Evidence based medicine (EBM) uses a systematic approach to medical decision making and patient care, combining the highest‐available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, an EBM approach helps clinicians collaborate with patients to make the best possible decisions for their inpatient care. Hospitalists use study evidence to answer clinical questions and to develop quality improvement projects, including protocols and clinical pathways that can improve the efficiency, quality, and safety of care within their organizations. Hospitalists further provide leadership in educational efforts that foster a rigorous evidence based approach among medical trainees, hospital staff, and physician colleagues.

KNOWLEDGE

Hospitalists should be able to:

• Describe the necessary steps required to ask and answer clinical questions using standardized EBM methods.

• Describe the four core components of framing clinical questions using an EBM approach.

• Identify peer‐reviewed databases and other resources to search for study evidence to answer clinical and systems questions.

• Differentiate between filtered and non‐filtered resources, list examples of each, and describe the advantages and disadvantages of each.

• Describe major study types including therapy, diagnosis, prognosis, harm, meta‐analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the important strengths and weaknesses of the following study designs: randomized controlled trials, meta‐analyses, cohort studies, case‐control studies, case series, cost‐effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, Relative Risk Reduction (RRR), Absolute Risk Reduction (ARR), Number Needed to Treat (NNT) and diagnosis studies, which may include sensitivity, specificity, and likelihood ratio.

SKILLS

Hospitalists should be able to:

• Formulate a well‐designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Identify the most appropriate study design(s) for the specific clinical or systems based question at hand.

• Search filtered and non‐filtered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

ATTITUDES

Hospitalists should be able to:

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Appreciate that filtered resources allow greater efficiency than non‐filtered resources in searching for answers to clinical and systems questions and locating high‐quality evidence.

• Reflect upon individual practice patterns to identify new questions.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Serve as a role model for evidence based point‐of‐care practice.

• Influence and support other clinicians to develop and utilize EBM skills to improve clinical practice and systems or processes within practice.

• Lead, coordinate or participate in systems interventions to improve the quality, efficiency and standardization of care based on EBM review of the literature.

• Advocate for the institution to provide or facilitate access to high quality point‐of‐care EBM information resources.

Evidence based medicine (EBM) uses a systematic approach to medical decision making and patient care, combining the highest‐available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, an EBM approach helps clinicians collaborate with patients to make the best possible decisions for their inpatient care. Hospitalists use study evidence to answer clinical questions and to develop quality improvement projects, including protocols and clinical pathways that can improve the efficiency, quality, and safety of care within their organizations. Hospitalists further provide leadership in educational efforts that foster a rigorous evidence based approach among medical trainees, hospital staff, and physician colleagues.

KNOWLEDGE

Hospitalists should be able to:

• Describe the necessary steps required to ask and answer clinical questions using standardized EBM methods.

• Describe the four core components of framing clinical questions using an EBM approach.

• Identify peer‐reviewed databases and other resources to search for study evidence to answer clinical and systems questions.

• Differentiate between filtered and non‐filtered resources, list examples of each, and describe the advantages and disadvantages of each.

• Describe major study types including therapy, diagnosis, prognosis, harm, meta‐analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the important strengths and weaknesses of the following study designs: randomized controlled trials, meta‐analyses, cohort studies, case‐control studies, case series, cost‐effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, Relative Risk Reduction (RRR), Absolute Risk Reduction (ARR), Number Needed to Treat (NNT) and diagnosis studies, which may include sensitivity, specificity, and likelihood ratio.

SKILLS

Hospitalists should be able to:

• Formulate a well‐designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Identify the most appropriate study design(s) for the specific clinical or systems based question at hand.

• Search filtered and non‐filtered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

ATTITUDES

Hospitalists should be able to:

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Appreciate that filtered resources allow greater efficiency than non‐filtered resources in searching for answers to clinical and systems questions and locating high‐quality evidence.

• Reflect upon individual practice patterns to identify new questions.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Serve as a role model for evidence based point‐of‐care practice.

• Influence and support other clinicians to develop and utilize EBM skills to improve clinical practice and systems or processes within practice.

• Lead, coordinate or participate in systems interventions to improve the quality, efficiency and standardization of care based on EBM review of the literature.

• Advocate for the institution to provide or facilitate access to high quality point‐of‐care EBM information resources.

Evidence based medicine (EBM) uses a systematic approach to medical decision making and patient care, combining the highest‐available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, an EBM approach helps clinicians collaborate with patients to make the best possible decisions for their inpatient care. Hospitalists use study evidence to answer clinical questions and to develop quality improvement projects, including protocols and clinical pathways that can improve the efficiency, quality, and safety of care within their organizations. Hospitalists further provide leadership in educational efforts that foster a rigorous evidence based approach among medical trainees, hospital staff, and physician colleagues.

KNOWLEDGE

Hospitalists should be able to:

• Describe the necessary steps required to ask and answer clinical questions using standardized EBM methods.

• Describe the four core components of framing clinical questions using an EBM approach.

• Identify peer‐reviewed databases and other resources to search for study evidence to answer clinical and systems questions.

• Differentiate between filtered and non‐filtered resources, list examples of each, and describe the advantages and disadvantages of each.

• Describe major study types including therapy, diagnosis, prognosis, harm, meta‐analysis (systematic review), economic analysis, and decision analysis.

• Describe and differentiate the important strengths and weaknesses of the following study designs: randomized controlled trials, meta‐analyses, cohort studies, case‐control studies, case series, cost‐effectiveness studies, and clinical decision analysis studies.

• Explain the core components and core statistical concepts used in therapy studies, including relative risk, Relative Risk Reduction (RRR), Absolute Risk Reduction (ARR), Number Needed to Treat (NNT) and diagnosis studies, which may include sensitivity, specificity, and likelihood ratio.

SKILLS

Hospitalists should be able to:

• Formulate a well‐designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.

• Identify the most appropriate study design(s) for the specific clinical or systems based question at hand.

• Search filtered and non‐filtered information resources efficiently to find answers to clinical questions.

• Critically appraise the validity of individual study methodology and reporting.

• Evaluate and interpret study results, including useful point estimates and precision analysis.

• Apply relevant results of validated studies to individual patient care or systems improvement projects.

ATTITUDES

Hospitalists should be able to:

• Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.

• Appreciate that filtered resources allow greater efficiency than non‐filtered resources in searching for answers to clinical and systems questions and locating high‐quality evidence.

• Reflect upon individual practice patterns to identify new questions.

• Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.

• Serve as a role model for evidence based point‐of‐care practice.

• Influence and support other clinicians to develop and utilize EBM skills to improve clinical practice and systems or processes within practice.

• Lead, coordinate or participate in systems interventions to improve the quality, efficiency and standardization of care based on EBM review of the literature.

• Advocate for the institution to provide or facilitate access to high quality point‐of‐care EBM information resources.

