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Tips for Improving Early Discharge Rates
Discharging patients before noon has many advantages: It creates open beds to accommodate the surge in admissions in the afternoon and helps minimize the bottleneck in system-wide patient flow, says Ragu P. Sanjeev, MD, unit-based medical director at Christiana Hospital in Newark, Del.
“Doing so can reduce ER wait times, reduce the percentage of patients leaving the ED without being seen—a safety issue for those patients—and also help to place the right patient in the right bed in a timely manner,” he says. “It’s a not just a patient flow issue; it’s a patient safety issue, as well.”
At his hospital, hospitalists developed a “Discharge by Appointment” process to address the issue systematically and completed a pilot project to test it. Their “‘Discharge by Appointment’ Improves Patient Flow, by Increasing Number of Discharges Before Noon,” was an abstract presented at HM16.1
“Giving patients that have a high predictability of being discharged next day, an appointment, and set off a series of steps to be completed the day before discharge including, notifying the transport team/family members of the appointment, helped improve the number of discharges before noon significantly,” according to the abstract.
Their successful pilot project has led to lasting changes, Dr. Sanjeev says. For about 16 months, the number of discharges before noon has been steadily increasing, helping the acute medicine service line perform better than its “Discharge by Noon” goal by 44.4% this fiscal year.
“As hospitalists, we have a great potential to positively impact the hospital-wide issues like patient flow and patient safety,” Dr. Sanjeev says. “By actively participating in important hospital committees, you can understand better and get inspired by the ongoing improvement efforts. By partnering with your care team, including bedside nurses, case managers, and social workers, we can make a big difference in early discharges. This success can be expanded to discharges throughout the day with appointments, thereby keeping the flow faucet open at all times.”
Reference
- Sanjeev R, McMillen J, Fedyk A. ‘discharge by Appointment’ Improves Patient Flow, by Increasing Number of Discharges Before Noon [abstract]. J Hosp Med. http://www.shmabstracts.com/abstract/discharge-by-appointment-improves-patient-flow-by-increasing-number-of-discharges-before-noon/. Accessed April 27, 2016.
Discharging patients before noon has many advantages: It creates open beds to accommodate the surge in admissions in the afternoon and helps minimize the bottleneck in system-wide patient flow, says Ragu P. Sanjeev, MD, unit-based medical director at Christiana Hospital in Newark, Del.
“Doing so can reduce ER wait times, reduce the percentage of patients leaving the ED without being seen—a safety issue for those patients—and also help to place the right patient in the right bed in a timely manner,” he says. “It’s a not just a patient flow issue; it’s a patient safety issue, as well.”
At his hospital, hospitalists developed a “Discharge by Appointment” process to address the issue systematically and completed a pilot project to test it. Their “‘Discharge by Appointment’ Improves Patient Flow, by Increasing Number of Discharges Before Noon,” was an abstract presented at HM16.1
“Giving patients that have a high predictability of being discharged next day, an appointment, and set off a series of steps to be completed the day before discharge including, notifying the transport team/family members of the appointment, helped improve the number of discharges before noon significantly,” according to the abstract.
Their successful pilot project has led to lasting changes, Dr. Sanjeev says. For about 16 months, the number of discharges before noon has been steadily increasing, helping the acute medicine service line perform better than its “Discharge by Noon” goal by 44.4% this fiscal year.
“As hospitalists, we have a great potential to positively impact the hospital-wide issues like patient flow and patient safety,” Dr. Sanjeev says. “By actively participating in important hospital committees, you can understand better and get inspired by the ongoing improvement efforts. By partnering with your care team, including bedside nurses, case managers, and social workers, we can make a big difference in early discharges. This success can be expanded to discharges throughout the day with appointments, thereby keeping the flow faucet open at all times.”
Reference
- Sanjeev R, McMillen J, Fedyk A. ‘discharge by Appointment’ Improves Patient Flow, by Increasing Number of Discharges Before Noon [abstract]. J Hosp Med. http://www.shmabstracts.com/abstract/discharge-by-appointment-improves-patient-flow-by-increasing-number-of-discharges-before-noon/. Accessed April 27, 2016.
Discharging patients before noon has many advantages: It creates open beds to accommodate the surge in admissions in the afternoon and helps minimize the bottleneck in system-wide patient flow, says Ragu P. Sanjeev, MD, unit-based medical director at Christiana Hospital in Newark, Del.
“Doing so can reduce ER wait times, reduce the percentage of patients leaving the ED without being seen—a safety issue for those patients—and also help to place the right patient in the right bed in a timely manner,” he says. “It’s a not just a patient flow issue; it’s a patient safety issue, as well.”
At his hospital, hospitalists developed a “Discharge by Appointment” process to address the issue systematically and completed a pilot project to test it. Their “‘Discharge by Appointment’ Improves Patient Flow, by Increasing Number of Discharges Before Noon,” was an abstract presented at HM16.1
“Giving patients that have a high predictability of being discharged next day, an appointment, and set off a series of steps to be completed the day before discharge including, notifying the transport team/family members of the appointment, helped improve the number of discharges before noon significantly,” according to the abstract.
Their successful pilot project has led to lasting changes, Dr. Sanjeev says. For about 16 months, the number of discharges before noon has been steadily increasing, helping the acute medicine service line perform better than its “Discharge by Noon” goal by 44.4% this fiscal year.
“As hospitalists, we have a great potential to positively impact the hospital-wide issues like patient flow and patient safety,” Dr. Sanjeev says. “By actively participating in important hospital committees, you can understand better and get inspired by the ongoing improvement efforts. By partnering with your care team, including bedside nurses, case managers, and social workers, we can make a big difference in early discharges. This success can be expanded to discharges throughout the day with appointments, thereby keeping the flow faucet open at all times.”
Reference
- Sanjeev R, McMillen J, Fedyk A. ‘discharge by Appointment’ Improves Patient Flow, by Increasing Number of Discharges Before Noon [abstract]. J Hosp Med. http://www.shmabstracts.com/abstract/discharge-by-appointment-improves-patient-flow-by-increasing-number-of-discharges-before-noon/. Accessed April 27, 2016.
Register for Pediatric Hospital Medicine 2016
PHM16 will provide in-depth review and challenge participants in various areas, including clinical practice, medical education, quality improvement, and professional development. Time will also be dedicated to networking and meeting with leaders in the field.
Register, book your hotel, and see the full course schedule at www.phmmeeting.org.
Brett Radler is SHM’s communications coordinator.
PHM16 will provide in-depth review and challenge participants in various areas, including clinical practice, medical education, quality improvement, and professional development. Time will also be dedicated to networking and meeting with leaders in the field.
Register, book your hotel, and see the full course schedule at www.phmmeeting.org.
Brett Radler is SHM’s communications coordinator.
PHM16 will provide in-depth review and challenge participants in various areas, including clinical practice, medical education, quality improvement, and professional development. Time will also be dedicated to networking and meeting with leaders in the field.
Register, book your hotel, and see the full course schedule at www.phmmeeting.org.
