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PHM16: Tips on Meeting Needs of Children with a Medical Complexity
Presenters: Mary L Ehlenbach, MD, FAAP; Megan Z Cardoso, MD, FAAP; and Christina Kleier, ARNP, PNP
This session at PHM16 was focused on logistical tips on how to build a pediatric complex care program. Presenters opened with a discussion of how to define children with medical complexity going through a variety of different methods including some research based aggregation of ICD-10 codes, referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about 1/3 of healthcare spending and due to advances in technology and medicine this group of children is growing in numbers. This group makes up about 10% of all pediatric admissions.
The session then went on to break down into four small groups which focused on details about how to create a complex care program and how to evaluate effectiveness of the program. Group 1 discussed methods of identifying patients that the program will serve. This included setting guidelines if a certain group or diagnosis should be excluded from the program. Different models of what services were also discussed which ranged from providing a comprehensive medical home to inpatient consults or care coordination services. The second group focused on what team members it may be beneficial to have involved. Team composition varied widely usually including MDs, NPs, social workers, RNs and at times a documentation expert who could aid with proper billing to boost revenue. The third group focused on how to measure quality services including family surveys of quantitative impact and satisfaction, PCP satisfaction. The final session consisted of the business and financial considerations of beginning a complex care program.
Key Takeaways:
- Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.
- When working to initiate a complex care program:
- Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
- Ensure the team composition is sustainable and meets the needs of the patients.
- Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
- Include team members who are non-clinical to aid in improving hospital revenue and highlighting program benefits to the institution.
Margaret Rush, MD, is a hospitalist fellow at Children's National Medical Center in Washington D.C.
Presenters: Mary L Ehlenbach, MD, FAAP; Megan Z Cardoso, MD, FAAP; and Christina Kleier, ARNP, PNP
This session at PHM16 was focused on logistical tips on how to build a pediatric complex care program. Presenters opened with a discussion of how to define children with medical complexity going through a variety of different methods including some research based aggregation of ICD-10 codes, referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about 1/3 of healthcare spending and due to advances in technology and medicine this group of children is growing in numbers. This group makes up about 10% of all pediatric admissions.
The session then went on to break down into four small groups which focused on details about how to create a complex care program and how to evaluate effectiveness of the program. Group 1 discussed methods of identifying patients that the program will serve. This included setting guidelines if a certain group or diagnosis should be excluded from the program. Different models of what services were also discussed which ranged from providing a comprehensive medical home to inpatient consults or care coordination services. The second group focused on what team members it may be beneficial to have involved. Team composition varied widely usually including MDs, NPs, social workers, RNs and at times a documentation expert who could aid with proper billing to boost revenue. The third group focused on how to measure quality services including family surveys of quantitative impact and satisfaction, PCP satisfaction. The final session consisted of the business and financial considerations of beginning a complex care program.
Key Takeaways:
- Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.
- When working to initiate a complex care program:
- Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
- Ensure the team composition is sustainable and meets the needs of the patients.
- Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
- Include team members who are non-clinical to aid in improving hospital revenue and highlighting program benefits to the institution.
Margaret Rush, MD, is a hospitalist fellow at Children's National Medical Center in Washington D.C.
Presenters: Mary L Ehlenbach, MD, FAAP; Megan Z Cardoso, MD, FAAP; and Christina Kleier, ARNP, PNP
This session at PHM16 was focused on logistical tips on how to build a pediatric complex care program. Presenters opened with a discussion of how to define children with medical complexity going through a variety of different methods including some research based aggregation of ICD-10 codes, referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about 1/3 of healthcare spending and due to advances in technology and medicine this group of children is growing in numbers. This group makes up about 10% of all pediatric admissions.
The session then went on to break down into four small groups which focused on details about how to create a complex care program and how to evaluate effectiveness of the program. Group 1 discussed methods of identifying patients that the program will serve. This included setting guidelines if a certain group or diagnosis should be excluded from the program. Different models of what services were also discussed which ranged from providing a comprehensive medical home to inpatient consults or care coordination services. The second group focused on what team members it may be beneficial to have involved. Team composition varied widely usually including MDs, NPs, social workers, RNs and at times a documentation expert who could aid with proper billing to boost revenue. The third group focused on how to measure quality services including family surveys of quantitative impact and satisfaction, PCP satisfaction. The final session consisted of the business and financial considerations of beginning a complex care program.
Key Takeaways:
- Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.
- When working to initiate a complex care program:
- Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
- Ensure the team composition is sustainable and meets the needs of the patients.
- Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
- Include team members who are non-clinical to aid in improving hospital revenue and highlighting program benefits to the institution.
Margaret Rush, MD, is a hospitalist fellow at Children's National Medical Center in Washington D.C.
Preorder 2016 State of Hospital Medicine Report
The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity, plus covers practice demographics, staffing levels, staff growth, and compensation models.
Order now and be notified directly when the report is released in September 2016 at www.hospitalmedicine.org/survey.
The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity, plus covers practice demographics, staffing levels, staff growth, and compensation models.
Order now and be notified directly when the report is released in September 2016 at www.hospitalmedicine.org/survey.
The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity, plus covers practice demographics, staffing levels, staff growth, and compensation models.
Order now and be notified directly when the report is released in September 2016 at www.hospitalmedicine.org/survey.
PAs, NPs: Register for 2016 Adult Hospital Medicine Boot Camp
During the course, you will:
- Learn the most current evidence-based clinical practices for key topics in hospital medicine
- Augment your knowledge base to enhance your existing hospital medicine practice
- Expand your knowledge to transition into hospital medicine practice
- Network with like-minded practitioners
To learn more and register, visit www.aapa.org/bootcamp.
During the course, you will:
- Learn the most current evidence-based clinical practices for key topics in hospital medicine
- Augment your knowledge base to enhance your existing hospital medicine practice
- Expand your knowledge to transition into hospital medicine practice
- Network with like-minded practitioners
To learn more and register, visit www.aapa.org/bootcamp.
During the course, you will:
- Learn the most current evidence-based clinical practices for key topics in hospital medicine
- Augment your knowledge base to enhance your existing hospital medicine practice
- Expand your knowledge to transition into hospital medicine practice
- Network with like-minded practitioners
To learn more and register, visit www.aapa.org/bootcamp.
PHM16: Visual Clues Can Help Establish a Diagnosis
PHM16’s Visual Diagnosis: Signs and Why They Matter session led by Dr. Kenneth Roberts and guest presenters was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses/over-diagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.
Many of the presented cases (such as the Gianotti-Crosti toddler over-diagnosed as eczema herpeticum, a child with pseudochromhidrosis misdiagnosed as a cyanotic disease, the case of phytophotodermatitis mistaken as child abuse, and a teen treated for 2 years for JIA before diagnosis of hypertrophic osteoarthropathy was made) highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.
In other instances, such as Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis is necessary to help guide management and future treatment, including subspecialty evaluation.
Many diseases with visual presentations also have a benign course and require no treatment, and acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.
This session underscores the need for experience and exposure to various signs, not only with rare medical conditions, but also in common illnesses such as Kawasaki and scarlet fever that may present similarly.