ABIM American Board of Internal Medicine (www.abim.org)

ABP American Board of Pediatrics (www.abp.org)

ACC American College of Cardiology (www.acc.org)

ACGME Accreditation Council for Graduate Medical Education (www.acgme.org)

ACLS Advanced Cardiac Life Support (www.americanheart.org or www.acls.net)

ADA American Diabetes Association (www.diabetes.org)

AHA American Heart Association (www.americanheart.org)

AHRQ Agency for Healthcare Research and Quality (www.ahrq.gov)

ATS American Thoracic Society (www.thoracic.org)

BLS Basic Life Support (www.americanheart.org or www.basiclifesupport.net)

CDCP Centers for Disease Control and Prevention (www.cdc.gov)

EMTALA Emergency Medical Treatment and Active Labor Act (www.emtala.com)

FDA Food and Drug Administration (www.fda.gov)

HCUP Healthcare Cost and Utilization Project (www.ahrq.gov/data/hcup)

HIPAA Health Insurance Portability and Accountability Act (http://aspe.hhs.gov)

IASP International Association for the Study of Pain (www.iasp‐pain.org)

IDSA Infectious Diseases Society of America (www.idsociety.org)

IOM Institute of Medicine (www.iom.edu)

JCAHO Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org)

NPSF National Patient Safety Foundation (www.npsf.org)

NIS Nationwide Inpatient Sample (www.hcup‐us.ahrq.gov/nisoverview.jsp)

SHM Society of Hospital Medicine (www.hospitalmedicine.org)

WHO World Health Organization (www.who.int/en/)

ABIM American Board of Internal Medicine (www.abim.org)

ABP American Board of Pediatrics (www.abp.org)

ACC American College of Cardiology (www.acc.org)

ACGME Accreditation Council for Graduate Medical Education (www.acgme.org)

ACLS Advanced Cardiac Life Support (www.americanheart.org or www.acls.net)

ADA American Diabetes Association (www.diabetes.org)

AHA American Heart Association (www.americanheart.org)

AHRQ Agency for Healthcare Research and Quality (www.ahrq.gov)

ATS American Thoracic Society (www.thoracic.org)

BLS Basic Life Support (www.americanheart.org or www.basiclifesupport.net)

CDCP Centers for Disease Control and Prevention (www.cdc.gov)

EMTALA Emergency Medical Treatment and Active Labor Act (www.emtala.com)

FDA Food and Drug Administration (www.fda.gov)

HCUP Healthcare Cost and Utilization Project (www.ahrq.gov/data/hcup)

HIPAA Health Insurance Portability and Accountability Act (http://aspe.hhs.gov)

IASP International Association for the Study of Pain (www.iasp‐pain.org)

IDSA Infectious Diseases Society of America (www.idsociety.org)

IOM Institute of Medicine (www.iom.edu)

JCAHO Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org)

NPSF National Patient Safety Foundation (www.npsf.org)

NIS Nationwide Inpatient Sample (www.hcup‐us.ahrq.gov/nisoverview.jsp)

SHM Society of Hospital Medicine (www.hospitalmedicine.org)

WHO World Health Organization (www.who.int/en/)

ABIM American Board of Internal Medicine (www.abim.org)

ABP American Board of Pediatrics (www.abp.org)

ACC American College of Cardiology (www.acc.org)

ACGME Accreditation Council for Graduate Medical Education (www.acgme.org)

ACLS Advanced Cardiac Life Support (www.americanheart.org or www.acls.net)

ADA American Diabetes Association (www.diabetes.org)

AHA American Heart Association (www.americanheart.org)

AHRQ Agency for Healthcare Research and Quality (www.ahrq.gov)

ATS American Thoracic Society (www.thoracic.org)

BLS Basic Life Support (www.americanheart.org or www.basiclifesupport.net)

CDCP Centers for Disease Control and Prevention (www.cdc.gov)

EMTALA Emergency Medical Treatment and Active Labor Act (www.emtala.com)

FDA Food and Drug Administration (www.fda.gov)

HCUP Healthcare Cost and Utilization Project (www.ahrq.gov/data/hcup)

HIPAA Health Insurance Portability and Accountability Act (http://aspe.hhs.gov)

IASP International Association for the Study of Pain (www.iasp‐pain.org)

IDSA Infectious Diseases Society of America (www.idsociety.org)

IOM Institute of Medicine (www.iom.edu)

JCAHO Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org)

NPSF National Patient Safety Foundation (www.npsf.org)

NIS Nationwide Inpatient Sample (www.hcup‐us.ahrq.gov/nisoverview.jsp)

SHM Society of Hospital Medicine (www.hospitalmedicine.org)

WHO World Health Organization (www.who.int/en/)

Arthrocentesis, the aspiration of synovial fluid from a joint, is frequently performed in the diagnosis and management of joint effusions. These effusions are associated with infectious, traumatic, and rheumatologic conditions. The Healthcare Cost and Utilization Project (HCUP) reports that arthrocentesis was performed in 32,961 hospitalized patients in 2002. Hospitalists may identify a joint effusion during the history and physical examination, and should use clinical expertise and evidence based decision making to determine whether arthrocentesis is required in the diagnosis and management of the patient's illness.

KNOWLEDGE

Hospitalists should be able to:

• Identify and locate anatomic landmarks to guide proper entry points for arthrocentesis.

• Define and differentiate the disease processes that may lead to the development of joint effusion.

• Explain the indications and contraindications for arthrocentesis, including potential risks and complications.

• Explain the appropriate diagnostic testing for synovial fluid.

• Describe indications for use of ultrasonography to guide arthrocentesis.

• Select the necessary equipment to perform an arthrocentesis at the bedside.

SKILLS

Hospitalists should be able to:

• Distinguish between the clinical features of a joint effusion and soft tissue swelling surrounding a joint.

• Demonstrate the optimal position for the patient and the patient's joint during an arthrocentesis.

• Select and use the correct equipment for a given joint.

• Use sterile techniques during preparation for and performance of arthrocentesis.

• Maintain clinician safety with appropriate protective wear.

• Manage the complications of arthrocentesis.

• Order radiographic studies and interpret findings.

• Order and interpret results of synovial fluid cell count, differential, crystal morphology, gram stain and culture.

• Order and interpret platelet and coagulation studies when indicated.

• Develop management plan based on results of fluid testing.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, recovery period, and potential and expected outcomes; and to obtain informed consent.

• Discuss with patients and families pain management strategies for discomfort during and after arthrocentesis.

• Relieve pain with splinting and analgesia targeted to the joint inflammation.

• Employ multidisciplinary teams, including physical and occupational therapy when appropriate, to assist with inpatient and outpatient rehabilitation.

• Recognize indications for specialty consultation, which may include rheumatology, orthopaedics or infectious disease.

• Consider early consultation in the management of effusion in a prosthetic joint.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve efficiency and quality within their organizations, Hospitalists should:

• Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.

• Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.

• Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of arthrocentesis.

• Lead, coordinate or participate in efforts to organize and consolidate arthrocentesis equipment in an identifiable location in the hospital, easily assessable to clinicians who perform the procedure.

Arthrocentesis, the aspiration of synovial fluid from a joint, is frequently performed in the diagnosis and management of joint effusions. These effusions are associated with infectious, traumatic, and rheumatologic conditions. The Healthcare Cost and Utilization Project (HCUP) reports that arthrocentesis was performed in 32,961 hospitalized patients in 2002. Hospitalists may identify a joint effusion during the history and physical examination, and should use clinical expertise and evidence based decision making to determine whether arthrocentesis is required in the diagnosis and management of the patient's illness.

