Career

Clinical question: Does ICU strain negatively affect the outcomes of patients transferred to the floor?

Background: With healthcare costs increasing and critical care staff shortages projected, ICUs will have to operate under increasing strain. This may influence decisions on discharging patients from ICUs and could affect patient outcomes.

Study design: Retrospective cohort study.

Setting: One hundred fifty-five ICUs in the United States.

Synopsis: Using the Project IMPACT database, 200,730 adult patients from 107 different hospitals were evaluated in times of ICU strain, determined by the current census, new admissions, and acuity level. Outcomes measured were initial ICU length of stay (LOS), readmission within 72 hours, in-hospital mortality rates, and post-ICU discharge LOS.

Increases of the strain variables from the fifth to the 95th percentiles resulted in a 6.3-hour reduction in ICU LOS, a 2.0-hour decrease in post-ICU discharge LOS, and a 1.0% increase in probability of ICU readmission within 72 hours. Mortality rates during the hospital stay and odds of being discharged home showed no significant change. This study was limited because the ICUs participating were not randomly chosen, outcomes of patients transferred to other hospitals were not measured, and no post-hospital data was collected, so no long-term outcomes could be measured.

Bottom line: ICU bed pressures prompt physicians to allocate ICU resources more efficiently without changing short-term patient outcomes.

Citation: Wagner J, Gabler NB, Ratcliffe SJ, Brown SE, Strom BL, Halpern SD. Outcomes among patients discharged from busy intensive care units. Ann Intern Med. 2013;159(7):447-455.

 

Clinical question: Does ICU strain negatively affect the outcomes of patients transferred to the floor?

Background: With healthcare costs increasing and critical care staff shortages projected, ICUs will have to operate under increasing strain. This may influence decisions on discharging patients from ICUs and could affect patient outcomes.

Study design: Retrospective cohort study.

Setting: One hundred fifty-five ICUs in the United States.

Synopsis: Using the Project IMPACT database, 200,730 adult patients from 107 different hospitals were evaluated in times of ICU strain, determined by the current census, new admissions, and acuity level. Outcomes measured were initial ICU length of stay (LOS), readmission within 72 hours, in-hospital mortality rates, and post-ICU discharge LOS.

Increases of the strain variables from the fifth to the 95th percentiles resulted in a 6.3-hour reduction in ICU LOS, a 2.0-hour decrease in post-ICU discharge LOS, and a 1.0% increase in probability of ICU readmission within 72 hours. Mortality rates during the hospital stay and odds of being discharged home showed no significant change. This study was limited because the ICUs participating were not randomly chosen, outcomes of patients transferred to other hospitals were not measured, and no post-hospital data was collected, so no long-term outcomes could be measured.

Bottom line: ICU bed pressures prompt physicians to allocate ICU resources more efficiently without changing short-term patient outcomes.

Citation: Wagner J, Gabler NB, Ratcliffe SJ, Brown SE, Strom BL, Halpern SD. Outcomes among patients discharged from busy intensive care units. Ann Intern Med. 2013;159(7):447-455.

 

Clinical question: Does ICU strain negatively affect the outcomes of patients transferred to the floor?

Background: With healthcare costs increasing and critical care staff shortages projected, ICUs will have to operate under increasing strain. This may influence decisions on discharging patients from ICUs and could affect patient outcomes.

Study design: Retrospective cohort study.

Setting: One hundred fifty-five ICUs in the United States.

Synopsis: Using the Project IMPACT database, 200,730 adult patients from 107 different hospitals were evaluated in times of ICU strain, determined by the current census, new admissions, and acuity level. Outcomes measured were initial ICU length of stay (LOS), readmission within 72 hours, in-hospital mortality rates, and post-ICU discharge LOS.

Increases of the strain variables from the fifth to the 95th percentiles resulted in a 6.3-hour reduction in ICU LOS, a 2.0-hour decrease in post-ICU discharge LOS, and a 1.0% increase in probability of ICU readmission within 72 hours. Mortality rates during the hospital stay and odds of being discharged home showed no significant change. This study was limited because the ICUs participating were not randomly chosen, outcomes of patients transferred to other hospitals were not measured, and no post-hospital data was collected, so no long-term outcomes could be measured.

Bottom line: ICU bed pressures prompt physicians to allocate ICU resources more efficiently without changing short-term patient outcomes.

Citation: Wagner J, Gabler NB, Ratcliffe SJ, Brown SE, Strom BL, Halpern SD. Outcomes among patients discharged from busy intensive care units. Ann Intern Med. 2013;159(7):447-455.