Key Takeaway:
Providers should have a high index of suspicion and use visual clues to make the correct diagnosis in order to guide treatment, avoid harm in children, and ensure appropriate utilization of resources.
Chandani DeZure, MD, FAAP, is a pediatric Hospitalist at Children’s National Health System, Instruction of Pediatrics at George Washington University’s School of Medicine and Health Sciences in Washington, D.C.
PHM16’s Visual Diagnosis: Signs and Why They Matter session led by Dr. Kenneth Roberts and guest presenters was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses/over-diagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.
Many of the presented cases (such as the Gianotti-Crosti toddler over-diagnosed as eczema herpeticum, a child with pseudochromhidrosis misdiagnosed as a cyanotic disease, the case of phytophotodermatitis mistaken as child abuse, and a teen treated for 2 years for JIA before diagnosis of hypertrophic osteoarthropathy was made) highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.
In other instances, such as Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis is necessary to help guide management and future treatment, including subspecialty evaluation.
Many diseases with visual presentations also have a benign course and require no treatment, and acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.
This session underscores the need for experience and exposure to various signs, not only with rare medical conditions, but also in common illnesses such as Kawasaki and scarlet fever that may present similarly.
Key Takeaway:
Providers should have a high index of suspicion and use visual clues to make the correct diagnosis in order to guide treatment, avoid harm in children, and ensure appropriate utilization of resources.
Chandani DeZure, MD, FAAP, is a pediatric Hospitalist at Children’s National Health System, Instruction of Pediatrics at George Washington University’s School of Medicine and Health Sciences in Washington, D.C.
PHM16’s Visual Diagnosis: Signs and Why They Matter session led by Dr. Kenneth Roberts and guest presenters was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses/over-diagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.
Many of the presented cases (such as the Gianotti-Crosti toddler over-diagnosed as eczema herpeticum, a child with pseudochromhidrosis misdiagnosed as a cyanotic disease, the case of phytophotodermatitis mistaken as child abuse, and a teen treated for 2 years for JIA before diagnosis of hypertrophic osteoarthropathy was made) highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.
In other instances, such as Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis is necessary to help guide management and future treatment, including subspecialty evaluation.
Many diseases with visual presentations also have a benign course and require no treatment, and acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.
This session underscores the need for experience and exposure to various signs, not only with rare medical conditions, but also in common illnesses such as Kawasaki and scarlet fever that may present similarly.
Key Takeaway:
Providers should have a high index of suspicion and use visual clues to make the correct diagnosis in order to guide treatment, avoid harm in children, and ensure appropriate utilization of resources.
Chandani DeZure, MD, FAAP, is a pediatric Hospitalist at Children’s National Health System, Instruction of Pediatrics at George Washington University’s School of Medicine and Health Sciences in Washington, D.C.
PHM16: The New AAP Clinical Practice Guideline on Evaluating, Managing Febrile Infants
One of PHM16’s most highly-attended sessions was an update on the anticipated AAP guidelines for febrile infants between ages 7-90 days given by Dr. Kenneth Roberts. The goal is to give evidence-based guidelines, not rules, from the most recent literature available. It also stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.
The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37-43 weeks gestation), aged 7-90 days, well-appearing, and presenting with a temperature of 38 degrees Celsius.
Exclusion criteria include perinatal/prenatal/neonatal: maternal fever, infection, or antimicrobial treatment, the presence of any evident infection, being technology-dependent, and the presence of congenital anomalies.
The updated guideline will aim to stratify management by age 7-28 days, 29-60 days, and 61 to 90 days to provide the most appropriate and directed treatment.
It will also include a role for inflammatory markers, and allow for a “kinder, gentler” approach to the management of febrile infants aged 7-90 days including withholding certain treatments and procedures if infants are at low risk of infection. An active, not passive, need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk in this population.
Key Takeaway:
An updated AAP Practice guideline algorithm for the management of well-appearing febrile infants 7-28 days, 29-60 days, and 60-90 days will be coming in the near future that will help standardize care in this population, but should not be used as a substitute for clinical judgment.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System, Instruction of Pediatrics at George Washington University’s School of Medicine and Health Sciences in Washington, D.C.
One of PHM16’s most highly-attended sessions was an update on the anticipated AAP guidelines for febrile infants between ages 7-90 days given by Dr. Kenneth Roberts. The goal is to give evidence-based guidelines, not rules, from the most recent literature available. It also stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.
The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37-43 weeks gestation), aged 7-90 days, well-appearing, and presenting with a temperature of 38 degrees Celsius.
Exclusion criteria include perinatal/prenatal/neonatal: maternal fever, infection, or antimicrobial treatment, the presence of any evident infection, being technology-dependent, and the presence of congenital anomalies.
The updated guideline will aim to stratify management by age 7-28 days, 29-60 days, and 61 to 90 days to provide the most appropriate and directed treatment.
It will also include a role for inflammatory markers, and allow for a “kinder, gentler” approach to the management of febrile infants aged 7-90 days including withholding certain treatments and procedures if infants are at low risk of infection. An active, not passive, need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk in this population.
Key Takeaway:
An updated AAP Practice guideline algorithm for the management of well-appearing febrile infants 7-28 days, 29-60 days, and 60-90 days will be coming in the near future that will help standardize care in this population, but should not be used as a substitute for clinical judgment.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System, Instruction of Pediatrics at George Washington University’s School of Medicine and Health Sciences in Washington, D.C.
One of PHM16’s most highly-attended sessions was an update on the anticipated AAP guidelines for febrile infants between ages 7-90 days given by Dr. Kenneth Roberts. The goal is to give evidence-based guidelines, not rules, from the most recent literature available. It also stresses the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.
The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37-43 weeks gestation), aged 7-90 days, well-appearing, and presenting with a temperature of 38 degrees Celsius.
Exclusion criteria include perinatal/prenatal/neonatal: maternal fever, infection, or antimicrobial treatment, the presence of any evident infection, being technology-dependent, and the presence of congenital anomalies.
The updated guideline will aim to stratify management by age 7-28 days, 29-60 days, and 61 to 90 days to provide the most appropriate and directed treatment.
It will also include a role for inflammatory markers, and allow for a “kinder, gentler” approach to the management of febrile infants aged 7-90 days including withholding certain treatments and procedures if infants are at low risk of infection. An active, not passive, need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk in this population.
Key Takeaway:
An updated AAP Practice guideline algorithm for the management of well-appearing febrile infants 7-28 days, 29-60 days, and 60-90 days will be coming in the near future that will help standardize care in this population, but should not be used as a substitute for clinical judgment.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System, Instruction of Pediatrics at George Washington University’s School of Medicine and Health Sciences in Washington, D.C.
Simple Strategy for Addressing Problematic Patient Behavior
Linden Spital, NP, a psychiatric mental-health nurse practitioner, staffs the Psychiatric Consultation Liaison Service at the University of Michigan in Ann Arbor. Nearly every hospital larger than about 200 beds, she says, could benefit from a similar service, and hospitalists could play an important role in creating it.