KNOWLEDGE

Hospitalists should be able to:

• Identify and locate anatomic landmarks to guide proper entry points for arthrocentesis.

• Define and differentiate the disease processes that may lead to the development of joint effusion.

• Explain the indications and contraindications for arthrocentesis, including potential risks and complications.

• Explain the appropriate diagnostic testing for synovial fluid.

• Describe indications for use of ultrasonography to guide arthrocentesis.

• Select the necessary equipment to perform an arthrocentesis at the bedside.

SKILLS

Hospitalists should be able to:

• Distinguish between the clinical features of a joint effusion and soft tissue swelling surrounding a joint.

• Demonstrate the optimal position for the patient and the patient's joint during an arthrocentesis.

• Select and use the correct equipment for a given joint.

• Use sterile techniques during preparation for and performance of arthrocentesis.

• Maintain clinician safety with appropriate protective wear.

• Manage the complications of arthrocentesis.

• Order radiographic studies and interpret findings.

• Order and interpret results of synovial fluid cell count, differential, crystal morphology, gram stain and culture.

• Order and interpret platelet and coagulation studies when indicated.

• Develop management plan based on results of fluid testing.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, recovery period, and potential and expected outcomes; and to obtain informed consent.

• Discuss with patients and families pain management strategies for discomfort during and after arthrocentesis.

• Relieve pain with splinting and analgesia targeted to the joint inflammation.

• Employ multidisciplinary teams, including physical and occupational therapy when appropriate, to assist with inpatient and outpatient rehabilitation.

• Recognize indications for specialty consultation, which may include rheumatology, orthopaedics or infectious disease.

• Consider early consultation in the management of effusion in a prosthetic joint.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve efficiency and quality within their organizations, Hospitalists should:

• Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.

• Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.

• Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of arthrocentesis.

• Lead, coordinate or participate in efforts to organize and consolidate arthrocentesis equipment in an identifiable location in the hospital, easily assessable to clinicians who perform the procedure.

Arthrocentesis, the aspiration of synovial fluid from a joint, is frequently performed in the diagnosis and management of joint effusions. These effusions are associated with infectious, traumatic, and rheumatologic conditions. The Healthcare Cost and Utilization Project (HCUP) reports that arthrocentesis was performed in 32,961 hospitalized patients in 2002. Hospitalists may identify a joint effusion during the history and physical examination, and should use clinical expertise and evidence based decision making to determine whether arthrocentesis is required in the diagnosis and management of the patient's illness.

KNOWLEDGE

Hospitalists should be able to:

• Identify and locate anatomic landmarks to guide proper entry points for arthrocentesis.

• Define and differentiate the disease processes that may lead to the development of joint effusion.

• Explain the indications and contraindications for arthrocentesis, including potential risks and complications.

• Explain the appropriate diagnostic testing for synovial fluid.

• Describe indications for use of ultrasonography to guide arthrocentesis.

• Select the necessary equipment to perform an arthrocentesis at the bedside.

SKILLS

Hospitalists should be able to:

• Distinguish between the clinical features of a joint effusion and soft tissue swelling surrounding a joint.

• Demonstrate the optimal position for the patient and the patient's joint during an arthrocentesis.

• Select and use the correct equipment for a given joint.

• Use sterile techniques during preparation for and performance of arthrocentesis.

• Maintain clinician safety with appropriate protective wear.

• Manage the complications of arthrocentesis.

• Order radiographic studies and interpret findings.

• Order and interpret results of synovial fluid cell count, differential, crystal morphology, gram stain and culture.

• Order and interpret platelet and coagulation studies when indicated.

• Develop management plan based on results of fluid testing.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, recovery period, and potential and expected outcomes; and to obtain informed consent.

• Discuss with patients and families pain management strategies for discomfort during and after arthrocentesis.

• Relieve pain with splinting and analgesia targeted to the joint inflammation.

• Employ multidisciplinary teams, including physical and occupational therapy when appropriate, to assist with inpatient and outpatient rehabilitation.

• Recognize indications for specialty consultation, which may include rheumatology, orthopaedics or infectious disease.

• Consider early consultation in the management of effusion in a prosthetic joint.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve efficiency and quality within their organizations, Hospitalists should:

• Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.

• Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.

• Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of arthrocentesis.

• Lead, coordinate or participate in efforts to organize and consolidate arthrocentesis equipment in an identifiable location in the hospital, easily assessable to clinicians who perform the procedure.

Heart disease continues to be the leading cause of hospital admissions and mortality in the United States, accounting for an estimated 13% of admissions in 2001, and 21% of in‐hospital deaths in 2000. The electrocardiogram (EKG), a graphical representation of cardiac electrical potentials, is a noninvasive, readily available diagnostic tool. It remains the most commonly used investigative modality for the initial evaluation of cardiovascular disease. Hospitalists interpret these results expediently and apply the results to estimate risk, diagnose disease, and determine therapeutic needs in the hospitalized patient.

KNOWLEDGE

Hospitalists should be able to:

• Explain the anatomy and physiology of normal and pathologic cardiac tissues, including spatial relationships, vascular supply, automaticity, conduction, and autonomic innervations and how these affect EKG interpretation.

• Compare the diagnostic utility of rhythm strips and telemetry monitors to 12‐lead EKG.

• Explain indications for ordering an EKG, including right‐sided EKG.

• Describe the implications of the acquisition, amplification, display, and standardization of electrocardiographic waveforms in different leads.

• Describe the relevant components of the EKG tracing.

• Explain the effect of cardiovascular, metabolic, toxic, and systemic disease processes on cardiac electrical potentials of the EKG.

• Explain the limitations of various EKG findings, including computerized interpretations.

SKILLS

Hospitalists should be able to:

• Demonstrate correct lead placement.

• Accurately measure and interpret the atrial and ventricular rates, voltages and intervals of EKG tracings.

• Recognize normal EKG findings, including variations associated with demographics, artifact, lead placement, and other technical problems.

• Recognize and categorize abnormal EKG findings, including abnormalities of conduction, automaticity, anatomy, and manifestations of non‐cardiac disease.

• Identify paced rhythms and describe the limitations of related EKG interpretations.

• Synthesize EKG data with other clinical information to risk stratify patients and develop a clinical plan.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain results of the EKG and how the findings impact the care plan.

• Personally and promptly interpret EKGs and compare them to previously recorded EKGs, when available.

• Review each EKG with a standard and consistent approach.

• Consult and collaborate with cardiologists in interpreting complex EKGs, and in ordering further diagnostic studies or procedures based on EKG interpretation.

• Determine the need for specialist intervention based on the urgency and patient risk.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve quality and efficiency within their organizations, Hospitalists should:

• Lead, coordinate or participate in efforts to expedite acquisition and interpretation of EKGs for hospitalized patients.

Heart disease continues to be the leading cause of hospital admissions and mortality in the United States, accounting for an estimated 13% of admissions in 2001, and 21% of in‐hospital deaths in 2000. The electrocardiogram (EKG), a graphical representation of cardiac electrical potentials, is a noninvasive, readily available diagnostic tool. It remains the most commonly used investigative modality for the initial evaluation of cardiovascular disease. Hospitalists interpret these results expediently and apply the results to estimate risk, diagnose disease, and determine therapeutic needs in the hospitalized patient.

