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VIDEO: Meta-analysis favors anticoagulation for patients with cirrhosis and portal vein thrombosis
Patients with cirrhosis and portal vein thrombosis (PVT) who received anticoagulation therapy had nearly fivefold greater odds of recanalization compared with untreated patients, and were no more likely to experience major or minor bleeding, in a pooled analysis of eight studies published in the August issue of Gastroenterology (doi: 10.1053/j.gastro.2017.04.042).
Rates of any recanalization were 71% in treated patients and 42% in untreated patients (P less than .0001), wrote Lorenzo Loffredo, MD, of Sapienza University, Rome, and his coinvestigators. Rates of complete recanalization were 53% and 33%, respectively (P = .002), rates of spontaneous variceal bleeding were 2% and 12% (P = .04), and bleeding affected 11% of patients in each group. Together, the findings “show that anticoagulants are efficacious and safe for treatment of portal vein thrombosis in cirrhotic patients,” although larger, interventional clinical trials are needed to pinpoint the clinical role of anticoagulation in cirrhotic patients with PVT, the reviewers reported.
Source: American Gastroenterological Association
Bleeding from portal hypertension is a major complication in cirrhosis, but PVT affects about 20% of patients and predicts poor outcomes, they noted. Anticoagulation in this setting can be difficult because patients often have concurrent coagulopathies that are hard to assess with standard techniques, such as PT-INR (international normalized ratio). Although some studies support anticoagulating these patients, data are limited. Therefore, the reviewers searched PubMed, the ISI Web of Science, SCOPUS, and the Cochrane database through Feb. 14, 2017, for trials comparing anticoagulation with no treatment in patients with cirrhosis and PVT.
This search yielded eight trials of 353 patients who received low-molecular-weight heparin, warfarin, or no treatment for about 6 months, with a typical follow-up period of 2 years. The reviewers found no evidence of publication bias or significant heterogeneity among the trials. Six studies evaluated complete recanalization, another set of six studies tracked progression of PVT, a third set of six studies evaluated major or minor bleeding events, and four studies evaluated spontaneous variceal bleeding. Compared with no treatment, anticoagulation was tied to a significantly greater likelihood of complete recanalization (pooled odds ratio, 3.4; 95% confidence interval, 1.5-7.4; P = .002), a significantly lower chance of PVT progressing (9% vs. 33%; pooled odds ratio, 0.14; 95% CI, 0.06-0.31; P less than .0001), no difference in bleeding rates (11% in each pooled group), and a significantly lower risk of spontaneous variceal bleeding (OR, 0.23; 95% CI, 0.06-0.94; P = .04).
“Metaregression analysis showed that duration of anticoagulation did not influence outcomes,” the reviewers wrote. “Low-molecular-weight heparin, but not warfarin, was significantly associated with a complete PVT resolution as compared to untreated patients, while both low-molecular-weight heparin and warfarin were effective in reducing PVT progression.” That finding merits careful interpretation, however, because most studies on warfarin were retrospective and lacked data on the quality of anticoagulation, they added.
“It is a challenge to treat patients with cirrhosis using anticoagulants because of the perception that the coexistent coagulopathy could promote bleeding,” the researchers wrote. Nonetheless, their analysis suggests that anticoagulation has significant benefits and does not increase bleeding risk, regardless of the severity of liver failure, they concluded.
The reviewers reported having no funding sources or conflicts of interest.
Patients with cirrhosis and portal vein thrombosis (PVT) who received anticoagulation therapy had nearly fivefold greater odds of recanalization compared with untreated patients, and were no more likely to experience major or minor bleeding, in a pooled analysis of eight studies published in the August issue of Gastroenterology (doi: 10.1053/j.gastro.2017.04.042).
Rates of any recanalization were 71% in treated patients and 42% in untreated patients (P less than .0001), wrote Lorenzo Loffredo, MD, of Sapienza University, Rome, and his coinvestigators. Rates of complete recanalization were 53% and 33%, respectively (P = .002), rates of spontaneous variceal bleeding were 2% and 12% (P = .04), and bleeding affected 11% of patients in each group. Together, the findings “show that anticoagulants are efficacious and safe for treatment of portal vein thrombosis in cirrhotic patients,” although larger, interventional clinical trials are needed to pinpoint the clinical role of anticoagulation in cirrhotic patients with PVT, the reviewers reported.
Source: American Gastroenterological Association
Bleeding from portal hypertension is a major complication in cirrhosis, but PVT affects about 20% of patients and predicts poor outcomes, they noted. Anticoagulation in this setting can be difficult because patients often have concurrent coagulopathies that are hard to assess with standard techniques, such as PT-INR (international normalized ratio). Although some studies support anticoagulating these patients, data are limited. Therefore, the reviewers searched PubMed, the ISI Web of Science, SCOPUS, and the Cochrane database through Feb. 14, 2017, for trials comparing anticoagulation with no treatment in patients with cirrhosis and PVT.
This search yielded eight trials of 353 patients who received low-molecular-weight heparin, warfarin, or no treatment for about 6 months, with a typical follow-up period of 2 years. The reviewers found no evidence of publication bias or significant heterogeneity among the trials. Six studies evaluated complete recanalization, another set of six studies tracked progression of PVT, a third set of six studies evaluated major or minor bleeding events, and four studies evaluated spontaneous variceal bleeding. Compared with no treatment, anticoagulation was tied to a significantly greater likelihood of complete recanalization (pooled odds ratio, 3.4; 95% confidence interval, 1.5-7.4; P = .002), a significantly lower chance of PVT progressing (9% vs. 33%; pooled odds ratio, 0.14; 95% CI, 0.06-0.31; P less than .0001), no difference in bleeding rates (11% in each pooled group), and a significantly lower risk of spontaneous variceal bleeding (OR, 0.23; 95% CI, 0.06-0.94; P = .04).
“Metaregression analysis showed that duration of anticoagulation did not influence outcomes,” the reviewers wrote. “Low-molecular-weight heparin, but not warfarin, was significantly associated with a complete PVT resolution as compared to untreated patients, while both low-molecular-weight heparin and warfarin were effective in reducing PVT progression.” That finding merits careful interpretation, however, because most studies on warfarin were retrospective and lacked data on the quality of anticoagulation, they added.
“It is a challenge to treat patients with cirrhosis using anticoagulants because of the perception that the coexistent coagulopathy could promote bleeding,” the researchers wrote. Nonetheless, their analysis suggests that anticoagulation has significant benefits and does not increase bleeding risk, regardless of the severity of liver failure, they concluded.
The reviewers reported having no funding sources or conflicts of interest.
Patients with cirrhosis and portal vein thrombosis (PVT) who received anticoagulation therapy had nearly fivefold greater odds of recanalization compared with untreated patients, and were no more likely to experience major or minor bleeding, in a pooled analysis of eight studies published in the August issue of Gastroenterology (doi: 10.1053/j.gastro.2017.04.042).
Rates of any recanalization were 71% in treated patients and 42% in untreated patients (P less than .0001), wrote Lorenzo Loffredo, MD, of Sapienza University, Rome, and his coinvestigators. Rates of complete recanalization were 53% and 33%, respectively (P = .002), rates of spontaneous variceal bleeding were 2% and 12% (P = .04), and bleeding affected 11% of patients in each group. Together, the findings “show that anticoagulants are efficacious and safe for treatment of portal vein thrombosis in cirrhotic patients,” although larger, interventional clinical trials are needed to pinpoint the clinical role of anticoagulation in cirrhotic patients with PVT, the reviewers reported.
Source: American Gastroenterological Association
Bleeding from portal hypertension is a major complication in cirrhosis, but PVT affects about 20% of patients and predicts poor outcomes, they noted. Anticoagulation in this setting can be difficult because patients often have concurrent coagulopathies that are hard to assess with standard techniques, such as PT-INR (international normalized ratio). Although some studies support anticoagulating these patients, data are limited. Therefore, the reviewers searched PubMed, the ISI Web of Science, SCOPUS, and the Cochrane database through Feb. 14, 2017, for trials comparing anticoagulation with no treatment in patients with cirrhosis and PVT.
This search yielded eight trials of 353 patients who received low-molecular-weight heparin, warfarin, or no treatment for about 6 months, with a typical follow-up period of 2 years. The reviewers found no evidence of publication bias or significant heterogeneity among the trials. Six studies evaluated complete recanalization, another set of six studies tracked progression of PVT, a third set of six studies evaluated major or minor bleeding events, and four studies evaluated spontaneous variceal bleeding. Compared with no treatment, anticoagulation was tied to a significantly greater likelihood of complete recanalization (pooled odds ratio, 3.4; 95% confidence interval, 1.5-7.4; P = .002), a significantly lower chance of PVT progressing (9% vs. 33%; pooled odds ratio, 0.14; 95% CI, 0.06-0.31; P less than .0001), no difference in bleeding rates (11% in each pooled group), and a significantly lower risk of spontaneous variceal bleeding (OR, 0.23; 95% CI, 0.06-0.94; P = .04).
“Metaregression analysis showed that duration of anticoagulation did not influence outcomes,” the reviewers wrote. “Low-molecular-weight heparin, but not warfarin, was significantly associated with a complete PVT resolution as compared to untreated patients, while both low-molecular-weight heparin and warfarin were effective in reducing PVT progression.” That finding merits careful interpretation, however, because most studies on warfarin were retrospective and lacked data on the quality of anticoagulation, they added.
“It is a challenge to treat patients with cirrhosis using anticoagulants because of the perception that the coexistent coagulopathy could promote bleeding,” the researchers wrote. Nonetheless, their analysis suggests that anticoagulation has significant benefits and does not increase bleeding risk, regardless of the severity of liver failure, they concluded.
The reviewers reported having no funding sources or conflicts of interest.
FROM GASTROENTEROLOGY
Key clinical point: Anticoagulation produced favorable outcomes with no increase in bleeding risk in patients with cirrhosis and portal vein thrombosis.
Major finding: Rates of any recanalization were 71% in treated patients and 42% in untreated patients (P less than .0001); rates of complete recanalization were 53% and 33%, respectively (P = .002), rates of spontaneous variceal bleeding were 2% and 12% (P = .04), and bleeding affected 11% of patients in each group.
Data source: A systematic review and meta-analysis of eight studies of 353 patients with cirrhosis and portal vein thrombosis.
Disclosures: The reviewers reported having no funding sources or conflicts of interest.
QI enthusiast to QI leader: John Bulger, DO
Editor’s Note: This SHM series highlights the professional pathways of quality improvement leaders. This month features the story of John Bulger, DO, chief medical officer for Geisinger Health Plan.