I wrote about the idea for a generally similar service in my April 2015 column, but at the time, I didn’t know of an institution that had something like this in place.
Along with her hospitalist colleagues, Anupama (Anu) Goyal, MBChB, and Rob Chang, MD, Linden has launched a service to provide assistance to bedside caregivers dealing with very difficult patients (eg, those who are verbally or physically threatening to staff, unreasonably demanding and angry, have bizarre behavior, etc.).
Sample Cases
Two recent cases illustrate the role of the service. A female patient in her 60s had several admissions characterized by what many caregivers agreed were unreasonably precise demands regarding how her care should be delivered. She was verbally abusive of caregivers, especially those who were young or of a different race, and her family member tended to reinforce these maladaptive behaviors. Staff found it very stressful to care for her and had concerns that her care suffered as a result.
Linden served as a resource and support for staff, plus worked with providers to set limits on the patient and family behavior and to separate patient behaviors that were and weren’t modifiable. Linden’s efforts helped clarify the goals for the patient’s care and reduced staff distress. Even though the patient’s behavior didn’t change significantly, staff anecdotally reported less distress and concern that the patient’s care suffered as a result.
Another case involved a man in his 50s who had a progressive neurodegenerative disease and was admitted because of increasingly aggressive behavior in his skilled-nursing facility (SNF). Providers at the SNF attributed the poor behavior to changes in medications. His behavior was very difficult to manage, and staff asked for Linden’s help. She worked with the patient and realized much of his difficult behavior stemmed from his frustration with communicating verbally because of his neurologic disease. Rather than pursue increasing psychotropics, Linden promoted efforts to develop a system of hand signals the patient could use to communicate needs. His behavior improved, presumably by reducing his own frustration and improving his autonomy.
Atypical Consults
This psychiatric consultation liaison service has some overlap with traditional inpatient psychiatry services, but it is configured so that the caregiver is essentially embedded on the medical units of the hospital and assists in the care of patients who wouldn’t typically be appropriate for a psychiatry consult. For example, patients and/or families who act out because of anger over being on observation status are appropriate for this service but would usually not be appropriate for a psychiatry consult. The two examples above aren’t ideal cases for a standard psychiatry consult; however, the attending hospitalist needed help nonetheless.
Operational Details
The liaison service started with a successful trial on two hospital units in 2013. Linden began serving as the sole clinician on the service in January 2015. She is available during the daytime on weekdays, and any staff can request her participation in the care of a patient. Her visits are billed when appropriate, but many aren’t billed (for example, if her primary work was to conference with staff regarding management of a patient).
Consults can be requested by anyone (nurses, etc., as well as physicians, though only the latter would be billable) via an electronic health record entry that helps ensure whether the request is for this service versus the inpatient psychiatry service. The order includes a standard list of potential reasons for consult that can be selected and amplified with free text comments. She also receives verbal consult requests as she moves through the hospital.
Linden’s position is budgeted through the psychiatry department and funded by the hospital with only modest professional fee collections.
An Idea That Is Catching On?
Anu Goyal made me aware of a study from 2004 that summarized findings from experience with a similar service at Washington University in St. Louis, but the service was cancelled after a short time due to its cost.1 She also found a few studies from the 1990s and a 2001 study from Australia that report on a similar service.
But maybe the idea is catching on again, at least a little.
On April 25, The Wall Street Journal published an article titled “Hospitals Test Putting Psychiatrists on Medical Wards.”2 It described programs at Brigham and Women’s Hospital in Boston, Johns Hopkins Hospital in Baltimore, and NewYork-Presbyterian/Columbia University Medical Center in New York City. They share some similarities with the service at the University of Michigan. However, according to the article, the three big-city programs tilt more toward a traditional consultation model than what Linden does.
I think every hospital should be thinking about a service other than traditional consult psychiatry that could help with challenging patient behavior. The University of Michigan model or similar ones seem like a good place to start. TH
Reference
- Yakimo R, Kurlowicz L, Murray R. Evaluation of outcomes in psychiatric consultation-liaison nursing practice. Arch Psychiatr Nurs. 2004;18(6):215-227.
2. Ladnado L. Hospitals test putting psychiatrists on medical wards. The Wall Street Journal website. Accessed July 3, 2016.
Linden Spital, NP, a psychiatric mental-health nurse practitioner, staffs the Psychiatric Consultation Liaison Service at the University of Michigan in Ann Arbor. Nearly every hospital larger than about 200 beds, she says, could benefit from a similar service, and hospitalists could play an important role in creating it.
I wrote about the idea for a generally similar service in my April 2015 column, but at the time, I didn’t know of an institution that had something like this in place.
Along with her hospitalist colleagues, Anupama (Anu) Goyal, MBChB, and Rob Chang, MD, Linden has launched a service to provide assistance to bedside caregivers dealing with very difficult patients (eg, those who are verbally or physically threatening to staff, unreasonably demanding and angry, have bizarre behavior, etc.).
Sample Cases
Two recent cases illustrate the role of the service. A female patient in her 60s had several admissions characterized by what many caregivers agreed were unreasonably precise demands regarding how her care should be delivered. She was verbally abusive of caregivers, especially those who were young or of a different race, and her family member tended to reinforce these maladaptive behaviors. Staff found it very stressful to care for her and had concerns that her care suffered as a result.
Linden served as a resource and support for staff, plus worked with providers to set limits on the patient and family behavior and to separate patient behaviors that were and weren’t modifiable. Linden’s efforts helped clarify the goals for the patient’s care and reduced staff distress. Even though the patient’s behavior didn’t change significantly, staff anecdotally reported less distress and concern that the patient’s care suffered as a result.
Another case involved a man in his 50s who had a progressive neurodegenerative disease and was admitted because of increasingly aggressive behavior in his skilled-nursing facility (SNF). Providers at the SNF attributed the poor behavior to changes in medications. His behavior was very difficult to manage, and staff asked for Linden’s help. She worked with the patient and realized much of his difficult behavior stemmed from his frustration with communicating verbally because of his neurologic disease. Rather than pursue increasing psychotropics, Linden promoted efforts to develop a system of hand signals the patient could use to communicate needs. His behavior improved, presumably by reducing his own frustration and improving his autonomy.
Atypical Consults
This psychiatric consultation liaison service has some overlap with traditional inpatient psychiatry services, but it is configured so that the caregiver is essentially embedded on the medical units of the hospital and assists in the care of patients who wouldn’t typically be appropriate for a psychiatry consult. For example, patients and/or families who act out because of anger over being on observation status are appropriate for this service but would usually not be appropriate for a psychiatry consult. The two examples above aren’t ideal cases for a standard psychiatry consult; however, the attending hospitalist needed help nonetheless.
Operational Details
The liaison service started with a successful trial on two hospital units in 2013. Linden began serving as the sole clinician on the service in January 2015. She is available during the daytime on weekdays, and any staff can request her participation in the care of a patient. Her visits are billed when appropriate, but many aren’t billed (for example, if her primary work was to conference with staff regarding management of a patient).