KNOWLEDGE

Hospitalists should be able to:

• Explain the anatomy and physiology of normal and pathologic cardiac tissues, including spatial relationships, vascular supply, automaticity, conduction, and autonomic innervations and how these affect EKG interpretation.

• Compare the diagnostic utility of rhythm strips and telemetry monitors to 12‐lead EKG.

• Explain indications for ordering an EKG, including right‐sided EKG.

• Describe the implications of the acquisition, amplification, display, and standardization of electrocardiographic waveforms in different leads.

• Describe the relevant components of the EKG tracing.

• Explain the effect of cardiovascular, metabolic, toxic, and systemic disease processes on cardiac electrical potentials of the EKG.

• Explain the limitations of various EKG findings, including computerized interpretations.

SKILLS

Hospitalists should be able to:

• Demonstrate correct lead placement.

• Accurately measure and interpret the atrial and ventricular rates, voltages and intervals of EKG tracings.

• Recognize normal EKG findings, including variations associated with demographics, artifact, lead placement, and other technical problems.

• Recognize and categorize abnormal EKG findings, including abnormalities of conduction, automaticity, anatomy, and manifestations of non‐cardiac disease.

• Identify paced rhythms and describe the limitations of related EKG interpretations.

• Synthesize EKG data with other clinical information to risk stratify patients and develop a clinical plan.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain results of the EKG and how the findings impact the care plan.

• Personally and promptly interpret EKGs and compare them to previously recorded EKGs, when available.

• Review each EKG with a standard and consistent approach.

• Consult and collaborate with cardiologists in interpreting complex EKGs, and in ordering further diagnostic studies or procedures based on EKG interpretation.

• Determine the need for specialist intervention based on the urgency and patient risk.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve quality and efficiency within their organizations, Hospitalists should:

• Lead, coordinate or participate in efforts to expedite acquisition and interpretation of EKGs for hospitalized patients.

Heart disease continues to be the leading cause of hospital admissions and mortality in the United States, accounting for an estimated 13% of admissions in 2001, and 21% of in‐hospital deaths in 2000. The electrocardiogram (EKG), a graphical representation of cardiac electrical potentials, is a noninvasive, readily available diagnostic tool. It remains the most commonly used investigative modality for the initial evaluation of cardiovascular disease. Hospitalists interpret these results expediently and apply the results to estimate risk, diagnose disease, and determine therapeutic needs in the hospitalized patient.

KNOWLEDGE

Hospitalists should be able to:

• Explain the anatomy and physiology of normal and pathologic cardiac tissues, including spatial relationships, vascular supply, automaticity, conduction, and autonomic innervations and how these affect EKG interpretation.

• Compare the diagnostic utility of rhythm strips and telemetry monitors to 12‐lead EKG.

• Explain indications for ordering an EKG, including right‐sided EKG.

• Describe the implications of the acquisition, amplification, display, and standardization of electrocardiographic waveforms in different leads.

• Describe the relevant components of the EKG tracing.

• Explain the effect of cardiovascular, metabolic, toxic, and systemic disease processes on cardiac electrical potentials of the EKG.

• Explain the limitations of various EKG findings, including computerized interpretations.

SKILLS

Hospitalists should be able to:

• Demonstrate correct lead placement.

• Accurately measure and interpret the atrial and ventricular rates, voltages and intervals of EKG tracings.

• Recognize normal EKG findings, including variations associated with demographics, artifact, lead placement, and other technical problems.

• Recognize and categorize abnormal EKG findings, including abnormalities of conduction, automaticity, anatomy, and manifestations of non‐cardiac disease.

• Identify paced rhythms and describe the limitations of related EKG interpretations.

• Synthesize EKG data with other clinical information to risk stratify patients and develop a clinical plan.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain results of the EKG and how the findings impact the care plan.

• Personally and promptly interpret EKGs and compare them to previously recorded EKGs, when available.

• Review each EKG with a standard and consistent approach.

• Consult and collaborate with cardiologists in interpreting complex EKGs, and in ordering further diagnostic studies or procedures based on EKG interpretation.

• Determine the need for specialist intervention based on the urgency and patient risk.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve quality and efficiency within their organizations, Hospitalists should:

• Lead, coordinate or participate in efforts to expedite acquisition and interpretation of EKGs for hospitalized patients.

Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.

KNOWLEDGE

Hospitalists should be able to:

• Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.

• List major barriers to effective team interactions.

• Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.

• List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.

SKILLS

Hospitalists should be able to:

• Determine an effective team composition and designate individual group member functions.

• Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.

• Assess individual member's strengths and incorporate them effectively and productively into the team.

• Assess group dynamics and facilitate optimal team functioning.

• Integrate the assessments and recommendations of all contributing team members into the care plan.

• Conduct effective multidisciplinary team rounds, which may include patients and their families.

• Utilize team members' time effectively, maximizing efficiency and consistency.

• Ensure the delivery of timely and accurate information.

• Assess performance of team members, including self‐assessment, and identify opportunities for improvement.

ATTITUDES

Hospitalists should be able to:

• Employ active listening techniques during interactions with team members and engage team participation.

• Communicate frequently with all members of the multidisciplinary team.

• Emphasize the importance of mutual respect among team members.

• Act as a role model in professional conflict resolution and discussion of disagreements.

• Share decision making responsibilities, within the appropriate scopes of practice, with care team members.

• Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.

• Facilitate opportunities for interactive education among team members and for team members to educate patients and families.

• Coordinate seamless transitions of care by utilizing combined expertise of team members.

• Establish a hospital wide, non‐punitive culture of error reporting and prevention.

Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.

KNOWLEDGE

Hospitalists should be able to:

• Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.

• List major barriers to effective team interactions.

• Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.

• List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.

SKILLS

Hospitalists should be able to:

• Determine an effective team composition and designate individual group member functions.

• Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.

• Assess individual member's strengths and incorporate them effectively and productively into the team.

• Assess group dynamics and facilitate optimal team functioning.

• Integrate the assessments and recommendations of all contributing team members into the care plan.

• Conduct effective multidisciplinary team rounds, which may include patients and their families.

• Utilize team members' time effectively, maximizing efficiency and consistency.

• Ensure the delivery of timely and accurate information.

• Assess performance of team members, including self‐assessment, and identify opportunities for improvement.

ATTITUDES

Hospitalists should be able to:

• Employ active listening techniques during interactions with team members and engage team participation.

• Communicate frequently with all members of the multidisciplinary team.

• Emphasize the importance of mutual respect among team members.

• Act as a role model in professional conflict resolution and discussion of disagreements.

• Share decision making responsibilities, within the appropriate scopes of practice, with care team members.

• Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.

• Facilitate opportunities for interactive education among team members and for team members to educate patients and families.

• Coordinate seamless transitions of care by utilizing combined expertise of team members.

• Establish a hospital wide, non‐punitive culture of error reporting and prevention.

Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.

KNOWLEDGE

Hospitalists should be able to:

• Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.

• List major barriers to effective team interactions.

• Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.

• List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.

SKILLS

Hospitalists should be able to:

• Determine an effective team composition and designate individual group member functions.

• Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.

• Assess individual member's strengths and incorporate them effectively and productively into the team.

• Assess group dynamics and facilitate optimal team functioning.

• Integrate the assessments and recommendations of all contributing team members into the care plan.

• Conduct effective multidisciplinary team rounds, which may include patients and their families.

• Utilize team members' time effectively, maximizing efficiency and consistency.

• Ensure the delivery of timely and accurate information.

• Assess performance of team members, including self‐assessment, and identify opportunities for improvement.

ATTITUDES

Hospitalists should be able to:

• Employ active listening techniques during interactions with team members and engage team participation.

• Communicate frequently with all members of the multidisciplinary team.

• Emphasize the importance of mutual respect among team members.

• Act as a role model in professional conflict resolution and discussion of disagreements.

• Share decision making responsibilities, within the appropriate scopes of practice, with care team members.

• Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.

• Facilitate opportunities for interactive education among team members and for team members to educate patients and families.

• Coordinate seamless transitions of care by utilizing combined expertise of team members.

• Establish a hospital wide, non‐punitive culture of error reporting and prevention.

Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.

KNOWLEDGE

Hospitalists should be able to:

• Describe different models of physician compensation and incentives.

• Explain the impact of third‐party payer contracts on hospital reimbursement.

• Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.

• Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.

• Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.

• Describe required system improvements needed to meet new healthcare legislation or public health guidelines.

• Describe the personnel file, its contents and usage.

• Define the role and value of hospitalists and hospital medicine programs.

• Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.

• Describe the necessary elements for effective and compliant billing, coding, and revenue capture.

• Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.

• Define the components of a useful financial report.

SKILLS

Hospitalists should be able to:

• Apply basic accounting practices to track financial performance and develop a practice budget.

• Develop practice staffing arrangements and schedules.

• Market the hospital medicine program.

• Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.

• Develop strategies for recruiting and retaining hospitalists.

• Conduct or participate in performance reviews for physician and non‐physician staff.

• Negotiate effectively with physicians, medical practices, hospitals, and third party payers.

• Interpret hospital generated reports on individual and group performance.

• Assess satisfaction of community physicians, patients, nurses and other user groups.

• Develop strategic planning processes to meet individual and group goals and establish accountability.

• Develop business plans to facilitate growth of the practice.

• Prepare an annual review of program performance for the hospital executive team.

• Demonstrate teamwork, organization, and leadership skills.

ATTITUDES

Hospitalists should be able to:

• Lead by example.

• Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.

• Recognize the importance of meeting or exceeding customer and colleague expectations.

• Recognize the importance of best management practice.

• Recognize the importance of marketing and public relations to foster sustainable practice growth.

Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.

KNOWLEDGE

Hospitalists should be able to:

• Describe different models of physician compensation and incentives.

• Explain the impact of third‐party payer contracts on hospital reimbursement.

• Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.

• Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.

• Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.

• Describe required system improvements needed to meet new healthcare legislation or public health guidelines.

• Describe the personnel file, its contents and usage.

• Define the role and value of hospitalists and hospital medicine programs.

• Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.

• Describe the necessary elements for effective and compliant billing, coding, and revenue capture.

• Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.

• Define the components of a useful financial report.

SKILLS

Hospitalists should be able to:

• Apply basic accounting practices to track financial performance and develop a practice budget.

• Develop practice staffing arrangements and schedules.

• Market the hospital medicine program.

• Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.

• Develop strategies for recruiting and retaining hospitalists.

• Conduct or participate in performance reviews for physician and non‐physician staff.

• Negotiate effectively with physicians, medical practices, hospitals, and third party payers.

• Interpret hospital generated reports on individual and group performance.

• Assess satisfaction of community physicians, patients, nurses and other user groups.

• Develop strategic planning processes to meet individual and group goals and establish accountability.

• Develop business plans to facilitate growth of the practice.

• Prepare an annual review of program performance for the hospital executive team.

• Demonstrate teamwork, organization, and leadership skills.

ATTITUDES

Hospitalists should be able to:

• Lead by example.

• Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.

• Recognize the importance of meeting or exceeding customer and colleague expectations.

• Recognize the importance of best management practice.

• Recognize the importance of marketing and public relations to foster sustainable practice growth.

Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.

KNOWLEDGE

Hospitalists should be able to:

• Describe different models of physician compensation and incentives.

• Explain the impact of third‐party payer contracts on hospital reimbursement.

• Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.

• Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.

• Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.

• Describe required system improvements needed to meet new healthcare legislation or public health guidelines.

• Describe the personnel file, its contents and usage.

• Define the role and value of hospitalists and hospital medicine programs.

• Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.

• Describe the necessary elements for effective and compliant billing, coding, and revenue capture.

• Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.

• Define the components of a useful financial report.

SKILLS

Hospitalists should be able to:

• Apply basic accounting practices to track financial performance and develop a practice budget.

• Develop practice staffing arrangements and schedules.

• Market the hospital medicine program.

• Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.

• Develop strategies for recruiting and retaining hospitalists.

• Conduct or participate in performance reviews for physician and non‐physician staff.

• Negotiate effectively with physicians, medical practices, hospitals, and third party payers.

• Interpret hospital generated reports on individual and group performance.

• Assess satisfaction of community physicians, patients, nurses and other user groups.

• Develop strategic planning processes to meet individual and group goals and establish accountability.

• Develop business plans to facilitate growth of the practice.

• Prepare an annual review of program performance for the hospital executive team.

• Demonstrate teamwork, organization, and leadership skills.

ATTITUDES

Hospitalists should be able to:

• Lead by example.

• Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.

• Recognize the importance of meeting or exceeding customer and colleague expectations.

• Recognize the importance of best management practice.

• Recognize the importance of marketing and public relations to foster sustainable practice growth.

Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.

KNOWLEDGE

Hospitalists should be able to:

• Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.

• Describe the concept of double effect.

• Define and differentiate competency and decision making capacity.

• Explain the utility of power of attorney and advance directives in medical care.

• List the key elements of informed consent.

• Explain determination of decision making capacity and steps required for surrogate decision making.

• Describe local laws and regulations relevant to the practice of hospital medicine.

• Explain medical futility.

SKILLS

Hospitalists should be able to:

• Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.

• Communicate with patient and family members on a regular basis.

• Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.

• Evaluate patients for medical decision making capacity.

• Obtain informed consent when indicated.

• Review power of attorney and advanced directives with patients and family members.

• Provide compassionate and relevant end of life care.

• Apply ethical principles to inpatient care.

• Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.

ATTITUDES

Hospitalists should be able to:

• Commit to life‐long self learning, maintenance of skills, and clinical excellence.

• Promote access to medical care for the community.

• Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.

• Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.

• Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.

• Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.

• Appreciate that physicians are not required to provide care that is medically futile.

• Demonstrate empathy for hospitalized patients.

• Endorse that physicians have an obligation not to discriminate against any patient or group of patients.

• Observe the boundaries of the physician‐patient relationship.

• Promote cost effective care.

• Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.

• Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.

• Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.

• Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.

• Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.

Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.

KNOWLEDGE

Hospitalists should be able to:

• Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.

• Describe the concept of double effect.

• Define and differentiate competency and decision making capacity.

• Explain the utility of power of attorney and advance directives in medical care.