Brett Radler is SHM’s communications coordinator.
New SHM Members – June 2016
B. Abdalsm, MD, MPH, Alabama
A. Aboutalib, Alabama
D. Adams, MD, Arkansas
A. Afzal, MD, FACP, Arizona
J. Aheam, MD, California
S. Ahluwalia, MBBS, California
A. Alhusseini, MD, FAACP, MBchB, California
L. Anderson, MD, California
K. Arunachalam, MD, California
B. Asalone, California
L. Atkins, MD, California
T. Aultman, MD, California
T. Ayangade, MD, California
A. Azizi, MD, California
F. Azizi, MD, California
S. Balu, MD, California
K. Basra, APRN, FNP, California
N. Bassi, California
C. Batchelor, MD, California
K. Beinlich, MD, California
S. Bhat, MD, MBBS, California
H. Bilal, MBBS, California
G. Bismack, MD, California
M. Bokhari, MD, California
M. Brandenbug, MD, Colorado
H. Briggs, MD, PhD, Colorado
E. Burgh, MD, Colorado
M. Cabrera, BC, Delaware
J. Camden, BA, Delaware
P. Chandra Mohan, MD, Delaware
D. Chau, MD, Delaware
M. Chen, Florida
V. Chennamaneni, Florida
L. Cler, Florida
D. Cooks, Florida
S. Crenshaw, Florida
K. Cunningham, MD, FACP, Florida
V. De Guzman, APRN, MSN, NP, Florida
M. Del Rosario, MD, Florida
D. DeVere, MD, Florida
S. Dharmapuri, Florida
P. Dodson, MD, Florida
A. Domaoal, Georgia
J. Duncan, MD, Georgia
B. Dyck, BSC, MD, PhD, Georgia
J. Dzundza, MD, Georgia
A. Ellis, FNP, Georgia
R. Erickson, Idaho
A. Faraj, Idaho
S. Fernandez, MD, Illinois
G. Ferrari, MD, Illinois
W. Folad, MD, Illinois
L. Fowler, ACNP, APRN, MBA, Illinois
J. Golderberg, MD, Illinois
G. Goldman, MD, Illinois
L. Gonzales, MD, Indiana
A. Gonzalez, Kansas
W. Griffo, MD, Kansas
R. Guzman, Kansas
L. Guzman Vinasco, MD, Kansas
K. Hageman, DO, Kentucky
M. Haggerty, PA-C, Kentucky
B. Hammond, Louisiana
G. Harris, MD, Louisiana
J. Hasan-Jones, RN, FACHE, Louisiana
J. Herring, Louisiana
L. Hsu, MD, Massachusetts
A. C. Hunag, DO, Massachusetts
M. Huq, Massachusetts
M. Jandrin, PA-C, Massachusetts
C. Janish, MD, Maryland
J. Jarin, MD, Maine
A. Jenkins, Maine
S. Jindal, MD, Michigan
M. Johl, Michigan
T. John, Michigan
N. Kapadia, MD, Michigan
L. Katona, Michigan
K. Kaye, Michigan
M. Keating, Michigan
L. Keeton, MD, Michigan
L. Kendall, Michigan
M. Kerlin, Michigan
A. Kia, MD, Minnesota
R. Klett, Minnesota
L. Knapp, DO, Minnesota
K. Knox, Missouri
M. Kraynak, MD, Missouri
P. Kuppireddy, MBBS, Missouri
W. Landrum, MD, Missouri
C. Larion, ACNP, Missouri
E. Latcheva, MD, Mississippi
D. Leforce, North Carolina
V. Leigh, DO, North Carolina
C. Leon, North Carolina
T. Li, MD, North Dakota
X. Li, MD, Nebraska
Y. Li, New Hampshire
J. Liu, New Hampshire
L. Lu, DO, New Jersey
S. Mathapathi, New Jersey
L. McGann, New Jersey
S. Melkaveri, MD, Nevada
R. Mercado Garcia, New York
S. Merry, MD, New York
P. Meyer, DO, New York
J. Mikulca, PharmD, New York
Z. Moyenda, MD, MBA, New York
K. Murphy, DO, MPH, New York
J. Musenze, New York
P. Mutungi, New York
G. Nanna, USA, New York
I. Nasir, New York
U. Nazario-Vidah, MD, New York
D. Nguyen, New York
C. Ojha, MBBS, New York
K. Olson, MD, Ohio
V. Paulson, MD, Ohio
R. Pearson, DO, PhD, Ohio
A. Peel, MD, Ohio
S. Pettis, PA-C, Ohio
E. Picloglou, MD, Ohio
H. Pokhrel, MD, Ohio
H. Bush, Oklahoma
R. Porter, PA, Oklahoma
P. Prabhakar, Oklahoma
U. Qamar, Oklahoma
R. Quansah, MD, Oklahoma
M. Rahman, Oklahoma
R. Rajeshwar, Oregon
E. Randal, Oregon
A. Ray, Oregon
V. Reddy, Oregon
J. Reed, MD, RN, Oregon
R. Regidor, Oregon
A. Reitsma-Mathias, MD, Oregon
R. Reyes, MD, Oregon
T. Richardson, NP, Oregon
T. Ringer, Oregon
L. Rivera-Crespo, Pennsylvania
T. Rothwell, PA, Pennsylvania
E. Sacolick, MD, Pennsylvania
E. Saluke, MD, Pennsylvania
M. Santinelli, NP, Pennsylvania
M. Sapon-Amoah, FNP, Pennsylvania
D. Scarine, NP, Pennsylvania
K. Seger, Pennsylvania
A. Shah, Pennsylvania
K. Shah, MD, Pennsylvania
S. Shah, MD, Pennsylvania
G. Sharma, MD, Pennsylvania
K. Shaukat, MD, Pennsylvania
E. Sheindler, Rhode Island
D. Sheps, South Carolina
J. Shipe-Spotloe, South Carolina
S. Sim, South Carolina
M. Simon, MD, MMM, CPE, South Carolina
A. Singh, South Carolina
S. Singh-Patel, PO, South Dakota
M. Snyder, South Dakota
A. Srikanth, MBBS, Tennessee
B. Staats, Tennessee
C. Standley, Texas
R. Stanhiser, Texas
M. Stevens, Texas
K. Stuart, Texas
A. Summers, Texas
E. Taylo, Texas
L. Taylor, PA-C, Texas
L. Theaker, Texas
M. Thieman, Texas
J. Tong, Texas
N. Trivedi, MD, Texas
L. Tuazon, MD, FACP, Texas
S. Tummalapalli, Texas
A. Ufferman, MD, Virginia
R. Urrea, MD, Virginia
N. Van Groningen, Virginia
D. Vaughn, MD, Vermont
R. Vento, MD, MPH, Washington
Y. Villaran, MD, Washington
L. Viscome, DO, Washington
K. Vo, Washington
H. Vu, MD, Washington
T. Washko, MD, Washington
T. Waters, DO, Wisconsin
L. Weisberger, USA, Wisconsin
A. Whitehead, Wisconsin
A. Workman, West Virginia
F. Yasin, MD, West Virginia
A. Yoon, MD, West Virginia
M. Yu, West Virginia
A. Yuen, DO, West Virginia
K. Zwieg, West Virginia
B. Abdalsm, MD, MPH, Alabama
A. Aboutalib, Alabama
D. Adams, MD, Arkansas
A. Afzal, MD, FACP, Arizona
J. Aheam, MD, California
S. Ahluwalia, MBBS, California
A. Alhusseini, MD, FAACP, MBchB, California
L. Anderson, MD, California
K. Arunachalam, MD, California
B. Asalone, California
L. Atkins, MD, California
T. Aultman, MD, California
T. Ayangade, MD, California
A. Azizi, MD, California
F. Azizi, MD, California
S. Balu, MD, California
K. Basra, APRN, FNP, California
N. Bassi, California
C. Batchelor, MD, California
K. Beinlich, MD, California
S. Bhat, MD, MBBS, California
H. Bilal, MBBS, California
G. Bismack, MD, California
M. Bokhari, MD, California
M. Brandenbug, MD, Colorado
H. Briggs, MD, PhD, Colorado
E. Burgh, MD, Colorado
M. Cabrera, BC, Delaware
J. Camden, BA, Delaware
P. Chandra Mohan, MD, Delaware
D. Chau, MD, Delaware
M. Chen, Florida
V. Chennamaneni, Florida
L. Cler, Florida
D. Cooks, Florida
S. Crenshaw, Florida
K. Cunningham, MD, FACP, Florida
V. De Guzman, APRN, MSN, NP, Florida
M. Del Rosario, MD, Florida
D. DeVere, MD, Florida
S. Dharmapuri, Florida
P. Dodson, MD, Florida
A. Domaoal, Georgia
J. Duncan, MD, Georgia
B. Dyck, BSC, MD, PhD, Georgia
J. Dzundza, MD, Georgia
A. Ellis, FNP, Georgia
R. Erickson, Idaho
A. Faraj, Idaho
S. Fernandez, MD, Illinois
G. Ferrari, MD, Illinois
W. Folad, MD, Illinois
L. Fowler, ACNP, APRN, MBA, Illinois
J. Golderberg, MD, Illinois
G. Goldman, MD, Illinois
L. Gonzales, MD, Indiana
A. Gonzalez, Kansas
W. Griffo, MD, Kansas
R. Guzman, Kansas
L. Guzman Vinasco, MD, Kansas
K. Hageman, DO, Kentucky
M. Haggerty, PA-C, Kentucky
B. Hammond, Louisiana
G. Harris, MD, Louisiana
J. Hasan-Jones, RN, FACHE, Louisiana
J. Herring, Louisiana
L. Hsu, MD, Massachusetts
A. C. Hunag, DO, Massachusetts
M. Huq, Massachusetts
M. Jandrin, PA-C, Massachusetts
C. Janish, MD, Maryland
J. Jarin, MD, Maine
A. Jenkins, Maine
S. Jindal, MD, Michigan
M. Johl, Michigan
T. John, Michigan
N. Kapadia, MD, Michigan
L. Katona, Michigan
K. Kaye, Michigan
M. Keating, Michigan
L. Keeton, MD, Michigan
L. Kendall, Michigan
M. Kerlin, Michigan
A. Kia, MD, Minnesota
R. Klett, Minnesota
L. Knapp, DO, Minnesota
K. Knox, Missouri
M. Kraynak, MD, Missouri
P. Kuppireddy, MBBS, Missouri
W. Landrum, MD, Missouri
C. Larion, ACNP, Missouri
E. Latcheva, MD, Mississippi
D. Leforce, North Carolina
V. Leigh, DO, North Carolina
C. Leon, North Carolina
T. Li, MD, North Dakota
X. Li, MD, Nebraska
Y. Li, New Hampshire
J. Liu, New Hampshire
L. Lu, DO, New Jersey
S. Mathapathi, New Jersey
L. McGann, New Jersey
S. Melkaveri, MD, Nevada
R. Mercado Garcia, New York
S. Merry, MD, New York
P. Meyer, DO, New York
J. Mikulca, PharmD, New York
Z. Moyenda, MD, MBA, New York
K. Murphy, DO, MPH, New York
J. Musenze, New York
P. Mutungi, New York
G. Nanna, USA, New York
I. Nasir, New York
U. Nazario-Vidah, MD, New York
D. Nguyen, New York
C. Ojha, MBBS, New York
K. Olson, MD, Ohio
V. Paulson, MD, Ohio
R. Pearson, DO, PhD, Ohio
A. Peel, MD, Ohio
S. Pettis, PA-C, Ohio
E. Picloglou, MD, Ohio
H. Pokhrel, MD, Ohio
H. Bush, Oklahoma
R. Porter, PA, Oklahoma
P. Prabhakar, Oklahoma
U. Qamar, Oklahoma
R. Quansah, MD, Oklahoma
M. Rahman, Oklahoma
R. Rajeshwar, Oregon
E. Randal, Oregon
A. Ray, Oregon
V. Reddy, Oregon
J. Reed, MD, RN, Oregon
R. Regidor, Oregon
A. Reitsma-Mathias, MD, Oregon
R. Reyes, MD, Oregon
T. Richardson, NP, Oregon
T. Ringer, Oregon
L. Rivera-Crespo, Pennsylvania
T. Rothwell, PA, Pennsylvania
E. Sacolick, MD, Pennsylvania
E. Saluke, MD, Pennsylvania
M. Santinelli, NP, Pennsylvania
M. Sapon-Amoah, FNP, Pennsylvania
D. Scarine, NP, Pennsylvania
K. Seger, Pennsylvania
A. Shah, Pennsylvania
K. Shah, MD, Pennsylvania