Consults can be requested by anyone (nurses, etc., as well as physicians, though only the latter would be billable) via an electronic health record entry that helps ensure whether the request is for this service versus the inpatient psychiatry service. The order includes a standard list of potential reasons for consult that can be selected and amplified with free text comments. She also receives verbal consult requests as she moves through the hospital.
Linden’s position is budgeted through the psychiatry department and funded by the hospital with only modest professional fee collections.
An Idea That Is Catching On?
Anu Goyal made me aware of a study from 2004 that summarized findings from experience with a similar service at Washington University in St. Louis, but the service was cancelled after a short time due to its cost.1 She also found a few studies from the 1990s and a 2001 study from Australia that report on a similar service.
But maybe the idea is catching on again, at least a little.
On April 25, The Wall Street Journal published an article titled “Hospitals Test Putting Psychiatrists on Medical Wards.”2 It described programs at Brigham and Women’s Hospital in Boston, Johns Hopkins Hospital in Baltimore, and NewYork-Presbyterian/Columbia University Medical Center in New York City. They share some similarities with the service at the University of Michigan. However, according to the article, the three big-city programs tilt more toward a traditional consultation model than what Linden does.
I think every hospital should be thinking about a service other than traditional consult psychiatry that could help with challenging patient behavior. The University of Michigan model or similar ones seem like a good place to start. TH
Reference
- Yakimo R, Kurlowicz L, Murray R. Evaluation of outcomes in psychiatric consultation-liaison nursing practice. Arch Psychiatr Nurs. 2004;18(6):215-227.
2. Ladnado L. Hospitals test putting psychiatrists on medical wards. The Wall Street Journal website. Accessed July 3, 2016.
Linden Spital, NP, a psychiatric mental-health nurse practitioner, staffs the Psychiatric Consultation Liaison Service at the University of Michigan in Ann Arbor. Nearly every hospital larger than about 200 beds, she says, could benefit from a similar service, and hospitalists could play an important role in creating it.
I wrote about the idea for a generally similar service in my April 2015 column, but at the time, I didn’t know of an institution that had something like this in place.
Along with her hospitalist colleagues, Anupama (Anu) Goyal, MBChB, and Rob Chang, MD, Linden has launched a service to provide assistance to bedside caregivers dealing with very difficult patients (eg, those who are verbally or physically threatening to staff, unreasonably demanding and angry, have bizarre behavior, etc.).
Sample Cases
Two recent cases illustrate the role of the service. A female patient in her 60s had several admissions characterized by what many caregivers agreed were unreasonably precise demands regarding how her care should be delivered. She was verbally abusive of caregivers, especially those who were young or of a different race, and her family member tended to reinforce these maladaptive behaviors. Staff found it very stressful to care for her and had concerns that her care suffered as a result.
Linden served as a resource and support for staff, plus worked with providers to set limits on the patient and family behavior and to separate patient behaviors that were and weren’t modifiable. Linden’s efforts helped clarify the goals for the patient’s care and reduced staff distress. Even though the patient’s behavior didn’t change significantly, staff anecdotally reported less distress and concern that the patient’s care suffered as a result.
Another case involved a man in his 50s who had a progressive neurodegenerative disease and was admitted because of increasingly aggressive behavior in his skilled-nursing facility (SNF). Providers at the SNF attributed the poor behavior to changes in medications. His behavior was very difficult to manage, and staff asked for Linden’s help. She worked with the patient and realized much of his difficult behavior stemmed from his frustration with communicating verbally because of his neurologic disease. Rather than pursue increasing psychotropics, Linden promoted efforts to develop a system of hand signals the patient could use to communicate needs. His behavior improved, presumably by reducing his own frustration and improving his autonomy.
Atypical Consults
This psychiatric consultation liaison service has some overlap with traditional inpatient psychiatry services, but it is configured so that the caregiver is essentially embedded on the medical units of the hospital and assists in the care of patients who wouldn’t typically be appropriate for a psychiatry consult. For example, patients and/or families who act out because of anger over being on observation status are appropriate for this service but would usually not be appropriate for a psychiatry consult. The two examples above aren’t ideal cases for a standard psychiatry consult; however, the attending hospitalist needed help nonetheless.
Operational Details
The liaison service started with a successful trial on two hospital units in 2013. Linden began serving as the sole clinician on the service in January 2015. She is available during the daytime on weekdays, and any staff can request her participation in the care of a patient. Her visits are billed when appropriate, but many aren’t billed (for example, if her primary work was to conference with staff regarding management of a patient).
Consults can be requested by anyone (nurses, etc., as well as physicians, though only the latter would be billable) via an electronic health record entry that helps ensure whether the request is for this service versus the inpatient psychiatry service. The order includes a standard list of potential reasons for consult that can be selected and amplified with free text comments. She also receives verbal consult requests as she moves through the hospital.
Linden’s position is budgeted through the psychiatry department and funded by the hospital with only modest professional fee collections.
An Idea That Is Catching On?
Anu Goyal made me aware of a study from 2004 that summarized findings from experience with a similar service at Washington University in St. Louis, but the service was cancelled after a short time due to its cost.1 She also found a few studies from the 1990s and a 2001 study from Australia that report on a similar service.
But maybe the idea is catching on again, at least a little.
On April 25, The Wall Street Journal published an article titled “Hospitals Test Putting Psychiatrists on Medical Wards.”2 It described programs at Brigham and Women’s Hospital in Boston, Johns Hopkins Hospital in Baltimore, and NewYork-Presbyterian/Columbia University Medical Center in New York City. They share some similarities with the service at the University of Michigan. However, according to the article, the three big-city programs tilt more toward a traditional consultation model than what Linden does.
I think every hospital should be thinking about a service other than traditional consult psychiatry that could help with challenging patient behavior. The University of Michigan model or similar ones seem like a good place to start. TH
Reference
- Yakimo R, Kurlowicz L, Murray R. Evaluation of outcomes in psychiatric consultation-liaison nursing practice. Arch Psychiatr Nurs. 2004;18(6):215-227.
2. Ladnado L. Hospitals test putting psychiatrists on medical wards. The Wall Street Journal website. Accessed July 3, 2016.
