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The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.

Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.

"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."

For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.

Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.

"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”

Visit our website for more information on hospitalists' role in preventing readmissions.

The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.

Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.

"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."

For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.

Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.

"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”

Visit our website for more information on hospitalists' role in preventing readmissions.

The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.

Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.

"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."

For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.

Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.

"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”

Visit our website for more information on hospitalists' role in preventing readmissions.

Clinical question: What is the impact of statin discontinuation in palliative care setting?

Background: There is compelling evidence for prescribing statins for primary or secondary prevention of cardiovascular disease for patients with long life expectancy, but there is no evidence to guide decisions to discontinue therapy in those with limited prognosis.

Study design: Multicenter, unblinded, randomized, and pragmatic clinical trial.

Setting: Academic and community-based clinical sites as a part of the Palliative Care Research Cooperative Group.

Synopsis: The study analyzed the outcomes of 381 patients who had received a prognosis of one-month to one-year life expectancy, with an average age of 74. The participants were divided into two groups: continued statin group and discontinued statin group. Of the 381 participants, 212 survived beyond 60 days.

There was no significant difference between the proportion of participants who died within 60 days, with 45 (23.8%) in the discontinued statin group and 39 (20.3%) in the continued statin group (90% Cl, -3.5%–10.5%; P=0.36). Total quality of life was better for the group discontinuing statin therapy (mean McGill QOL score 7.11 versus 6.85; P=0.04). The researchers estimated that surviving participants would save $3.37 per day and $716 per patient.

Because of a lack of formal guidelines for discontinuation of statin therapy in patients with life-limiting illness, the discontinuation of statin therapy is mostly based on patient-provider decisions.

The results from this study will help physicians have thoughtful patient-provider discussions regarding statin discontinuation.

Citation: Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. doi:10.1001/jamainternmed.2015.0289.

Visit our website for more research reviews.

Clinical question: What is the impact of statin discontinuation in palliative care setting?

Background: There is compelling evidence for prescribing statins for primary or secondary prevention of cardiovascular disease for patients with long life expectancy, but there is no evidence to guide decisions to discontinue therapy in those with limited prognosis.

Study design: Multicenter, unblinded, randomized, and pragmatic clinical trial.

Setting: Academic and community-based clinical sites as a part of the Palliative Care Research Cooperative Group.

Synopsis: The study analyzed the outcomes of 381 patients who had received a prognosis of one-month to one-year life expectancy, with an average age of 74. The participants were divided into two groups: continued statin group and discontinued statin group. Of the 381 participants, 212 survived beyond 60 days.

There was no significant difference between the proportion of participants who died within 60 days, with 45 (23.8%) in the discontinued statin group and 39 (20.3%) in the continued statin group (90% Cl, -3.5%–10.5%; P=0.36). Total quality of life was better for the group discontinuing statin therapy (mean McGill QOL score 7.11 versus 6.85; P=0.04). The researchers estimated that surviving participants would save $3.37 per day and $716 per patient.

Because of a lack of formal guidelines for discontinuation of statin therapy in patients with life-limiting illness, the discontinuation of statin therapy is mostly based on patient-provider decisions.

The results from this study will help physicians have thoughtful patient-provider discussions regarding statin discontinuation.

Citation: Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. doi:10.1001/jamainternmed.2015.0289.

Visit our website for more research reviews.

Clinical question: What is the impact of statin discontinuation in palliative care setting?

Background: There is compelling evidence for prescribing statins for primary or secondary prevention of cardiovascular disease for patients with long life expectancy, but there is no evidence to guide decisions to discontinue therapy in those with limited prognosis.

Study design: Multicenter, unblinded, randomized, and pragmatic clinical trial.

Setting: Academic and community-based clinical sites as a part of the Palliative Care Research Cooperative Group.

Synopsis: The study analyzed the outcomes of 381 patients who had received a prognosis of one-month to one-year life expectancy, with an average age of 74. The participants were divided into two groups: continued statin group and discontinued statin group. Of the 381 participants, 212 survived beyond 60 days.

