospitalist movement, we are going to need more and more people with different skill sets,” Dr. Friar said during his presentation at HM10. “I think one of those important areas is nonphysician providers.”

A quick survey of the 300 or so hospitalists at the session showed most HM groups employ NPPs, but less than a third of those thought they were “using NPPs well.” Dr. Friar, who has worked with NPs and PAs for 14 years, said he has found NPPs “to be an integral part of our practice. They have become indispensable to us in the way we provide services to our hospitals and patients.”

Still, many hospitalist groups waste NPP potential, Dr. Friar explained. He suggested HM groups evaluate their NPP roster and duties, and make necessary changes. “Make sure you treat them as if they are part of the team. That is very important,” he said. “NPPs can and should take care of patients throughout all stages of the hospital stay, from admission to discharge.”

When hiring NPPs, look for team players who are flexible and willing to learn. Make sure the NPP knows their limits and is comfortable asking for help. Target local training programs or other departments in the hospital as fertile ground for new hires. But, most importantly, know what you are getting when you hire an NPP.

“Don’t underestimate the cost of the inexperienced NPP in terms of training. If you think it’s two weeks or two months, you are fooling yourself,” Dr. Friar emphasized, adding an inexperienced NPP could take from six months to two years to reach full competency in hospitalist service. “Know the tradeoffs,” he said. “It might be more important for you to hire the more experienced—and more costly—NPP so you don’t have to spend two years to get them up to speed.” HM10

PHYSICIAN ASSISTANTS (PAs) and nurse practitioners can do almost anything a physician can do, and many have skill sets physicians lack, according to David Friar, MD, FHM, president of Hospitalists of Northwest Michigan based in Traverse City.

“As we go forward, with continued physician shortages and with the growing responsibilities of the hospitalist movement, we are going to need more and more people with different skill sets,” Dr. Friar said during his presentation at HM10. “I think one of those important areas is nonphysician providers.”

A quick survey of the 300 or so hospitalists at the session showed most HM groups employ NPPs, but less than a third of those thought they were “using NPPs well.” Dr. Friar, who has worked with NPs and PAs for 14 years, said he has found NPPs “to be an integral part of our practice. They have become indispensable to us in the way we provide services to our hospitals and patients.”

Still, many hospitalist groups waste NPP potential, Dr. Friar explained. He suggested HM groups evaluate their NPP roster and duties, and make necessary changes. “Make sure you treat them as if they are part of the team. That is very important,” he said. “NPPs can and should take care of patients throughout all stages of the hospital stay, from admission to discharge.”

When hiring NPPs, look for team players who are flexible and willing to learn. Make sure the NPP knows their limits and is comfortable asking for help. Target local training programs or other departments in the hospital as fertile ground for new hires. But, most importantly, know what you are getting when you hire an NPP.

“Don’t underestimate the cost of the inexperienced NPP in terms of training. If you think it’s two weeks or two months, you are fooling yourself,” Dr. Friar emphasized, adding an inexperienced NPP could take from six months to two years to reach full competency in hospitalist service. “Know the tradeoffs,” he said. “It might be more important for you to hire the more experienced—and more costly—NPP so you don’t have to spend two years to get them up to speed.” HM10

PHYSICIAN ASSISTANTS (PAs) and nurse practitioners can do almost anything a physician can do, and many have skill sets physicians lack, according to David Friar, MD, FHM, president of Hospitalists of Northwest Michigan based in Traverse City.

“As we go forward, with continued physician shortages and with the growing responsibilities of the hospitalist movement, we are going to need more and more people with different skill sets,” Dr. Friar said during his presentation at HM10. “I think one of those important areas is nonphysician providers.”

A quick survey of the 300 or so hospitalists at the session showed most HM groups employ NPPs, but less than a third of those thought they were “using NPPs well.” Dr. Friar, who has worked with NPs and PAs for 14 years, said he has found NPPs “to be an integral part of our practice. They have become indispensable to us in the way we provide services to our hospitals and patients.”

Still, many hospitalist groups waste NPP potential, Dr. Friar explained. He suggested HM groups evaluate their NPP roster and duties, and make necessary changes. “Make sure you treat them as if they are part of the team. That is very important,” he said. “NPPs can and should take care of patients throughout all stages of the hospital stay, from admission to discharge.”

When hiring NPPs, look for team players who are flexible and willing to learn. Make sure the NPP knows their limits and is comfortable asking for help. Target local training programs or other departments in the hospital as fertile ground for new hires. But, most importantly, know what you are getting when you hire an NPP.

