Career

One of the things that Jennifer Feighner, MD, cheerfully came away with at HM16 was how to better complete a task that is distinctly uncheerful but also important to any high-performing hospital: how to collect the data of the dead.

The quality improvement session “Reducing Inpatient Mortality: A Standardized Approach to Identify Preventable Deaths” demonstrated still evolving but, so far, well-performing projects that have been rolled out at Brigham and Women’s Hospital and the Duke University Health System.

“I was struck by the methodology for getting input from multiple providers and the nursing staff,” said Dr. Feighner, director of hospital medicine at Marcus Daly Memorial Hospital in Hamilton, Mont.

As the role of the hospitalist as agent of change and improvement continues to grow, the topic of quality improvement (QI) maintained a high profile at the annual meeting, with talks on the latest literature, sustaining motivation to complete projects, and dealing with issues such as handoffs and frequent fliers.

In the mortality review session, presenters set out to give details that could be a model to be used elsewhere. At Brigham and Women’s, all of the frontline clinicians are asked by email to fill out a report when a death occurs in any case with which they’ve been involved, with the Web-based reports to be completed within 48 to 72 hours of the death.

The number of deaths, the report completion rate, death “preventability,” and issues that arose for the patient during hospitalization are some of the data that are tracked. So far, the system has identified such themes as “alarm fatigue,” high oxygen requirements on non-intensive-care floors, handoffs, and transfers from other hospitals, said Kiran Gupta, MD, MPH, who completed her residency at Brigham and is now assistant professor of clinical medicine at the University of California San Francisco.

At Duke, where the mortality review system improvements have been led by Jonathan Bae, MD, assistant professor of medicine, self-nicknamed “Dr. Death,” inpatient deaths undergo a similarly comprehensive review, with an enhanced end-of-life section to cover issues particular to those cases and flags for cases that need independent review.

Dr. Gupta and Dr. Bae emphasized the confidentiality of the reviews and that they are non-discoverable in the event of litigation, which they hope give clinicians the freedom to fully report their observations.

Dr. Feighner said that her 23-bed hospital is far smaller than either Brigham or Duke, of course, but that the overall ideas can translate.

“I am the medical director of our hospitalist program, and our chief of staff and I’ve created a peer-review medical staff quality improvement committee,” she said. “So this obviously has a lot of interest to me.”

With only 4.2 full-time equivalents (FTEs) in her department, she said changes would be even easier to put into place.

“I think that will be really helpful for our peer-review committee and our quality and safety committee. I could see how we could take this and kind of revise it a little bit,” she said. “When you’re in charge of that few people, it’s easy to get processes implemented. We are more limited in monetary resources, but we make up for that in manpower-to-problem ratio, I guess.”

In another session, Jordan Messler, MD, SFHM, a hospitalist and former medical director of the hospitalist group at Morton Plant Hospital in Clearwater, Fla., confronted the startling statistic that 80% of initiatives in hospitals never meet their objectives. Hurdles such as burnout and disengagement, he said, often stand in the way of successful QI projects.

He emphasized the importance of intrinsic motivation (a sense of ownership and passion for the work) over extrinsic motivation (a fear of reprisal if something isn’t done). A step as simple as assigning a title (e.g., “head of readmissions”) can be a motivator, he said. But he also emphasized that project ideas need to be timed correctly and the ideas should ideally come from the physicians leading them.

Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, said he was struck by the lessons gleaned in a workshop on the I-PASS system of handoffs—a standardized system with a handoff sheet, studied prospectively, in which medical errors decreased by 23% and preventable adverse events fell by 30%.1 The system was created in pediatric departments but was deliberately made to be translatable to other settings.

“Instead of focusing on the outcome of the quality of the handoff, they focus on the quality of the feedback sessions,” Clothier said. “So it’s not the person giving the handoff or receiving the handoff that actually assesses it. It’s just the person who’s sitting there watching.”

He said the workshop underscored the importance of standardization, a concept with which he was familiar but which now seemed particularly vital.

“If you do the process and everybody does it the same, then it’s not only the person that’s giving the information who can do it in a very standardized way but the person who’s listening already knows what they’re going to be listening for so they hear it more clearly because they don’t have to discern what’s coming next,” Clothier said. “They already know what’s coming next.” TH

Reference

1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803-1812.

One of the things that Jennifer Feighner, MD, cheerfully came away with at HM16 was how to better complete a task that is distinctly uncheerful but also important to any high-performing hospital: how to collect the data of the dead.

The quality improvement session “Reducing Inpatient Mortality: A Standardized Approach to Identify Preventable Deaths” demonstrated still evolving but, so far, well-performing projects that have been rolled out at Brigham and Women’s Hospital and the Duke University Health System.