• List the key elements of informed consent.

• Explain determination of decision making capacity and steps required for surrogate decision making.

• Describe local laws and regulations relevant to the practice of hospital medicine.

• Explain medical futility.

SKILLS

Hospitalists should be able to:

• Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.

• Communicate with patient and family members on a regular basis.

• Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.

• Evaluate patients for medical decision making capacity.

• Obtain informed consent when indicated.

• Review power of attorney and advanced directives with patients and family members.

• Provide compassionate and relevant end of life care.

• Apply ethical principles to inpatient care.

• Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.

ATTITUDES

Hospitalists should be able to:

• Commit to life‐long self learning, maintenance of skills, and clinical excellence.

• Promote access to medical care for the community.

• Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.

• Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.

• Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.

• Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.

• Appreciate that physicians are not required to provide care that is medically futile.

• Demonstrate empathy for hospitalized patients.

• Endorse that physicians have an obligation not to discriminate against any patient or group of patients.

• Observe the boundaries of the physician‐patient relationship.

• Promote cost effective care.

• Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.

• Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.

• Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.

• Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.

• Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.

Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.

KNOWLEDGE

Hospitalists should be able to:

• Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.

• Describe the concept of double effect.

• Define and differentiate competency and decision making capacity.

• Explain the utility of power of attorney and advance directives in medical care.

• List the key elements of informed consent.

• Explain determination of decision making capacity and steps required for surrogate decision making.

• Describe local laws and regulations relevant to the practice of hospital medicine.

• Explain medical futility.

SKILLS

Hospitalists should be able to:

• Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.

• Communicate with patient and family members on a regular basis.

• Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.

• Evaluate patients for medical decision making capacity.

• Obtain informed consent when indicated.

• Review power of attorney and advanced directives with patients and family members.

• Provide compassionate and relevant end of life care.

• Apply ethical principles to inpatient care.

• Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.

ATTITUDES

Hospitalists should be able to:

• Commit to life‐long self learning, maintenance of skills, and clinical excellence.

• Promote access to medical care for the community.

• Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.

• Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.

• Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.

• Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.

• Appreciate that physicians are not required to provide care that is medically futile.

• Demonstrate empathy for hospitalized patients.

• Endorse that physicians have an obligation not to discriminate against any patient or group of patients.

• Observe the boundaries of the physician‐patient relationship.

• Promote cost effective care.

• Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.

• Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.

• Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.

• Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.

• Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.

Pain, defined by International Association for the Study of Pain (IASP), as an unpleasant experience associated with actual or potential tissue damage to a person's body, is a very common presenting or accompanying symptom of hospitalized patients. Pain management involves utilizing various modalities to alleviate suffering and restore patient function. Proper assessment and treatment of pain can improve clinical outcomes, discharge planning and patient and family satisfaction. Pain management of inpatients necessitates understanding the various mechanisms that cause pain, properties of analgesic pharmacological and non‐pharmacological modalities, as well as the accurate assessment of severity and treatment response. Hospitalists assess and manage patients experiencing pain. This role encompasses empathy, clinical excellence, and understanding of the myriad obstacles, cautions and specific knowledge, skills and attitudes necessary for appropriate pain management. Hospitalists serve as leaders of multidisciplinary teams to develop policies and protocols to improve pain management in their health care system.

KNOWLEDGE

Hospitalists should be able to:

• Describe the mechanisms that cause pain.

• Describe the symptoms and signs of pain.

• Differentiate acute, chronic, somatic, neuropathic, referred and visceral pain syndromes.

• Differentiate tolerance, dependence, addiction and pseudo‐addiction.

• Describe the value and limitations of the physical examination and various validated pain intensity assessment scales.

• Explain the relationship between physical, cultural and psychological factors and pain and pain thresholds.

• Discuss the genetic, social, and psychological factors that may contribute to opioid addiction.

• Explain the indications and limitations of non‐pharmacological methods of pain control available in the inpatient setting.

• Explain the indications and limitations of non‐opioids including acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), and topical agents.

• Explain the indications and limitations of opioid pharmacotherapy.

• Explain the indications and limitations of other analgesics including, tramadol, tricyclic agents and anti‐epileptic medications in the treatment of various pain syndromes.

• Describe specific factors that affect dosing regimes, such as drug half‐life, renal and hepatic function.

• Establish functional criteria for discharge.

SKILLS

Hospitalists should be able to:

• Elicit a detailed history and description of pain and review the medical record to determine likely source and acuity of pain.

• Review patient pharmacologic and psychosocial history and identify factors contributing to pain or factors that might impact its management.

• Conduct a physical examination to determine the likely source of pain.

• Order and interpret diagnostic studies to determine the source of pain when underlying acute illness is suspected.

• Assess pain severity using validated measurement tools.

• Formulate an initial pain management plan.

• Determine appropriate route, dosing and frequency for pharmacologic agents based on patient‐specific factors.

• Reassess pain severity and determine the need for escalating therapy and/or adjuvant therapies.

• Determine equianalgesic dosing for pharmacologic therapy when needed.

• Titrate short and long acting narcotics to desired effect.

• Predict and counteract as needed expected analgesic side effects, including use of reversal and specific agents, especially in elderly.

• Initiate appropriate therapies to prevent and treat constipation when using opioid analgesics.

• Anticipate and manage side effects of pain medications including respiratory depression and sedation, nausea, vomiting and pruritis.

• Assess and communicate need for pain management during medical consultation.

ATTITUDES

Hospitalists should be able to:

• Promote the ethical imperative of frequent pain assessment and adequate control.

• Appreciate that all pain is subjective and acknowledge patients' self‐reports of pain.

• Appreciate the value of patient controlled analgesia.

• Discuss with patients and families the goals for pain management strategies and functional status, and set targets for pain control.

• Recognize indications for specialty consultation, which may include pain service, anesthesiology, and physical and rehabilitation medicine.

• Employ a multidisciplinary approach to the assessment and management of patients with pain that begins on admission and continues through all care transitions.

• Educate patients and physicians on the importance of appropriate use of opioids in pain management and explain the rarity of opioid addiction in the setting of appropriate pain management.

• Establish and maintain an open dialogue with patients and families regarding care goals and limitations, which may include palliative care and end‐of‐life wishes.

• Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patient and/or family when indicated or desired.

• Document treatment plan and discharge instructions, and communicate with the outpatient clinician responsible for follow‐up.

• Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.

• Utilize evidence based recommendations, including the World Health Organization (WHO) step approach to pain management.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve efficiency and quality within their organizations, Hospitalists should:

• Lead, coordinate, or participate in efforts to develop educational modules, order sets, and/or pathways that facilitate effective pain management in the hospital setting, with goals of improving outcomes and patient satisfaction, decreasing length of stay, and reducing re‐hospitalization rates.

• Lead, coordinate or participate in efforts to measure quality of inpatient pain control and operationalize system improvements and reduction of barriers to adequate pain control

• Lead, coordinate or participate in efforts to establish or support existing multidisciplinary pain control teams.