S. Shah, MD, Pennsylvania
G. Sharma, MD, Pennsylvania
K. Shaukat, MD, Pennsylvania
E. Sheindler, Rhode Island
D. Sheps, South Carolina
J. Shipe-Spotloe, South Carolina
S. Sim, South Carolina
M. Simon, MD, MMM, CPE, South Carolina
A. Singh, South Carolina
S. Singh-Patel, PO, South Dakota
M. Snyder, South Dakota
A. Srikanth, MBBS, Tennessee
B. Staats, Tennessee
C. Standley, Texas
R. Stanhiser, Texas
M. Stevens, Texas
K. Stuart, Texas
A. Summers, Texas
E. Taylo, Texas
L. Taylor, PA-C, Texas
L. Theaker, Texas
M. Thieman, Texas
J. Tong, Texas
N. Trivedi, MD, Texas
L. Tuazon, MD, FACP, Texas
S. Tummalapalli, Texas
A. Ufferman, MD, Virginia
R. Urrea, MD, Virginia
N. Van Groningen, Virginia
D. Vaughn, MD, Vermont
R. Vento, MD, MPH, Washington
Y. Villaran, MD, Washington
L. Viscome, DO, Washington
K. Vo, Washington
H. Vu, MD, Washington
T. Washko, MD, Washington
T. Waters, DO, Wisconsin
L. Weisberger, USA, Wisconsin
A. Whitehead, Wisconsin
A. Workman, West Virginia
F. Yasin, MD, West Virginia
A. Yoon, MD, West Virginia
M. Yu, West Virginia
A. Yuen, DO, West Virginia
K. Zwieg, West Virginia
B. Abdalsm, MD, MPH, Alabama
A. Aboutalib, Alabama
D. Adams, MD, Arkansas
A. Afzal, MD, FACP, Arizona
J. Aheam, MD, California
S. Ahluwalia, MBBS, California
A. Alhusseini, MD, FAACP, MBchB, California
L. Anderson, MD, California
K. Arunachalam, MD, California
B. Asalone, California
L. Atkins, MD, California
T. Aultman, MD, California
T. Ayangade, MD, California
A. Azizi, MD, California
F. Azizi, MD, California
S. Balu, MD, California
K. Basra, APRN, FNP, California
N. Bassi, California
C. Batchelor, MD, California
K. Beinlich, MD, California
S. Bhat, MD, MBBS, California
H. Bilal, MBBS, California
G. Bismack, MD, California
M. Bokhari, MD, California
M. Brandenbug, MD, Colorado
H. Briggs, MD, PhD, Colorado
E. Burgh, MD, Colorado
M. Cabrera, BC, Delaware
J. Camden, BA, Delaware
P. Chandra Mohan, MD, Delaware
D. Chau, MD, Delaware
M. Chen, Florida
V. Chennamaneni, Florida
L. Cler, Florida
D. Cooks, Florida
S. Crenshaw, Florida
K. Cunningham, MD, FACP, Florida
V. De Guzman, APRN, MSN, NP, Florida
M. Del Rosario, MD, Florida
D. DeVere, MD, Florida
S. Dharmapuri, Florida
P. Dodson, MD, Florida
A. Domaoal, Georgia
J. Duncan, MD, Georgia
B. Dyck, BSC, MD, PhD, Georgia
J. Dzundza, MD, Georgia
A. Ellis, FNP, Georgia
R. Erickson, Idaho
A. Faraj, Idaho
S. Fernandez, MD, Illinois
G. Ferrari, MD, Illinois
W. Folad, MD, Illinois
L. Fowler, ACNP, APRN, MBA, Illinois
J. Golderberg, MD, Illinois
G. Goldman, MD, Illinois
L. Gonzales, MD, Indiana
A. Gonzalez, Kansas
W. Griffo, MD, Kansas
R. Guzman, Kansas
L. Guzman Vinasco, MD, Kansas
K. Hageman, DO, Kentucky
M. Haggerty, PA-C, Kentucky
B. Hammond, Louisiana
G. Harris, MD, Louisiana
J. Hasan-Jones, RN, FACHE, Louisiana
J. Herring, Louisiana
L. Hsu, MD, Massachusetts
A. C. Hunag, DO, Massachusetts
M. Huq, Massachusetts
M. Jandrin, PA-C, Massachusetts
C. Janish, MD, Maryland
J. Jarin, MD, Maine
A. Jenkins, Maine
S. Jindal, MD, Michigan
M. Johl, Michigan
T. John, Michigan
N. Kapadia, MD, Michigan
L. Katona, Michigan
K. Kaye, Michigan
M. Keating, Michigan
L. Keeton, MD, Michigan
L. Kendall, Michigan
M. Kerlin, Michigan
A. Kia, MD, Minnesota
R. Klett, Minnesota
L. Knapp, DO, Minnesota
K. Knox, Missouri
M. Kraynak, MD, Missouri
P. Kuppireddy, MBBS, Missouri
W. Landrum, MD, Missouri
C. Larion, ACNP, Missouri
E. Latcheva, MD, Mississippi
D. Leforce, North Carolina
V. Leigh, DO, North Carolina
C. Leon, North Carolina
T. Li, MD, North Dakota
X. Li, MD, Nebraska
Y. Li, New Hampshire
J. Liu, New Hampshire
L. Lu, DO, New Jersey
S. Mathapathi, New Jersey
L. McGann, New Jersey
S. Melkaveri, MD, Nevada
R. Mercado Garcia, New York
S. Merry, MD, New York
P. Meyer, DO, New York
J. Mikulca, PharmD, New York
Z. Moyenda, MD, MBA, New York
K. Murphy, DO, MPH, New York
J. Musenze, New York
P. Mutungi, New York
G. Nanna, USA, New York
I. Nasir, New York
U. Nazario-Vidah, MD, New York
D. Nguyen, New York
C. Ojha, MBBS, New York
K. Olson, MD, Ohio
V. Paulson, MD, Ohio
R. Pearson, DO, PhD, Ohio
A. Peel, MD, Ohio
S. Pettis, PA-C, Ohio
E. Picloglou, MD, Ohio
H. Pokhrel, MD, Ohio
H. Bush, Oklahoma
R. Porter, PA, Oklahoma
P. Prabhakar, Oklahoma
U. Qamar, Oklahoma
R. Quansah, MD, Oklahoma
M. Rahman, Oklahoma
R. Rajeshwar, Oregon
E. Randal, Oregon
A. Ray, Oregon
V. Reddy, Oregon
J. Reed, MD, RN, Oregon
R. Regidor, Oregon
A. Reitsma-Mathias, MD, Oregon
R. Reyes, MD, Oregon
T. Richardson, NP, Oregon
T. Ringer, Oregon
L. Rivera-Crespo, Pennsylvania
T. Rothwell, PA, Pennsylvania
E. Sacolick, MD, Pennsylvania
E. Saluke, MD, Pennsylvania
M. Santinelli, NP, Pennsylvania
M. Sapon-Amoah, FNP, Pennsylvania
D. Scarine, NP, Pennsylvania
K. Seger, Pennsylvania
A. Shah, Pennsylvania
K. Shah, MD, Pennsylvania
S. Shah, MD, Pennsylvania
G. Sharma, MD, Pennsylvania
K. Shaukat, MD, Pennsylvania
E. Sheindler, Rhode Island
D. Sheps, South Carolina
J. Shipe-Spotloe, South Carolina
S. Sim, South Carolina
M. Simon, MD, MMM, CPE, South Carolina
A. Singh, South Carolina
S. Singh-Patel, PO, South Dakota
M. Snyder, South Dakota
A. Srikanth, MBBS, Tennessee
B. Staats, Tennessee
C. Standley, Texas
R. Stanhiser, Texas
M. Stevens, Texas
K. Stuart, Texas
A. Summers, Texas
E. Taylo, Texas
L. Taylor, PA-C, Texas
L. Theaker, Texas
M. Thieman, Texas
J. Tong, Texas
N. Trivedi, MD, Texas
L. Tuazon, MD, FACP, Texas
S. Tummalapalli, Texas
A. Ufferman, MD, Virginia
R. Urrea, MD, Virginia
N. Van Groningen, Virginia
D. Vaughn, MD, Vermont
R. Vento, MD, MPH, Washington
Y. Villaran, MD, Washington
L. Viscome, DO, Washington
K. Vo, Washington
H. Vu, MD, Washington
T. Washko, MD, Washington
T. Waters, DO, Wisconsin
L. Weisberger, USA, Wisconsin
A. Whitehead, Wisconsin
A. Workman, West Virginia
F. Yasin, MD, West Virginia
A. Yoon, MD, West Virginia
M. Yu, West Virginia
A. Yuen, DO, West Virginia
K. Zwieg, West Virginia
Chronic Kidney Disease Risk with Proton Pump Inhibitors
Clinical question: What is the association between proton pump inhibitor (PPI) use and incident chronic kidney disease (CKD)?
Background: Medication use may play a potential role in the increasing prevalence of CKD. PPIs are commonly prescribed, and several observational studies have linked their use with multiple adverse outcomes, including acute interstitial nephritis. The risk for CKD with PPI use has never been evaluated.
Study design: Prospective cohort study.
Setting: U.S., multi-center.
Synopsis: Among 10,482 patients in the Atherosclerosis Risk in Communities study (ARIC) with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2, PPI use was associated with a 1.50 times risk of incident CKD (95% CI, 1.14–1.96; P=0.003) and a 1.64 times risk of incident acute kidney injury (95% CI, 1.22–2.21; P<0.001) when compared to nonusers. PPI use continued to have an association with incident CKD even when compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01–1.91). Findings were replicated in a cohort of 248,751 patients in the Geisinger Health System, and in all analyses, PPI use was associated with CKD.
One limitation is that this was an observational study and causality between PPI use and CKD cannot be established.
Bottom line: PPIs are associated with risk for CKD, and in patients on therapy, its use should be reevaluated.
Citation: Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238-246.
Clinical question: What is the association between proton pump inhibitor (PPI) use and incident chronic kidney disease (CKD)?
Background: Medication use may play a potential role in the increasing prevalence of CKD. PPIs are commonly prescribed, and several observational studies have linked their use with multiple adverse outcomes, including acute interstitial nephritis. The risk for CKD with PPI use has never been evaluated.
Study design: Prospective cohort study.
Setting: U.S., multi-center.
Synopsis: Among 10,482 patients in the Atherosclerosis Risk in Communities study (ARIC) with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2, PPI use was associated with a 1.50 times risk of incident CKD (95% CI, 1.14–1.96; P=0.003) and a 1.64 times risk of incident acute kidney injury (95% CI, 1.22–2.21; P<0.001) when compared to nonusers. PPI use continued to have an association with incident CKD even when compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01–1.91). Findings were replicated in a cohort of 248,751 patients in the Geisinger Health System, and in all analyses, PPI use was associated with CKD.