New SHM Members – August 2016
J. Nicholson, Alabama
N. Tangutur, MD, Alabama
E. Ali, MD, Arizona
B. Cabrera, MD, Arizona
J. Castrolondono, MD, Arizona
T. Djurisic, MD, Arizona
R. Ernst, MD, Arizona
A. M. Mendez, Arizona
B. Mozaffari, DO, Arizona
A. Sharma, MD, Arizona
R. Soni, MD, Arizona
G. Neaville, MD, Arkansas
D. Sidhu, PA-C, British Columbia
S. Sidhu, EMBA, British Columbia
G. Bean, MD, MPH, MBA, FAAP, California
K. Bechler, MD, California
K. Chauhan, MPH, MD, California
N. Dave, MD, California
G. Dhanoa, California
A. Fisher, California
Y. Youssef, MD, California
S. De La Garza, MD, Colorado
V. Gundu, MD, Colorado
B. McCoy, DO, Colorado
J. Costanzo-Brown, FNP, Delaware
G. Siu, MD, Delaware
Y. Tal, MD, Delaware
J. Browning, NP-BC, DCNP, Florida
A. Chamseddin, MD, Florida
J. Florindez, MD, Florida
I. Gadalla, PA-C, Florida
G. Guess, Florida
M. E. Huckestein, ANP, Florida
D. Keerty, Florida
M. Mayo, DO, Florida
H. Nasser, MD, Florida
S. Rothstein, MSc, Florida
L. Succari, MD, Florida
S. Zimmer, MD, Florida
C. Ezigbo, Georgia
A. Mann, MD, Georgia
D. Wilmoth, Georgia
A. M. Sanchez Varela, MD, Guam
S. Cline, PhD, MBA, RN, Idaho
K. Abe, PA-C, Illinois
S. Chaudhry-Khan, MD, Illinois
K. Gallagher, Illinois
S. Kuhns, RN, Illinois
S. Pulimi, MD, Illinois
A. Urbonas, MD, Illinois
J. Chounramany, Iowa
B. Daniel, MD, Iowa
S. Joy, ARNP, Iowa
E. Kuperman, MD, Iowa
E. Shinozaki, MD, Iowa
S. Velur, MBBS, Iowa
L. Amos, MD, Kansas
L. Olson, MD, Kansas
M. Schultz, ANP, Kansas
M. Sharma, MD, Kansas
C. Castellanos, Kentucky
B. Mauldin, Louisiana
A. Thompson Soileau, MD, Louisiana
K. Hartman, MD, Maine
K. Carr, MD, Maryland
M. J. Dales, Maryland
K. Jansen, MPAS, PA-C, Maryland
A. Jubon, PA-C, Maryland
O. Schwartz, MD, Maryland
J. Withey, MD, Maryland
J. Louloudes, PA-C, Massachusetts
A. Susheelo, Massachusetts
T. Vu, Massachusetts
K. Bhatti, PA-C, Manitoba
R. Akram, Michigan
S. Federico, APRN-BC, Michigan
A. Mohammed, MBBS, Michigan
Q. Salamah, MD, Michigan
M. Schmuker, DO, Michigan
J. Dressen, Minnesota
G. Larson, MHA, Minnesota
T. Starkey, MD, Minnesota
V. Adike, MBBS, Mississippi
A. Collins, MD, Mississippi
J. Foreman, AGNP, Mississippi
J. Grady, MD, Mississippi
K. Heintzelman, DO, Mississippi
M. Moon, MD, Mississippi
A. Pamarthy, MD, Mississippi
J. Shores, Mississippi
J. Halsey, MD, MA, Missouri
M. Hendrix, MD, Missouri
U. Inampudi, MD, Missouri
C. Paris, APRN, FNP, Missouri
D. Payton, MD, Missouri
N. Crump, MD, Nebraska
T. Langenhan, MD, Nebraska
S. Garrett, MD, Nevada
C. Szot, MD, New Hampshire
D. Abbasi, MD, MBBS, New Jersey
S. M. Abel, ACNP, New Jersey
K. Alban, New Jersey
R. Amarini, New Jersey
J. Bauer, New Jersey
M. Branca, New Jersey
A. Hamarich, DO, New Jersey
S. Jaleel, MD, New Jersey
J. Knight, New Jersey
C. Lucchese, New Jersey
J. Peterson, New Jersey
M. Sohaib, MD, New Jersey
A. Azhar, MD, New York
B. Changlai, MD, New York
D. Gerling, New York
Y. Jin, New York
E. Palermo, ACNP, New York
V. Phillips, FNP, New York
P. Shi, DO, New York
B. Wertheimer, MD, New York
M. Yarowsky, MD, New York
C. Yates, MD, New York
J. Adams, MD, North Carolina
S. Akkaladevi, North Carolina
M. Arapian, MD, North Carolina
J. Cunningham, MD, North Carolina
K. Desronvil, ACNP, North Carolina
M. Dittmer, PA-C, North Carolina
Z. Edinger, ANP, North Carolina
T. Elswick, PA-C, North Carolina
D. Goble, MD, North Carolina
O. Jeelani, MD, MBBS, North Carolina
S. Lateef, North Carolina
G. Shalhoub, MD, North Carolina
J. Townsend, North Carolina
T. Turbett, North Carolina
K. Broderick-Forsgren, MD, Ohio
D. Foote, ACNP, Ohio
R. Muriithi, MBchB, Ohio
K. Patel, MD, Ohio
P. Veeramreddy, MBBS, Ohio
Y. Chen, MD, Oklahoma
M. Langmacher, BS, MD, Oklahoma
R. Mourh, MD, Oklahoma
M. Lukban, MD, Oregon
B. Ongole, MD, Oregon
J. Brunner, BS, MBA, Pennsylvania
M. Butala, Pennsylvania
B. Y. Chen, Pennsylvania
Z. Chen, MD, Pennsylvania
R. House, CRNP, Pennsylvania
M. Mar Fan, MD, Pennsylvania
E. McCamant, Pennsylvania
O. Okonkwo, MD, FACP, Pennsylvania
A. Savini, PA-C, Pennsylvania
A. Singh, MD, Pennsylvania
B. Smith, Pennsylvania
A. Tarique, MD, Pennsylvania
A. Whitsel, CRNP, Pennsylvania
P. Woods, MD, Pennsylvania
R. Ball, MHA, South Carolina
D. Burns, South Carolina
A. Kachalia, MD, South Carolina
L. Teague, South Carolina
D. Kindelspire, South Dakota
J. Bynum, Tennessee
A. Davidson, APRN-BC, Tennessee
P. Goleb, Tennessee
P. McCain, FNP, Tennessee
S. Patel, MD, Tennessee
A. Proffitt, ACNP, ANP, APRN, MSN, Tennessee
J. Tompkins, MD, Tennessee
F. Cardona, MD, Texas
N. Civunigunta, Texas
S. Khan, Texas
M. Mann, Texas
J. Muntz, MD, Texas
L. Swift, Texas
M. Abbott, FACHE, MBA, PharmD, Virginia
M. Alfaris, MD, Virginia
H. Aros, MD, Virginia
S. Naidu, MD, Virginia
M. Shaub, Virginia
O. Adeyeri, West Virginia
F. Farahmand, MD, West Virginia
J. Guinto, ARNP, West Virginia
S. Shiveley, MD, West Virginia
J. Singh, MBBch, West Virginia
G. Johnson, DO, Wisconsin
V. McFadden, MD, PhD, Wisconsin
S. Alam, Dhaka, Bangladesh
A. Fathala, MD, Saudi Arabia
J. Nicholson, Alabama
N. Tangutur, MD, Alabama
E. Ali, MD, Arizona
B. Cabrera, MD, Arizona
J. Castrolondono, MD, Arizona
T. Djurisic, MD, Arizona