As chief medical officer for Geisinger Health Plan, John Bulger, DO, MBA, is intimately acquainted with the daily challenges that intersect with the delivery of safe, quality-driven care in the hospital system.
He’s also very familiar with the intricacies of carving out a professional road map. When Dr. Bulger began practicing as an internist at Geisinger Health System in the late 1990s, there wasn’t a formal hospitalist designation. He created one and became director of the hospital medicine program. Years later, when the opportunity arose to become chief quality officer, Dr. Bulger was a natural fit for the position, having led many improvement-centered committees and projects while running the hospital medicine group.
Early in his QI immersion, Dr. Bulger sought training where available from sources such as ACP and SHM, while familiarizing himself with methodologies such as PDSA and Lean. There are far more QI training opportunities available to hospitalists today than when Dr. Bulger began his journey, but the fundamentals of success come back to finding the right mentors, team building, and implementing projects built around SMART goals.
Getting started, Dr. Bulger suggests to “pick something within your scope, like medical reconciliation for every patient, or ensuring that every patient who leaves the hospital gets an appointment with their primary physician within 7 days. Early on, we were working on issues like pneumonia core measures and providing discharge instructions.”
He cautions those starting out in QI against viewing unintended outcomes or project setbacks as failure. “If your goal is to take a (scenario) from bad to perfect, you’ll end up getting discouraged. Any effort toward making things better is helpful. If it doesn’t work you try something else.”
While Dr. Bulger is fully supportive of the impact that quality improvement projects make at the institutional level, he encourages clinicians and researchers to always keep the Institute for Healthcare Improvement Triple Aim in sight.
“We need better measures and more discussion about what is best for patients,” Dr. Bulger said. “The things we talk about in (health care) – readmission rates, glycemic control – have a minimal impact on people’s health, but the social determinants of health – the patient’s housing and economic situation – play a bigger role than anything else. As we move from provider- to patient-centric communities by fixing the Triple Aim, the experience will be better for both providers and patients.”
Claudia Stahl is content manager for the Society of Hospital Medicine.
Editor’s Note: This SHM series highlights the professional pathways of quality improvement leaders. This month features the story of John Bulger, DO, chief medical officer for Geisinger Health Plan.
As chief medical officer for Geisinger Health Plan, John Bulger, DO, MBA, is intimately acquainted with the daily challenges that intersect with the delivery of safe, quality-driven care in the hospital system.
He’s also very familiar with the intricacies of carving out a professional road map. When Dr. Bulger began practicing as an internist at Geisinger Health System in the late 1990s, there wasn’t a formal hospitalist designation. He created one and became director of the hospital medicine program. Years later, when the opportunity arose to become chief quality officer, Dr. Bulger was a natural fit for the position, having led many improvement-centered committees and projects while running the hospital medicine group.
Early in his QI immersion, Dr. Bulger sought training where available from sources such as ACP and SHM, while familiarizing himself with methodologies such as PDSA and Lean. There are far more QI training opportunities available to hospitalists today than when Dr. Bulger began his journey, but the fundamentals of success come back to finding the right mentors, team building, and implementing projects built around SMART goals.
Getting started, Dr. Bulger suggests to “pick something within your scope, like medical reconciliation for every patient, or ensuring that every patient who leaves the hospital gets an appointment with their primary physician within 7 days. Early on, we were working on issues like pneumonia core measures and providing discharge instructions.”
He cautions those starting out in QI against viewing unintended outcomes or project setbacks as failure. “If your goal is to take a (scenario) from bad to perfect, you’ll end up getting discouraged. Any effort toward making things better is helpful. If it doesn’t work you try something else.”
While Dr. Bulger is fully supportive of the impact that quality improvement projects make at the institutional level, he encourages clinicians and researchers to always keep the Institute for Healthcare Improvement Triple Aim in sight.
“We need better measures and more discussion about what is best for patients,” Dr. Bulger said. “The things we talk about in (health care) – readmission rates, glycemic control – have a minimal impact on people’s health, but the social determinants of health – the patient’s housing and economic situation – play a bigger role than anything else. As we move from provider- to patient-centric communities by fixing the Triple Aim, the experience will be better for both providers and patients.”
Claudia Stahl is content manager for the Society of Hospital Medicine.
Editor’s Note: This SHM series highlights the professional pathways of quality improvement leaders. This month features the story of John Bulger, DO, chief medical officer for Geisinger Health Plan.
As chief medical officer for Geisinger Health Plan, John Bulger, DO, MBA, is intimately acquainted with the daily challenges that intersect with the delivery of safe, quality-driven care in the hospital system.
He’s also very familiar with the intricacies of carving out a professional road map. When Dr. Bulger began practicing as an internist at Geisinger Health System in the late 1990s, there wasn’t a formal hospitalist designation. He created one and became director of the hospital medicine program. Years later, when the opportunity arose to become chief quality officer, Dr. Bulger was a natural fit for the position, having led many improvement-centered committees and projects while running the hospital medicine group.
Early in his QI immersion, Dr. Bulger sought training where available from sources such as ACP and SHM, while familiarizing himself with methodologies such as PDSA and Lean. There are far more QI training opportunities available to hospitalists today than when Dr. Bulger began his journey, but the fundamentals of success come back to finding the right mentors, team building, and implementing projects built around SMART goals.
Getting started, Dr. Bulger suggests to “pick something within your scope, like medical reconciliation for every patient, or ensuring that every patient who leaves the hospital gets an appointment with their primary physician within 7 days. Early on, we were working on issues like pneumonia core measures and providing discharge instructions.”
He cautions those starting out in QI against viewing unintended outcomes or project setbacks as failure. “If your goal is to take a (scenario) from bad to perfect, you’ll end up getting discouraged. Any effort toward making things better is helpful. If it doesn’t work you try something else.”
While Dr. Bulger is fully supportive of the impact that quality improvement projects make at the institutional level, he encourages clinicians and researchers to always keep the Institute for Healthcare Improvement Triple Aim in sight.
“We need better measures and more discussion about what is best for patients,” Dr. Bulger said. “The things we talk about in (health care) – readmission rates, glycemic control – have a minimal impact on people’s health, but the social determinants of health – the patient’s housing and economic situation – play a bigger role than anything else. As we move from provider- to patient-centric communities by fixing the Triple Aim, the experience will be better for both providers and patients.”
Claudia Stahl is content manager for the Society of Hospital Medicine.
Here’s what’s trending at SHM: July 2017
Updated Clinical Documentation & Coding resources now available
SHM’s Clinical Documentation & Coding for Hospitalists, formerly CODE-H, has been updated for 2017.
“[It’s] an exciting program that offers valuable insight into the coding and billing challenges of hospitalist services. Whether you are a new or seasoned physician, SHM’s Clinical Documentation & Coding for Hospitalists provides you with a solid foundation for documentation, identifies common problems, and offers strategies for success.” – Carol Pohlig, BSN, RN, CPC, ASC Senior Coding and Compliance Specialist
For more information, visit hospitalmedicine.org/codeh.
Registration now open for NP/PA Bootcamp
Whether you’re new to hospital medicine or need a refresher on the latest topics, this course from the AAPA and SHM is perfect for you and offers up to 34.75 AAPA Category 1 CME credits.
At the Adult Hospital Medicine Bootcamp, you will cover commonly encountered diagnoses and diseases of adult hospitalized patients while networking with other hospital-based practitioners. Plus, attend optional pre-courses on reimbursement, hands-on ultrasound or hospital medicine basics.
Join us at the ninth annual Adult Hospital Medicine Boot Camp, September 27 – October 1, 2017, in San Diego. To register and learn more visit: aapa.org/bootcamp.
Learn how your HMG stacks up with the State of Hospital Medicine report
Did you know that hospitalist compensation typically consists of 80% base pay and 20% supplemental income based on production and performance? SHM’s State of Hospital Medicine Report continues to be your best source of information about how hospital medicine groups (HMGs) operate.
Don’t miss the new additions to the report for the 2016 version, including:
• Percentage of the hospital’s total patient volume the HMG was responsible for caring for.
• Presence of medical hospitalists within the HMG focusing their practice in a specific medical subspecialty.
• Value of CME allowances for hospitalists.
• Utilization of prolonged service codes by hospitalists.
• Charge capture methodologies being used by HMGs.
• For academic HMGs, the dollar amount of financial support provided for non-clinical work.
Order your print or digital copy at hospitalmedicine.org/sohm.
Enhance your leadership skills at SHM’s Leadership Academy
SHM’s Leadership Academy is the only leadership program designed specifically for hospitalists. The 2017 meeting will be held October 23 – 26 at the JW Marriott Camelback Inn in Scottsdale, Ariz.
Course highlight: Leadership mastering teamwork
Developed in response to high demand from previous Leadership Academy attendees, this course focuses on strengthening teams and institutions. Participants learn how to critically assess program growth opportunities and develop operational plans; utilize the principles of SWARM intelligence; lead, manage, and motivate teams in complex hospital environments; and develop effective communication strategies.
Upon completion of this course, participants will be able to apply communication strategies that allow others to fully experience their message, lead teams in complex environments to achieve the best results, invest in themselves as leaders to optimize their professional growth and career path, and critically assess program growth opportunities and implement the necessary infrastructure for success.
To view the course schedule, faculty and more visit shmleadershipacademy.org/masteringteamwork.
Improve glycemic control efforts in your hospital with online resources & mentorship
SHM offers a variety of resources to improve glycemic control in your hospital. Glycemic Control Electronic Quality Improvement Programs (eQUIPS) are designed to enhance the efficiency and reliability of your quality improvement efforts to close the gap between best practices and methods for caring for the inpatient with hyperglycemia.
Benefits of SHM’s eQUIPS include:
• Data and performance tracking tools.
• Step-by-step instructions for improving glycemic control, preventing hypoglycemia, and optimizing care of inpatients with hyperglycemia and diabetes.
• An online community and library of tools and documents, including sample order sets and protocols, awareness campaigns, patient educational materials, and supplemental articles.
• Toolkit of clinical tools and interventions, research materials, literature reviews, case studies, teaching slide sets, and more.
SHM’s Glycemic Control Mentored Implementation program sites receive 1 year of individualized mentoring including:
• On-site mentoring and training for the entire care team to help members interpret needs and resource assessments, map system processes, and develop site-specific action and intervention plans.
• Monthly coaching calls with the mentor to develop, modify, and implement interventions, establish evaluation processes, and monitor performance over time.
• SHM-facilitated calls with live webinars with other sites in the collaborative to share success stories and experiences.
• Access to the online community to share ideas, documents, and other resources.
• Data collection and analysis tools to generate on-demand reports and benchmark against other program participants.
Learn more about all of SHM’s Glycemic Control offerings by watching the recorded webinar from June 28, 2017, at hospitalmedicine.org/gc.