One limitation is that this was an observational study and causality between PPI use and CKD cannot be established.
Bottom line: PPIs are associated with risk for CKD, and in patients on therapy, its use should be reevaluated.
Citation: Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238-246.
Clinical question: What is the association between proton pump inhibitor (PPI) use and incident chronic kidney disease (CKD)?
Background: Medication use may play a potential role in the increasing prevalence of CKD. PPIs are commonly prescribed, and several observational studies have linked their use with multiple adverse outcomes, including acute interstitial nephritis. The risk for CKD with PPI use has never been evaluated.
Study design: Prospective cohort study.
Setting: U.S., multi-center.
Synopsis: Among 10,482 patients in the Atherosclerosis Risk in Communities study (ARIC) with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2, PPI use was associated with a 1.50 times risk of incident CKD (95% CI, 1.14–1.96; P=0.003) and a 1.64 times risk of incident acute kidney injury (95% CI, 1.22–2.21; P<0.001) when compared to nonusers. PPI use continued to have an association with incident CKD even when compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01–1.91). Findings were replicated in a cohort of 248,751 patients in the Geisinger Health System, and in all analyses, PPI use was associated with CKD.
One limitation is that this was an observational study and causality between PPI use and CKD cannot be established.
Bottom line: PPIs are associated with risk for CKD, and in patients on therapy, its use should be reevaluated.
Citation: Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238-246.
Risk Factors for Pseudomonas, MRSA in Healthcare-Associated Pneumonia
Clinical question: What risk factors could predict the likelihood of Pseudomonas and methicillin-resistant Staphylococcus aureus (MRSA) in patients hospitalized with healthcare-associated pneumonia (HCAP)?
Background: Patients identified with HCAP have an increased risk for multi-drug-resistant pathogens, such as gram-negative (GNR) organisms and MRSA. Meeting criteria for HCAP does not discriminate between the different infections, which require different antibiotic classes for treatment. Risk factors need to be identified to determine the most likely infectious organism to help guide initial empiric antibiotic therapy.
Study design: Retrospective cohort study.
Setting: Veterans Affairs hospitals.
Synopsis: Of 61,651 veterans with HCAP diagnosis, 1,156 (1.9%) had a discharge diagnosis of Pseudomonas pneumonia and were found to be younger and more likely to be immunocompromised; have hemiplegia; have a history of chronic obstructive pulmonary disease; have had corticosteroid exposure; and have been exposed to a fluoroquinolone, β-lactam, cephalosporin, or carbapenem antiobiotic within 90 days prior to admission. Pseudomonas pneumonia was negatively associated with age >84, drug abuse, diabetes, and higher socioeconomic status. A discharge diagnosis of MRSA pneumonia was found in 641 patients (1.0%), who also were positively associated with the male gender, age >74, recent nursing home stay, and recent exposure to fluoroquinolone antibiotics within 90 days prior to admission.
MRSA pneumonia was negatively associated with complicated diabetes. Neither diagnosis was present in 59,854 patients (97.1%).
This study was limited due to its predominantly male veteran population, low incidence of Pseudomonas and MRSA pneumonia being identified, and Pseudomonas as the only GNR organism analyzed.
Bottom line: Risk factors identified for Pseudomonas and MRSA pneumonia can help guide targeted antibiotics for HCAP patients.
Citation: Metersky ML, Frei CR, Mortenson EM. Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia. Respirology. 2016;21(1):157-163.
Short Take
Hematuria as Marker of Urologic Cancer
Narrative literature review did not demonstrate beneficial role of screening urinalysis for cancer detection in asymptomatic patients, but it did suggest including gross hematuria as part of routine review of systems.
Citation: Nielsen M, Qaseem A, High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016;164(7):488-497. doi:10.7326/M15-1496.
Clinical question: What risk factors could predict the likelihood of Pseudomonas and methicillin-resistant Staphylococcus aureus (MRSA) in patients hospitalized with healthcare-associated pneumonia (HCAP)?
Background: Patients identified with HCAP have an increased risk for multi-drug-resistant pathogens, such as gram-negative (GNR) organisms and MRSA. Meeting criteria for HCAP does not discriminate between the different infections, which require different antibiotic classes for treatment. Risk factors need to be identified to determine the most likely infectious organism to help guide initial empiric antibiotic therapy.
Study design: Retrospective cohort study.
Setting: Veterans Affairs hospitals.
Synopsis: Of 61,651 veterans with HCAP diagnosis, 1,156 (1.9%) had a discharge diagnosis of Pseudomonas pneumonia and were found to be younger and more likely to be immunocompromised; have hemiplegia; have a history of chronic obstructive pulmonary disease; have had corticosteroid exposure; and have been exposed to a fluoroquinolone, β-lactam, cephalosporin, or carbapenem antiobiotic within 90 days prior to admission. Pseudomonas pneumonia was negatively associated with age >84, drug abuse, diabetes, and higher socioeconomic status. A discharge diagnosis of MRSA pneumonia was found in 641 patients (1.0%), who also were positively associated with the male gender, age >74, recent nursing home stay, and recent exposure to fluoroquinolone antibiotics within 90 days prior to admission.
MRSA pneumonia was negatively associated with complicated diabetes. Neither diagnosis was present in 59,854 patients (97.1%).
This study was limited due to its predominantly male veteran population, low incidence of Pseudomonas and MRSA pneumonia being identified, and Pseudomonas as the only GNR organism analyzed.
Bottom line: Risk factors identified for Pseudomonas and MRSA pneumonia can help guide targeted antibiotics for HCAP patients.
Citation: Metersky ML, Frei CR, Mortenson EM. Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia. Respirology. 2016;21(1):157-163.
Short Take
Hematuria as Marker of Urologic Cancer
Narrative literature review did not demonstrate beneficial role of screening urinalysis for cancer detection in asymptomatic patients, but it did suggest including gross hematuria as part of routine review of systems.
Citation: Nielsen M, Qaseem A, High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016;164(7):488-497. doi:10.7326/M15-1496.
Clinical question: What risk factors could predict the likelihood of Pseudomonas and methicillin-resistant Staphylococcus aureus (MRSA) in patients hospitalized with healthcare-associated pneumonia (HCAP)?
Background: Patients identified with HCAP have an increased risk for multi-drug-resistant pathogens, such as gram-negative (GNR) organisms and MRSA. Meeting criteria for HCAP does not discriminate between the different infections, which require different antibiotic classes for treatment. Risk factors need to be identified to determine the most likely infectious organism to help guide initial empiric antibiotic therapy.
Study design: Retrospective cohort study.
Setting: Veterans Affairs hospitals.
Synopsis: Of 61,651 veterans with HCAP diagnosis, 1,156 (1.9%) had a discharge diagnosis of Pseudomonas pneumonia and were found to be younger and more likely to be immunocompromised; have hemiplegia; have a history of chronic obstructive pulmonary disease; have had corticosteroid exposure; and have been exposed to a fluoroquinolone, β-lactam, cephalosporin, or carbapenem antiobiotic within 90 days prior to admission. Pseudomonas pneumonia was negatively associated with age >84, drug abuse, diabetes, and higher socioeconomic status. A discharge diagnosis of MRSA pneumonia was found in 641 patients (1.0%), who also were positively associated with the male gender, age >74, recent nursing home stay, and recent exposure to fluoroquinolone antibiotics within 90 days prior to admission.
MRSA pneumonia was negatively associated with complicated diabetes. Neither diagnosis was present in 59,854 patients (97.1%).
This study was limited due to its predominantly male veteran population, low incidence of Pseudomonas and MRSA pneumonia being identified, and Pseudomonas as the only GNR organism analyzed.
Bottom line: Risk factors identified for Pseudomonas and MRSA pneumonia can help guide targeted antibiotics for HCAP patients.
Citation: Metersky ML, Frei CR, Mortenson EM. Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia. Respirology. 2016;21(1):157-163.
Short Take
Hematuria as Marker of Urologic Cancer
Narrative literature review did not demonstrate beneficial role of screening urinalysis for cancer detection in asymptomatic patients, but it did suggest including gross hematuria as part of routine review of systems.
Citation: Nielsen M, Qaseem A, High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016;164(7):488-497. doi:10.7326/M15-1496.
Keys to Success on the Focused Practice in Hospital Medicine Exam
- Enroll in the Focused Practice in Hospital Medicine MOC program by August 1 at www.abim.org.
- Schedule a seat for the exam before August 15 at www.abim.org.
- Order SHM SPARK, the missing piece of the MOC exam-prep puzzle.
SHM recently developed the only MOC exam-preparation tool by hospitalists for hospitalists, SHM SPARK. It complements tools already on the market and will help hospitalists succeed on the upcoming exam. SHM SPARK delivers 175 vignette-style multiple-choice questions that bridge the primary knowledge gaps found within existing MOC exam-preparation products and provides in-depth review on:
- Palliative care, ethics, and decision making
- Patient safety
- Perioperative care and consultative co-management
- Quality, cost, and clinical reasoning
SHM SPARK offers detailed learning objectives and discussion points and allows users to define individual areas of strengths and weaknesses. Users can claim 58 ABIM MOC Medical Knowledge points upon completion of all four modules with a minimum passing score of 80%. After successful completion of all four modules, participants may claim up to 10.5 AMA PRA Category 1 credits.
- Enroll in the Focused Practice in Hospital Medicine MOC program by August 1 at www.abim.org.
- Schedule a seat for the exam before August 15 at www.abim.org.
- Order SHM SPARK, the missing piece of the MOC exam-prep puzzle.
SHM recently developed the only MOC exam-preparation tool by hospitalists for hospitalists, SHM SPARK. It complements tools already on the market and will help hospitalists succeed on the upcoming exam. SHM SPARK delivers 175 vignette-style multiple-choice questions that bridge the primary knowledge gaps found within existing MOC exam-preparation products and provides in-depth review on:
- Palliative care, ethics, and decision making
- Patient safety
- Perioperative care and consultative co-management
- Quality, cost, and clinical reasoning
SHM SPARK offers detailed learning objectives and discussion points and allows users to define individual areas of strengths and weaknesses. Users can claim 58 ABIM MOC Medical Knowledge points upon completion of all four modules with a minimum passing score of 80%. After successful completion of all four modules, participants may claim up to 10.5 AMA PRA Category 1 credits.