“I was struck by the methodology for getting input from multiple providers and the nursing staff,” said Dr. Feighner, director of hospital medicine at Marcus Daly Memorial Hospital in Hamilton, Mont.

As the role of the hospitalist as agent of change and improvement continues to grow, the topic of quality improvement (QI) maintained a high profile at the annual meeting, with talks on the latest literature, sustaining motivation to complete projects, and dealing with issues such as handoffs and frequent fliers.

In the mortality review session, presenters set out to give details that could be a model to be used elsewhere. At Brigham and Women’s, all of the frontline clinicians are asked by email to fill out a report when a death occurs in any case with which they’ve been involved, with the Web-based reports to be completed within 48 to 72 hours of the death.

The number of deaths, the report completion rate, death “preventability,” and issues that arose for the patient during hospitalization are some of the data that are tracked. So far, the system has identified such themes as “alarm fatigue,” high oxygen requirements on non-intensive-care floors, handoffs, and transfers from other hospitals, said Kiran Gupta, MD, MPH, who completed her residency at Brigham and is now assistant professor of clinical medicine at the University of California San Francisco.

At Duke, where the mortality review system improvements have been led by Jonathan Bae, MD, assistant professor of medicine, self-nicknamed “Dr. Death,” inpatient deaths undergo a similarly comprehensive review, with an enhanced end-of-life section to cover issues particular to those cases and flags for cases that need independent review.

Dr. Gupta and Dr. Bae emphasized the confidentiality of the reviews and that they are non-discoverable in the event of litigation, which they hope give clinicians the freedom to fully report their observations.

Dr. Feighner said that her 23-bed hospital is far smaller than either Brigham or Duke, of course, but that the overall ideas can translate.

“I am the medical director of our hospitalist program, and our chief of staff and I’ve created a peer-review medical staff quality improvement committee,” she said. “So this obviously has a lot of interest to me.”

With only 4.2 full-time equivalents (FTEs) in her department, she said changes would be even easier to put into place.

“I think that will be really helpful for our peer-review committee and our quality and safety committee. I could see how we could take this and kind of revise it a little bit,” she said. “When you’re in charge of that few people, it’s easy to get processes implemented. We are more limited in monetary resources, but we make up for that in manpower-to-problem ratio, I guess.”

In another session, Jordan Messler, MD, SFHM, a hospitalist and former medical director of the hospitalist group at Morton Plant Hospital in Clearwater, Fla., confronted the startling statistic that 80% of initiatives in hospitals never meet their objectives. Hurdles such as burnout and disengagement, he said, often stand in the way of successful QI projects.

He emphasized the importance of intrinsic motivation (a sense of ownership and passion for the work) over extrinsic motivation (a fear of reprisal if something isn’t done). A step as simple as assigning a title (e.g., “head of readmissions”) can be a motivator, he said. But he also emphasized that project ideas need to be timed correctly and the ideas should ideally come from the physicians leading them.

Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, said he was struck by the lessons gleaned in a workshop on the I-PASS system of handoffs—a standardized system with a handoff sheet, studied prospectively, in which medical errors decreased by 23% and preventable adverse events fell by 30%.1 The system was created in pediatric departments but was deliberately made to be translatable to other settings.

“Instead of focusing on the outcome of the quality of the handoff, they focus on the quality of the feedback sessions,” Clothier said. “So it’s not the person giving the handoff or receiving the handoff that actually assesses it. It’s just the person who’s sitting there watching.”

He said the workshop underscored the importance of standardization, a concept with which he was familiar but which now seemed particularly vital.

“If you do the process and everybody does it the same, then it’s not only the person that’s giving the information who can do it in a very standardized way but the person who’s listening already knows what they’re going to be listening for so they hear it more clearly because they don’t have to discern what’s coming next,” Clothier said. “They already know what’s coming next.” TH

Reference

1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803-1812.

One of the things that Jennifer Feighner, MD, cheerfully came away with at HM16 was how to better complete a task that is distinctly uncheerful but also important to any high-performing hospital: how to collect the data of the dead.

The quality improvement session “Reducing Inpatient Mortality: A Standardized Approach to Identify Preventable Deaths” demonstrated still evolving but, so far, well-performing projects that have been rolled out at Brigham and Women’s Hospital and the Duke University Health System.

“I was struck by the methodology for getting input from multiple providers and the nursing staff,” said Dr. Feighner, director of hospital medicine at Marcus Daly Memorial Hospital in Hamilton, Mont.