Earn CME with SHM’s Learning Portal
SHM’s Learning Portal is the online learning destination for hospitalists, featuring all of SHM’s eLearning initiatives in one place. Members can access over 85 CME credits for free in the Learning Portal.
Featured topics currently include perioperative medicine, anticoagulation, quality improvement, cardiac arrhythmia, and antimicrobial stewardship.
Try out the most popular modules:
• The Role of the Medical Consultant.
• Pulmonary Risk Management in the Perioperative Setting.
• Perioperative Medication Management.
• Venous Thromboembolism Prophylaxis in Surgical Patients.
• Perioperative Cardiac Risk Assessment.
Not a member? Join today or pay a small fee per module. Visit shmlearningportal.org to learn more and earn CME credits today.
Brett Radler is communications specialist at the Society of Hospital Medicine.
Updated Clinical Documentation & Coding resources now available
SHM’s Clinical Documentation & Coding for Hospitalists, formerly CODE-H, has been updated for 2017.
“[It’s] an exciting program that offers valuable insight into the coding and billing challenges of hospitalist services. Whether you are a new or seasoned physician, SHM’s Clinical Documentation & Coding for Hospitalists provides you with a solid foundation for documentation, identifies common problems, and offers strategies for success.” – Carol Pohlig, BSN, RN, CPC, ASC Senior Coding and Compliance Specialist
For more information, visit hospitalmedicine.org/codeh.
Registration now open for NP/PA Bootcamp
Whether you’re new to hospital medicine or need a refresher on the latest topics, this course from the AAPA and SHM is perfect for you and offers up to 34.75 AAPA Category 1 CME credits.
At the Adult Hospital Medicine Bootcamp, you will cover commonly encountered diagnoses and diseases of adult hospitalized patients while networking with other hospital-based practitioners. Plus, attend optional pre-courses on reimbursement, hands-on ultrasound or hospital medicine basics.
Join us at the ninth annual Adult Hospital Medicine Boot Camp, September 27 – October 1, 2017, in San Diego. To register and learn more visit: aapa.org/bootcamp.
Learn how your HMG stacks up with the State of Hospital Medicine report
Did you know that hospitalist compensation typically consists of 80% base pay and 20% supplemental income based on production and performance? SHM’s State of Hospital Medicine Report continues to be your best source of information about how hospital medicine groups (HMGs) operate.
Don’t miss the new additions to the report for the 2016 version, including:
• Percentage of the hospital’s total patient volume the HMG was responsible for caring for.
• Presence of medical hospitalists within the HMG focusing their practice in a specific medical subspecialty.
• Value of CME allowances for hospitalists.
• Utilization of prolonged service codes by hospitalists.
• Charge capture methodologies being used by HMGs.
• For academic HMGs, the dollar amount of financial support provided for non-clinical work.
Order your print or digital copy at hospitalmedicine.org/sohm.
Enhance your leadership skills at SHM’s Leadership Academy
SHM’s Leadership Academy is the only leadership program designed specifically for hospitalists. The 2017 meeting will be held October 23 – 26 at the JW Marriott Camelback Inn in Scottsdale, Ariz.
Course highlight: Leadership mastering teamwork
Developed in response to high demand from previous Leadership Academy attendees, this course focuses on strengthening teams and institutions. Participants learn how to critically assess program growth opportunities and develop operational plans; utilize the principles of SWARM intelligence; lead, manage, and motivate teams in complex hospital environments; and develop effective communication strategies.
Upon completion of this course, participants will be able to apply communication strategies that allow others to fully experience their message, lead teams in complex environments to achieve the best results, invest in themselves as leaders to optimize their professional growth and career path, and critically assess program growth opportunities and implement the necessary infrastructure for success.
To view the course schedule, faculty and more visit shmleadershipacademy.org/masteringteamwork.
Improve glycemic control efforts in your hospital with online resources & mentorship
SHM offers a variety of resources to improve glycemic control in your hospital. Glycemic Control Electronic Quality Improvement Programs (eQUIPS) are designed to enhance the efficiency and reliability of your quality improvement efforts to close the gap between best practices and methods for caring for the inpatient with hyperglycemia.
Benefits of SHM’s eQUIPS include:
• Data and performance tracking tools.
• Step-by-step instructions for improving glycemic control, preventing hypoglycemia, and optimizing care of inpatients with hyperglycemia and diabetes.
• An online community and library of tools and documents, including sample order sets and protocols, awareness campaigns, patient educational materials, and supplemental articles.
• Toolkit of clinical tools and interventions, research materials, literature reviews, case studies, teaching slide sets, and more.
SHM’s Glycemic Control Mentored Implementation program sites receive 1 year of individualized mentoring including:
• On-site mentoring and training for the entire care team to help members interpret needs and resource assessments, map system processes, and develop site-specific action and intervention plans.
• Monthly coaching calls with the mentor to develop, modify, and implement interventions, establish evaluation processes, and monitor performance over time.
• SHM-facilitated calls with live webinars with other sites in the collaborative to share success stories and experiences.
• Access to the online community to share ideas, documents, and other resources.
• Data collection and analysis tools to generate on-demand reports and benchmark against other program participants.
Learn more about all of SHM’s Glycemic Control offerings by watching the recorded webinar from June 28, 2017, at hospitalmedicine.org/gc.
Earn CME with SHM’s Learning Portal
SHM’s Learning Portal is the online learning destination for hospitalists, featuring all of SHM’s eLearning initiatives in one place. Members can access over 85 CME credits for free in the Learning Portal.
Featured topics currently include perioperative medicine, anticoagulation, quality improvement, cardiac arrhythmia, and antimicrobial stewardship.
Try out the most popular modules:
• The Role of the Medical Consultant.
• Pulmonary Risk Management in the Perioperative Setting.
• Perioperative Medication Management.
• Venous Thromboembolism Prophylaxis in Surgical Patients.
• Perioperative Cardiac Risk Assessment.
Not a member? Join today or pay a small fee per module. Visit shmlearningportal.org to learn more and earn CME credits today.
Brett Radler is communications specialist at the Society of Hospital Medicine.
Updated Clinical Documentation & Coding resources now available
SHM’s Clinical Documentation & Coding for Hospitalists, formerly CODE-H, has been updated for 2017.
“[It’s] an exciting program that offers valuable insight into the coding and billing challenges of hospitalist services. Whether you are a new or seasoned physician, SHM’s Clinical Documentation & Coding for Hospitalists provides you with a solid foundation for documentation, identifies common problems, and offers strategies for success.” – Carol Pohlig, BSN, RN, CPC, ASC Senior Coding and Compliance Specialist
For more information, visit hospitalmedicine.org/codeh.
Registration now open for NP/PA Bootcamp
Whether you’re new to hospital medicine or need a refresher on the latest topics, this course from the AAPA and SHM is perfect for you and offers up to 34.75 AAPA Category 1 CME credits.
At the Adult Hospital Medicine Bootcamp, you will cover commonly encountered diagnoses and diseases of adult hospitalized patients while networking with other hospital-based practitioners. Plus, attend optional pre-courses on reimbursement, hands-on ultrasound or hospital medicine basics.
Join us at the ninth annual Adult Hospital Medicine Boot Camp, September 27 – October 1, 2017, in San Diego. To register and learn more visit: aapa.org/bootcamp.
Learn how your HMG stacks up with the State of Hospital Medicine report
Did you know that hospitalist compensation typically consists of 80% base pay and 20% supplemental income based on production and performance? SHM’s State of Hospital Medicine Report continues to be your best source of information about how hospital medicine groups (HMGs) operate.
Don’t miss the new additions to the report for the 2016 version, including:
• Percentage of the hospital’s total patient volume the HMG was responsible for caring for.
• Presence of medical hospitalists within the HMG focusing their practice in a specific medical subspecialty.
• Value of CME allowances for hospitalists.
• Utilization of prolonged service codes by hospitalists.
• Charge capture methodologies being used by HMGs.
• For academic HMGs, the dollar amount of financial support provided for non-clinical work.
Order your print or digital copy at hospitalmedicine.org/sohm.
Enhance your leadership skills at SHM’s Leadership Academy
SHM’s Leadership Academy is the only leadership program designed specifically for hospitalists. The 2017 meeting will be held October 23 – 26 at the JW Marriott Camelback Inn in Scottsdale, Ariz.
Course highlight: Leadership mastering teamwork
Developed in response to high demand from previous Leadership Academy attendees, this course focuses on strengthening teams and institutions. Participants learn how to critically assess program growth opportunities and develop operational plans; utilize the principles of SWARM intelligence; lead, manage, and motivate teams in complex hospital environments; and develop effective communication strategies.
Upon completion of this course, participants will be able to apply communication strategies that allow others to fully experience their message, lead teams in complex environments to achieve the best results, invest in themselves as leaders to optimize their professional growth and career path, and critically assess program growth opportunities and implement the necessary infrastructure for success.
To view the course schedule, faculty and more visit shmleadershipacademy.org/masteringteamwork.
Improve glycemic control efforts in your hospital with online resources & mentorship
SHM offers a variety of resources to improve glycemic control in your hospital. Glycemic Control Electronic Quality Improvement Programs (eQUIPS) are designed to enhance the efficiency and reliability of your quality improvement efforts to close the gap between best practices and methods for caring for the inpatient with hyperglycemia.
Benefits of SHM’s eQUIPS include:
• Data and performance tracking tools.
• Step-by-step instructions for improving glycemic control, preventing hypoglycemia, and optimizing care of inpatients with hyperglycemia and diabetes.
• An online community and library of tools and documents, including sample order sets and protocols, awareness campaigns, patient educational materials, and supplemental articles.
• Toolkit of clinical tools and interventions, research materials, literature reviews, case studies, teaching slide sets, and more.
SHM’s Glycemic Control Mentored Implementation program sites receive 1 year of individualized mentoring including:
• On-site mentoring and training for the entire care team to help members interpret needs and resource assessments, map system processes, and develop site-specific action and intervention plans.
• Monthly coaching calls with the mentor to develop, modify, and implement interventions, establish evaluation processes, and monitor performance over time.
• SHM-facilitated calls with live webinars with other sites in the collaborative to share success stories and experiences.
• Access to the online community to share ideas, documents, and other resources.
• Data collection and analysis tools to generate on-demand reports and benchmark against other program participants.
Learn more about all of SHM’s Glycemic Control offerings by watching the recorded webinar from June 28, 2017, at hospitalmedicine.org/gc.
Earn CME with SHM’s Learning Portal
SHM’s Learning Portal is the online learning destination for hospitalists, featuring all of SHM’s eLearning initiatives in one place. Members can access over 85 CME credits for free in the Learning Portal.