- Enroll in the Focused Practice in Hospital Medicine MOC program by August 1 at www.abim.org.
- Schedule a seat for the exam before August 15 at www.abim.org.
- Order SHM SPARK, the missing piece of the MOC exam-prep puzzle.
SHM recently developed the only MOC exam-preparation tool by hospitalists for hospitalists, SHM SPARK. It complements tools already on the market and will help hospitalists succeed on the upcoming exam. SHM SPARK delivers 175 vignette-style multiple-choice questions that bridge the primary knowledge gaps found within existing MOC exam-preparation products and provides in-depth review on:
- Palliative care, ethics, and decision making
- Patient safety
- Perioperative care and consultative co-management
- Quality, cost, and clinical reasoning
SHM SPARK offers detailed learning objectives and discussion points and allows users to define individual areas of strengths and weaknesses. Users can claim 58 ABIM MOC Medical Knowledge points upon completion of all four modules with a minimum passing score of 80%. After successful completion of all four modules, participants may claim up to 10.5 AMA PRA Category 1 credits.
Update on the Interstate Medical Licensure Compact
In 2014, the Society of Hospital Medicine endorsed the Interstate Medical Licensure Compact as a way to address divergent physician licensing requirements among states. The thrust of SHM’s reasoning was that differing licensing policies across state lines not only hinder the ability of hospitalists to quickly adjust staffing to meet the needs of hospitals and patients but also create extensive, costly, and often redundant administrative hurdles for individual hospitalists and hospital medicine groups. For hospitalists looking to relocate to another state, practice in multiple states, provide telemedicine services, or even take on some per diem work, the Interstate Medical Licensure Compact should be of great help.
To briefly summarize, states participating in the compact agree to share information with one another and work together in streamlining the licensing process. For example, the compact aims to reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education credentials. The compact does not establish a national license; a license to practice medicine will still be issued by individual state medical boards. Physicians will still need to be licensed in the state where the patient is located, but the difference is that the process of obtaining a license will be streamlined significantly.
To join the Interstate Medical Licensure Compact, state legislatures must enact the compact into state law. Two years in, the compact is now being implemented in 12 states: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States where it has been introduced but not yet adopted include Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Washington.
Licenses via the compact process are not currently being issued, but representatives from the 12 participating states have begun to formally meet and are working out the administrative procedures needed to begin expedited licensure processes. With a core group of states adopting and implementing the compact, it will be important for state officials to hear why adoption of the compact is important to physicians.
This presents an opportunity for hospitalists residing in holdout states to participate in some advocacy work at the state level—on their own, as a group, or even within one of SHM’s many state chapters. To find your local chapter and get involved, visit www.hospitalmedicine.org/chapters.
To assist, detailed information on the Interstate Medical Licensure Compact can be found at www.licenseportability.org, and SHM advocacy staff is available to address questions members may have about getting started. You can reach them via email at [email protected]. TH
Josh Boswell is SHM’s director of government affairs.
In 2014, the Society of Hospital Medicine endorsed the Interstate Medical Licensure Compact as a way to address divergent physician licensing requirements among states. The thrust of SHM’s reasoning was that differing licensing policies across state lines not only hinder the ability of hospitalists to quickly adjust staffing to meet the needs of hospitals and patients but also create extensive, costly, and often redundant administrative hurdles for individual hospitalists and hospital medicine groups. For hospitalists looking to relocate to another state, practice in multiple states, provide telemedicine services, or even take on some per diem work, the Interstate Medical Licensure Compact should be of great help.
To briefly summarize, states participating in the compact agree to share information with one another and work together in streamlining the licensing process. For example, the compact aims to reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education credentials. The compact does not establish a national license; a license to practice medicine will still be issued by individual state medical boards. Physicians will still need to be licensed in the state where the patient is located, but the difference is that the process of obtaining a license will be streamlined significantly.
To join the Interstate Medical Licensure Compact, state legislatures must enact the compact into state law. Two years in, the compact is now being implemented in 12 states: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States where it has been introduced but not yet adopted include Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Washington.
Licenses via the compact process are not currently being issued, but representatives from the 12 participating states have begun to formally meet and are working out the administrative procedures needed to begin expedited licensure processes. With a core group of states adopting and implementing the compact, it will be important for state officials to hear why adoption of the compact is important to physicians.
This presents an opportunity for hospitalists residing in holdout states to participate in some advocacy work at the state level—on their own, as a group, or even within one of SHM’s many state chapters. To find your local chapter and get involved, visit www.hospitalmedicine.org/chapters.
To assist, detailed information on the Interstate Medical Licensure Compact can be found at www.licenseportability.org, and SHM advocacy staff is available to address questions members may have about getting started. You can reach them via email at [email protected]. TH
Josh Boswell is SHM’s director of government affairs.
In 2014, the Society of Hospital Medicine endorsed the Interstate Medical Licensure Compact as a way to address divergent physician licensing requirements among states. The thrust of SHM’s reasoning was that differing licensing policies across state lines not only hinder the ability of hospitalists to quickly adjust staffing to meet the needs of hospitals and patients but also create extensive, costly, and often redundant administrative hurdles for individual hospitalists and hospital medicine groups. For hospitalists looking to relocate to another state, practice in multiple states, provide telemedicine services, or even take on some per diem work, the Interstate Medical Licensure Compact should be of great help.
To briefly summarize, states participating in the compact agree to share information with one another and work together in streamlining the licensing process. For example, the compact aims to reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education credentials. The compact does not establish a national license; a license to practice medicine will still be issued by individual state medical boards. Physicians will still need to be licensed in the state where the patient is located, but the difference is that the process of obtaining a license will be streamlined significantly.
To join the Interstate Medical Licensure Compact, state legislatures must enact the compact into state law. Two years in, the compact is now being implemented in 12 states: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States where it has been introduced but not yet adopted include Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Washington.
Licenses via the compact process are not currently being issued, but representatives from the 12 participating states have begun to formally meet and are working out the administrative procedures needed to begin expedited licensure processes. With a core group of states adopting and implementing the compact, it will be important for state officials to hear why adoption of the compact is important to physicians.
This presents an opportunity for hospitalists residing in holdout states to participate in some advocacy work at the state level—on their own, as a group, or even within one of SHM’s many state chapters. To find your local chapter and get involved, visit www.hospitalmedicine.org/chapters.
To assist, detailed information on the Interstate Medical Licensure Compact can be found at www.licenseportability.org, and SHM advocacy staff is available to address questions members may have about getting started. You can reach them via email at [email protected]. TH
Josh Boswell is SHM’s director of government affairs.
Stella Fitzgibbons, MD, FHM, Relishes the Variety, Interactions of Hospitalist Practice
Stella Fitzgibbons, MD, FHM, was an engineer for several years after college. But there wasn’t enough working with people for her taste. So she moved into internal medicine. But then there was, how to put this, something lacking in office work.
“I realized how bored I was with office practice and how much more interesting were the problems at the hospital than outpatient ones,” Dr. Fitzgibbons says.
So she went to work in hospitals. She hasn’t left.
Dr. Fitzgibbons is a hospitalist and ED practitioner with Mint Physician Staffing, primarily in the Apollo Hospital System in The Woodlands, Texas. And the best part of the job for Dr. Fitzgibbons, one of eight new members of Team Hospitalist, the volunteer editorial advisory board of The Hospitalist newsmagazine, is easy to pick.
“Seeing sick people get better,” she says.
Question: Switching careers from engineering to medicine is a big step. What motivated that?
Answer: I wanted to see my efforts helping people I could actually see, and I thought—and still do—that medicine uses my talents better and is far more interesting.
Q: You say office practice became a bit boring. How so? What appealed about the inpatient setting?
A: An internist in the office only sees a tiny fraction of the interesting problems that our field covers. Rheumatoid arthritis is diagnosed by a rheumatologist, who then makes all the decisions. Abdominal pain gets sent to the hospital, where all the diagnostic tests are done.
Fortunately, my multispecialty group arranged for about a quarter of its internists [the youngest quarter in most cases] to manage hospital patients; I figured out pretty quickly that it was only there that I got to see pulmonary hypertension, congestive heart failure, and acute abdomens. Even night call was better at the hospital since office doctors only answered phone calls and never had a chance to do any real evaluation and treatment no matter how sick the caller was.
And a problem at the office was something that made me run behind that odious and impractical appointment schedule; at the hospital I was seeing real illnesses, not people who wanted a prescription med for their sore throat so they wouldn’t be bothered with it on their vacation.
Q: What is your biggest professional challenge?
A: EHRs.
Q: What is your biggest professional reward?
A: When a patient says, “Thanks for taking care of me, doctor.”
Q: What does teaching mean to you, and how has it been gratifying in your career?
A: Teaching means paying it forward, in gratitude to those who taught me, with the reward of seeing light bulbs go off behind the eyes of students and younger doctors who are eager to learn.
Q: When you aren’t working, what is important to you?
A: Family and music and church.
Q: Faith is obviously important to you. How does that help your work as a care provider?
A: I don’t think anybody goes around being religious all the time. But it sometimes makes all the difference knowing that a higher power is looking out for me and the patients.
Q: You’ve described mentoring as fun for you. What exactly do you mean by fun?
A: Mentoring is what we do. Patients, nurses—anybody we work with—need explanations and clarifications. About the third day of med school, docs in training realize that anybody who can help us understand and retain the huge stream of information directed at us is performing a necessary service. Throughout the training period, residents teach students, fellows teach residents, and attending faculty teach everybody. Doctors in training are bright people who want to learn both the facts and how to deal with patients’ side of things, and feeding their desires is very enjoyable.
Q: You’d like to see more physicians than MBAs in decision-making positions. Why? What real changes do you think that would effectuate?