 

This month in our issue, we look at the challenges and rewards of global health work. Hospitalist Dr. Brett Hendel-Paterson, who participates in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minnesota discusses how humility, curiosity, and hope are at the root of clinicians’ experiences in global health work, and the long-term commitment and social contract needed to do the job. Dr. Evan Lyon, head of the University of Chicago’s Global Hospital Medicine Fellowship program, shares how global health work has influenced his interactions with his patients.

For those attending the Society of Hospital Medicine’s annual conference, HM14, we offer tips on using the HM14 In Hand mobile app to navigate the courses, events, and must-sees at this year’s convention.

Also in this issue, we look at what makes a hospital medicine group effective, offer Dr. Win Whitcomb’s primer on the relative value unit and its place in the shift from volume-to-value reimbursement, look at CMS’s efforts to increase participation in the physician quality reporting system, and our Key Clinical Question covers which patients undergoing gastrointestinal endoscopic procedures should receive antibiotic prophylaxis.

Click here to listen to the March highlights podcast.

 

This month in our issue, we look at the challenges and rewards of global health work. Hospitalist Dr. Brett Hendel-Paterson, who participates in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minnesota discusses how humility, curiosity, and hope are at the root of clinicians’ experiences in global health work, and the long-term commitment and social contract needed to do the job. Dr. Evan Lyon, head of the University of Chicago’s Global Hospital Medicine Fellowship program, shares how global health work has influenced his interactions with his patients.

For those attending the Society of Hospital Medicine’s annual conference, HM14, we offer tips on using the HM14 In Hand mobile app to navigate the courses, events, and must-sees at this year’s convention.

Also in this issue, we look at what makes a hospital medicine group effective, offer Dr. Win Whitcomb’s primer on the relative value unit and its place in the shift from volume-to-value reimbursement, look at CMS’s efforts to increase participation in the physician quality reporting system, and our Key Clinical Question covers which patients undergoing gastrointestinal endoscopic procedures should receive antibiotic prophylaxis.

Click here to listen to the March highlights podcast.

 

This month in our issue, we look at the challenges and rewards of global health work. Hospitalist Dr. Brett Hendel-Paterson, who participates in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minnesota discusses how humility, curiosity, and hope are at the root of clinicians’ experiences in global health work, and the long-term commitment and social contract needed to do the job. Dr. Evan Lyon, head of the University of Chicago’s Global Hospital Medicine Fellowship program, shares how global health work has influenced his interactions with his patients.

For those attending the Society of Hospital Medicine’s annual conference, HM14, we offer tips on using the HM14 In Hand mobile app to navigate the courses, events, and must-sees at this year’s convention.

Also in this issue, we look at what makes a hospital medicine group effective, offer Dr. Win Whitcomb’s primer on the relative value unit and its place in the shift from volume-to-value reimbursement, look at CMS’s efforts to increase participation in the physician quality reporting system, and our Key Clinical Question covers which patients undergoing gastrointestinal endoscopic procedures should receive antibiotic prophylaxis.

Click here to listen to the March highlights podcast.

 

A Journal of Hospital Medicine study billed as the first of its kind found that patients who had received chronic opioid therapy (COT) in the six months prior to admission were more likely to either die in the hospital within 30 days or be readmitted.

The report, "Prevalence and Characteristics of Hospitalized Adults on Chronic Opioid Therapy," found that after adjustments, COT was associated with higher rates of hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.10–1.20) and death (OR: 1.19, 95% CI: 1.10–1.29). The observational study—conducted on veterans with acute medical conditions admitted to Veterans Administration hospitals between 2009 and 2011—found that 25.9% had received COT in the six months prior to admission.

Hospitalist and lead author Hilary Mosher, MD, of the Iowa City Veterans Affairs Health Care System in Des Moines, says that as COT use increases and the HM model expands, hospitalists should know more about how to treat these patients. "I can't imagine being a hospitalist practicing anywhere in the United States and not seeing these patients on a fairly regular basis," she adds.

Dr. Mosher says hospitalists could view COT similar to diabetes: while chronic pain is a condition managed primarily on an outpatient basis, hospitalists might see better outcomes if they address it as a condition that "affects how we care for patients during the inpatient stay." To that end, she is surprised that this study is the first to report the prevalence of, and characteristics associated with, prior opioid use among inpatients.

"We can't make claims [from this study] to answer [the question of] if we are over-treating or under-treating pain during the hospital stay," Dr. Mosher adds. "One of the really interesting things I'm looking forward to finding out is how will people respond to the idea that...chronic pain is a disease where what we do during the hospital stay matters to the eventual course."

Visit our website for more information on hospitalists and chronic pain management.

A Journal of Hospital Medicine study billed as the first of its kind found that patients who had received chronic opioid therapy (COT) in the six months prior to admission were more likely to either die in the hospital within 30 days or be readmitted.