Featured topics currently include perioperative medicine, anticoagulation, quality improvement, cardiac arrhythmia, and antimicrobial stewardship.
Try out the most popular modules:
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Brett Radler is communications specialist at the Society of Hospital Medicine.
Sneak Peek: The Hospital Leader blog - July 2017
“We Are Not Done Changing”
Recently, the online version of JAMA published an original investigation titled, “Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.” The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care.
The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks, a 5.9% relative decrease. The positive effects of being monitored have been well documented in all kinds of arenas, such as hand washing and antibiotic stewardship. But mortality?
Overall, I feel like I’m a reasonable person, but the clear lack of interest – or willingness to consider that this might not be a good idea on the part of the hospitalist in charge – incited a certain amount of anger and disbelief in me. She also received an antibiotic that she had a documented allergy to – a clear medical error. I instructed my sis-in-law to refuse access to the line; it was removed, and she ultimately recovered to discharge.
This brings me back to the JAMA study. It’s easy to perceive unannounced inspections as merely an inconvenience, where things are locked up that normally aren’t, or where that coveted cup of coffee you normally bring on rounds to get you through your day is summarily yanked out of your hand.
Read the full text of this blog post at hospitalleader.org.
Also on The Hospital Leader…
• How Often Do You Ask This (Ineffective) Question? by Brad Flansbaum, DO, MPH, MHM• Building a Practice that People Want to Be a Part Of by Leslie Flores, MHA• A Need for Medicare Appeals Process Reform in Hospital Observation Care by Anne Sheehy, MD, MS, FHM
“We Are Not Done Changing”
Recently, the online version of JAMA published an original investigation titled, “Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.” The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care.
The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks, a 5.9% relative decrease. The positive effects of being monitored have been well documented in all kinds of arenas, such as hand washing and antibiotic stewardship. But mortality?
Overall, I feel like I’m a reasonable person, but the clear lack of interest – or willingness to consider that this might not be a good idea on the part of the hospitalist in charge – incited a certain amount of anger and disbelief in me. She also received an antibiotic that she had a documented allergy to – a clear medical error. I instructed my sis-in-law to refuse access to the line; it was removed, and she ultimately recovered to discharge.
This brings me back to the JAMA study. It’s easy to perceive unannounced inspections as merely an inconvenience, where things are locked up that normally aren’t, or where that coveted cup of coffee you normally bring on rounds to get you through your day is summarily yanked out of your hand.
Read the full text of this blog post at hospitalleader.org.
Also on The Hospital Leader…
• How Often Do You Ask This (Ineffective) Question? by Brad Flansbaum, DO, MPH, MHM• Building a Practice that People Want to Be a Part Of by Leslie Flores, MHA• A Need for Medicare Appeals Process Reform in Hospital Observation Care by Anne Sheehy, MD, MS, FHM
“We Are Not Done Changing”
Recently, the online version of JAMA published an original investigation titled, “Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.” The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care.
The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks, a 5.9% relative decrease. The positive effects of being monitored have been well documented in all kinds of arenas, such as hand washing and antibiotic stewardship. But mortality?
Overall, I feel like I’m a reasonable person, but the clear lack of interest – or willingness to consider that this might not be a good idea on the part of the hospitalist in charge – incited a certain amount of anger and disbelief in me. She also received an antibiotic that she had a documented allergy to – a clear medical error. I instructed my sis-in-law to refuse access to the line; it was removed, and she ultimately recovered to discharge.
This brings me back to the JAMA study. It’s easy to perceive unannounced inspections as merely an inconvenience, where things are locked up that normally aren’t, or where that coveted cup of coffee you normally bring on rounds to get you through your day is summarily yanked out of your hand.
Read the full text of this blog post at hospitalleader.org.
Also on The Hospital Leader…
• How Often Do You Ask This (Ineffective) Question? by Brad Flansbaum, DO, MPH, MHM• Building a Practice that People Want to Be a Part Of by Leslie Flores, MHA• A Need for Medicare Appeals Process Reform in Hospital Observation Care by Anne Sheehy, MD, MS, FHM
From hospitalist to health plan CMO
Several times a year, I’m privileged to step away from my role as chief medical officer of a health insurance company and return to a previous role I cherish – teaching.
This isn’t the clinical teaching that I used to do as a hospital medicine attending or palliative medicine consultant. These are mostly 4th-year medical students who have 90 minutes or so set aside during their primary care rotation to learn about “the business of medicine.”
I always begin by telling them that when I went to medical school, “I always intended to become a health insurance executive – NOT!” (If I get a few laughs, I know the time will fly by.) I share the history of my improbable career arc and how I wound up doing something I didn’t even know existed when I was their age. And, I still try to impart some pearls of wisdom in case they remember any of this discussion as they embark on their own personal and professional journeys, knowing that at this stage in their young careers, they will be almost totally immersed in their clinical training.
1. Do what you love
Sounds simple, but too many of us make the expedient choice, or the one expected of us. Work is hard enough without being able to find some joy and meaning every day in what you do. Every job has aspects that must be tolerated, but if you don’t find a greater purpose in practicing medicine, then find a way to get it back – or think about doing something else.
2. When opportunity knocks, be prepared to answer the door
For me, I enjoyed caring for patients one at a time, perhaps 15 or so during any particular day. Being a hospitalist is important and fulfilling work. But my experience as a hospitalist enabled me to recognize the “quality chasms” that existed in my hospital and across the “system,” namely lost opportunities to provide better end-of-life care and to better coordinate care within the hospital and across the care continuum. A new mission evolved for me: to do whatever I could to improve the safety, quality, and efficiency of the care we provided, and to make the hospital a better place to work. I taught myself the clinical skills to practice palliative medicine, and I attended courses that helped me prepare to become a service line medical director in hopes of starting a program at my hospital. I also took on the role of medical director of care management at my hospital, which in a sense allowed me to help take care of several hundred patients at a time – the beginning of my transition to population health.
3. Be a lifelong learner
When these opportunities arose, I was prepared for the challenges thanks to training opportunities I actively sought out, and thanks to the support of my mentors and my medical group to attend leadership training, such as SHM’s Leadership Academy. No matter what your role in your group or at your hospital, gaining these valuable skills outside of the usual medical training will help position you for new opportunities that can only help you create a more sustainable career. And although I never went back to school to earn another advanced degree such as an MBA or MHA, additional formal education is something to consider. You can never have too many tools in your toolkit.
4. Diversify!
It’s good advice from your financial adviser, and it’s good advice for your career. I’m not suggesting you take on a side job as a lawyer or a carpenter, but you might want to think about becoming an expert in a related field like perioperative medicine, primary palliative care, or postacute care. Or consider developing a niche as a sought-after leader for hospital-based committees, such as Quality or P&T. Or maybe consider clinical research, even if you’re not at an academic medical center. The point I’m making – and I know this may seem controversial – is that practicing medicine 100% of the time is probably no longer a sustainable plan for the entire 30- to 40-year span of your postgraduate career. Find an area that you can develop into protected, paid time apart from providing direct clinical care.
5. If you are thinking of changing jobs or even careers, run toward something – not away from something else
When I was first recruited to be a medical director at another health plan, I struggled mightily as to whether leaving full-time practice was an opportunity or a foolish, dead-end career move. Ultimately, I made my decision not to avoid night call or working every other weekend; I did it because I felt I had made a difference in the hospital where I had worked for 15 years and was ready to take on a new challenge by learning the business side of health care. It provided me the opportunity to positively impact the care of not just several hundred patients, but as many as two million! My current position now allows me to have even greater influence in pursuing my personal mission to improve the quality, safety, and affordability of health care.
6. Seek balance in life
Again, sounds trite, but think about it. Most health care professionals, especially physicians, have spent most of their adult lives focused on a single goal – and that often comes at a great cost, both financially and personally. (By the way, I say “seek” because at this point in my career, I doubt any of us ever really find balance.) The best you can hope for is to be wise enough to know that amongst all the balls we are juggling, there are a few that you just can’t let drop without possibly breaking without repair.
As I conclude my talks, I tell those young medical students to practice resiliency; the only constant is change. Remain inquisitive, open yourself to whatever life may bring and enjoy the ride. With a specialty as dynamic and diverse as hospital medicine, you never know where it will take you.
Dr. Epstein is executive vice president & chief medical officer at PreferredOne, and adjunct assistant professor of medicine at the University of Minnesota, Minneapolis. He also serves as Board Secretary of SHM.
Several times a year, I’m privileged to step away from my role as chief medical officer of a health insurance company and return to a previous role I cherish – teaching.
This isn’t the clinical teaching that I used to do as a hospital medicine attending or palliative medicine consultant. These are mostly 4th-year medical students who have 90 minutes or so set aside during their primary care rotation to learn about “the business of medicine.”
I always begin by telling them that when I went to medical school, “I always intended to become a health insurance executive – NOT!” (If I get a few laughs, I know the time will fly by.) I share the history of my improbable career arc and how I wound up doing something I didn’t even know existed when I was their age. And, I still try to impart some pearls of wisdom in case they remember any of this discussion as they embark on their own personal and professional journeys, knowing that at this stage in their young careers, they will be almost totally immersed in their clinical training.
1. Do what you love
Sounds simple, but too many of us make the expedient choice, or the one expected of us. Work is hard enough without being able to find some joy and meaning every day in what you do. Every job has aspects that must be tolerated, but if you don’t find a greater purpose in practicing medicine, then find a way to get it back – or think about doing something else.
2. When opportunity knocks, be prepared to answer the door
For me, I enjoyed caring for patients one at a time, perhaps 15 or so during any particular day. Being a hospitalist is important and fulfilling work. But my experience as a hospitalist enabled me to recognize the “quality chasms” that existed in my hospital and across the “system,” namely lost opportunities to provide better end-of-life care and to better coordinate care within the hospital and across the care continuum. A new mission evolved for me: to do whatever I could to improve the safety, quality, and efficiency of the care we provided, and to make the hospital a better place to work. I taught myself the clinical skills to practice palliative medicine, and I attended courses that helped me prepare to become a service line medical director in hopes of starting a program at my hospital. I also took on the role of medical director of care management at my hospital, which in a sense allowed me to help take care of several hundred patients at a time – the beginning of my transition to population health.
3. Be a lifelong learner
When these opportunities arose, I was prepared for the challenges thanks to training opportunities I actively sought out, and thanks to the support of my mentors and my medical group to attend leadership training, such as SHM’s Leadership Academy. No matter what your role in your group or at your hospital, gaining these valuable skills outside of the usual medical training will help position you for new opportunities that can only help you create a more sustainable career. And although I never went back to school to earn another advanced degree such as an MBA or MHA, additional formal education is something to consider. You can never have too many tools in your toolkit.