As the role of the hospitalist as agent of change and improvement continues to grow, the topic of quality improvement (QI) maintained a high profile at the annual meeting, with talks on the latest literature, sustaining motivation to complete projects, and dealing with issues such as handoffs and frequent fliers.

In the mortality review session, presenters set out to give details that could be a model to be used elsewhere. At Brigham and Women’s, all of the frontline clinicians are asked by email to fill out a report when a death occurs in any case with which they’ve been involved, with the Web-based reports to be completed within 48 to 72 hours of the death.

The number of deaths, the report completion rate, death “preventability,” and issues that arose for the patient during hospitalization are some of the data that are tracked. So far, the system has identified such themes as “alarm fatigue,” high oxygen requirements on non-intensive-care floors, handoffs, and transfers from other hospitals, said Kiran Gupta, MD, MPH, who completed her residency at Brigham and is now assistant professor of clinical medicine at the University of California San Francisco.

At Duke, where the mortality review system improvements have been led by Jonathan Bae, MD, assistant professor of medicine, self-nicknamed “Dr. Death,” inpatient deaths undergo a similarly comprehensive review, with an enhanced end-of-life section to cover issues particular to those cases and flags for cases that need independent review.

Dr. Gupta and Dr. Bae emphasized the confidentiality of the reviews and that they are non-discoverable in the event of litigation, which they hope give clinicians the freedom to fully report their observations.

Dr. Feighner said that her 23-bed hospital is far smaller than either Brigham or Duke, of course, but that the overall ideas can translate.

“I am the medical director of our hospitalist program, and our chief of staff and I’ve created a peer-review medical staff quality improvement committee,” she said. “So this obviously has a lot of interest to me.”

With only 4.2 full-time equivalents (FTEs) in her department, she said changes would be even easier to put into place.

“I think that will be really helpful for our peer-review committee and our quality and safety committee. I could see how we could take this and kind of revise it a little bit,” she said. “When you’re in charge of that few people, it’s easy to get processes implemented. We are more limited in monetary resources, but we make up for that in manpower-to-problem ratio, I guess.”

In another session, Jordan Messler, MD, SFHM, a hospitalist and former medical director of the hospitalist group at Morton Plant Hospital in Clearwater, Fla., confronted the startling statistic that 80% of initiatives in hospitals never meet their objectives. Hurdles such as burnout and disengagement, he said, often stand in the way of successful QI projects.

He emphasized the importance of intrinsic motivation (a sense of ownership and passion for the work) over extrinsic motivation (a fear of reprisal if something isn’t done). A step as simple as assigning a title (e.g., “head of readmissions”) can be a motivator, he said. But he also emphasized that project ideas need to be timed correctly and the ideas should ideally come from the physicians leading them.

Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, said he was struck by the lessons gleaned in a workshop on the I-PASS system of handoffs—a standardized system with a handoff sheet, studied prospectively, in which medical errors decreased by 23% and preventable adverse events fell by 30%.1 The system was created in pediatric departments but was deliberately made to be translatable to other settings.

“Instead of focusing on the outcome of the quality of the handoff, they focus on the quality of the feedback sessions,” Clothier said. “So it’s not the person giving the handoff or receiving the handoff that actually assesses it. It’s just the person who’s sitting there watching.”

He said the workshop underscored the importance of standardization, a concept with which he was familiar but which now seemed particularly vital.

“If you do the process and everybody does it the same, then it’s not only the person that’s giving the information who can do it in a very standardized way but the person who’s listening already knows what they’re going to be listening for so they hear it more clearly because they don’t have to discern what’s coming next,” Clothier said. “They already know what’s coming next.” TH

Reference

1. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371:1803-1812.

Two academic hospitalists talk about why they teach, what they're learning from their students, and what they see as the future of hospital medicine. Since academic HM is the new-hospitalist pipeline, hearing what they're seeing in their student and resident trainee corps is a snapshot of HM's sustainability.

Two academic hospitalists talk about why they teach, what they're learning from their students, and what they see as the future of hospital medicine. Since academic HM is the new-hospitalist pipeline, hearing what they're seeing in their student and resident trainee corps is a snapshot of HM's sustainability.

Two academic hospitalists talk about why they teach, what they're learning from their students, and what they see as the future of hospital medicine. Since academic HM is the new-hospitalist pipeline, hearing what they're seeing in their student and resident trainee corps is a snapshot of HM's sustainability.

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

In November, Barbara Weisenbach took a new job as practice manager for the hospitalist group at Northwest Hospital in Seattle. She’s an experienced administrator but as for hospital medicine, not so much. And she is the group’s first full-fledged practice manager—as in, she’s not a physician taking on admin responsibilities and seeing a partial census.