The report, "Prevalence and Characteristics of Hospitalized Adults on Chronic Opioid Therapy," found that after adjustments, COT was associated with higher rates of hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.10–1.20) and death (OR: 1.19, 95% CI: 1.10–1.29). The observational study—conducted on veterans with acute medical conditions admitted to Veterans Administration hospitals between 2009 and 2011—found that 25.9% had received COT in the six months prior to admission.

Hospitalist and lead author Hilary Mosher, MD, of the Iowa City Veterans Affairs Health Care System in Des Moines, says that as COT use increases and the HM model expands, hospitalists should know more about how to treat these patients. "I can't imagine being a hospitalist practicing anywhere in the United States and not seeing these patients on a fairly regular basis," she adds.

Dr. Mosher says hospitalists could view COT similar to diabetes: while chronic pain is a condition managed primarily on an outpatient basis, hospitalists might see better outcomes if they address it as a condition that "affects how we care for patients during the inpatient stay." To that end, she is surprised that this study is the first to report the prevalence of, and characteristics associated with, prior opioid use among inpatients.

"We can't make claims [from this study] to answer [the question of] if we are over-treating or under-treating pain during the hospital stay," Dr. Mosher adds. "One of the really interesting things I'm looking forward to finding out is how will people respond to the idea that...chronic pain is a disease where what we do during the hospital stay matters to the eventual course."

Visit our website for more information on hospitalists and chronic pain management.

A Journal of Hospital Medicine study billed as the first of its kind found that patients who had received chronic opioid therapy (COT) in the six months prior to admission were more likely to either die in the hospital within 30 days or be readmitted.

The report, "Prevalence and Characteristics of Hospitalized Adults on Chronic Opioid Therapy," found that after adjustments, COT was associated with higher rates of hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.10–1.20) and death (OR: 1.19, 95% CI: 1.10–1.29). The observational study—conducted on veterans with acute medical conditions admitted to Veterans Administration hospitals between 2009 and 2011—found that 25.9% had received COT in the six months prior to admission.

Hospitalist and lead author Hilary Mosher, MD, of the Iowa City Veterans Affairs Health Care System in Des Moines, says that as COT use increases and the HM model expands, hospitalists should know more about how to treat these patients. "I can't imagine being a hospitalist practicing anywhere in the United States and not seeing these patients on a fairly regular basis," she adds.

Dr. Mosher says hospitalists could view COT similar to diabetes: while chronic pain is a condition managed primarily on an outpatient basis, hospitalists might see better outcomes if they address it as a condition that "affects how we care for patients during the inpatient stay." To that end, she is surprised that this study is the first to report the prevalence of, and characteristics associated with, prior opioid use among inpatients.

"We can't make claims [from this study] to answer [the question of] if we are over-treating or under-treating pain during the hospital stay," Dr. Mosher adds. "One of the really interesting things I'm looking forward to finding out is how will people respond to the idea that...chronic pain is a disease where what we do during the hospital stay matters to the eventual course."

Visit our website for more information on hospitalists and chronic pain management.

Hospitalists have little choice but to wait and see when it comes to the release by Medicare of information on how much it pays doctors, according to an SHM committee member.

The decision [PDF] by the Centers for Medicare & Medicaid Service (CMS) to release the data starting in mid-March was long in the making and is aimed at "making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries," the agency notes on its website.

CMS will respond to individual Freedom of Information Act requests for physician-payment data and generate aggregate data sets regarding Medicare physician services for the public. The agency will make case-by-base decisions on whether to release data and will "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information," according to a notice [PDF] issued last January.

"It all boils down to how the information is released and how the information is going to be interpreted," says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. "Generally, most physician groups are supportive of improving access to information…but that's bounded by having context and privacy issues addressed."

In a letter to Congress [PDF], SHM, the American Medical Association, and others have cautioned that the balancing act is a tricky procedure that must take into account the privacy concerns of both patients and physicians. Dr. Lenchus adds that he is skeptical of creating rules to govern the release of information after announcing the intention to release it.

"It tends to make me feel like the horse is already out of the barn, and now we're going to try to corral him back in to some degree," he says. "The case-by-case standard with which they say they are evaluating the [requests] makes sense, but they haven't really defined what their balancing act will be…if there's fraud, waste, and abuse found, it should, of course, be rooted out, but it's tough to root out that abuse just based on the highest-paid cardiologist in your area."

Visit our website for more information on Medicare payment reform.

 

Hospitalists have little choice but to wait and see when it comes to the release by Medicare of information on how much it pays doctors, according to an SHM committee member.

The decision [PDF] by the Centers for Medicare & Medicaid Service (CMS) to release the data starting in mid-March was long in the making and is aimed at "making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries," the agency notes on its website.