4. Diversify!
It’s good advice from your financial adviser, and it’s good advice for your career. I’m not suggesting you take on a side job as a lawyer or a carpenter, but you might want to think about becoming an expert in a related field like perioperative medicine, primary palliative care, or postacute care. Or consider developing a niche as a sought-after leader for hospital-based committees, such as Quality or P&T. Or maybe consider clinical research, even if you’re not at an academic medical center. The point I’m making – and I know this may seem controversial – is that practicing medicine 100% of the time is probably no longer a sustainable plan for the entire 30- to 40-year span of your postgraduate career. Find an area that you can develop into protected, paid time apart from providing direct clinical care.
5. If you are thinking of changing jobs or even careers, run toward something – not away from something else
When I was first recruited to be a medical director at another health plan, I struggled mightily as to whether leaving full-time practice was an opportunity or a foolish, dead-end career move. Ultimately, I made my decision not to avoid night call or working every other weekend; I did it because I felt I had made a difference in the hospital where I had worked for 15 years and was ready to take on a new challenge by learning the business side of health care. It provided me the opportunity to positively impact the care of not just several hundred patients, but as many as two million! My current position now allows me to have even greater influence in pursuing my personal mission to improve the quality, safety, and affordability of health care.
6. Seek balance in life
Again, sounds trite, but think about it. Most health care professionals, especially physicians, have spent most of their adult lives focused on a single goal – and that often comes at a great cost, both financially and personally. (By the way, I say “seek” because at this point in my career, I doubt any of us ever really find balance.) The best you can hope for is to be wise enough to know that amongst all the balls we are juggling, there are a few that you just can’t let drop without possibly breaking without repair.
As I conclude my talks, I tell those young medical students to practice resiliency; the only constant is change. Remain inquisitive, open yourself to whatever life may bring and enjoy the ride. With a specialty as dynamic and diverse as hospital medicine, you never know where it will take you.
Dr. Epstein is executive vice president & chief medical officer at PreferredOne, and adjunct assistant professor of medicine at the University of Minnesota, Minneapolis. He also serves as Board Secretary of SHM.
Several times a year, I’m privileged to step away from my role as chief medical officer of a health insurance company and return to a previous role I cherish – teaching.
This isn’t the clinical teaching that I used to do as a hospital medicine attending or palliative medicine consultant. These are mostly 4th-year medical students who have 90 minutes or so set aside during their primary care rotation to learn about “the business of medicine.”
I always begin by telling them that when I went to medical school, “I always intended to become a health insurance executive – NOT!” (If I get a few laughs, I know the time will fly by.) I share the history of my improbable career arc and how I wound up doing something I didn’t even know existed when I was their age. And, I still try to impart some pearls of wisdom in case they remember any of this discussion as they embark on their own personal and professional journeys, knowing that at this stage in their young careers, they will be almost totally immersed in their clinical training.
1. Do what you love
Sounds simple, but too many of us make the expedient choice, or the one expected of us. Work is hard enough without being able to find some joy and meaning every day in what you do. Every job has aspects that must be tolerated, but if you don’t find a greater purpose in practicing medicine, then find a way to get it back – or think about doing something else.
2. When opportunity knocks, be prepared to answer the door
For me, I enjoyed caring for patients one at a time, perhaps 15 or so during any particular day. Being a hospitalist is important and fulfilling work. But my experience as a hospitalist enabled me to recognize the “quality chasms” that existed in my hospital and across the “system,” namely lost opportunities to provide better end-of-life care and to better coordinate care within the hospital and across the care continuum. A new mission evolved for me: to do whatever I could to improve the safety, quality, and efficiency of the care we provided, and to make the hospital a better place to work. I taught myself the clinical skills to practice palliative medicine, and I attended courses that helped me prepare to become a service line medical director in hopes of starting a program at my hospital. I also took on the role of medical director of care management at my hospital, which in a sense allowed me to help take care of several hundred patients at a time – the beginning of my transition to population health.
3. Be a lifelong learner
When these opportunities arose, I was prepared for the challenges thanks to training opportunities I actively sought out, and thanks to the support of my mentors and my medical group to attend leadership training, such as SHM’s Leadership Academy. No matter what your role in your group or at your hospital, gaining these valuable skills outside of the usual medical training will help position you for new opportunities that can only help you create a more sustainable career. And although I never went back to school to earn another advanced degree such as an MBA or MHA, additional formal education is something to consider. You can never have too many tools in your toolkit.
4. Diversify!
It’s good advice from your financial adviser, and it’s good advice for your career. I’m not suggesting you take on a side job as a lawyer or a carpenter, but you might want to think about becoming an expert in a related field like perioperative medicine, primary palliative care, or postacute care. Or consider developing a niche as a sought-after leader for hospital-based committees, such as Quality or P&T. Or maybe consider clinical research, even if you’re not at an academic medical center. The point I’m making – and I know this may seem controversial – is that practicing medicine 100% of the time is probably no longer a sustainable plan for the entire 30- to 40-year span of your postgraduate career. Find an area that you can develop into protected, paid time apart from providing direct clinical care.
5. If you are thinking of changing jobs or even careers, run toward something – not away from something else
When I was first recruited to be a medical director at another health plan, I struggled mightily as to whether leaving full-time practice was an opportunity or a foolish, dead-end career move. Ultimately, I made my decision not to avoid night call or working every other weekend; I did it because I felt I had made a difference in the hospital where I had worked for 15 years and was ready to take on a new challenge by learning the business side of health care. It provided me the opportunity to positively impact the care of not just several hundred patients, but as many as two million! My current position now allows me to have even greater influence in pursuing my personal mission to improve the quality, safety, and affordability of health care.
6. Seek balance in life
Again, sounds trite, but think about it. Most health care professionals, especially physicians, have spent most of their adult lives focused on a single goal – and that often comes at a great cost, both financially and personally. (By the way, I say “seek” because at this point in my career, I doubt any of us ever really find balance.) The best you can hope for is to be wise enough to know that amongst all the balls we are juggling, there are a few that you just can’t let drop without possibly breaking without repair.
As I conclude my talks, I tell those young medical students to practice resiliency; the only constant is change. Remain inquisitive, open yourself to whatever life may bring and enjoy the ride. With a specialty as dynamic and diverse as hospital medicine, you never know where it will take you.
Dr. Epstein is executive vice president & chief medical officer at PreferredOne, and adjunct assistant professor of medicine at the University of Minnesota, Minneapolis. He also serves as Board Secretary of SHM.
Everything We Say and Do: Take time to leave a good impression
Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one or more of the “key communication” tactics in practice to maintain provider accountability for “everything we say and do that affects our patients’ thoughts, feelings, and well-being.”
What I say and do
I say “thank you” to each patient at the close of the clinical encounter and ask if there is something I can do for him or her before leaving the room.
Why I do it
The beginning and the end of a medical visit each have a significant impact on how patients view their overall experience with the physician. Devoting energy and thought to these critical moments during the patient-physician interaction is simple and rewarding, and helps leave patients with a good impression.
How I do it
At the close of each patient visit, whether in the emergency department with a new admission or during daily rounds, I incorporate a “thank you” prior to leaving the room.
For example, I thank the patient for going over the details of her history with me; I know she has repeated the same information several times already. I thank the patient who brought in a detailed home medication list that made medication reconciliation a breeze for this organization. If I discussed a sensitive or difficult topic with the patient, such as substance use, I thank the patient for being honest. Another option is to thank the patient for trusting me with his care during the hospitalization. My favorite “thank you,” and one that will work in any situation, is to thank a patient for his or her patience. Whether it is waiting for a procedure, waiting to eat, or waiting for the green light to go home, our patients’ patience is tremendous and absolutely deserves to be recognized.
After saying “thank you,” I close with a simple but powerful question: “Is there something I can do for you before I leave? I have time.” Perhaps I can assist with a refill of ice chips, help find the call button, or relay a message to the bedside nurse. Whatever the task may be, offering to help before departing humanizes the interaction between physician and patient and is sure to be appreciated and remembered. Furthermore, taking a pause in the hectic pace of the day to show patients that we care can give busy hospitalists a moment to recharge before moving on to the next item on the to-do list. Any way you look at it, thanking our patients and offering to help is time well spent.
Dr. Sebasky is assistant clinical professor at the University of California, San Diego.
Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one or more of the “key communication” tactics in practice to maintain provider accountability for “everything we say and do that affects our patients’ thoughts, feelings, and well-being.”
What I say and do
I say “thank you” to each patient at the close of the clinical encounter and ask if there is something I can do for him or her before leaving the room.
Why I do it
The beginning and the end of a medical visit each have a significant impact on how patients view their overall experience with the physician. Devoting energy and thought to these critical moments during the patient-physician interaction is simple and rewarding, and helps leave patients with a good impression.
How I do it
At the close of each patient visit, whether in the emergency department with a new admission or during daily rounds, I incorporate a “thank you” prior to leaving the room.
For example, I thank the patient for going over the details of her history with me; I know she has repeated the same information several times already. I thank the patient who brought in a detailed home medication list that made medication reconciliation a breeze for this organization. If I discussed a sensitive or difficult topic with the patient, such as substance use, I thank the patient for being honest. Another option is to thank the patient for trusting me with his care during the hospitalization. My favorite “thank you,” and one that will work in any situation, is to thank a patient for his or her patience. Whether it is waiting for a procedure, waiting to eat, or waiting for the green light to go home, our patients’ patience is tremendous and absolutely deserves to be recognized.
After saying “thank you,” I close with a simple but powerful question: “Is there something I can do for you before I leave? I have time.” Perhaps I can assist with a refill of ice chips, help find the call button, or relay a message to the bedside nurse. Whatever the task may be, offering to help before departing humanizes the interaction between physician and patient and is sure to be appreciated and remembered. Furthermore, taking a pause in the hectic pace of the day to show patients that we care can give busy hospitalists a moment to recharge before moving on to the next item on the to-do list. Any way you look at it, thanking our patients and offering to help is time well spent.
Dr. Sebasky is assistant clinical professor at the University of California, San Diego.
Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one or more of the “key communication” tactics in practice to maintain provider accountability for “everything we say and do that affects our patients’ thoughts, feelings, and well-being.”
What I say and do
I say “thank you” to each patient at the close of the clinical encounter and ask if there is something I can do for him or her before leaving the room.
Why I do it
The beginning and the end of a medical visit each have a significant impact on how patients view their overall experience with the physician. Devoting energy and thought to these critical moments during the patient-physician interaction is simple and rewarding, and helps leave patients with a good impression.