She’s doing a lot of reshaping and a lot of learning, she said, standing outside Room 10 of the San Diego Convention Center, where a daylong pre-course on practice management was being held at SHM’s annual meeting.

“There have been a lot of business things that have been overlooked and not addressed ever before,” she said.

The pre-course, “The Highly Effective Hospital Medicine Group: Using SHM’s Key Characteristics to Drive Performance,” was led by John Nelson, MD, MHM, and Leslie Flores, MHA, SFHM, and offered one useful lesson after another, Weisenbach said.

“One of the most practical portions of the session this morning was about dashboards, which is something I’m currently working on and could definitely use some insight,” Weisenbach said, adding that a list of metrics a dashboard should include and general guidelines on effective dashboards were things she’ll find useful in her own implementation.

The pre-course expanded on the key principles and traits for effective groups, including effective leadership, engaged hospitalists, adequate resources, alignment with the hospital, and care coordination across settings.

HM16 also included two and a half days of practice management sessions. Plus, management themes were woven through workshops and sprinkled into other sessions.

In one session on handling change, presenters used a surfing analogy: Like a surfer’s intensity just before riding a wave, a laser focus is called for when the moment arrives to execute change.

“Get ready for the ride,” said Steve Behnke, MD, president of Columbus, Ohio–based MedOne Hospital Physicians.

He discussed details of introducing the electronic health record system Epic at their group. There was 18 months of planning involving the practice’s whole operational team, then a doubling of the staffing ratios when the system went live, followed by catered lunches to gather feedback and identify problems.

Presenters emphasized the idea of agility in responding to obstacles and realizing that change affects everyone. Successful change, they said, involves seeing the process from all perspectives and leaders should expect resistance.

“Court them. Listen to them. I can’t tell you how many times I’ve done that,” said Dea Robinson, MA, MedOne’s vice president of operations. “Just listening and giving a platform.”

Back at the pre-course, Dr. Nelson, a hospital medicine consultant, talked about the importance of effective leadership.

“An effective group leader is a really key element of a successful group,” said The Hospitalist’s resident practice management columnist. “I’ve worked on-site with many hundreds of hospitalist groups around the country. There’s pretty good correlation between the effectiveness of the leader and the success of the group overall. But a good leader alone is not enough.”

He added that there are too “few leaders to go around.”

A good leader is an active one, he said, adding with funny-because-it’s-true humor that a lot of leaders say their main job is to make the schedule. Good leaders, he said, need to be focused on making the group high-functioning, should be available for administrative work even when not on a clinical shift, and must be able to delegate.

Another critical ingredient for a successful group, he said, is having engaged frontline hospitalists. Reviews need to be meaningful, and meetings should be held regularly with attendance essentially mandatory. Meetings, he said, might need a “tune-up,” with actual voting, written agendas, minutes taken, and group problem-solving above one-way information.

Win Whitcomb, MD, MHM, on care coordination, said the relationship with primary care physicians is crucial though difficult.

“I think we have to go out of our way to build relationships,” he said. “And we don’t have occasion to see them, so we need to figure out a way to get to know our community.”

He suggested:

• Having dedicated transcriptionists for hospitalists,
• Tracking the rate at which discharge summaries are generated within 24 hours,
• Making sure PCPs know how to reach hospitalists, and
• Scheduling events—perhaps an annual event—for meeting PCPs and skill-nursing facility healthcare professionals.

It was clear that, in a field whose dimensions seem to be changing all the time, practice management remained a top interest at HM16. Robert Clothier, RN, a practice manager for the hospitalist group at ThedaCare in Wisconsin, recently switched from managing a cardiology clinic. He said there were huge differences in hospital medicine.

“The profession is growing so fast, and really nobody knows where the end is,” he said. “I can’t even think of anything where you could say, ‘Well, no, they’ll never do that.’ It’s endless. That’s going to be hardest thing. People are going to be pulling on us, and leadership from the hospital is going to be saying, ‘You guys need to do this.’

“So how can I control what we pick, and how can I make sure that we have the resources to do it?” TH

Presenter: Kyung E. Rhee, MD, MSc, MA

Summary: Eating disorders (ED) are common and have significant morbidity and mortality. EDs are the third most common psychiatric disorder of adolescents with a prevalence of 0.5-2% for anorexia and 0.9-3% for bulimia; 90% of patients are female. Mortality rate can be as high as 10% for anorexia and 1% for bulimia. Diagnosis is formally guided by DSM 5 criteria, but the mnemonic SCOFF can be useful:

1. Do you feel or make yourself SICK when eating?
2. Do you feel you’ve lost CONTROL of your eating?
3. Have you lost one STONE (14 lbs. developed by the British) of weight?
4. Do you feel FAT?
5. Does FOOD dominate your life?