“Don’t underestimate the cost of the inexperienced NPP in terms of training. If you think it’s two weeks or two months, you are fooling yourself,” Dr. Friar emphasized, adding an inexperienced NPP could take from six months to two years to reach full competency in hospitalist service. “Know the tradeoffs,” he said. “It might be more important for you to hire the more experienced—and more costly—NPP so you don’t have to spend two years to get them up to speed.” HM10

ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

• Treat UEDVT seriously;
• Understand there is a higher rate of PE than previously thought;
• Insert central-vein catheters judiciously, and keep them in if you still need them;
• Manage the duration of therapy parallel to that of lower extremity DVT; and
• Routine thrombolytics use isn’t indicated at this time. HM10

ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

• Treat UEDVT seriously;
• Understand there is a higher rate of PE than previously thought;
• Insert central-vein catheters judiciously, and keep them in if you still need them;
• Manage the duration of therapy parallel to that of lower extremity DVT; and
• Routine thrombolytics use isn’t indicated at this time. HM10

ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

• Treat UEDVT seriously;
• Understand there is a higher rate of PE than previously thought;
• Insert central-vein catheters judiciously, and keep them in if you still need them;
• Manage the duration of therapy parallel to that of lower extremity DVT; and
• Routine thrombolytics use isn’t indicated at this time. HM10

BUILDING QUALITY improvement (QI) into the healthcare process starts with education, but to date, standardized QI curriculums have not taken root across academic medical centers.

A quartet of academic hospitalists pushed the concept during an HM10 session titled “Quality Improvement Curriculum: How to Get Started and to Keep Going.” All four speakers agreed that QI “empowers providers to create change.”

The presentation was based on a 1998 book from first author David Kern, MD, MPH, FACP, professor at the Johns Hopkins University School of Medicine in Baltimore: “Curriculum Development for Medical Education: A Six-Step Process.” Some of the take-home points included:

• Problem identification and a general-needs assessment, followed by a targeted needs assessment. Combined, the two steps create a construct for an issue, such as “residents lack knowledge skills in QI,” and then hone in with such queries as “What is the baseline knowledge?”
• Goals and objectives. There is a difference between the two. Goals are broad-based with little specificity; objectives are measurable items that gauge progress.
• Educational strategies. Cognitive objectives can be taught via lectures or team-based projects; however, skill-based objectives traditionally are better taught via hands-on experience.
• Implementation, evaluation, and feedback. Many programs try to move too quickly and put something in place before fully planning out the curriculum.

“Take a step back,” said Arpana Vidyarthi, MD, assistant professor and director of quality University of California at San Francisco. “What you do in implementing your curriculum ought to be connected to what your goals and objectives are.” HM10

BUILDING QUALITY improvement (QI) into the healthcare process starts with education, but to date, standardized QI curriculums have not taken root across academic medical centers.

A quartet of academic hospitalists pushed the concept during an HM10 session titled “Quality Improvement Curriculum: How to Get Started and to Keep Going.” All four speakers agreed that QI “empowers providers to create change.”

The presentation was based on a 1998 book from first author David Kern, MD, MPH, FACP, professor at the Johns Hopkins University School of Medicine in Baltimore: “Curriculum Development for Medical Education: A Six-Step Process.” Some of the take-home points included:

• Problem identification and a general-needs assessment, followed by a targeted needs assessment. Combined, the two steps create a construct for an issue, such as “residents lack knowledge skills in QI,” and then hone in with such queries as “What is the baseline knowledge?”
• Goals and objectives. There is a difference between the two. Goals are broad-based with little specificity; objectives are measurable items that gauge progress.
• Educational strategies. Cognitive objectives can be taught via lectures or team-based projects; however, skill-based objectives traditionally are better taught via hands-on experience.
• Implementation, evaluation, and feedback. Many programs try to move too quickly and put something in place before fully planning out the curriculum.

“Take a step back,” said Arpana Vidyarthi, MD, assistant professor and director of quality University of California at San Francisco. “What you do in implementing your curriculum ought to be connected to what your goals and objectives are.” HM10

BUILDING QUALITY improvement (QI) into the healthcare process starts with education, but to date, standardized QI curriculums have not taken root across academic medical centers.

A quartet of academic hospitalists pushed the concept during an HM10 session titled “Quality Improvement Curriculum: How to Get Started and to Keep Going.” All four speakers agreed that QI “empowers providers to create change.”

The presentation was based on a 1998 book from first author David Kern, MD, MPH, FACP, professor at the Johns Hopkins University School of Medicine in Baltimore: “Curriculum Development for Medical Education: A Six-Step Process.” Some of the take-home points included:

• Problem identification and a general-needs assessment, followed by a targeted needs assessment. Combined, the two steps create a construct for an issue, such as “residents lack knowledge skills in QI,” and then hone in with such queries as “What is the baseline knowledge?”
• Goals and objectives. There is a difference between the two. Goals are broad-based with little specificity; objectives are measurable items that gauge progress.
• Educational strategies. Cognitive objectives can be taught via lectures or team-based projects; however, skill-based objectives traditionally are better taught via hands-on experience.
• Implementation, evaluation, and feedback. Many programs try to move too quickly and put something in place before fully planning out the curriculum.