How I do it
At the close of each patient visit, whether in the emergency department with a new admission or during daily rounds, I incorporate a “thank you” prior to leaving the room.
For example, I thank the patient for going over the details of her history with me; I know she has repeated the same information several times already. I thank the patient who brought in a detailed home medication list that made medication reconciliation a breeze for this organization. If I discussed a sensitive or difficult topic with the patient, such as substance use, I thank the patient for being honest. Another option is to thank the patient for trusting me with his care during the hospitalization. My favorite “thank you,” and one that will work in any situation, is to thank a patient for his or her patience. Whether it is waiting for a procedure, waiting to eat, or waiting for the green light to go home, our patients’ patience is tremendous and absolutely deserves to be recognized.
After saying “thank you,” I close with a simple but powerful question: “Is there something I can do for you before I leave? I have time.” Perhaps I can assist with a refill of ice chips, help find the call button, or relay a message to the bedside nurse. Whatever the task may be, offering to help before departing humanizes the interaction between physician and patient and is sure to be appreciated and remembered. Furthermore, taking a pause in the hectic pace of the day to show patients that we care can give busy hospitalists a moment to recharge before moving on to the next item on the to-do list. Any way you look at it, thanking our patients and offering to help is time well spent.
Dr. Sebasky is assistant clinical professor at the University of California, San Diego.
New drug choices emerging to battle antibiotic resistance
SAN FRANCISCO – When the Infectious Diseases Society of America released the “Bad Bugs, No Drugs” report in 2004, its authors warned that effective antibiotics may not be available to treat seriously ill patients in the near future.
It also proposed legislative, regulatory, and funding solutions with a goal of developing and licensing 10 new antibiotics by the year 2020.
One such advancement was the Generating Antibiotics Incentives Now Act, which was signed into law in 2012 and created a designation for new antibiotics that are used to treat serious and/or life-threatening diseases due to certain pathogens. It also extends the patent life of these antibiotics and allows for fast-track Food and Drug Administration approval.
According to Dr. Erlich, chief of staff and medical director of infection control and antibiotic stewardship at Mills Peninsula Medical Center, Burlingame, Calif., increasingly common antibiotic-resistant pathogens besides MRSA and VRE include penicillin-resistant Streptococcus pneumoniae, extended-spectrum beta-lactamase–producing gram-negative rods, carbapenem-resistant Enterobacteriaceae (CRE), multidrug-resistant Mycobacterium tuberculosis, Salmonella enterica serotype Typhimurium DT 104, and drug-resistant Candida species.
Since 2010, several new antibiotics have been introduced to the market, including three second-generation lipoglycopeptide antibiotics with gram-positive coverage that are approved primarily for skin and soft tissue infections: dalbavancin (Dalvance), telavancin (Vibativ), and oritavancin (Orbactiv).
Compared with vancomycin, these new agents have more convenient dosing and a longer half life, “but they’re also more expensive,” said Dr. Erlich. Dalbavancin can be dosed once a week intravenously, telavancin can be dosed once daily intravenously, and oritavancin requires just one dose.
Another new agent is tedizolid phosphate (Sivextro), a second-generation oxazolidinone that is in the same drug class as linezolid (Zyvox). Tedizolid phosphate has gram-positive coverage including MRSA, but it is not approved for VRE. “It’s FDA approved for skin and soft-tissue infections (SSTI) but can be used for other locations as well,” Dr. Erlich said. “It features once-daily dosing IV or PO.”
Ceftaroline fosamil (Teflaro), ceftolozane/tazobactam (Zerbaxa), and ceftazidime/avibactam (Avycaz) are broad-spectrum cephalosporins with or without beta-lactamase inhibitors resulting in extended gram-negative coverage. FDA-approved indications include complicated urinary tract infections, complicated abdominal infections, SSTI, and pneumonia.
The primary advantage of these drugs, compared with other agents, is for multidrug-resistant gram-negative bacteria such as extended-spectrum beta-lactamase producers and CRE. “We’re not using a lot of these drugs in clinical practice, but they are available for patients with multidrug-resistant gram-negative rods who have no other options,” Dr. Erlich said.
Practical ways that clinicians can prevent antibiotic resistance include prescribing antibiotics only when necessary. “Be aware of local resistance patterns, avoid antibiotics for probable viral infections, use narrow-spectrum choices when possible, use shorter durations when appropriate, and consult published guidelines for optimal empiric antibiotic therapy,” Dr. Erlich advised.
In addition, “advocate infection control measures to keep patients from developing infections, including proper wound care, hand washing, respiratory etiquette, vaccinations, and social isolation for symptomatic individuals,” he noted.
Dr. Erlich reported having no relevant financial disclosures.
SAN FRANCISCO – When the Infectious Diseases Society of America released the “Bad Bugs, No Drugs” report in 2004, its authors warned that effective antibiotics may not be available to treat seriously ill patients in the near future.
It also proposed legislative, regulatory, and funding solutions with a goal of developing and licensing 10 new antibiotics by the year 2020.
One such advancement was the Generating Antibiotics Incentives Now Act, which was signed into law in 2012 and created a designation for new antibiotics that are used to treat serious and/or life-threatening diseases due to certain pathogens. It also extends the patent life of these antibiotics and allows for fast-track Food and Drug Administration approval.
According to Dr. Erlich, chief of staff and medical director of infection control and antibiotic stewardship at Mills Peninsula Medical Center, Burlingame, Calif., increasingly common antibiotic-resistant pathogens besides MRSA and VRE include penicillin-resistant Streptococcus pneumoniae, extended-spectrum beta-lactamase–producing gram-negative rods, carbapenem-resistant Enterobacteriaceae (CRE), multidrug-resistant Mycobacterium tuberculosis, Salmonella enterica serotype Typhimurium DT 104, and drug-resistant Candida species.
Since 2010, several new antibiotics have been introduced to the market, including three second-generation lipoglycopeptide antibiotics with gram-positive coverage that are approved primarily for skin and soft tissue infections: dalbavancin (Dalvance), telavancin (Vibativ), and oritavancin (Orbactiv).
Compared with vancomycin, these new agents have more convenient dosing and a longer half life, “but they’re also more expensive,” said Dr. Erlich. Dalbavancin can be dosed once a week intravenously, telavancin can be dosed once daily intravenously, and oritavancin requires just one dose.
Another new agent is tedizolid phosphate (Sivextro), a second-generation oxazolidinone that is in the same drug class as linezolid (Zyvox). Tedizolid phosphate has gram-positive coverage including MRSA, but it is not approved for VRE. “It’s FDA approved for skin and soft-tissue infections (SSTI) but can be used for other locations as well,” Dr. Erlich said. “It features once-daily dosing IV or PO.”
Ceftaroline fosamil (Teflaro), ceftolozane/tazobactam (Zerbaxa), and ceftazidime/avibactam (Avycaz) are broad-spectrum cephalosporins with or without beta-lactamase inhibitors resulting in extended gram-negative coverage. FDA-approved indications include complicated urinary tract infections, complicated abdominal infections, SSTI, and pneumonia.
The primary advantage of these drugs, compared with other agents, is for multidrug-resistant gram-negative bacteria such as extended-spectrum beta-lactamase producers and CRE. “We’re not using a lot of these drugs in clinical practice, but they are available for patients with multidrug-resistant gram-negative rods who have no other options,” Dr. Erlich said.
Practical ways that clinicians can prevent antibiotic resistance include prescribing antibiotics only when necessary. “Be aware of local resistance patterns, avoid antibiotics for probable viral infections, use narrow-spectrum choices when possible, use shorter durations when appropriate, and consult published guidelines for optimal empiric antibiotic therapy,” Dr. Erlich advised.
In addition, “advocate infection control measures to keep patients from developing infections, including proper wound care, hand washing, respiratory etiquette, vaccinations, and social isolation for symptomatic individuals,” he noted.
Dr. Erlich reported having no relevant financial disclosures.
SAN FRANCISCO – When the Infectious Diseases Society of America released the “Bad Bugs, No Drugs” report in 2004, its authors warned that effective antibiotics may not be available to treat seriously ill patients in the near future.
It also proposed legislative, regulatory, and funding solutions with a goal of developing and licensing 10 new antibiotics by the year 2020.
One such advancement was the Generating Antibiotics Incentives Now Act, which was signed into law in 2012 and created a designation for new antibiotics that are used to treat serious and/or life-threatening diseases due to certain pathogens. It also extends the patent life of these antibiotics and allows for fast-track Food and Drug Administration approval.
According to Dr. Erlich, chief of staff and medical director of infection control and antibiotic stewardship at Mills Peninsula Medical Center, Burlingame, Calif., increasingly common antibiotic-resistant pathogens besides MRSA and VRE include penicillin-resistant Streptococcus pneumoniae, extended-spectrum beta-lactamase–producing gram-negative rods, carbapenem-resistant Enterobacteriaceae (CRE), multidrug-resistant Mycobacterium tuberculosis, Salmonella enterica serotype Typhimurium DT 104, and drug-resistant Candida species.
Since 2010, several new antibiotics have been introduced to the market, including three second-generation lipoglycopeptide antibiotics with gram-positive coverage that are approved primarily for skin and soft tissue infections: dalbavancin (Dalvance), telavancin (Vibativ), and oritavancin (Orbactiv).
Compared with vancomycin, these new agents have more convenient dosing and a longer half life, “but they’re also more expensive,” said Dr. Erlich. Dalbavancin can be dosed once a week intravenously, telavancin can be dosed once daily intravenously, and oritavancin requires just one dose.
Another new agent is tedizolid phosphate (Sivextro), a second-generation oxazolidinone that is in the same drug class as linezolid (Zyvox). Tedizolid phosphate has gram-positive coverage including MRSA, but it is not approved for VRE. “It’s FDA approved for skin and soft-tissue infections (SSTI) but can be used for other locations as well,” Dr. Erlich said. “It features once-daily dosing IV or PO.”
Ceftaroline fosamil (Teflaro), ceftolozane/tazobactam (Zerbaxa), and ceftazidime/avibactam (Avycaz) are broad-spectrum cephalosporins with or without beta-lactamase inhibitors resulting in extended gram-negative coverage. FDA-approved indications include complicated urinary tract infections, complicated abdominal infections, SSTI, and pneumonia.
The primary advantage of these drugs, compared with other agents, is for multidrug-resistant gram-negative bacteria such as extended-spectrum beta-lactamase producers and CRE. “We’re not using a lot of these drugs in clinical practice, but they are available for patients with multidrug-resistant gram-negative rods who have no other options,” Dr. Erlich said.