R. Ernst, MD, Arizona
A. M. Mendez, Arizona
B. Mozaffari, DO, Arizona
A. Sharma, MD, Arizona
R. Soni, MD, Arizona
G. Neaville, MD, Arkansas
D. Sidhu, PA-C, British Columbia
S. Sidhu, EMBA, British Columbia
G. Bean, MD, MPH, MBA, FAAP, California
K. Bechler, MD, California
K. Chauhan, MPH, MD, California
N. Dave, MD, California
G. Dhanoa, California
A. Fisher, California
Y. Youssef, MD, California
S. De La Garza, MD, Colorado
V. Gundu, MD, Colorado
B. McCoy, DO, Colorado
J. Costanzo-Brown, FNP, Delaware
G. Siu, MD, Delaware
Y. Tal, MD, Delaware
J. Browning, NP-BC, DCNP, Florida
A. Chamseddin, MD, Florida
J. Florindez, MD, Florida
I. Gadalla, PA-C, Florida
G. Guess, Florida
M. E. Huckestein, ANP, Florida
D. Keerty, Florida
M. Mayo, DO, Florida
H. Nasser, MD, Florida
S. Rothstein, MSc, Florida
L. Succari, MD, Florida
S. Zimmer, MD, Florida
C. Ezigbo, Georgia
A. Mann, MD, Georgia
D. Wilmoth, Georgia
A. M. Sanchez Varela, MD, Guam
S. Cline, PhD, MBA, RN, Idaho
K. Abe, PA-C, Illinois
S. Chaudhry-Khan, MD, Illinois
K. Gallagher, Illinois
S. Kuhns, RN, Illinois
S. Pulimi, MD, Illinois
A. Urbonas, MD, Illinois
J. Chounramany, Iowa
B. Daniel, MD, Iowa
S. Joy, ARNP, Iowa
E. Kuperman, MD, Iowa
E. Shinozaki, MD, Iowa
S. Velur, MBBS, Iowa
L. Amos, MD, Kansas
L. Olson, MD, Kansas
M. Schultz, ANP, Kansas
M. Sharma, MD, Kansas
C. Castellanos, Kentucky
B. Mauldin, Louisiana
A. Thompson Soileau, MD, Louisiana
K. Hartman, MD, Maine
K. Carr, MD, Maryland
M. J. Dales, Maryland
K. Jansen, MPAS, PA-C, Maryland
A. Jubon, PA-C, Maryland
O. Schwartz, MD, Maryland
J. Withey, MD, Maryland
J. Louloudes, PA-C, Massachusetts
A. Susheelo, Massachusetts
T. Vu, Massachusetts
K. Bhatti, PA-C, Manitoba
R. Akram, Michigan
S. Federico, APRN-BC, Michigan
A. Mohammed, MBBS, Michigan
Q. Salamah, MD, Michigan
M. Schmuker, DO, Michigan
J. Dressen, Minnesota
G. Larson, MHA, Minnesota
T. Starkey, MD, Minnesota
V. Adike, MBBS, Mississippi
A. Collins, MD, Mississippi
J. Foreman, AGNP, Mississippi
J. Grady, MD, Mississippi
K. Heintzelman, DO, Mississippi
M. Moon, MD, Mississippi
A. Pamarthy, MD, Mississippi
J. Shores, Mississippi
J. Halsey, MD, MA, Missouri
M. Hendrix, MD, Missouri
U. Inampudi, MD, Missouri
C. Paris, APRN, FNP, Missouri
D. Payton, MD, Missouri
N. Crump, MD, Nebraska
T. Langenhan, MD, Nebraska
S. Garrett, MD, Nevada
C. Szot, MD, New Hampshire
D. Abbasi, MD, MBBS, New Jersey
S. M. Abel, ACNP, New Jersey
K. Alban, New Jersey
R. Amarini, New Jersey
J. Bauer, New Jersey
M. Branca, New Jersey
A. Hamarich, DO, New Jersey
S. Jaleel, MD, New Jersey
J. Knight, New Jersey
C. Lucchese, New Jersey
J. Peterson, New Jersey
M. Sohaib, MD, New Jersey
A. Azhar, MD, New York
B. Changlai, MD, New York
D. Gerling, New York
Y. Jin, New York
E. Palermo, ACNP, New York
V. Phillips, FNP, New York
P. Shi, DO, New York
B. Wertheimer, MD, New York
M. Yarowsky, MD, New York
C. Yates, MD, New York
J. Adams, MD, North Carolina
S. Akkaladevi, North Carolina
M. Arapian, MD, North Carolina
J. Cunningham, MD, North Carolina
K. Desronvil, ACNP, North Carolina
M. Dittmer, PA-C, North Carolina
Z. Edinger, ANP, North Carolina
T. Elswick, PA-C, North Carolina
D. Goble, MD, North Carolina
O. Jeelani, MD, MBBS, North Carolina
S. Lateef, North Carolina
G. Shalhoub, MD, North Carolina
J. Townsend, North Carolina
T. Turbett, North Carolina
K. Broderick-Forsgren, MD, Ohio
D. Foote, ACNP, Ohio
R. Muriithi, MBchB, Ohio
K. Patel, MD, Ohio
P. Veeramreddy, MBBS, Ohio
Y. Chen, MD, Oklahoma
M. Langmacher, BS, MD, Oklahoma
R. Mourh, MD, Oklahoma
M. Lukban, MD, Oregon
B. Ongole, MD, Oregon
J. Brunner, BS, MBA, Pennsylvania
M. Butala, Pennsylvania
B. Y. Chen, Pennsylvania
Z. Chen, MD, Pennsylvania
R. House, CRNP, Pennsylvania
M. Mar Fan, MD, Pennsylvania
E. McCamant, Pennsylvania
O. Okonkwo, MD, FACP, Pennsylvania
A. Savini, PA-C, Pennsylvania
A. Singh, MD, Pennsylvania
B. Smith, Pennsylvania
A. Tarique, MD, Pennsylvania
A. Whitsel, CRNP, Pennsylvania
P. Woods, MD, Pennsylvania
R. Ball, MHA, South Carolina
D. Burns, South Carolina
A. Kachalia, MD, South Carolina
L. Teague, South Carolina
D. Kindelspire, South Dakota
J. Bynum, Tennessee
A. Davidson, APRN-BC, Tennessee
P. Goleb, Tennessee
P. McCain, FNP, Tennessee
S. Patel, MD, Tennessee
A. Proffitt, ACNP, ANP, APRN, MSN, Tennessee
J. Tompkins, MD, Tennessee
F. Cardona, MD, Texas
N. Civunigunta, Texas
S. Khan, Texas
M. Mann, Texas
J. Muntz, MD, Texas
L. Swift, Texas
M. Abbott, FACHE, MBA, PharmD, Virginia
M. Alfaris, MD, Virginia
H. Aros, MD, Virginia
S. Naidu, MD, Virginia
M. Shaub, Virginia
O. Adeyeri, West Virginia
F. Farahmand, MD, West Virginia
J. Guinto, ARNP, West Virginia
S. Shiveley, MD, West Virginia
J. Singh, MBBch, West Virginia
G. Johnson, DO, Wisconsin
V. McFadden, MD, PhD, Wisconsin
S. Alam, Dhaka, Bangladesh
A. Fathala, MD, Saudi Arabia
J. Nicholson, Alabama
N. Tangutur, MD, Alabama
E. Ali, MD, Arizona
B. Cabrera, MD, Arizona
J. Castrolondono, MD, Arizona
T. Djurisic, MD, Arizona
R. Ernst, MD, Arizona
A. M. Mendez, Arizona
B. Mozaffari, DO, Arizona
A. Sharma, MD, Arizona
R. Soni, MD, Arizona
G. Neaville, MD, Arkansas
D. Sidhu, PA-C, British Columbia