A detailed history is needed as patients with ED may engage in secretive behaviors to hide their illness. After diagnosis, treatment may be outpatient or inpatient. Medical issues hospitalists are likely to see with inpatients include re-feeding syndrome, various metabolic disturbances, secondary amenorrhea, sleep disturbances, and for patients with bulimia, evidence of dental or esophageal trauma from purging. Differential diagnoses include: IBD, thyroid disease, celiac, diabetes, and Addison’s disease.

Hospitalists’ role in treatment is as part of a multidisciplinary group to manage the medical complications. Inpatient management includes individual and group therapy, monitored group meals, daily blind weights, bathroom visits, and focused lab studies. There is no “cure” and only ~50% of patients are free of ongoing symptoms after treatment.

Key Takeaways

• Eating disorders are common in adolescent females and have significant morbidity and mortality.
• Hospitalists’ role is diagnosis via careful history and management of medical complications with an eating disorder team. TH

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Presenter: Kyung E. Rhee, MD, MSc, MA

Summary: Eating disorders (ED) are common and have significant morbidity and mortality. EDs are the third most common psychiatric disorder of adolescents with a prevalence of 0.5-2% for anorexia and 0.9-3% for bulimia; 90% of patients are female. Mortality rate can be as high as 10% for anorexia and 1% for bulimia. Diagnosis is formally guided by DSM 5 criteria, but the mnemonic SCOFF can be useful:

1. Do you feel or make yourself SICK when eating?
2. Do you feel you’ve lost CONTROL of your eating?
3. Have you lost one STONE (14 lbs. developed by the British) of weight?
4. Do you feel FAT?
5. Does FOOD dominate your life?

A detailed history is needed as patients with ED may engage in secretive behaviors to hide their illness. After diagnosis, treatment may be outpatient or inpatient. Medical issues hospitalists are likely to see with inpatients include re-feeding syndrome, various metabolic disturbances, secondary amenorrhea, sleep disturbances, and for patients with bulimia, evidence of dental or esophageal trauma from purging. Differential diagnoses include: IBD, thyroid disease, celiac, diabetes, and Addison’s disease.

Hospitalists’ role in treatment is as part of a multidisciplinary group to manage the medical complications. Inpatient management includes individual and group therapy, monitored group meals, daily blind weights, bathroom visits, and focused lab studies. There is no “cure” and only ~50% of patients are free of ongoing symptoms after treatment.

Key Takeaways

• Eating disorders are common in adolescent females and have significant morbidity and mortality.
• Hospitalists’ role is diagnosis via careful history and management of medical complications with an eating disorder team. TH

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Presenter: Kyung E. Rhee, MD, MSc, MA

Summary: Eating disorders (ED) are common and have significant morbidity and mortality. EDs are the third most common psychiatric disorder of adolescents with a prevalence of 0.5-2% for anorexia and 0.9-3% for bulimia; 90% of patients are female. Mortality rate can be as high as 10% for anorexia and 1% for bulimia. Diagnosis is formally guided by DSM 5 criteria, but the mnemonic SCOFF can be useful:

1. Do you feel or make yourself SICK when eating?
2. Do you feel you’ve lost CONTROL of your eating?
3. Have you lost one STONE (14 lbs. developed by the British) of weight?
4. Do you feel FAT?
5. Does FOOD dominate your life?

A detailed history is needed as patients with ED may engage in secretive behaviors to hide their illness. After diagnosis, treatment may be outpatient or inpatient. Medical issues hospitalists are likely to see with inpatients include re-feeding syndrome, various metabolic disturbances, secondary amenorrhea, sleep disturbances, and for patients with bulimia, evidence of dental or esophageal trauma from purging. Differential diagnoses include: IBD, thyroid disease, celiac, diabetes, and Addison’s disease.

Hospitalists’ role in treatment is as part of a multidisciplinary group to manage the medical complications. Inpatient management includes individual and group therapy, monitored group meals, daily blind weights, bathroom visits, and focused lab studies. There is no “cure” and only ~50% of patients are free of ongoing symptoms after treatment.