Practical ways that clinicians can prevent antibiotic resistance include prescribing antibiotics only when necessary. “Be aware of local resistance patterns, avoid antibiotics for probable viral infections, use narrow-spectrum choices when possible, use shorter durations when appropriate, and consult published guidelines for optimal empiric antibiotic therapy,” Dr. Erlich advised.
In addition, “advocate infection control measures to keep patients from developing infections, including proper wound care, hand washing, respiratory etiquette, vaccinations, and social isolation for symptomatic individuals,” he noted.
Dr. Erlich reported having no relevant financial disclosures.
AT THE ANNUAL ADVANCES IN INTERNAL MEDICINE
Study shows that 20% of inpatients given antibiotics develop adverse reactions
Twenty percent of hospitalized adults given antibiotics develop adverse drug events, including GI, nephrotoxic, hematologic, cardiac, and neurotoxic effects, according to a report in JAMA Internal Medicine.
This high frequency of adverse reactions “may not be recognized by clinicians because [these events] have varied manifestations, clinicians may be unaware of the risks associated with specific antibiotic agents, or because they occur after patients are discharged from the hospital,” said Pranita D. Tamma, MD, of the division of pediatric infectious diseases, Johns Hopkins University, Baltimore, and her associates.
They assessed antibiotic-associated adverse drug events in all 1,488 adults admitted to four general medicine services at a single medical center during a 9-month period and given at least 24 hours of any antibiotic therapy. The most common indications for antibiotics were urinary tract infections (12%), skin and soft-tissue infections (8%), and community-acquired pneumonia (7%).
Perhaps as important, the researchers noted, 19% of these adverse drug events were attributed to unnecessary antibiotics – drugs given for conditions for which they were not clinically indicated according to the hospital’s own antibiotic guidelines. These included asymptomatic bacteriuria, aspiration pneumonitis, and heart failure (JAMA Intern. Med. 2017 June 12. doi: 10.1001/jamainternmed.2017.1938).
The most common adverse reactions that developed within 30 days were GI, renal, and hematologic abnormalities. Neurotoxic effects included encephalopathy and seizures; cardiotoxic effects included QTc prolongation. Less frequent adverse events included anaphylaxis, daptomycin-associated myositis, trimethoprim/sulfamethoxazole-associated pancreatitis, linezolid-associated neuropathy, and ciprofloxacin-related tendinitis. The most common adverse reactions that developed within 90 days were C. difficile infections and infections involving multidrug-resistant organisms.
“Our findings underscore the importance of avoiding unnecessary antibiotic prescribing to reduce the harm that can result from antibiotic-associated adverse drug events,” Dr. Tamma and her associates said.
Twenty percent of hospitalized adults given antibiotics develop adverse drug events, including GI, nephrotoxic, hematologic, cardiac, and neurotoxic effects, according to a report in JAMA Internal Medicine.
This high frequency of adverse reactions “may not be recognized by clinicians because [these events] have varied manifestations, clinicians may be unaware of the risks associated with specific antibiotic agents, or because they occur after patients are discharged from the hospital,” said Pranita D. Tamma, MD, of the division of pediatric infectious diseases, Johns Hopkins University, Baltimore, and her associates.
They assessed antibiotic-associated adverse drug events in all 1,488 adults admitted to four general medicine services at a single medical center during a 9-month period and given at least 24 hours of any antibiotic therapy. The most common indications for antibiotics were urinary tract infections (12%), skin and soft-tissue infections (8%), and community-acquired pneumonia (7%).
Perhaps as important, the researchers noted, 19% of these adverse drug events were attributed to unnecessary antibiotics – drugs given for conditions for which they were not clinically indicated according to the hospital’s own antibiotic guidelines. These included asymptomatic bacteriuria, aspiration pneumonitis, and heart failure (JAMA Intern. Med. 2017 June 12. doi: 10.1001/jamainternmed.2017.1938).
The most common adverse reactions that developed within 30 days were GI, renal, and hematologic abnormalities. Neurotoxic effects included encephalopathy and seizures; cardiotoxic effects included QTc prolongation. Less frequent adverse events included anaphylaxis, daptomycin-associated myositis, trimethoprim/sulfamethoxazole-associated pancreatitis, linezolid-associated neuropathy, and ciprofloxacin-related tendinitis. The most common adverse reactions that developed within 90 days were C. difficile infections and infections involving multidrug-resistant organisms.
“Our findings underscore the importance of avoiding unnecessary antibiotic prescribing to reduce the harm that can result from antibiotic-associated adverse drug events,” Dr. Tamma and her associates said.
Twenty percent of hospitalized adults given antibiotics develop adverse drug events, including GI, nephrotoxic, hematologic, cardiac, and neurotoxic effects, according to a report in JAMA Internal Medicine.
This high frequency of adverse reactions “may not be recognized by clinicians because [these events] have varied manifestations, clinicians may be unaware of the risks associated with specific antibiotic agents, or because they occur after patients are discharged from the hospital,” said Pranita D. Tamma, MD, of the division of pediatric infectious diseases, Johns Hopkins University, Baltimore, and her associates.
They assessed antibiotic-associated adverse drug events in all 1,488 adults admitted to four general medicine services at a single medical center during a 9-month period and given at least 24 hours of any antibiotic therapy. The most common indications for antibiotics were urinary tract infections (12%), skin and soft-tissue infections (8%), and community-acquired pneumonia (7%).
Perhaps as important, the researchers noted, 19% of these adverse drug events were attributed to unnecessary antibiotics – drugs given for conditions for which they were not clinically indicated according to the hospital’s own antibiotic guidelines. These included asymptomatic bacteriuria, aspiration pneumonitis, and heart failure (JAMA Intern. Med. 2017 June 12. doi: 10.1001/jamainternmed.2017.1938).
The most common adverse reactions that developed within 30 days were GI, renal, and hematologic abnormalities. Neurotoxic effects included encephalopathy and seizures; cardiotoxic effects included QTc prolongation. Less frequent adverse events included anaphylaxis, daptomycin-associated myositis, trimethoprim/sulfamethoxazole-associated pancreatitis, linezolid-associated neuropathy, and ciprofloxacin-related tendinitis. The most common adverse reactions that developed within 90 days were C. difficile infections and infections involving multidrug-resistant organisms.
“Our findings underscore the importance of avoiding unnecessary antibiotic prescribing to reduce the harm that can result from antibiotic-associated adverse drug events,” Dr. Tamma and her associates said.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Among hospitalized adults given antibiotics, 20% develop adverse reactions, including GI, nephrotoxic, hematologic, cardiac, and neurotoxic effects.
Major finding: Among 1,488 patients, 298 (20%) developed 324 adverse reactions to antibiotics – 73% during hospitalization and 27% after discharge – requiring prolonged hospitalization; a subsequent hospitalization; an ED visit; or additional lab tests, ECGs, or imaging studies.
Data source: A single-center retrospective cohort study involving all 1,488 general medicine inpatients admitted during a 9-month period who received any antibiotic for at least 24 hours.
Disclosures: This study was supported by Pfizer Independent Grants for Learning and Change and the Joint Commission. Dr. Tamma and her associates reported having no relevant financial disclosures.
Meet the two newest SHM board members
SHM’s two newest board members – pediatric hospitalist Kris Rehm, MD, SFHM, and perioperative specialist Rachel Thompson, MD, MPH, SFHM – will bring their expertise to bear on the society’s top panel.
However, neither woman sees her role as shaping the board. In fact, they see themselves as lucky to be joining the team.
“I really want to hear everyone’s voice, and I hope to see how we can all move to better places together,” added Dr. Rehm, associate professor of clinical pediatrics and director of the division of hospital medicine at Vanderbilt University in Nashville.
Both board members were officially seated for three-year terms at HM17 in Las Vegas. They replace former SHM president Robert Harrington, MD, SFHM, and veteran pediatric hospitalist Erin Stucky Fisher, MD, MHM.
Each of the new board members brings a strong perspective to the panel.
For Dr. Thompson, that viewpoint is based in engagement. She is the former chair of SHM’s Pacific Northwest chapter and has spent the past few years leading the perioperative issues for the society’s work group.
“We get to a certain point of our career as hospitalists, and if we’re just plugging in and working, doing our shifts, somewhere in that 8- to 10-year range, we might get a little bored, tired, worn out,” Dr. Thompson said. “I believe, if we have the community and professional home to keep us engaged, that helps us see the value in what we’re doing every day. It helps us continue to grow, so we don’t hit that wall.”
Given Dr. Thompson’s involvement both with her chapter and the society’s chapter support committee, she will likely continue that effort to make sure SHM’s board sees the value of encouraging and partnering with local chapters. She will also work with SHM president Ron Greeno, MD, FCCP, MHM, on policy issues, as her background in public health has aligned her interests on health care reform and other headwinds facing the specialty.
“I went in to do my masters in public health with the idea that I wanted to build the skill set so that I could be more analytical in how I approach our problem solving, our discovery in the hospital setting,” she said. “It really speaks to a part of me that has always been interested in finding ways to prevent illness and moving beyond that reactivity that we have in medicine into a prevention-based [approach].”
Dr. Thompson noted that her background in perioperative medicine helps her work as part of a team because it “entirely relies on collaboration and coordination of care, which is pretty much the basis of what we do in the hospital any day.”
Dr. Rehm, who serves as a pediatric hospitalist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, said she will also bring a teamwork-focused perspective to the SHM board.
She could be expected to view everything through the lens of inpatient pediatrics, but that’s not her style.
“I think we have so many similarities and so many things that [pediatric and adult hospitalists] can partner to do together,” she said. “We all are involved in, for example, medication reconciliation or discharge-management planning or postacute care follow-up. There’s a lot of synergy, and I think we can learn so much from each other.”
Dr. Rehm, who chairs SHM’s Pediatrics Committee and the 2017 Pediatric Hospital Medicine meeting, pointed out that working well with others is a natural skill set for hospitalists.
“Collaboration is probably my biggest skill set and that of many hospital medicine providers,” she said. “I think I do that in my job here at Vanderbilt in thinking about complicated patients that requirement multiple subspecialists and in bringing together people to figure out the question at hand. That is definitely my leadership style.”
If Dr. Rehm has one goal on the board, it is to become a little bit more like Dr. Thompson and focus on chapter development for pediatric hospitalists.
“I’m really interested in engaging with members to better understand the struggles on the front line so that we can make sure that, as an organization, we’re offering a brand of things that our membership needs,” she said. “So, I’m really looking forward to becoming more involved in the chapter engagement and development. The Nashville chapter is getting re-engaged now and I’m excited to be involved.”
To prepare for her debut board meeting in Las Vegas, Dr. Rehm attended SHM board meetings at the group’s Philadelphia headquarters over the past two years.