A: Physicians and nurses were administrators for decades before insurance company penny-pinching and government regulations led hospitals to hire “bean counters” to replace them. It is a tremendous change for the worse, to have people making decisions for patients whose primary consideration is the bottom line.
Q: What’s next professionally?
A: Small-volume ERs, where I don’t have to do discharge planning while being harassed by insurance company reps.
Q: Where do you see yourself in 10 years?
A: Retired.
Q: If you weren’t a doctor, what would you be doing right now?
A: Law enforcement.
Q: Devices like iPhones and tablets can take away from patient face time. But they can also be valuable. How do you balance that? How do you encourage younger docs to do so, particularly when they’re much more used to having smartphones glued to their hands?
A: I use my iPhone when I’m with patients … but only when they can see the reason I need it to help them, such as looking up the side effects of a medication. Electronic health records can work on an iPad, but I hesitate to use them unless the patient knows just what I am doing, such as looking up results of a lab test that concerns them. Taking a computer on wheels into a patient’s room means that I spend part of the visit looking at a screen instead of at the patient, and I prefer to avoid it if at all possible.
Q: What’s the best book you’ve read recently? Why?
A: The House of Silk by Anthony Horowitz. Great continuation of the Holmes stories, with a seamless link to [Sir Arthur] Conan Doyle’s style.
Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?
A: Three.
Q: What’s your favorite social network? Do you use it all for work or professional development?
A: Facebook. Heck no, it’s just fun.
Q: What’s next in your Netflix queue?
A: Last two episodes of Game of Thrones season 5.
Richard Quinn is a freelance writer in New Jersey.
Stella Fitzgibbons, MD, FHM, was an engineer for several years after college. But there wasn’t enough working with people for her taste. So she moved into internal medicine. But then there was, how to put this, something lacking in office work.
“I realized how bored I was with office practice and how much more interesting were the problems at the hospital than outpatient ones,” Dr. Fitzgibbons says.
So she went to work in hospitals. She hasn’t left.
Dr. Fitzgibbons is a hospitalist and ED practitioner with Mint Physician Staffing, primarily in the Apollo Hospital System in The Woodlands, Texas. And the best part of the job for Dr. Fitzgibbons, one of eight new members of Team Hospitalist, the volunteer editorial advisory board of The Hospitalist newsmagazine, is easy to pick.
“Seeing sick people get better,” she says.
Question: Switching careers from engineering to medicine is a big step. What motivated that?
Answer: I wanted to see my efforts helping people I could actually see, and I thought—and still do—that medicine uses my talents better and is far more interesting.
Q: You say office practice became a bit boring. How so? What appealed about the inpatient setting?
A: An internist in the office only sees a tiny fraction of the interesting problems that our field covers. Rheumatoid arthritis is diagnosed by a rheumatologist, who then makes all the decisions. Abdominal pain gets sent to the hospital, where all the diagnostic tests are done.
Fortunately, my multispecialty group arranged for about a quarter of its internists [the youngest quarter in most cases] to manage hospital patients; I figured out pretty quickly that it was only there that I got to see pulmonary hypertension, congestive heart failure, and acute abdomens. Even night call was better at the hospital since office doctors only answered phone calls and never had a chance to do any real evaluation and treatment no matter how sick the caller was.
And a problem at the office was something that made me run behind that odious and impractical appointment schedule; at the hospital I was seeing real illnesses, not people who wanted a prescription med for their sore throat so they wouldn’t be bothered with it on their vacation.
Q: What is your biggest professional challenge?
A: EHRs.
Q: What is your biggest professional reward?
A: When a patient says, “Thanks for taking care of me, doctor.”
Q: What does teaching mean to you, and how has it been gratifying in your career?
A: Teaching means paying it forward, in gratitude to those who taught me, with the reward of seeing light bulbs go off behind the eyes of students and younger doctors who are eager to learn.
Q: When you aren’t working, what is important to you?
A: Family and music and church.
Q: Faith is obviously important to you. How does that help your work as a care provider?
A: I don’t think anybody goes around being religious all the time. But it sometimes makes all the difference knowing that a higher power is looking out for me and the patients.
Q: You’ve described mentoring as fun for you. What exactly do you mean by fun?
A: Mentoring is what we do. Patients, nurses—anybody we work with—need explanations and clarifications. About the third day of med school, docs in training realize that anybody who can help us understand and retain the huge stream of information directed at us is performing a necessary service. Throughout the training period, residents teach students, fellows teach residents, and attending faculty teach everybody. Doctors in training are bright people who want to learn both the facts and how to deal with patients’ side of things, and feeding their desires is very enjoyable.
Q: You’d like to see more physicians than MBAs in decision-making positions. Why? What real changes do you think that would effectuate?
A: Physicians and nurses were administrators for decades before insurance company penny-pinching and government regulations led hospitals to hire “bean counters” to replace them. It is a tremendous change for the worse, to have people making decisions for patients whose primary consideration is the bottom line.
Q: What’s next professionally?
A: Small-volume ERs, where I don’t have to do discharge planning while being harassed by insurance company reps.
Q: Where do you see yourself in 10 years?
A: Retired.
Q: If you weren’t a doctor, what would you be doing right now?
A: Law enforcement.
Q: Devices like iPhones and tablets can take away from patient face time. But they can also be valuable. How do you balance that? How do you encourage younger docs to do so, particularly when they’re much more used to having smartphones glued to their hands?
A: I use my iPhone when I’m with patients … but only when they can see the reason I need it to help them, such as looking up the side effects of a medication. Electronic health records can work on an iPad, but I hesitate to use them unless the patient knows just what I am doing, such as looking up results of a lab test that concerns them. Taking a computer on wheels into a patient’s room means that I spend part of the visit looking at a screen instead of at the patient, and I prefer to avoid it if at all possible.
Q: What’s the best book you’ve read recently? Why?
A: The House of Silk by Anthony Horowitz. Great continuation of the Holmes stories, with a seamless link to [Sir Arthur] Conan Doyle’s style.
Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?
A: Three.
Q: What’s your favorite social network? Do you use it all for work or professional development?
A: Facebook. Heck no, it’s just fun.
Q: What’s next in your Netflix queue?
A: Last two episodes of Game of Thrones season 5.
Richard Quinn is a freelance writer in New Jersey.
Stella Fitzgibbons, MD, FHM, was an engineer for several years after college. But there wasn’t enough working with people for her taste. So she moved into internal medicine. But then there was, how to put this, something lacking in office work.
“I realized how bored I was with office practice and how much more interesting were the problems at the hospital than outpatient ones,” Dr. Fitzgibbons says.
So she went to work in hospitals. She hasn’t left.
Dr. Fitzgibbons is a hospitalist and ED practitioner with Mint Physician Staffing, primarily in the Apollo Hospital System in The Woodlands, Texas. And the best part of the job for Dr. Fitzgibbons, one of eight new members of Team Hospitalist, the volunteer editorial advisory board of The Hospitalist newsmagazine, is easy to pick.
“Seeing sick people get better,” she says.
Question: Switching careers from engineering to medicine is a big step. What motivated that?
Answer: I wanted to see my efforts helping people I could actually see, and I thought—and still do—that medicine uses my talents better and is far more interesting.
Q: You say office practice became a bit boring. How so? What appealed about the inpatient setting?
A: An internist in the office only sees a tiny fraction of the interesting problems that our field covers. Rheumatoid arthritis is diagnosed by a rheumatologist, who then makes all the decisions. Abdominal pain gets sent to the hospital, where all the diagnostic tests are done.
Fortunately, my multispecialty group arranged for about a quarter of its internists [the youngest quarter in most cases] to manage hospital patients; I figured out pretty quickly that it was only there that I got to see pulmonary hypertension, congestive heart failure, and acute abdomens. Even night call was better at the hospital since office doctors only answered phone calls and never had a chance to do any real evaluation and treatment no matter how sick the caller was.
And a problem at the office was something that made me run behind that odious and impractical appointment schedule; at the hospital I was seeing real illnesses, not people who wanted a prescription med for their sore throat so they wouldn’t be bothered with it on their vacation.
Q: What is your biggest professional challenge?
A: EHRs.
Q: What is your biggest professional reward?
A: When a patient says, “Thanks for taking care of me, doctor.”
Q: What does teaching mean to you, and how has it been gratifying in your career?
A: Teaching means paying it forward, in gratitude to those who taught me, with the reward of seeing light bulbs go off behind the eyes of students and younger doctors who are eager to learn.
Q: When you aren’t working, what is important to you?
A: Family and music and church.
Q: Faith is obviously important to you. How does that help your work as a care provider?
A: I don’t think anybody goes around being religious all the time. But it sometimes makes all the difference knowing that a higher power is looking out for me and the patients.
Q: You’ve described mentoring as fun for you. What exactly do you mean by fun?
A: Mentoring is what we do. Patients, nurses—anybody we work with—need explanations and clarifications. About the third day of med school, docs in training realize that anybody who can help us understand and retain the huge stream of information directed at us is performing a necessary service. Throughout the training period, residents teach students, fellows teach residents, and attending faculty teach everybody. Doctors in training are bright people who want to learn both the facts and how to deal with patients’ side of things, and feeding their desires is very enjoyable.
Q: You’d like to see more physicians than MBAs in decision-making positions. Why? What real changes do you think that would effectuate?
A: Physicians and nurses were administrators for decades before insurance company penny-pinching and government regulations led hospitals to hire “bean counters” to replace them. It is a tremendous change for the worse, to have people making decisions for patients whose primary consideration is the bottom line.
Q: What’s next professionally?
A: Small-volume ERs, where I don’t have to do discharge planning while being harassed by insurance company reps.
Q: Where do you see yourself in 10 years?
A: Retired.
Q: If you weren’t a doctor, what would you be doing right now?
A: Law enforcement.
Q: Devices like iPhones and tablets can take away from patient face time. But they can also be valuable. How do you balance that? How do you encourage younger docs to do so, particularly when they’re much more used to having smartphones glued to their hands?
A: I use my iPhone when I’m with patients … but only when they can see the reason I need it to help them, such as looking up the side effects of a medication. Electronic health records can work on an iPad, but I hesitate to use them unless the patient knows just what I am doing, such as looking up results of a lab test that concerns them. Taking a computer on wheels into a patient’s room means that I spend part of the visit looking at a screen instead of at the patient, and I prefer to avoid it if at all possible.