There was no significant difference between the proportion of participants who died within 60 days, with 45 (23.8%) in the discontinued statin group and 39 (20.3%) in the continued statin group (90% Cl, -3.5%–10.5%; P=0.36). Total quality of life was better for the group discontinuing statin therapy (mean McGill QOL score 7.11 versus 6.85; P=0.04). The researchers estimated that surviving participants would save $3.37 per day and $716 per patient.

Because of a lack of formal guidelines for discontinuation of statin therapy in patients with life-limiting illness, the discontinuation of statin therapy is mostly based on patient-provider decisions.

The results from this study will help physicians have thoughtful patient-provider discussions regarding statin discontinuation.

Citation: Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. doi:10.1001/jamainternmed.2015.0289.

Visit our website for more research reviews.

Dr. Phuoc Le of the University of California at San Francisco and Dr. Bijay Achariya of Mass General Hospital in Boston, both practicing global hospitalists, share their perspectives on the US hospitalist movement, how it intersects with the global patient safety movement, and the opportunities presented for hospitalists with a global perspective to make a difference for patients everywhere.

Dr. Phuoc Le of the University of California at San Francisco and Dr. Bijay Achariya of Mass General Hospital in Boston, both practicing global hospitalists, share their perspectives on the US hospitalist movement, how it intersects with the global patient safety movement, and the opportunities presented for hospitalists with a global perspective to make a difference for patients everywhere.

Dr. Phuoc Le of the University of California at San Francisco and Dr. Bijay Achariya of Mass General Hospital in Boston, both practicing global hospitalists, share their perspectives on the US hospitalist movement, how it intersects with the global patient safety movement, and the opportunities presented for hospitalists with a global perspective to make a difference for patients everywhere.

It only takes one idea to help change the face of medicine and, recently, Forbes posted an article outlining a small startup pharmacy that could change the way we get our medication. Manchester, N.H.-based Pill Pack takes the whole mail-order pharmacy to a new level.

Medication management can be a major issue for seniors and their caregivers. Seniors are at risk for such problems as overmedication and drug interactions, if medications are not properly managed.

An UpToDate article says that a survey for adults aged 57-85 shows:

• At least one prescription medication was used by 81%;
• Five or more prescription medications were used by 29% of the overall survey population and by 36% of people aged 75 to 85 years; and
• 46% of prescription users also took at least one over-the-counter medication.

Hospitalists see it every day; the readmit because prescribed medication isn’t taken correctly. Possibly, Pill Pack might be one step in the right direction. TH

Lisa Courtney is director of operations at Baptist Health Systems in Birmingham, Ala., and a member of Team Hospitalist.

It only takes one idea to help change the face of medicine and, recently, Forbes posted an article outlining a small startup pharmacy that could change the way we get our medication. Manchester, N.H.-based Pill Pack takes the whole mail-order pharmacy to a new level.

Medication management can be a major issue for seniors and their caregivers. Seniors are at risk for such problems as overmedication and drug interactions, if medications are not properly managed.

An UpToDate article says that a survey for adults aged 57-85 shows:

• At least one prescription medication was used by 81%;
• Five or more prescription medications were used by 29% of the overall survey population and by 36% of people aged 75 to 85 years; and
• 46% of prescription users also took at least one over-the-counter medication.

Hospitalists see it every day; the readmit because prescribed medication isn’t taken correctly. Possibly, Pill Pack might be one step in the right direction. TH

Lisa Courtney is director of operations at Baptist Health Systems in Birmingham, Ala., and a member of Team Hospitalist.

It only takes one idea to help change the face of medicine and, recently, Forbes posted an article outlining a small startup pharmacy that could change the way we get our medication. Manchester, N.H.-based Pill Pack takes the whole mail-order pharmacy to a new level.

Medication management can be a major issue for seniors and their caregivers. Seniors are at risk for such problems as overmedication and drug interactions, if medications are not properly managed.

An UpToDate article says that a survey for adults aged 57-85 shows:

• At least one prescription medication was used by 81%;
• Five or more prescription medications were used by 29% of the overall survey population and by 36% of people aged 75 to 85 years; and
• 46% of prescription users also took at least one over-the-counter medication.