S. Sidhu, EMBA, British Columbia
G. Bean, MD, MPH, MBA, FAAP, California
K. Bechler, MD, California
K. Chauhan, MPH, MD, California
N. Dave, MD, California
G. Dhanoa, California
A. Fisher, California
Y. Youssef, MD, California
S. De La Garza, MD, Colorado
V. Gundu, MD, Colorado
B. McCoy, DO, Colorado
J. Costanzo-Brown, FNP, Delaware
G. Siu, MD, Delaware
Y. Tal, MD, Delaware
J. Browning, NP-BC, DCNP, Florida
A. Chamseddin, MD, Florida
J. Florindez, MD, Florida
I. Gadalla, PA-C, Florida
G. Guess, Florida
M. E. Huckestein, ANP, Florida
D. Keerty, Florida
M. Mayo, DO, Florida
H. Nasser, MD, Florida
S. Rothstein, MSc, Florida
L. Succari, MD, Florida
S. Zimmer, MD, Florida
C. Ezigbo, Georgia
A. Mann, MD, Georgia
D. Wilmoth, Georgia
A. M. Sanchez Varela, MD, Guam
S. Cline, PhD, MBA, RN, Idaho
K. Abe, PA-C, Illinois
S. Chaudhry-Khan, MD, Illinois
K. Gallagher, Illinois
S. Kuhns, RN, Illinois
S. Pulimi, MD, Illinois
A. Urbonas, MD, Illinois
J. Chounramany, Iowa
B. Daniel, MD, Iowa
S. Joy, ARNP, Iowa
E. Kuperman, MD, Iowa
E. Shinozaki, MD, Iowa
S. Velur, MBBS, Iowa
L. Amos, MD, Kansas
L. Olson, MD, Kansas
M. Schultz, ANP, Kansas
M. Sharma, MD, Kansas
C. Castellanos, Kentucky
B. Mauldin, Louisiana
A. Thompson Soileau, MD, Louisiana
K. Hartman, MD, Maine
K. Carr, MD, Maryland
M. J. Dales, Maryland
K. Jansen, MPAS, PA-C, Maryland
A. Jubon, PA-C, Maryland
O. Schwartz, MD, Maryland
J. Withey, MD, Maryland
J. Louloudes, PA-C, Massachusetts
A. Susheelo, Massachusetts
T. Vu, Massachusetts
K. Bhatti, PA-C, Manitoba
R. Akram, Michigan
S. Federico, APRN-BC, Michigan
A. Mohammed, MBBS, Michigan
Q. Salamah, MD, Michigan
M. Schmuker, DO, Michigan
J. Dressen, Minnesota
G. Larson, MHA, Minnesota
T. Starkey, MD, Minnesota
V. Adike, MBBS, Mississippi
A. Collins, MD, Mississippi
J. Foreman, AGNP, Mississippi
J. Grady, MD, Mississippi
K. Heintzelman, DO, Mississippi
M. Moon, MD, Mississippi
A. Pamarthy, MD, Mississippi
J. Shores, Mississippi
J. Halsey, MD, MA, Missouri
M. Hendrix, MD, Missouri
U. Inampudi, MD, Missouri
C. Paris, APRN, FNP, Missouri
D. Payton, MD, Missouri
N. Crump, MD, Nebraska
T. Langenhan, MD, Nebraska
S. Garrett, MD, Nevada
C. Szot, MD, New Hampshire
D. Abbasi, MD, MBBS, New Jersey
S. M. Abel, ACNP, New Jersey
K. Alban, New Jersey
R. Amarini, New Jersey
J. Bauer, New Jersey
M. Branca, New Jersey
A. Hamarich, DO, New Jersey
S. Jaleel, MD, New Jersey
J. Knight, New Jersey
C. Lucchese, New Jersey
J. Peterson, New Jersey
M. Sohaib, MD, New Jersey
A. Azhar, MD, New York
B. Changlai, MD, New York
D. Gerling, New York
Y. Jin, New York
E. Palermo, ACNP, New York
V. Phillips, FNP, New York
P. Shi, DO, New York
B. Wertheimer, MD, New York
M. Yarowsky, MD, New York
C. Yates, MD, New York
J. Adams, MD, North Carolina
S. Akkaladevi, North Carolina
M. Arapian, MD, North Carolina
J. Cunningham, MD, North Carolina
K. Desronvil, ACNP, North Carolina
M. Dittmer, PA-C, North Carolina
Z. Edinger, ANP, North Carolina
T. Elswick, PA-C, North Carolina
D. Goble, MD, North Carolina
O. Jeelani, MD, MBBS, North Carolina
S. Lateef, North Carolina
G. Shalhoub, MD, North Carolina
J. Townsend, North Carolina
T. Turbett, North Carolina
K. Broderick-Forsgren, MD, Ohio
D. Foote, ACNP, Ohio
R. Muriithi, MBchB, Ohio
K. Patel, MD, Ohio
P. Veeramreddy, MBBS, Ohio
Y. Chen, MD, Oklahoma
M. Langmacher, BS, MD, Oklahoma
R. Mourh, MD, Oklahoma
M. Lukban, MD, Oregon
B. Ongole, MD, Oregon
J. Brunner, BS, MBA, Pennsylvania
M. Butala, Pennsylvania
B. Y. Chen, Pennsylvania
Z. Chen, MD, Pennsylvania
R. House, CRNP, Pennsylvania
M. Mar Fan, MD, Pennsylvania
E. McCamant, Pennsylvania
O. Okonkwo, MD, FACP, Pennsylvania
A. Savini, PA-C, Pennsylvania
A. Singh, MD, Pennsylvania
B. Smith, Pennsylvania
A. Tarique, MD, Pennsylvania
A. Whitsel, CRNP, Pennsylvania
P. Woods, MD, Pennsylvania
R. Ball, MHA, South Carolina
D. Burns, South Carolina
A. Kachalia, MD, South Carolina
L. Teague, South Carolina
D. Kindelspire, South Dakota
J. Bynum, Tennessee
A. Davidson, APRN-BC, Tennessee
P. Goleb, Tennessee
P. McCain, FNP, Tennessee
S. Patel, MD, Tennessee
A. Proffitt, ACNP, ANP, APRN, MSN, Tennessee
J. Tompkins, MD, Tennessee
F. Cardona, MD, Texas
N. Civunigunta, Texas
S. Khan, Texas
M. Mann, Texas
J. Muntz, MD, Texas
L. Swift, Texas
M. Abbott, FACHE, MBA, PharmD, Virginia
M. Alfaris, MD, Virginia
H. Aros, MD, Virginia
S. Naidu, MD, Virginia
M. Shaub, Virginia
O. Adeyeri, West Virginia
F. Farahmand, MD, West Virginia
J. Guinto, ARNP, West Virginia
S. Shiveley, MD, West Virginia
J. Singh, MBBch, West Virginia
G. Johnson, DO, Wisconsin
V. McFadden, MD, PhD, Wisconsin
S. Alam, Dhaka, Bangladesh
A. Fathala, MD, Saudi Arabia
Register for Academic Hospitalist Academy
Don’t miss the eighth annual Academic Hospitalist Academy (AHA), Sept. 12–15, at the scenic Lakeway Resort and Spa in Austin, Texas. You will experience an energizing, interactive learning environment featuring didactics, small-group exercises, and skill-building breakout sessions. Each full day of learning is facilitated by leading clinician-educators, hospitalist-researchers, and clinical administrators in a 1-to-10 faculty-to-student ratio.