Q: What’s the best book you’ve read recently? Why?
A: The House of Silk by Anthony Horowitz. Great continuation of the Holmes stories, with a seamless link to [Sir Arthur] Conan Doyle’s style.
Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?
A: Three.
Q: What’s your favorite social network? Do you use it all for work or professional development?
A: Facebook. Heck no, it’s just fun.
Q: What’s next in your Netflix queue?
A: Last two episodes of Game of Thrones season 5.
Richard Quinn is a freelance writer in New Jersey.
Things Hospitalists Want Hospital Administrators to Know
I think it is really cool that this publication has a series of articles on “What Cardiologists [or infection disease specialists, nephrologists, etc.] Want Hospitalists to Know.” I’m always interested to see which clinical topics made the list and which I’m already reasonably familiar with versus know little about. I’ve added this series to my list of things that are always worth the time to read, along with the “What’s New” section in UpToDate, review articles in major journals, and the Cleveland Clinic Journal of Medicine.
Not long ago, I worked with a hospitalist group that had agreed to cardiologists’ request that new hospitalists round with a cardiologist for something like three days as part of their orientation. This seems like they’ve taken the idea of “What Cardiologists Want Hospitalists to Know” a lot further than I had ever considered. I’m sure it would have value on many levels, including positioning the new hospitalist to work more effectively with the cardiologists, but I’m not sure it’s worth the cost. And I’m really concerned it sends a signal that the relationship is one way—that is, the hospitalists need to understand what the cardiologists do and want from them and not the reverse. For many reasons, I think this should be a reciprocal relationship, and it seems reasonable that new cardiologists should orient by rounding with hospitalists.
Same goes for the “… Want Hospitalists to Know” series. I’d like to see articles enumerating what hospitalists want doctors in other fields to know either in this magazine or its counterpart in the other specialty. What follows is the first of these. It is my take on non-clinical topics hospitalists want hospital leaders to know, and I’ll leave it to others to write about clinical topics.
We Aren’t on ‘Vacation’ Every Other Week
If you always think of our days off as a vacation, as in, “Those hospitalists get 26 weeks of vacation a year,” you’re making a mistake. A significant portion of our weekdays off are just like your weekends; they’re days to take a breather.
And you’re likely forgetting how many weekends we work.
And maybe lots of nights also.
You probably work more hours annually, but having more days for a breather are one offset for our weekends and nights.
Insisting Hospitalists Work an Entire Shift (12 Hours) Doesn’t Make a Lot of Sense on Slow Days
Staying around after completing clinical work yields no value. Too often, the time is spent watching YouTube or similar activities. And it means the doctor will be much more frustrated, and more likely to lobby for overtime compensation, when needing to stay beyond the scheduled end of the shift on busy days.
Avoid measuring work effort in hours. And in many cases, it is best to avoid precise determinations of when a day shift ends. At most hospitals, you do need at least one daytime doctor to stay on duty until the next shift arrives, but it rarely makes sense to have all of the hospitalists stay.
Your hospitalists need to be professional enough not to dash out the door the minute they’ve put notes on every patient’s chart. Instead, rather than leaving at the first opportunity on slow days, they could do all of the discharge preparation (med rec, discharge summary, etc.) for patients likely ready for discharge the next day; this can help a lot to discharge patients early the next day. Or they could make “secondary” rounds focused on patient satisfaction, etc.
Obs Patients Usually Are No Less Complicated—or Labor-Intensive—to Care For
It’s best to think of observation as solely a payor classification and not a good indicator of risk, complexity, or work required. Unfortunately “observation” is often thought of as shorthand for simple, not sick, easy to manage, etc. While true for a small subset of observation patients, such as younger people with a single problem such as atypical chest pain, it isn’t true for older (Medicare) patients with multiple chronic illnesses, on multiple medications, and with complex social situations.
Shouldn’t We Measure Length of Stay for All Patients in Hours Rather Than Days?
Then we could better understand throughput issues such as whether afternoon discharges for inpatients are late discharges or really very early discharges that weren’t held until the next morning.
Even High-Performing Hospitalist Groups Are Likely to Have Patient Satisfaction Scores on the Lower End of Doctors at Your Hospital
Don’t decide that just because they have much lower scores than the orthopedists, cardiologists, obstetricians, and other specialties, it is the hospitalists who are falling furthest below their potential. It may be the cardiologists who have a long way to go to achieve great scores for their specialty.
This isn’t an excuse. Just about every hospitalist group can do better and should work to make it happen. And because in nearly every hospital more HCAHPS surveys are attributed to hospitalists than any other specialty by a wide margin, our scores have a huge impact on the overall hospital averages. But you should keep in mind that, for a variety of reasons, hospitalists everywhere have physician communication scores that are lower than many or most other specialties.
To my knowledge, there isn’t a data set that provides patient satisfaction scores by specialty. And scores seem to vary a lot by geographic region, e.g., they’re nearly always higher in the South than other parts of the country. So there isn’t a good way to control for all the variables and know you’re setting appropriate improvement goals for each specialty. But your hospitalists will appreciate it if you acknowledge it may be unreasonable to set the same goals across specialties.
We’d Love Your Help Getting Rid of Pagers
Secure text messaging between all caregivers seems to be the way to go, and we will look to the hospital to make an investment in technology to make it possible and train users to ensure that by making messaging easier the volume of messages (interruptions) doesn’t just skyrocket. We, the hospitalists at your hospital, are happy to help with all of this, from vendor selection to plans for implementation. Please ask! TH
I think it is really cool that this publication has a series of articles on “What Cardiologists [or infection disease specialists, nephrologists, etc.] Want Hospitalists to Know.” I’m always interested to see which clinical topics made the list and which I’m already reasonably familiar with versus know little about. I’ve added this series to my list of things that are always worth the time to read, along with the “What’s New” section in UpToDate, review articles in major journals, and the Cleveland Clinic Journal of Medicine.
Not long ago, I worked with a hospitalist group that had agreed to cardiologists’ request that new hospitalists round with a cardiologist for something like three days as part of their orientation. This seems like they’ve taken the idea of “What Cardiologists Want Hospitalists to Know” a lot further than I had ever considered. I’m sure it would have value on many levels, including positioning the new hospitalist to work more effectively with the cardiologists, but I’m not sure it’s worth the cost. And I’m really concerned it sends a signal that the relationship is one way—that is, the hospitalists need to understand what the cardiologists do and want from them and not the reverse. For many reasons, I think this should be a reciprocal relationship, and it seems reasonable that new cardiologists should orient by rounding with hospitalists.
Same goes for the “… Want Hospitalists to Know” series. I’d like to see articles enumerating what hospitalists want doctors in other fields to know either in this magazine or its counterpart in the other specialty. What follows is the first of these. It is my take on non-clinical topics hospitalists want hospital leaders to know, and I’ll leave it to others to write about clinical topics.
We Aren’t on ‘Vacation’ Every Other Week
If you always think of our days off as a vacation, as in, “Those hospitalists get 26 weeks of vacation a year,” you’re making a mistake. A significant portion of our weekdays off are just like your weekends; they’re days to take a breather.
And you’re likely forgetting how many weekends we work.
And maybe lots of nights also.
You probably work more hours annually, but having more days for a breather are one offset for our weekends and nights.
Insisting Hospitalists Work an Entire Shift (12 Hours) Doesn’t Make a Lot of Sense on Slow Days
Staying around after completing clinical work yields no value. Too often, the time is spent watching YouTube or similar activities. And it means the doctor will be much more frustrated, and more likely to lobby for overtime compensation, when needing to stay beyond the scheduled end of the shift on busy days.
Avoid measuring work effort in hours. And in many cases, it is best to avoid precise determinations of when a day shift ends. At most hospitals, you do need at least one daytime doctor to stay on duty until the next shift arrives, but it rarely makes sense to have all of the hospitalists stay.
Your hospitalists need to be professional enough not to dash out the door the minute they’ve put notes on every patient’s chart. Instead, rather than leaving at the first opportunity on slow days, they could do all of the discharge preparation (med rec, discharge summary, etc.) for patients likely ready for discharge the next day; this can help a lot to discharge patients early the next day. Or they could make “secondary” rounds focused on patient satisfaction, etc.
Obs Patients Usually Are No Less Complicated—or Labor-Intensive—to Care For
It’s best to think of observation as solely a payor classification and not a good indicator of risk, complexity, or work required. Unfortunately “observation” is often thought of as shorthand for simple, not sick, easy to manage, etc. While true for a small subset of observation patients, such as younger people with a single problem such as atypical chest pain, it isn’t true for older (Medicare) patients with multiple chronic illnesses, on multiple medications, and with complex social situations.
Shouldn’t We Measure Length of Stay for All Patients in Hours Rather Than Days?
Then we could better understand throughput issues such as whether afternoon discharges for inpatients are late discharges or really very early discharges that weren’t held until the next morning.
Even High-Performing Hospitalist Groups Are Likely to Have Patient Satisfaction Scores on the Lower End of Doctors at Your Hospital
Don’t decide that just because they have much lower scores than the orthopedists, cardiologists, obstetricians, and other specialties, it is the hospitalists who are falling furthest below their potential. It may be the cardiologists who have a long way to go to achieve great scores for their specialty.
This isn’t an excuse. Just about every hospitalist group can do better and should work to make it happen. And because in nearly every hospital more HCAHPS surveys are attributed to hospitalists than any other specialty by a wide margin, our scores have a huge impact on the overall hospital averages. But you should keep in mind that, for a variety of reasons, hospitalists everywhere have physician communication scores that are lower than many or most other specialties.
To my knowledge, there isn’t a data set that provides patient satisfaction scores by specialty. And scores seem to vary a lot by geographic region, e.g., they’re nearly always higher in the South than other parts of the country. So there isn’t a good way to control for all the variables and know you’re setting appropriate improvement goals for each specialty. But your hospitalists will appreciate it if you acknowledge it may be unreasonable to set the same goals across specialties.