Key Takeaways

• Eating disorders are common in adolescent females and have significant morbidity and mortality.
• Hospitalists’ role is diagnosis via careful history and management of medical complications with an eating disorder team. TH

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Presenters: David Pressel, MD, PhD, FAAP, FHM, Emily Fingado, MD, FAAP, and Jessica Tomaszewski, MD, FAAP

Summary: Patients may engage in violent behaviors that pose a danger to themselves or others. Behavioral emergencies may be rare, can be dangerous, and staff may feel ill-trained to respond appropriately. Patients with ingestions, or underlying psychiatric or developmental difficulties, are at highest risk for developing a behavioral emergency.

The first strategy in handling a potentially violent patient is de-escalation, i.e., trying to identify and rectify the behavioral trigger. If de-escalation is not successful, personal safety is paramount. Get away from the patient and get help. If a patient needs to be physically restrained, minimally there should be one staff member per limb. Various physical devices, including soft restraints, four-point leathers, hand mittens, and spit hoods may be used to control a violent patient. A violent restraint is characterized by the indication, not the device. Medications may be used to treat the underlying mental health issue and should not be used as PRN chemical restraints.

After a violent patient is safely restrained, further steps need to be taken, including notification of the attending or legal guardian if a minor; documentation of the event, including a debrief of what occurred; a room sweep to ensure securing any dangerous items (metal eating utensils); and modification of the care plan to strategize on removal of the restraints as soon as is safe.

Hospitals should view behavioral emergencies similarly to a Code Blue. Have a specialized team that responds and undergoes regular training.

Key Takeaways

1. Behavioral emergencies occur when a patient becomes violent.
2. De-escalation is the best response.
3. If not successful, maintain personal safety, control and medicate the patient as appropriate, and document clearly. TH

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Presenters: David Pressel, MD, PhD, FAAP, FHM, Emily Fingado, MD, FAAP, and Jessica Tomaszewski, MD, FAAP

Summary: Patients may engage in violent behaviors that pose a danger to themselves or others. Behavioral emergencies may be rare, can be dangerous, and staff may feel ill-trained to respond appropriately. Patients with ingestions, or underlying psychiatric or developmental difficulties, are at highest risk for developing a behavioral emergency.

The first strategy in handling a potentially violent patient is de-escalation, i.e., trying to identify and rectify the behavioral trigger. If de-escalation is not successful, personal safety is paramount. Get away from the patient and get help. If a patient needs to be physically restrained, minimally there should be one staff member per limb. Various physical devices, including soft restraints, four-point leathers, hand mittens, and spit hoods may be used to control a violent patient. A violent restraint is characterized by the indication, not the device. Medications may be used to treat the underlying mental health issue and should not be used as PRN chemical restraints.

After a violent patient is safely restrained, further steps need to be taken, including notification of the attending or legal guardian if a minor; documentation of the event, including a debrief of what occurred; a room sweep to ensure securing any dangerous items (metal eating utensils); and modification of the care plan to strategize on removal of the restraints as soon as is safe.

Hospitals should view behavioral emergencies similarly to a Code Blue. Have a specialized team that responds and undergoes regular training.

Key Takeaways

1. Behavioral emergencies occur when a patient becomes violent.
2. De-escalation is the best response.
3. If not successful, maintain personal safety, control and medicate the patient as appropriate, and document clearly. TH

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Presenters: David Pressel, MD, PhD, FAAP, FHM, Emily Fingado, MD, FAAP, and Jessica Tomaszewski, MD, FAAP

Summary: Patients may engage in violent behaviors that pose a danger to themselves or others. Behavioral emergencies may be rare, can be dangerous, and staff may feel ill-trained to respond appropriately. Patients with ingestions, or underlying psychiatric or developmental difficulties, are at highest risk for developing a behavioral emergency.

The first strategy in handling a potentially violent patient is de-escalation, i.e., trying to identify and rectify the behavioral trigger. If de-escalation is not successful, personal safety is paramount. Get away from the patient and get help. If a patient needs to be physically restrained, minimally there should be one staff member per limb. Various physical devices, including soft restraints, four-point leathers, hand mittens, and spit hoods may be used to control a violent patient. A violent restraint is characterized by the indication, not the device. Medications may be used to treat the underlying mental health issue and should not be used as PRN chemical restraints.

After a violent patient is safely restrained, further steps need to be taken, including notification of the attending or legal guardian if a minor; documentation of the event, including a debrief of what occurred; a room sweep to ensure securing any dangerous items (metal eating utensils); and modification of the care plan to strategize on removal of the restraints as soon as is safe.

Hospitals should view behavioral emergencies similarly to a Code Blue. Have a specialized team that responds and undergoes regular training.

Key Takeaways

1. Behavioral emergencies occur when a patient becomes violent.
2. De-escalation is the best response.
3. If not successful, maintain personal safety, control and medicate the patient as appropriate, and document clearly. TH

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Steve Harris, Esq., legal columnist for The Hospitalist, explains the ins and outs of a hospitalist contract.