“Take a step back,” said Arpana Vidyarthi, MD, assistant professor and director of quality University of California at San Francisco. “What you do in implementing your curriculum ought to be connected to what your goals and objectives are.” HM10

SIT DOWN.

A simple piece of advice, to be sure, but one that can also humanize a hospitalist in the eyes of a patient, said panelists of “The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting and Benchmarking.”

“As many doctors are figuring out, perception is reality,” said Patrick Blakeslee, DO, a hospitalist with Premiere Medical Partners in Cuyahoga Falls, Ohio. The credentialing process at his hospital takes into account patient-satisfaction levels. “This is articulation ability, not necessarily your technical skill,” he said.

But like any other facet of medicine, with training, hospitalists can improve the patient’s interaction with physicians. Some tips:

• Craft a script for introductions. While it might sound rehearsed, it also gives the hospitalist a chance to lay out ahead of time what they want to say instead of curtailing the message because of a daily time crunch.
• Develop a business card with your picture or a brochure with an FAQ. Give the patient a sense of what they can expect from their doctor and vice versa.
• End with an open-ended question. This technique engages the patient in their treatment.

HM leaders looking to go even further with patient-satisfaction programs can develop an in-house survey that might gauge responses more accurately, said Nancy Mihevc, PhD, president of The Research Group in Florence, Mass. Outside surveys can be valuable, depending on the methodology they use, she said.

“We’re all, at this point, being measured in this realm,” said Winthrop Whitcomb, MD, MHM, medical director for healthcare quality at Baystate Medical Center in Springfield, Mass. “Should you as a hospitalist be compared to all programs, or should you be compared to just hospitalists?” HM10

SIT DOWN.

A simple piece of advice, to be sure, but one that can also humanize a hospitalist in the eyes of a patient, said panelists of “The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting and Benchmarking.”

“As many doctors are figuring out, perception is reality,” said Patrick Blakeslee, DO, a hospitalist with Premiere Medical Partners in Cuyahoga Falls, Ohio. The credentialing process at his hospital takes into account patient-satisfaction levels. “This is articulation ability, not necessarily your technical skill,” he said.

But like any other facet of medicine, with training, hospitalists can improve the patient’s interaction with physicians. Some tips:

• Craft a script for introductions. While it might sound rehearsed, it also gives the hospitalist a chance to lay out ahead of time what they want to say instead of curtailing the message because of a daily time crunch.
• Develop a business card with your picture or a brochure with an FAQ. Give the patient a sense of what they can expect from their doctor and vice versa.
• End with an open-ended question. This technique engages the patient in their treatment.

HM leaders looking to go even further with patient-satisfaction programs can develop an in-house survey that might gauge responses more accurately, said Nancy Mihevc, PhD, president of The Research Group in Florence, Mass. Outside surveys can be valuable, depending on the methodology they use, she said.

“We’re all, at this point, being measured in this realm,” said Winthrop Whitcomb, MD, MHM, medical director for healthcare quality at Baystate Medical Center in Springfield, Mass. “Should you as a hospitalist be compared to all programs, or should you be compared to just hospitalists?” HM10

SIT DOWN.

A simple piece of advice, to be sure, but one that can also humanize a hospitalist in the eyes of a patient, said panelists of “The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting and Benchmarking.”

“As many doctors are figuring out, perception is reality,” said Patrick Blakeslee, DO, a hospitalist with Premiere Medical Partners in Cuyahoga Falls, Ohio. The credentialing process at his hospital takes into account patient-satisfaction levels. “This is articulation ability, not necessarily your technical skill,” he said.

But like any other facet of medicine, with training, hospitalists can improve the patient’s interaction with physicians. Some tips:

• Craft a script for introductions. While it might sound rehearsed, it also gives the hospitalist a chance to lay out ahead of time what they want to say instead of curtailing the message because of a daily time crunch.
• Develop a business card with your picture or a brochure with an FAQ. Give the patient a sense of what they can expect from their doctor and vice versa.
• End with an open-ended question. This technique engages the patient in their treatment.

HM leaders looking to go even further with patient-satisfaction programs can develop an in-house survey that might gauge responses more accurately, said Nancy Mihevc, PhD, president of The Research Group in Florence, Mass. Outside surveys can be valuable, depending on the methodology they use, she said.

“We’re all, at this point, being measured in this realm,” said Winthrop Whitcomb, MD, MHM, medical director for healthcare quality at Baystate Medical Center in Springfield, Mass. “Should you as a hospitalist be compared to all programs, or should you be compared to just hospitalists?” HM10

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10

NATIONAL HARBOR, Md.—It’s happened to every hospitalist who has pushed for a quality improvement (QI) project in their hospital: A chief says no because there’s no money for it. Doesn’t matter if it was the chief medical officer, chief operating officer, or the chief financial officer—the answer is no, no, no.