Pain, defined by International Association for the Study of Pain (IASP), as an unpleasant experience associated with actual or potential tissue damage to a person's body, is a very common presenting or accompanying symptom of hospitalized patients. Pain management involves utilizing various modalities to alleviate suffering and restore patient function. Proper assessment and treatment of pain can improve clinical outcomes, discharge planning and patient and family satisfaction. Pain management of inpatients necessitates understanding the various mechanisms that cause pain, properties of analgesic pharmacological and non‐pharmacological modalities, as well as the accurate assessment of severity and treatment response. Hospitalists assess and manage patients experiencing pain. This role encompasses empathy, clinical excellence, and understanding of the myriad obstacles, cautions and specific knowledge, skills and attitudes necessary for appropriate pain management. Hospitalists serve as leaders of multidisciplinary teams to develop policies and protocols to improve pain management in their health care system.

KNOWLEDGE

Hospitalists should be able to:

• Describe the mechanisms that cause pain.

• Describe the symptoms and signs of pain.

• Differentiate acute, chronic, somatic, neuropathic, referred and visceral pain syndromes.

• Differentiate tolerance, dependence, addiction and pseudo‐addiction.

• Describe the value and limitations of the physical examination and various validated pain intensity assessment scales.

• Explain the relationship between physical, cultural and psychological factors and pain and pain thresholds.

• Discuss the genetic, social, and psychological factors that may contribute to opioid addiction.

• Explain the indications and limitations of non‐pharmacological methods of pain control available in the inpatient setting.

• Explain the indications and limitations of non‐opioids including acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), and topical agents.

• Explain the indications and limitations of opioid pharmacotherapy.

• Explain the indications and limitations of other analgesics including, tramadol, tricyclic agents and anti‐epileptic medications in the treatment of various pain syndromes.

• Describe specific factors that affect dosing regimes, such as drug half‐life, renal and hepatic function.

• Establish functional criteria for discharge.

SKILLS

Hospitalists should be able to:

• Elicit a detailed history and description of pain and review the medical record to determine likely source and acuity of pain.

• Review patient pharmacologic and psychosocial history and identify factors contributing to pain or factors that might impact its management.

• Conduct a physical examination to determine the likely source of pain.

• Order and interpret diagnostic studies to determine the source of pain when underlying acute illness is suspected.

• Assess pain severity using validated measurement tools.

• Formulate an initial pain management plan.

• Determine appropriate route, dosing and frequency for pharmacologic agents based on patient‐specific factors.

• Reassess pain severity and determine the need for escalating therapy and/or adjuvant therapies.

• Determine equianalgesic dosing for pharmacologic therapy when needed.

• Titrate short and long acting narcotics to desired effect.

• Predict and counteract as needed expected analgesic side effects, including use of reversal and specific agents, especially in elderly.

• Initiate appropriate therapies to prevent and treat constipation when using opioid analgesics.

• Anticipate and manage side effects of pain medications including respiratory depression and sedation, nausea, vomiting and pruritis.

• Assess and communicate need for pain management during medical consultation.

ATTITUDES

Hospitalists should be able to:

• Promote the ethical imperative of frequent pain assessment and adequate control.

• Appreciate that all pain is subjective and acknowledge patients' self‐reports of pain.

• Appreciate the value of patient controlled analgesia.

• Discuss with patients and families the goals for pain management strategies and functional status, and set targets for pain control.

• Recognize indications for specialty consultation, which may include pain service, anesthesiology, and physical and rehabilitation medicine.

• Employ a multidisciplinary approach to the assessment and management of patients with pain that begins on admission and continues through all care transitions.

• Educate patients and physicians on the importance of appropriate use of opioids in pain management and explain the rarity of opioid addiction in the setting of appropriate pain management.

• Establish and maintain an open dialogue with patients and families regarding care goals and limitations, which may include palliative care and end‐of‐life wishes.

• Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patient and/or family when indicated or desired.

• Document treatment plan and discharge instructions, and communicate with the outpatient clinician responsible for follow‐up.

• Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.

• Utilize evidence based recommendations, including the World Health Organization (WHO) step approach to pain management.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve efficiency and quality within their organizations, Hospitalists should:

• Lead, coordinate, or participate in efforts to develop educational modules, order sets, and/or pathways that facilitate effective pain management in the hospital setting, with goals of improving outcomes and patient satisfaction, decreasing length of stay, and reducing re‐hospitalization rates.

• Lead, coordinate or participate in efforts to measure quality of inpatient pain control and operationalize system improvements and reduction of barriers to adequate pain control

• Lead, coordinate or participate in efforts to establish or support existing multidisciplinary pain control teams.

Pain, defined by International Association for the Study of Pain (IASP), as an unpleasant experience associated with actual or potential tissue damage to a person's body, is a very common presenting or accompanying symptom of hospitalized patients. Pain management involves utilizing various modalities to alleviate suffering and restore patient function. Proper assessment and treatment of pain can improve clinical outcomes, discharge planning and patient and family satisfaction. Pain management of inpatients necessitates understanding the various mechanisms that cause pain, properties of analgesic pharmacological and non‐pharmacological modalities, as well as the accurate assessment of severity and treatment response. Hospitalists assess and manage patients experiencing pain. This role encompasses empathy, clinical excellence, and understanding of the myriad obstacles, cautions and specific knowledge, skills and attitudes necessary for appropriate pain management. Hospitalists serve as leaders of multidisciplinary teams to develop policies and protocols to improve pain management in their health care system.

KNOWLEDGE

Hospitalists should be able to:

• Describe the mechanisms that cause pain.

• Describe the symptoms and signs of pain.

• Differentiate acute, chronic, somatic, neuropathic, referred and visceral pain syndromes.

• Differentiate tolerance, dependence, addiction and pseudo‐addiction.

• Describe the value and limitations of the physical examination and various validated pain intensity assessment scales.

• Explain the relationship between physical, cultural and psychological factors and pain and pain thresholds.

• Discuss the genetic, social, and psychological factors that may contribute to opioid addiction.

• Explain the indications and limitations of non‐pharmacological methods of pain control available in the inpatient setting.

• Explain the indications and limitations of non‐opioids including acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), and topical agents.

• Explain the indications and limitations of opioid pharmacotherapy.

• Explain the indications and limitations of other analgesics including, tramadol, tricyclic agents and anti‐epileptic medications in the treatment of various pain syndromes.

• Describe specific factors that affect dosing regimes, such as drug half‐life, renal and hepatic function.

• Establish functional criteria for discharge.

SKILLS

Hospitalists should be able to:

• Elicit a detailed history and description of pain and review the medical record to determine likely source and acuity of pain.

• Review patient pharmacologic and psychosocial history and identify factors contributing to pain or factors that might impact its management.

• Conduct a physical examination to determine the likely source of pain.

• Order and interpret diagnostic studies to determine the source of pain when underlying acute illness is suspected.

• Assess pain severity using validated measurement tools.

• Formulate an initial pain management plan.

• Determine appropriate route, dosing and frequency for pharmacologic agents based on patient‐specific factors.

• Reassess pain severity and determine the need for escalating therapy and/or adjuvant therapies.

• Determine equianalgesic dosing for pharmacologic therapy when needed.

• Titrate short and long acting narcotics to desired effect.

• Predict and counteract as needed expected analgesic side effects, including use of reversal and specific agents, especially in elderly.

• Initiate appropriate therapies to prevent and treat constipation when using opioid analgesics.