Hospitalists see it every day; the readmit because prescribed medication isn’t taken correctly. Possibly, Pill Pack might be one step in the right direction. TH

Lisa Courtney is director of operations at Baptist Health Systems in Birmingham, Ala., and a member of Team Hospitalist.

ROBERT FOGERTY, MD, MPH, a hospitalist and assistant professor of medicine at Yale University, talks about how his own bout with cancer as a college senior heading to medical school helped influence his I-CARE education initiative, which introduces cost awareness into internal medicine residency programs.

ROBERT FOGERTY, MD, MPH, a hospitalist and assistant professor of medicine at Yale University, talks about how his own bout with cancer as a college senior heading to medical school helped influence his I-CARE education initiative, which introduces cost awareness into internal medicine residency programs.

ROBERT FOGERTY, MD, MPH, a hospitalist and assistant professor of medicine at Yale University, talks about how his own bout with cancer as a college senior heading to medical school helped influence his I-CARE education initiative, which introduces cost awareness into internal medicine residency programs.

CHRISTOPHER MORIATES, MD, assistant clinical professor in the Division of Hospital Medicine at the University of California, San Francisco, talks about the change in focus and priorities needed for medicine to make progress in waste-reduction efforts.

CHRISTOPHER MORIATES, MD, assistant clinical professor in the Division of Hospital Medicine at the University of California, San Francisco, talks about the change in focus and priorities needed for medicine to make progress in waste-reduction efforts.

CHRISTOPHER MORIATES, MD, assistant clinical professor in the Division of Hospital Medicine at the University of California, San Francisco, talks about the change in focus and priorities needed for medicine to make progress in waste-reduction efforts.

VLADIMIR N. CADET, MPH, associate with the Applied Solutions Group at ECRI Institute in Plymouth Meeting, Pa., discusses why it can be challenging for hospitals to reduce alarm fatigue and provides strategies to address this growing problem.

VLADIMIR N. CADET, MPH, associate with the Applied Solutions Group at ECRI Institute in Plymouth Meeting, Pa., discusses why it can be challenging for hospitals to reduce alarm fatigue and provides strategies to address this growing problem.

VLADIMIR N. CADET, MPH, associate with the Applied Solutions Group at ECRI Institute in Plymouth Meeting, Pa., discusses why it can be challenging for hospitals to reduce alarm fatigue and provides strategies to address this growing problem.

For Robert Fogerty, MD, MPH, it’s more than just a story. It’s a nightmare that he only narrowly avoided.

Now a hospitalist at Yale University School of Medicine in New Haven, Conn., Dr. Fogerty was an economics major in his senior year of college when he was diagnosed with metastatic testicular cancer. Early in the course of his treatment, amid multiple rounds of chemotherapy and before a major surgery, his insurance company informed him that his benefits had been exhausted. Even with family resources, the remaining bills would have been crippling. Luckily, he went to college in Massachusetts, where a state law allowed him to enroll in an individual insurance plan by exempting him from the normal pre-existing condition exclusion. Two years later, he got his life back in order and enrolled in medical school.

“What stuck with me is, yes, I was sick, and yes, I lost all my hair, and yes, I went to my final exams bald with my nausea medicine and my steroids in my pocket and all of those things,” he says. “But after that was all gone, after my hair grew back, and I had my last chemo and my surgery, and I was really starting to get my life back on track, the financial implications of that disease were still there. The financial impact of my illness outlasted the pathological impact of my illness, and the financial burdens could easily have been just as life-altering as a permanent disability.”

Although he was “unbelievably lucky” to escape with manageable medical bills, Dr. Fogerty says, other patients haven’t been as fortunate. That lesson is why he identifies so much with his patients. It’s why he posted his own story to the Costs of Care website, which stresses the importance of cost awareness in healthcare. And it’s why he has committed himself to helping other medical students and residents “remove the blinders” to understand healthcare’s often devastating financial impact.