AHA’s principal goals are to:
- Develop junior academic hospitalists as the premier teachers and educational leaders at their institutions
- Help academic hospitalists develop scholarly work and increase scholarly output
- Enhance awareness of the value of quality improvement and patient safety work
- Support academic promotion of all attendees
Register now at www.academichospitalist.org.
Don’t miss the eighth annual Academic Hospitalist Academy (AHA), Sept. 12–15, at the scenic Lakeway Resort and Spa in Austin, Texas. You will experience an energizing, interactive learning environment featuring didactics, small-group exercises, and skill-building breakout sessions. Each full day of learning is facilitated by leading clinician-educators, hospitalist-researchers, and clinical administrators in a 1-to-10 faculty-to-student ratio.
AHA’s principal goals are to:
- Develop junior academic hospitalists as the premier teachers and educational leaders at their institutions
- Help academic hospitalists develop scholarly work and increase scholarly output
- Enhance awareness of the value of quality improvement and patient safety work
- Support academic promotion of all attendees
Register now at www.academichospitalist.org.
Don’t miss the eighth annual Academic Hospitalist Academy (AHA), Sept. 12–15, at the scenic Lakeway Resort and Spa in Austin, Texas. You will experience an energizing, interactive learning environment featuring didactics, small-group exercises, and skill-building breakout sessions. Each full day of learning is facilitated by leading clinician-educators, hospitalist-researchers, and clinical administrators in a 1-to-10 faculty-to-student ratio.
AHA’s principal goals are to:
- Develop junior academic hospitalists as the premier teachers and educational leaders at their institutions
- Help academic hospitalists develop scholarly work and increase scholarly output
- Enhance awareness of the value of quality improvement and patient safety work
- Support academic promotion of all attendees
Register now at www.academichospitalist.org.
PHM16: How to Design, Improve Educational Programs at Community Hospitals
Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD
This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.
During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.
Some of the challenges discussed in regards to developing an educational structure in community settings included:
- Logistics
- Making the case for education
- Legal framework (i.e. Affiliation agreements, Liability)
- Finances (i.e. GME funding)
- Paperwork burden (ex. Licensing, Credentialing)
- Learning Environment
- Complementing clinical work with materials
- Autonomy/Supervision balancing
- Developing Clinical teachers
The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.
Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.
A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.
Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.
Dr. Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children's National Health System Community Hospital Services in Washington, D.C.
Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD
This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.
During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.
Some of the challenges discussed in regards to developing an educational structure in community settings included:
- Logistics
- Making the case for education
- Legal framework (i.e. Affiliation agreements, Liability)
- Finances (i.e. GME funding)
- Paperwork burden (ex. Licensing, Credentialing)
- Learning Environment
- Complementing clinical work with materials
- Autonomy/Supervision balancing
- Developing Clinical teachers
The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.
Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.
A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.
Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.
Dr. Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children's National Health System Community Hospital Services in Washington, D.C.
Facilitators: Christopher Russo, MD, FAAP, Laura Hodo, MD, and Lauren Wilson, MD
This session discussed ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool that can be used beyond the session. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.
During the didactic session a general background of importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy”, “exposure to different career paths”, and “transfer decision-making”.
Some of the challenges discussed in regards to developing an educational structure in community settings included:
- Logistics
- Making the case for education
- Legal framework (i.e. Affiliation agreements, Liability)
- Finances (i.e. GME funding)
- Paperwork burden (ex. Licensing, Credentialing)
- Learning Environment
- Complementing clinical work with materials
- Autonomy/Supervision balancing
- Developing Clinical teachers
The didactic session also reviewed the 6 steps for curriculum development: General Needs Assessment, Targeted Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, and Evaluation/Feedback. Each of these was described in further detail with relevant examples.
Groups were broken out into small groups based on four learner types: Medical Students, Family Medicine Residents, Pediatric Residents, and PHM Fellows. Within each group a “Program Development Matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.
A separate “Curriculum Development Matrix” was utilized during breakout groups that focused on curriculum development. This matrix was broken into 3 areas: Educational Strategies, Implementation, and Evaluation/Feedback. These were broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short and long term goals with action steps for both of these matrix subgroups.
Overall the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools to develop a needs assessment and planning to achieve the defined goals that can be readily used by sites who wish to develop or improve their current educational framework.
Dr. Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children's National Health System Community Hospital Services in Washington, D.C.
PHM16: Promoting, Teaching Pediatric High Value Care
As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.
Perhaps the questions we should be asking ourselves, our trainees and our families are:
- Instead of “What’s the matter?” ask “What matters?”
- Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”
Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.
A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.
One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.
When asking for the Pediatric Value Meal, this is one where I will not Super size it!
Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.
As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.
Perhaps the questions we should be asking ourselves, our trainees and our families are:
- Instead of “What’s the matter?” ask “What matters?”
- Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”
Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.
A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.
One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.
When asking for the Pediatric Value Meal, this is one where I will not Super size it!
Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.
As we embark on Choosing Wisely, pediatric hospitalists gathered to attend this fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high value care are plenty and essentially universal to academic and community sites: we have had no formal teaching, there is cultural resistance and there is lack of transparency on costs and charges.
Perhaps the questions we should be asking ourselves, our trainees and our families are:
- Instead of “What’s the matter?” ask “What matters?”
- Instead of asking “Will that test change our management?” ask “Does that test benefit the patient? What are the harms of the test?”
Thinking about effects of tests downstream, the “testing cascade” can be a great mental exercise for the higher-level learner to understand the value, the unknowns we face in our daily decisions and simultaneously improving our understanding of best practices.
A toolkit was provided to help bring back resources and methods to teach high value care in morning report/ case conference settings, bedside teaching and family discussions.
One point is clear though—there is still a long way to go to move the pendulum to the side of value based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary values—family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
This serves as an exciting time to unite and better our understanding on why we do what we do and deliberately think about downstream effects. High value care curriculum for medical students, residents, fellows and even faculty is an area ripe for further educational and clinical research.
When asking for the Pediatric Value Meal, this is one where I will not Super size it!
Dr. Akshata Hopkins, MD FAAP, is an academic hospitalist at Johns Hopkins All Children's Hospital, St. Petersburg, Fla.