We’d Love Your Help Getting Rid of Pagers
Secure text messaging between all caregivers seems to be the way to go, and we will look to the hospital to make an investment in technology to make it possible and train users to ensure that by making messaging easier the volume of messages (interruptions) doesn’t just skyrocket. We, the hospitalists at your hospital, are happy to help with all of this, from vendor selection to plans for implementation. Please ask! TH
I think it is really cool that this publication has a series of articles on “What Cardiologists [or infection disease specialists, nephrologists, etc.] Want Hospitalists to Know.” I’m always interested to see which clinical topics made the list and which I’m already reasonably familiar with versus know little about. I’ve added this series to my list of things that are always worth the time to read, along with the “What’s New” section in UpToDate, review articles in major journals, and the Cleveland Clinic Journal of Medicine.
Not long ago, I worked with a hospitalist group that had agreed to cardiologists’ request that new hospitalists round with a cardiologist for something like three days as part of their orientation. This seems like they’ve taken the idea of “What Cardiologists Want Hospitalists to Know” a lot further than I had ever considered. I’m sure it would have value on many levels, including positioning the new hospitalist to work more effectively with the cardiologists, but I’m not sure it’s worth the cost. And I’m really concerned it sends a signal that the relationship is one way—that is, the hospitalists need to understand what the cardiologists do and want from them and not the reverse. For many reasons, I think this should be a reciprocal relationship, and it seems reasonable that new cardiologists should orient by rounding with hospitalists.
Same goes for the “… Want Hospitalists to Know” series. I’d like to see articles enumerating what hospitalists want doctors in other fields to know either in this magazine or its counterpart in the other specialty. What follows is the first of these. It is my take on non-clinical topics hospitalists want hospital leaders to know, and I’ll leave it to others to write about clinical topics.
We Aren’t on ‘Vacation’ Every Other Week
If you always think of our days off as a vacation, as in, “Those hospitalists get 26 weeks of vacation a year,” you’re making a mistake. A significant portion of our weekdays off are just like your weekends; they’re days to take a breather.
And you’re likely forgetting how many weekends we work.
And maybe lots of nights also.
You probably work more hours annually, but having more days for a breather are one offset for our weekends and nights.
Insisting Hospitalists Work an Entire Shift (12 Hours) Doesn’t Make a Lot of Sense on Slow Days
Staying around after completing clinical work yields no value. Too often, the time is spent watching YouTube or similar activities. And it means the doctor will be much more frustrated, and more likely to lobby for overtime compensation, when needing to stay beyond the scheduled end of the shift on busy days.
Avoid measuring work effort in hours. And in many cases, it is best to avoid precise determinations of when a day shift ends. At most hospitals, you do need at least one daytime doctor to stay on duty until the next shift arrives, but it rarely makes sense to have all of the hospitalists stay.
Your hospitalists need to be professional enough not to dash out the door the minute they’ve put notes on every patient’s chart. Instead, rather than leaving at the first opportunity on slow days, they could do all of the discharge preparation (med rec, discharge summary, etc.) for patients likely ready for discharge the next day; this can help a lot to discharge patients early the next day. Or they could make “secondary” rounds focused on patient satisfaction, etc.
Obs Patients Usually Are No Less Complicated—or Labor-Intensive—to Care For
It’s best to think of observation as solely a payor classification and not a good indicator of risk, complexity, or work required. Unfortunately “observation” is often thought of as shorthand for simple, not sick, easy to manage, etc. While true for a small subset of observation patients, such as younger people with a single problem such as atypical chest pain, it isn’t true for older (Medicare) patients with multiple chronic illnesses, on multiple medications, and with complex social situations.
Shouldn’t We Measure Length of Stay for All Patients in Hours Rather Than Days?
Then we could better understand throughput issues such as whether afternoon discharges for inpatients are late discharges or really very early discharges that weren’t held until the next morning.
Even High-Performing Hospitalist Groups Are Likely to Have Patient Satisfaction Scores on the Lower End of Doctors at Your Hospital
Don’t decide that just because they have much lower scores than the orthopedists, cardiologists, obstetricians, and other specialties, it is the hospitalists who are falling furthest below their potential. It may be the cardiologists who have a long way to go to achieve great scores for their specialty.
This isn’t an excuse. Just about every hospitalist group can do better and should work to make it happen. And because in nearly every hospital more HCAHPS surveys are attributed to hospitalists than any other specialty by a wide margin, our scores have a huge impact on the overall hospital averages. But you should keep in mind that, for a variety of reasons, hospitalists everywhere have physician communication scores that are lower than many or most other specialties.
To my knowledge, there isn’t a data set that provides patient satisfaction scores by specialty. And scores seem to vary a lot by geographic region, e.g., they’re nearly always higher in the South than other parts of the country. So there isn’t a good way to control for all the variables and know you’re setting appropriate improvement goals for each specialty. But your hospitalists will appreciate it if you acknowledge it may be unreasonable to set the same goals across specialties.
We’d Love Your Help Getting Rid of Pagers
Secure text messaging between all caregivers seems to be the way to go, and we will look to the hospital to make an investment in technology to make it possible and train users to ensure that by making messaging easier the volume of messages (interruptions) doesn’t just skyrocket. We, the hospitalists at your hospital, are happy to help with all of this, from vendor selection to plans for implementation. Please ask! TH
Updated CHEST Guidelines for Antithrombotic Therapy of VTE
Clinical question: What are the current recommendations for antithrombotic therapy in various venous thromboembolism (VTE) scenarios?
Background: VTE is commonly encountered with a multitude of therapeutic options. Selecting the optimal anticoagulant is as important as making the diagnosis and requires knowledge of individual patient characteristics to initiate the correct therapy. These factors include malignancy, location of thrombus, and history of recurrent VTE despite anticoagulation.
Study design: Guideline.
Setting: Expert panel.
Synopsis: For VTE patients without cancer, non-vitamin K oral anticoagulants (NOAC) are now suggested over vitamin K antagonists (Grade 2B). However, there remains no strong evidence to favor one NOAC over another.
Better evidence now supports the prior recommendation to discourage IVC filters for VTE that is being treated with anticoagulation (Grade 1B).
In pulmonary embolism of the subsegmental type without proximal DVT, clinical surveillance is favored over anticoagulation in lower-risk patients (Grade 2C).
Low-molecular-weight heparin (LMWH) is advised in recurrent VTE treated with non-LMWH, and for recurrences on LMWH, a dose increase of LMWH is advised (Grade 2C).
Finally, routine use of compression stockings for post-thrombotic syndrome prevention is not routinely recommended (Grade 2B).
Limitations include only 20 of the 54 total recommendations being of strong Grade 1 criteria. Additionally, none of the 54 statements are drawn from high-quality evidence.
Further study is needed to continually update our practice in caring for VTE disease as more experience and comparison data are obtained with the use of NOAC drugs.
Bottom line: Anticoagulant therapy recommendations have been updated, but few are strong recommendations and none are based on high-quality evidence.
Citation: Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.
Clinical question: What are the current recommendations for antithrombotic therapy in various venous thromboembolism (VTE) scenarios?
Background: VTE is commonly encountered with a multitude of therapeutic options. Selecting the optimal anticoagulant is as important as making the diagnosis and requires knowledge of individual patient characteristics to initiate the correct therapy. These factors include malignancy, location of thrombus, and history of recurrent VTE despite anticoagulation.
Study design: Guideline.
Setting: Expert panel.
Synopsis: For VTE patients without cancer, non-vitamin K oral anticoagulants (NOAC) are now suggested over vitamin K antagonists (Grade 2B). However, there remains no strong evidence to favor one NOAC over another.
Better evidence now supports the prior recommendation to discourage IVC filters for VTE that is being treated with anticoagulation (Grade 1B).
In pulmonary embolism of the subsegmental type without proximal DVT, clinical surveillance is favored over anticoagulation in lower-risk patients (Grade 2C).
Low-molecular-weight heparin (LMWH) is advised in recurrent VTE treated with non-LMWH, and for recurrences on LMWH, a dose increase of LMWH is advised (Grade 2C).
Finally, routine use of compression stockings for post-thrombotic syndrome prevention is not routinely recommended (Grade 2B).
Limitations include only 20 of the 54 total recommendations being of strong Grade 1 criteria. Additionally, none of the 54 statements are drawn from high-quality evidence.
Further study is needed to continually update our practice in caring for VTE disease as more experience and comparison data are obtained with the use of NOAC drugs.
Bottom line: Anticoagulant therapy recommendations have been updated, but few are strong recommendations and none are based on high-quality evidence.
Citation: Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.
Clinical question: What are the current recommendations for antithrombotic therapy in various venous thromboembolism (VTE) scenarios?
Background: VTE is commonly encountered with a multitude of therapeutic options. Selecting the optimal anticoagulant is as important as making the diagnosis and requires knowledge of individual patient characteristics to initiate the correct therapy. These factors include malignancy, location of thrombus, and history of recurrent VTE despite anticoagulation.
Study design: Guideline.
Setting: Expert panel.
Synopsis: For VTE patients without cancer, non-vitamin K oral anticoagulants (NOAC) are now suggested over vitamin K antagonists (Grade 2B). However, there remains no strong evidence to favor one NOAC over another.
Better evidence now supports the prior recommendation to discourage IVC filters for VTE that is being treated with anticoagulation (Grade 1B).
In pulmonary embolism of the subsegmental type without proximal DVT, clinical surveillance is favored over anticoagulation in lower-risk patients (Grade 2C).
Low-molecular-weight heparin (LMWH) is advised in recurrent VTE treated with non-LMWH, and for recurrences on LMWH, a dose increase of LMWH is advised (Grade 2C).
Finally, routine use of compression stockings for post-thrombotic syndrome prevention is not routinely recommended (Grade 2B).
Limitations include only 20 of the 54 total recommendations being of strong Grade 1 criteria. Additionally, none of the 54 statements are drawn from high-quality evidence.
Further study is needed to continually update our practice in caring for VTE disease as more experience and comparison data are obtained with the use of NOAC drugs.
Bottom line: Anticoagulant therapy recommendations have been updated, but few are strong recommendations and none are based on high-quality evidence.
Citation: Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.