“When I was going through my residency, I learned a lot about low sodium, and I learned a lot about bloodstream infections and what to do when someone can’t breathe and how to do a skin exam, and all of these things,” Dr. Fogerty says. “But all of these other components that were so devastating to me as a patient weren’t really a main portion of the education that we’re providing tomorrow’s doctors. I thought that was an opportunity to really change things."

By combining his clinical and economics expertise, Dr. Fogerty helped to develop a program called the Interactive Cost-Awareness Resident Exercise, or I-CARE. Launched in 2011, I-CARE seeks to make the abstract problem of healthcare costs—including unnecessary ones—more accessible to trainees. The concept is deceptively simple: Residents compete to see who can reach the correct diagnosis for a given case using the fewest possible resources.

By talking through each case, both trainees and faculty can discuss concepts like waste prevention and financial stewardship in a safe environment. Giving young doctors that “basic set of vocabulary,” Dr. Fogerty says, may help them engage in real decisions later on about a group or health system’s financial pressures and obligations.

The program has since spread to other medical centers, and what began as a cost-awareness exercise has blossomed into a broader discussion about minimizing the cost and burden to patients while maximizing safety and good medicine. TH

For Robert Fogerty, MD, MPH, it’s more than just a story. It’s a nightmare that he only narrowly avoided.

Now a hospitalist at Yale University School of Medicine in New Haven, Conn., Dr. Fogerty was an economics major in his senior year of college when he was diagnosed with metastatic testicular cancer. Early in the course of his treatment, amid multiple rounds of chemotherapy and before a major surgery, his insurance company informed him that his benefits had been exhausted. Even with family resources, the remaining bills would have been crippling. Luckily, he went to college in Massachusetts, where a state law allowed him to enroll in an individual insurance plan by exempting him from the normal pre-existing condition exclusion. Two years later, he got his life back in order and enrolled in medical school.

“What stuck with me is, yes, I was sick, and yes, I lost all my hair, and yes, I went to my final exams bald with my nausea medicine and my steroids in my pocket and all of those things,” he says. “But after that was all gone, after my hair grew back, and I had my last chemo and my surgery, and I was really starting to get my life back on track, the financial implications of that disease were still there. The financial impact of my illness outlasted the pathological impact of my illness, and the financial burdens could easily have been just as life-altering as a permanent disability.”

Although he was “unbelievably lucky” to escape with manageable medical bills, Dr. Fogerty says, other patients haven’t been as fortunate. That lesson is why he identifies so much with his patients. It’s why he posted his own story to the Costs of Care website, which stresses the importance of cost awareness in healthcare. And it’s why he has committed himself to helping other medical students and residents “remove the blinders” to understand healthcare’s often devastating financial impact.

“When I was going through my residency, I learned a lot about low sodium, and I learned a lot about bloodstream infections and what to do when someone can’t breathe and how to do a skin exam, and all of these things,” Dr. Fogerty says. “But all of these other components that were so devastating to me as a patient weren’t really a main portion of the education that we’re providing tomorrow’s doctors. I thought that was an opportunity to really change things."

By combining his clinical and economics expertise, Dr. Fogerty helped to develop a program called the Interactive Cost-Awareness Resident Exercise, or I-CARE. Launched in 2011, I-CARE seeks to make the abstract problem of healthcare costs—including unnecessary ones—more accessible to trainees. The concept is deceptively simple: Residents compete to see who can reach the correct diagnosis for a given case using the fewest possible resources.

By talking through each case, both trainees and faculty can discuss concepts like waste prevention and financial stewardship in a safe environment. Giving young doctors that “basic set of vocabulary,” Dr. Fogerty says, may help them engage in real decisions later on about a group or health system’s financial pressures and obligations.

The program has since spread to other medical centers, and what began as a cost-awareness exercise has blossomed into a broader discussion about minimizing the cost and burden to patients while maximizing safety and good medicine. TH

For Robert Fogerty, MD, MPH, it’s more than just a story. It’s a nightmare that he only narrowly avoided.