The best way to change the answer? Change the question.

“Think like they do,” said Mahalakshmi K. Halasymani, MD, SFHM, vice president for quality and systems improvement
at Saint Joseph Mercy Health System in Ann Arbor, Mich. “Think about how healthcare is paid for. … [Administrators are] much more likely to release resources if it matters to the institution’s ability to collect money, or get a better survey next time.”

Dr. Halasymani, an SHM board member, co-led the session “The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI” with hospitalist Mark Novotny, MD, FHM, who held several C-suite positions at Southwestern Vermont Medical Center in Bennington, Vt., before parting ways with the hospital in early April. Both physicians urge getting organized before taking any case to hospital or health system administrators. Some of their tips:

• Define the scope of your proposal. Tackling too many issues can appear over-reaching. Attain a reasonable goal and build on success; that works better than swinging and missing with loftier goals.
• Attack topic areas with metrics. QI projects are only as good as the data they produce.
• Be interactive. Bring a C-suite member along on daily rounds for a week to showcase the problem you hope to address. When an administrator sees a need for improvement in real time, the issue is personalized. If administrators won’t come to rounds, go to them wherever they are—medical executive committee meetings, patient safety sessions, etc.

“Create a compelling story so people can see you not as an enemy, but as an ally,” Dr. Halasymani said. “To do that, you have to be where the conversations take place.” HM10

NATIONAL HARBOR, Md.—It’s happened to every hospitalist who has pushed for a quality improvement (QI) project in their hospital: A chief says no because there’s no money for it. Doesn’t matter if it was the chief medical officer, chief operating officer, or the chief financial officer—the answer is no, no, no.

The best way to change the answer? Change the question.

“Think like they do,” said Mahalakshmi K. Halasymani, MD, SFHM, vice president for quality and systems improvement
at Saint Joseph Mercy Health System in Ann Arbor, Mich. “Think about how healthcare is paid for. … [Administrators are] much more likely to release resources if it matters to the institution’s ability to collect money, or get a better survey next time.”

Dr. Halasymani, an SHM board member, co-led the session “The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI” with hospitalist Mark Novotny, MD, FHM, who held several C-suite positions at Southwestern Vermont Medical Center in Bennington, Vt., before parting ways with the hospital in early April. Both physicians urge getting organized before taking any case to hospital or health system administrators. Some of their tips:

• Define the scope of your proposal. Tackling too many issues can appear over-reaching. Attain a reasonable goal and build on success; that works better than swinging and missing with loftier goals.
• Attack topic areas with metrics. QI projects are only as good as the data they produce.
• Be interactive. Bring a C-suite member along on daily rounds for a week to showcase the problem you hope to address. When an administrator sees a need for improvement in real time, the issue is personalized. If administrators won’t come to rounds, go to them wherever they are—medical executive committee meetings, patient safety sessions, etc.

“Create a compelling story so people can see you not as an enemy, but as an ally,” Dr. Halasymani said. “To do that, you have to be where the conversations take place.” HM10

NATIONAL HARBOR, Md.—It’s happened to every hospitalist who has pushed for a quality improvement (QI) project in their hospital: A chief says no because there’s no money for it. Doesn’t matter if it was the chief medical officer, chief operating officer, or the chief financial officer—the answer is no, no, no.

The best way to change the answer? Change the question.

“Think like they do,” said Mahalakshmi K. Halasymani, MD, SFHM, vice president for quality and systems improvement
at Saint Joseph Mercy Health System in Ann Arbor, Mich. “Think about how healthcare is paid for. … [Administrators are] much more likely to release resources if it matters to the institution’s ability to collect money, or get a better survey next time.”

Dr. Halasymani, an SHM board member, co-led the session “The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI” with hospitalist Mark Novotny, MD, FHM, who held several C-suite positions at Southwestern Vermont Medical Center in Bennington, Vt., before parting ways with the hospital in early April. Both physicians urge getting organized before taking any case to hospital or health system administrators. Some of their tips:

• Define the scope of your proposal. Tackling too many issues can appear over-reaching. Attain a reasonable goal and build on success; that works better than swinging and missing with loftier goals.
• Attack topic areas with metrics. QI projects are only as good as the data they produce.
• Be interactive. Bring a C-suite member along on daily rounds for a week to showcase the problem you hope to address. When an administrator sees a need for improvement in real time, the issue is personalized. If administrators won’t come to rounds, go to them wherever they are—medical executive committee meetings, patient safety sessions, etc.

“Create a compelling story so people can see you not as an enemy, but as an ally,” Dr. Halasymani said. “To do that, you have to be where the conversations take place.” HM10