“I’ve been lucky enough to attend the fall board meeting in Philadelphia and observe the board in action, and I think that has helped me get to know some of the current board members and to have a little bit of a vision of what the meetings will be like,” she said.
SHM’s two newest board members – pediatric hospitalist Kris Rehm, MD, SFHM, and perioperative specialist Rachel Thompson, MD, MPH, SFHM – will bring their expertise to bear on the society’s top panel.
However, neither woman sees her role as shaping the board. In fact, they see themselves as lucky to be joining the team.
“I really want to hear everyone’s voice, and I hope to see how we can all move to better places together,” added Dr. Rehm, associate professor of clinical pediatrics and director of the division of hospital medicine at Vanderbilt University in Nashville.
Both board members were officially seated for three-year terms at HM17 in Las Vegas. They replace former SHM president Robert Harrington, MD, SFHM, and veteran pediatric hospitalist Erin Stucky Fisher, MD, MHM.
Each of the new board members brings a strong perspective to the panel.
For Dr. Thompson, that viewpoint is based in engagement. She is the former chair of SHM’s Pacific Northwest chapter and has spent the past few years leading the perioperative issues for the society’s work group.
“We get to a certain point of our career as hospitalists, and if we’re just plugging in and working, doing our shifts, somewhere in that 8- to 10-year range, we might get a little bored, tired, worn out,” Dr. Thompson said. “I believe, if we have the community and professional home to keep us engaged, that helps us see the value in what we’re doing every day. It helps us continue to grow, so we don’t hit that wall.”
Given Dr. Thompson’s involvement both with her chapter and the society’s chapter support committee, she will likely continue that effort to make sure SHM’s board sees the value of encouraging and partnering with local chapters. She will also work with SHM president Ron Greeno, MD, FCCP, MHM, on policy issues, as her background in public health has aligned her interests on health care reform and other headwinds facing the specialty.
“I went in to do my masters in public health with the idea that I wanted to build the skill set so that I could be more analytical in how I approach our problem solving, our discovery in the hospital setting,” she said. “It really speaks to a part of me that has always been interested in finding ways to prevent illness and moving beyond that reactivity that we have in medicine into a prevention-based [approach].”
Dr. Thompson noted that her background in perioperative medicine helps her work as part of a team because it “entirely relies on collaboration and coordination of care, which is pretty much the basis of what we do in the hospital any day.”
Dr. Rehm, who serves as a pediatric hospitalist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, said she will also bring a teamwork-focused perspective to the SHM board.
She could be expected to view everything through the lens of inpatient pediatrics, but that’s not her style.
“I think we have so many similarities and so many things that [pediatric and adult hospitalists] can partner to do together,” she said. “We all are involved in, for example, medication reconciliation or discharge-management planning or postacute care follow-up. There’s a lot of synergy, and I think we can learn so much from each other.”
Dr. Rehm, who chairs SHM’s Pediatrics Committee and the 2017 Pediatric Hospital Medicine meeting, pointed out that working well with others is a natural skill set for hospitalists.
“Collaboration is probably my biggest skill set and that of many hospital medicine providers,” she said. “I think I do that in my job here at Vanderbilt in thinking about complicated patients that requirement multiple subspecialists and in bringing together people to figure out the question at hand. That is definitely my leadership style.”
If Dr. Rehm has one goal on the board, it is to become a little bit more like Dr. Thompson and focus on chapter development for pediatric hospitalists.
“I’m really interested in engaging with members to better understand the struggles on the front line so that we can make sure that, as an organization, we’re offering a brand of things that our membership needs,” she said. “So, I’m really looking forward to becoming more involved in the chapter engagement and development. The Nashville chapter is getting re-engaged now and I’m excited to be involved.”
To prepare for her debut board meeting in Las Vegas, Dr. Rehm attended SHM board meetings at the group’s Philadelphia headquarters over the past two years.
“I’ve been lucky enough to attend the fall board meeting in Philadelphia and observe the board in action, and I think that has helped me get to know some of the current board members and to have a little bit of a vision of what the meetings will be like,” she said.
SHM’s two newest board members – pediatric hospitalist Kris Rehm, MD, SFHM, and perioperative specialist Rachel Thompson, MD, MPH, SFHM – will bring their expertise to bear on the society’s top panel.
However, neither woman sees her role as shaping the board. In fact, they see themselves as lucky to be joining the team.
“I really want to hear everyone’s voice, and I hope to see how we can all move to better places together,” added Dr. Rehm, associate professor of clinical pediatrics and director of the division of hospital medicine at Vanderbilt University in Nashville.
Both board members were officially seated for three-year terms at HM17 in Las Vegas. They replace former SHM president Robert Harrington, MD, SFHM, and veteran pediatric hospitalist Erin Stucky Fisher, MD, MHM.
Each of the new board members brings a strong perspective to the panel.
For Dr. Thompson, that viewpoint is based in engagement. She is the former chair of SHM’s Pacific Northwest chapter and has spent the past few years leading the perioperative issues for the society’s work group.
“We get to a certain point of our career as hospitalists, and if we’re just plugging in and working, doing our shifts, somewhere in that 8- to 10-year range, we might get a little bored, tired, worn out,” Dr. Thompson said. “I believe, if we have the community and professional home to keep us engaged, that helps us see the value in what we’re doing every day. It helps us continue to grow, so we don’t hit that wall.”
Given Dr. Thompson’s involvement both with her chapter and the society’s chapter support committee, she will likely continue that effort to make sure SHM’s board sees the value of encouraging and partnering with local chapters. She will also work with SHM president Ron Greeno, MD, FCCP, MHM, on policy issues, as her background in public health has aligned her interests on health care reform and other headwinds facing the specialty.
“I went in to do my masters in public health with the idea that I wanted to build the skill set so that I could be more analytical in how I approach our problem solving, our discovery in the hospital setting,” she said. “It really speaks to a part of me that has always been interested in finding ways to prevent illness and moving beyond that reactivity that we have in medicine into a prevention-based [approach].”
Dr. Thompson noted that her background in perioperative medicine helps her work as part of a team because it “entirely relies on collaboration and coordination of care, which is pretty much the basis of what we do in the hospital any day.”
Dr. Rehm, who serves as a pediatric hospitalist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, said she will also bring a teamwork-focused perspective to the SHM board.
She could be expected to view everything through the lens of inpatient pediatrics, but that’s not her style.
“I think we have so many similarities and so many things that [pediatric and adult hospitalists] can partner to do together,” she said. “We all are involved in, for example, medication reconciliation or discharge-management planning or postacute care follow-up. There’s a lot of synergy, and I think we can learn so much from each other.”
Dr. Rehm, who chairs SHM’s Pediatrics Committee and the 2017 Pediatric Hospital Medicine meeting, pointed out that working well with others is a natural skill set for hospitalists.
“Collaboration is probably my biggest skill set and that of many hospital medicine providers,” she said. “I think I do that in my job here at Vanderbilt in thinking about complicated patients that requirement multiple subspecialists and in bringing together people to figure out the question at hand. That is definitely my leadership style.”
If Dr. Rehm has one goal on the board, it is to become a little bit more like Dr. Thompson and focus on chapter development for pediatric hospitalists.
“I’m really interested in engaging with members to better understand the struggles on the front line so that we can make sure that, as an organization, we’re offering a brand of things that our membership needs,” she said. “So, I’m really looking forward to becoming more involved in the chapter engagement and development. The Nashville chapter is getting re-engaged now and I’m excited to be involved.”
To prepare for her debut board meeting in Las Vegas, Dr. Rehm attended SHM board meetings at the group’s Philadelphia headquarters over the past two years.
“I’ve been lucky enough to attend the fall board meeting in Philadelphia and observe the board in action, and I think that has helped me get to know some of the current board members and to have a little bit of a vision of what the meetings will be like,” she said.
FDA approves betrixaban for VTE prophylaxis
Betrixaban, a factor Xa inhibitor, has been approved for the prophylaxis of venous thromboembolism (VTE) in at-risk adult patients hospitalized with an acute illness, according to an announcement from the Food and Drug Administration.
Approval was based on results from a randomized, double-blind clinical trial in which over 7,000 hospitalized patients at risk for VTE received either extended-duration betrixaban (35-42 days) or short duration enoxaparin (6-14 days), a low molecular weight heparin administered subcutaneously. The rate of deep vein thrombosis, nonfatal pulmonary embolism, or VTE-related death was 4.4% among patients receiving betrixaban and 6% among patients receiving enoxaparin (relative risk, 0.75; 95% confidence interval: 0.61, 0.91).
The recommended dosage for betrixaban is 80 mg per day for 35-42 days at the same time every day with food, after a dose of 160 mg on the first day of treatment.
Betrixaban will be marketed as Bevyxxa by Portola.
Find the full FDA announcement and prescribing information on the FDA website.
Betrixaban, a factor Xa inhibitor, has been approved for the prophylaxis of venous thromboembolism (VTE) in at-risk adult patients hospitalized with an acute illness, according to an announcement from the Food and Drug Administration.
Approval was based on results from a randomized, double-blind clinical trial in which over 7,000 hospitalized patients at risk for VTE received either extended-duration betrixaban (35-42 days) or short duration enoxaparin (6-14 days), a low molecular weight heparin administered subcutaneously. The rate of deep vein thrombosis, nonfatal pulmonary embolism, or VTE-related death was 4.4% among patients receiving betrixaban and 6% among patients receiving enoxaparin (relative risk, 0.75; 95% confidence interval: 0.61, 0.91).
The recommended dosage for betrixaban is 80 mg per day for 35-42 days at the same time every day with food, after a dose of 160 mg on the first day of treatment.
Betrixaban will be marketed as Bevyxxa by Portola.
Find the full FDA announcement and prescribing information on the FDA website.
Betrixaban, a factor Xa inhibitor, has been approved for the prophylaxis of venous thromboembolism (VTE) in at-risk adult patients hospitalized with an acute illness, according to an announcement from the Food and Drug Administration.
Approval was based on results from a randomized, double-blind clinical trial in which over 7,000 hospitalized patients at risk for VTE received either extended-duration betrixaban (35-42 days) or short duration enoxaparin (6-14 days), a low molecular weight heparin administered subcutaneously. The rate of deep vein thrombosis, nonfatal pulmonary embolism, or VTE-related death was 4.4% among patients receiving betrixaban and 6% among patients receiving enoxaparin (relative risk, 0.75; 95% confidence interval: 0.61, 0.91).
The recommended dosage for betrixaban is 80 mg per day for 35-42 days at the same time every day with food, after a dose of 160 mg on the first day of treatment.
Betrixaban will be marketed as Bevyxxa by Portola.
Find the full FDA announcement and prescribing information on the FDA website.