Now a hospitalist at Yale University School of Medicine in New Haven, Conn., Dr. Fogerty was an economics major in his senior year of college when he was diagnosed with metastatic testicular cancer. Early in the course of his treatment, amid multiple rounds of chemotherapy and before a major surgery, his insurance company informed him that his benefits had been exhausted. Even with family resources, the remaining bills would have been crippling. Luckily, he went to college in Massachusetts, where a state law allowed him to enroll in an individual insurance plan by exempting him from the normal pre-existing condition exclusion. Two years later, he got his life back in order and enrolled in medical school.

“What stuck with me is, yes, I was sick, and yes, I lost all my hair, and yes, I went to my final exams bald with my nausea medicine and my steroids in my pocket and all of those things,” he says. “But after that was all gone, after my hair grew back, and I had my last chemo and my surgery, and I was really starting to get my life back on track, the financial implications of that disease were still there. The financial impact of my illness outlasted the pathological impact of my illness, and the financial burdens could easily have been just as life-altering as a permanent disability.”

Although he was “unbelievably lucky” to escape with manageable medical bills, Dr. Fogerty says, other patients haven’t been as fortunate. That lesson is why he identifies so much with his patients. It’s why he posted his own story to the Costs of Care website, which stresses the importance of cost awareness in healthcare. And it’s why he has committed himself to helping other medical students and residents “remove the blinders” to understand healthcare’s often devastating financial impact.

“When I was going through my residency, I learned a lot about low sodium, and I learned a lot about bloodstream infections and what to do when someone can’t breathe and how to do a skin exam, and all of these things,” Dr. Fogerty says. “But all of these other components that were so devastating to me as a patient weren’t really a main portion of the education that we’re providing tomorrow’s doctors. I thought that was an opportunity to really change things."

By combining his clinical and economics expertise, Dr. Fogerty helped to develop a program called the Interactive Cost-Awareness Resident Exercise, or I-CARE. Launched in 2011, I-CARE seeks to make the abstract problem of healthcare costs—including unnecessary ones—more accessible to trainees. The concept is deceptively simple: Residents compete to see who can reach the correct diagnosis for a given case using the fewest possible resources.

By talking through each case, both trainees and faculty can discuss concepts like waste prevention and financial stewardship in a safe environment. Giving young doctors that “basic set of vocabulary,” Dr. Fogerty says, may help them engage in real decisions later on about a group or health system’s financial pressures and obligations.

The program has since spread to other medical centers, and what began as a cost-awareness exercise has blossomed into a broader discussion about minimizing the cost and burden to patients while maximizing safety and good medicine. TH

As the hospital medicine specialty matures in the U.S., HM is establishing itself globally. Two American hospitalists who have moved to Doha, Qatar to build a hospital medicine program at Hamid General Hospital talk about their experiences, how they decided to practice overseas, and what they see as an opportunity for HM globally.

As the hospital medicine specialty matures in the U.S., HM is establishing itself globally. Two American hospitalists who have moved to Doha, Qatar to build a hospital medicine program at Hamid General Hospital talk about their experiences, how they decided to practice overseas, and what they see as an opportunity for HM globally.

As the hospital medicine specialty matures in the U.S., HM is establishing itself globally. Two American hospitalists who have moved to Doha, Qatar to build a hospital medicine program at Hamid General Hospital talk about their experiences, how they decided to practice overseas, and what they see as an opportunity for HM globally.

In this issue of The Hospitalist, ECRI Institute's Vladmir Cadet discusses alarm fatigue, Dr. Christopher Moriates talks about reducing waste by eliminating overtreatment, and Dr. Robert Fogerty stresses the need to build awareness of the financial impact of treatment from the start of a doctor’s medical training.

In this issue of The Hospitalist, ECRI Institute's Vladmir Cadet discusses alarm fatigue, Dr. Christopher Moriates talks about reducing waste by eliminating overtreatment, and Dr. Robert Fogerty stresses the need to build awareness of the financial impact of treatment from the start of a doctor’s medical training.

In this issue of The Hospitalist, ECRI Institute's Vladmir Cadet discusses alarm fatigue, Dr. Christopher Moriates talks about reducing waste by eliminating overtreatment, and Dr. Robert Fogerty stresses the need to build awareness of the financial impact of treatment from the start of a doctor’s medical training.