• Anticipate and manage side effects of pain medications including respiratory depression and sedation, nausea, vomiting and pruritis.

• Assess and communicate need for pain management during medical consultation.

ATTITUDES

Hospitalists should be able to:

• Promote the ethical imperative of frequent pain assessment and adequate control.

• Appreciate that all pain is subjective and acknowledge patients' self‐reports of pain.

• Appreciate the value of patient controlled analgesia.

• Discuss with patients and families the goals for pain management strategies and functional status, and set targets for pain control.

• Recognize indications for specialty consultation, which may include pain service, anesthesiology, and physical and rehabilitation medicine.

• Employ a multidisciplinary approach to the assessment and management of patients with pain that begins on admission and continues through all care transitions.

• Educate patients and physicians on the importance of appropriate use of opioids in pain management and explain the rarity of opioid addiction in the setting of appropriate pain management.

• Establish and maintain an open dialogue with patients and families regarding care goals and limitations, which may include palliative care and end‐of‐life wishes.

• Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patient and/or family when indicated or desired.

• Document treatment plan and discharge instructions, and communicate with the outpatient clinician responsible for follow‐up.

• Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.

• Utilize evidence based recommendations, including the World Health Organization (WHO) step approach to pain management.

SYSTEM ORGANIZATION AND IMPROVEMENT

To improve efficiency and quality within their organizations, Hospitalists should:

• Lead, coordinate, or participate in efforts to develop educational modules, order sets, and/or pathways that facilitate effective pain management in the hospital setting, with goals of improving outcomes and patient satisfaction, decreasing length of stay, and reducing re‐hospitalization rates.

• Lead, coordinate or participate in efforts to measure quality of inpatient pain control and operationalize system improvements and reduction of barriers to adequate pain control

• Lead, coordinate or participate in efforts to establish or support existing multidisciplinary pain control teams.

Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.

KNOWLEDGE

Hospitalists should be able to:

• Describe the prevalence of common disease states to the local patient population.

• Explain appropriate resources to determine prevalence and incidence of disease states.

• Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.

• Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.

• Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.

• Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.

• Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.

• Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.

• Name appropriate sources of information regarding evidence based clinical decision making.

• Describe the factors that account for excessive or indiscriminate testing.

SKILLS

Hospitalists should be able to:

• Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.

• Perform a physical examination to further refine the diagnostic hypothesis.

• Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.

• Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.

• Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.

• Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.

• Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.

• Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.

• Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.

• Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.

• Lead, coordinate or participate in the development of clinical care pathways.

• Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.

Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.

KNOWLEDGE

Hospitalists should be able to:

• Describe the prevalence of common disease states to the local patient population.

• Explain appropriate resources to determine prevalence and incidence of disease states.

• Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.

• Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.

• Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.

• Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.

• Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.

• Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.

• Name appropriate sources of information regarding evidence based clinical decision making.

• Describe the factors that account for excessive or indiscriminate testing.

SKILLS

Hospitalists should be able to:

• Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.

• Perform a physical examination to further refine the diagnostic hypothesis.

• Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.

• Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.

• Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.

• Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.

• Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.

• Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.

• Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.

• Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.

• Lead, coordinate or participate in the development of clinical care pathways.

• Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.

Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.

KNOWLEDGE

Hospitalists should be able to:

• Describe the prevalence of common disease states to the local patient population.

• Explain appropriate resources to determine prevalence and incidence of disease states.

• Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.

• Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.

• Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.

• Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.

• Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.

• Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.

• Name appropriate sources of information regarding evidence based clinical decision making.

• Describe the factors that account for excessive or indiscriminate testing.

SKILLS

Hospitalists should be able to:

• Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.

• Perform a physical examination to further refine the diagnostic hypothesis.

• Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.

• Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.

ATTITUDES

Hospitalists should be able to:

• Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.

• Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.

• Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.

• Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.

• Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.

• Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.

• Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.

• Lead, coordinate or participate in the development of clinical care pathways.

• Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.

Information management refers to the acquisition and utilization of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal work flow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computer based provider order entry, event monitoring, electronic charting and bar coding. Hospitalists use local systems to acquire data and information that support optimal medical decision making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, utilize and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers.

KNOWLEDGE

Hospitalists should be able to:

• Describe how hospital information systems are utilized by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe how to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators and practice guidelines to support optimal patient care.

• Explain how information systems can facilitate the practice of evidence based medical decision making.

• Explain how computer physician order entry (CPOE) with decision support favorably impacts on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

SKILLS

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include EKG monitors, glucometers, or oxygen saturation monitors.

• Access and interpret information from internet‐based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

ATTITUDES

Hospitalists should be able to:

• Recognize the limitations of acquisition devices or equipment, and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Adhere to principles of data integrity, security and confidentiality.

• Lead, coordinate or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Advocate for information decision support to facilitate efficient and optimal medical management.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework.

Information management refers to the acquisition and utilization of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal work flow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computer based provider order entry, event monitoring, electronic charting and bar coding. Hospitalists use local systems to acquire data and information that support optimal medical decision making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, utilize and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers.

KNOWLEDGE

Hospitalists should be able to:

• Describe how hospital information systems are utilized by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe how to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators and practice guidelines to support optimal patient care.

• Explain how information systems can facilitate the practice of evidence based medical decision making.

• Explain how computer physician order entry (CPOE) with decision support favorably impacts on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

SKILLS

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include EKG monitors, glucometers, or oxygen saturation monitors.

• Access and interpret information from internet‐based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

ATTITUDES

Hospitalists should be able to:

• Recognize the limitations of acquisition devices or equipment, and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Adhere to principles of data integrity, security and confidentiality.

• Lead, coordinate or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Advocate for information decision support to facilitate efficient and optimal medical management.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework.

Information management refers to the acquisition and utilization of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal work flow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computer based provider order entry, event monitoring, electronic charting and bar coding. Hospitalists use local systems to acquire data and information that support optimal medical decision making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, utilize and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers.

KNOWLEDGE

Hospitalists should be able to:

• Describe how hospital information systems are utilized by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.

• Identify and describe how to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators and practice guidelines to support optimal patient care.

• Explain how information systems can facilitate the practice of evidence based medical decision making.

• Explain how computer physician order entry (CPOE) with decision support favorably impacts on patient safety in the hospital setting.

• Explain potential pitfalls of the use of CPOE.

• Describe potential advantages and disadvantages of written and electronic patient records.

• Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.

• Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.

SKILLS

Hospitalists should be able to:

• Efficiently retrieve and interpret data, images, and other information from available clinical information systems.

• Interpret data from digital devices, which may include EKG monitors, glucometers, or oxygen saturation monitors.

• Access and interpret information from internet‐based clinical information systems when available.

• Interpret results incorporating statistical principles of probability and uncertainty.

ATTITUDES

Hospitalists should be able to:

• Recognize the limitations of acquisition devices or equipment, and use clinical judgment to interpret results that fall either within or outside the expected ranges.

• Recognize the influence of individual patient factors in the interpretation of available information.

• Adhere to principles of data integrity, security and confidentiality.

• Lead, coordinate or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.

• Lead, coordinate or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.

• Advocate for order entry systems that promote patient safety and ease of use.

• Advocate for information decision support to facilitate efficient and optimal medical management.

• Identify issues, provide feedback, and resolve conflicts within an information systems framework.