Steve Harris, Esq., legal columnist for The Hospitalist, explains the ins and outs of a hospitalist contract.

Steve Harris, Esq., legal columnist for The Hospitalist, explains the ins and outs of a hospitalist contract.

Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

• PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
• Supervision/collaboration, as defined by Medicare requirements.
• Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

• PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
• Supervision/collaboration, as defined by Medicare requirements.
• Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

• PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
• Supervision/collaboration, as defined by Medicare requirements.
• Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

Presenter: Julie Hollberg, MD

Summary: Dr. Julie Hollberg, the chief medical information officer for Emory Healthcare, presented an overview of three pressing health information technology (IT) concerns at Hospital Medicine 2016, the “Year of the Hospitalist.” These issues are the use of copy-and-paste functions in electronic charting, alert fatigue, and patient access to electronic charts.

Dr. Hollberg states the key to leveraging healthcare IT to improve the patient and clinician experience is to coordinate people, technology, and the process. She relates that electronic note quality is poor due to lost narratives, “note bloat” (unnecessary text and data), and the use of copy-and-paste.

However, hospitalists themselves are essential in improving documentation. “We have 100% control of what goes into the note,” she describes. Some 90% of residents and attendings use copy-and-paste often. Most of the physicians agree the use of copy-and-paste increases inconsistencies, but 80% of physicians desire to continue the practice. The need for copy-and-paste should decrease as EMRs advance and expectations of note content is more broadly communicated.

Alerts are designed to improve patient safety and are a Meaningful Use initiative. The goal of clinical decision support is to provide the right information to the right person at the right time. However alert fatigue is a concern. Recommendations to address alert fatigue include making alerts non-interruptive, tier basing the alerts by severity, and decreasing the frequency of drug interaction alerts.

Dr. Hollberg also described the benefits of patient access to healthcare information on web portals. These benefits lead to improved patient engagement. Most physician concerns about open access has not been seen in actual practice. For example, only 1-8% of patients say that access to notes causes confusion, worry, or offense.

Key Takeaways:

1. Use of copy-and-paste creates “note bloat” and inconsistencies. The practice is discouraged.
2. Patients prefer access to healthcare information on portals. The benefit to improved access is greater patient engagement.
3. While alert fatigue is a concern, clinicians should still read alerts! TH

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston and a former member of Team Hospitalist.

Presenter: Julie Hollberg, MD

Summary: Dr. Julie Hollberg, the chief medical information officer for Emory Healthcare, presented an overview of three pressing health information technology (IT) concerns at Hospital Medicine 2016, the “Year of the Hospitalist.” These issues are the use of copy-and-paste functions in electronic charting, alert fatigue, and patient access to electronic charts.

Dr. Hollberg states the key to leveraging healthcare IT to improve the patient and clinician experience is to coordinate people, technology, and the process. She relates that electronic note quality is poor due to lost narratives, “note bloat” (unnecessary text and data), and the use of copy-and-paste.

However, hospitalists themselves are essential in improving documentation. “We have 100% control of what goes into the note,” she describes. Some 90% of residents and attendings use copy-and-paste often. Most of the physicians agree the use of copy-and-paste increases inconsistencies, but 80% of physicians desire to continue the practice. The need for copy-and-paste should decrease as EMRs advance and expectations of note content is more broadly communicated.

Alerts are designed to improve patient safety and are a Meaningful Use initiative. The goal of clinical decision support is to provide the right information to the right person at the right time. However alert fatigue is a concern. Recommendations to address alert fatigue include making alerts non-interruptive, tier basing the alerts by severity, and decreasing the frequency of drug interaction alerts.

Dr. Hollberg also described the benefits of patient access to healthcare information on web portals. These benefits lead to improved patient engagement. Most physician concerns about open access has not been seen in actual practice. For example, only 1-8% of patients say that access to notes causes confusion, worry, or offense.

Key Takeaways:

1. Use of copy-and-paste creates “note bloat” and inconsistencies. The practice is discouraged.
2. Patients prefer access to healthcare information on portals. The benefit to improved access is greater patient engagement.
3. While alert fatigue is a concern, clinicians should still read alerts! TH

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston and a former member of Team Hospitalist.

Presenter: Julie Hollberg, MD

Summary: Dr. Julie Hollberg, the chief medical information officer for Emory Healthcare, presented an overview of three pressing health information technology (IT) concerns at Hospital Medicine 2016, the “Year of the Hospitalist.” These issues are the use of copy-and-paste functions in electronic charting, alert fatigue, and patient access to electronic charts.

Dr. Hollberg states the key to leveraging healthcare IT to improve the patient and clinician experience is to coordinate people, technology, and the process. She relates that electronic note quality is poor due to lost narratives, “note bloat” (unnecessary text and data), and the use of copy-and-paste.

However, hospitalists themselves are essential in improving documentation. “We have 100% control of what goes into the note,” she describes. Some 90% of residents and attendings use copy-and-paste often. Most of the physicians agree the use of copy-and-paste increases inconsistencies, but 80% of physicians desire to continue the practice. The need for copy-and-paste should decrease as EMRs advance and expectations of note content is more broadly communicated.

Alerts are designed to improve patient safety and are a Meaningful Use initiative. The goal of clinical decision support is to provide the right information to the right person at the right time. However alert fatigue is a concern. Recommendations to address alert fatigue include making alerts non-interruptive, tier basing the alerts by severity, and decreasing the frequency of drug interaction alerts.

Dr. Hollberg also described the benefits of patient access to healthcare information on web portals. These benefits lead to improved patient engagement. Most physician concerns about open access has not been seen in actual practice. For example, only 1-8% of patients say that access to notes causes confusion, worry, or offense.

Key Takeaways:

1. Use of copy-and-paste creates “note bloat” and inconsistencies. The practice is discouraged.
2. Patients prefer access to healthcare information on portals. The benefit to improved access is greater patient engagement.
3. While alert fatigue is a concern, clinicians should still read alerts! TH

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston and a former member of Team Hospitalist.

HM16 Presenters: Dr. Scott Rissmiller, Dr. Steve Deitelzweig, Dr. Jerome Siy, Dr. Thomas Mcllraith, and Dr. Michael Reitz

Summary: This session at #HospMed16 explored lessons learned from five hospitalist leaders across the country about improving hospitalist practice through enhancing hospitalist engagement, group communication, and leadership development. It was proposed that the “new” value equation is [Engagement * (quality/cost)] = Value. Engagement is the multiplier of value. The speakers highlighted the following:

Build a Plan : Approach engagement like any other business plan with metrics, accountability, and “S.M.A.R.T." goals.

Build Trust: Visibility breeds credibility. Credibility breeds Trust. Trust encourages Engagement.

Build Transparency: Keep communication simple and be sure that it’s helpful information.

Build Leaders: All hospitalists are leaders. Strong leadership skills promote effective communication across the system. Nurture leadership skills for the right level of leadership, to find the right seat on the bus.

Build Celebrations: Celebrate successes, and learn from failure. TH

HM16 Presenters: Dr. Scott Rissmiller, Dr. Steve Deitelzweig, Dr. Jerome Siy, Dr. Thomas Mcllraith, and Dr. Michael Reitz

Summary: This session at #HospMed16 explored lessons learned from five hospitalist leaders across the country about improving hospitalist practice through enhancing hospitalist engagement, group communication, and leadership development. It was proposed that the “new” value equation is [Engagement * (quality/cost)] = Value. Engagement is the multiplier of value. The speakers highlighted the following:

Build a Plan : Approach engagement like any other business plan with metrics, accountability, and “S.M.A.R.T." goals.

Build Trust: Visibility breeds credibility. Credibility breeds Trust. Trust encourages Engagement.

Build Transparency: Keep communication simple and be sure that it’s helpful information.

Build Leaders: All hospitalists are leaders. Strong leadership skills promote effective communication across the system. Nurture leadership skills for the right level of leadership, to find the right seat on the bus.

Build Celebrations: Celebrate successes, and learn from failure. TH

HM16 Presenters: Dr. Scott Rissmiller, Dr. Steve Deitelzweig, Dr. Jerome Siy, Dr. Thomas Mcllraith, and Dr. Michael Reitz

Summary: This session at #HospMed16 explored lessons learned from five hospitalist leaders across the country about improving hospitalist practice through enhancing hospitalist engagement, group communication, and leadership development. It was proposed that the “new” value equation is [Engagement * (quality/cost)] = Value. Engagement is the multiplier of value. The speakers highlighted the following:

Build a Plan : Approach engagement like any other business plan with metrics, accountability, and “S.M.A.R.T." goals.

Build Trust: Visibility breeds credibility. Credibility breeds Trust. Trust encourages Engagement.

Build Transparency: Keep communication simple and be sure that it’s helpful information.

Build Leaders: All hospitalists are leaders. Strong leadership skills promote effective communication across the system. Nurture leadership skills for the right level of leadership, to find the right seat on the bus.

Build Celebrations: Celebrate successes, and learn from failure. TH