CMS will respond to individual Freedom of Information Act requests for physician-payment data and generate aggregate data sets regarding Medicare physician services for the public. The agency will make case-by-base decisions on whether to release data and will "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information," according to a notice [PDF] issued last January.

"It all boils down to how the information is released and how the information is going to be interpreted," says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. "Generally, most physician groups are supportive of improving access to information…but that's bounded by having context and privacy issues addressed."

In a letter to Congress [PDF], SHM, the American Medical Association, and others have cautioned that the balancing act is a tricky procedure that must take into account the privacy concerns of both patients and physicians. Dr. Lenchus adds that he is skeptical of creating rules to govern the release of information after announcing the intention to release it.

"It tends to make me feel like the horse is already out of the barn, and now we're going to try to corral him back in to some degree," he says. "The case-by-case standard with which they say they are evaluating the [requests] makes sense, but they haven't really defined what their balancing act will be…if there's fraud, waste, and abuse found, it should, of course, be rooted out, but it's tough to root out that abuse just based on the highest-paid cardiologist in your area."

Visit our website for more information on Medicare payment reform.

 

Hospitalists have little choice but to wait and see when it comes to the release by Medicare of information on how much it pays doctors, according to an SHM committee member.

The decision [PDF] by the Centers for Medicare & Medicaid Service (CMS) to release the data starting in mid-March was long in the making and is aimed at "making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries," the agency notes on its website.

CMS will respond to individual Freedom of Information Act requests for physician-payment data and generate aggregate data sets regarding Medicare physician services for the public. The agency will make case-by-base decisions on whether to release data and will "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information," according to a notice [PDF] issued last January.

"It all boils down to how the information is released and how the information is going to be interpreted," says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. "Generally, most physician groups are supportive of improving access to information…but that's bounded by having context and privacy issues addressed."

In a letter to Congress [PDF], SHM, the American Medical Association, and others have cautioned that the balancing act is a tricky procedure that must take into account the privacy concerns of both patients and physicians. Dr. Lenchus adds that he is skeptical of creating rules to govern the release of information after announcing the intention to release it.

"It tends to make me feel like the horse is already out of the barn, and now we're going to try to corral him back in to some degree," he says. "The case-by-case standard with which they say they are evaluating the [requests] makes sense, but they haven't really defined what their balancing act will be…if there's fraud, waste, and abuse found, it should, of course, be rooted out, but it's tough to root out that abuse just based on the highest-paid cardiologist in your area."

Visit our website for more information on Medicare payment reform.

 

HM MOVERS AND SHAKERS

John Colombo, MD, received the 2013 Horace Furness Taylor Physician Service Excellence Award from Taylor Hospital in Ridley Park, Pa. Dr. Colombo is an SHM member and chief of hospital medicine for Crozer-Keystone Health System based in Springfield, Pa. He has been on staff at Taylor Hospital since 1985.

 

 

Ron Greeno, MD, MHM, FCCP, is the new executive vice president of strategy and innovation for Brentwood, Tenn.-based Cogent Healthcare. Dr. Greeno is a founding member of SHM and Cogent, and he previously served as Cogent’s chief medical officer. He also currently serves as a senior consultant for The Cogent Group and as chair of SHM’s Public Policy Committee.

 

 

Anne Whitis, MD, received the 2013 Most Valuable Provider award from Mahaska Health Partnership (MHP) in Oskaloosa, Iowa. Dr. Whitis is medical director of the MHP hospitalist program. She also mentors medical students and volunteers at the Oskaloosa Free Clinic.

 

 

Geoffrey Lamb, MD, received a Learning Health System Planning Award from the Association of American Medical Colleges based in Washington, D.C. Dr. Lamb is a professor of medicine and the section chief of hospital medicine in the general internal medicine division at the Medical College of Wisconsin (MCW) in Milwaukee. Dr. Lamb also serves as associate director of the joint quality office for Froedtert Hospital and MCW.

 

 

Evangeline Gutierrez, MD, FHM, is the new medical director of hospitalist service for Summit Medical Group at Morristown (N.J.) Medical Center. Dr. Gutierrez previously served as medical director of Inpatient Medical Associates in Parsippany, N.J., and practiced at Overlook Medical Center for more than 10 years.

Business Moves

Sound Physicians, based in Tacoma, Wash., is now providing hospitalist services at both Christus Santa Rosa Health System in San Antonio, Texas, and John Peter Smith Hospital in Fort Worth, Texas. Christus Santa Rosa consists of four acute care hospitals, the Children’s Hospital of San Antonio, and several outpatient clinics and emergency centers in the greater San Antonio area. John Peter Smith Hospital is a 537-bed trauma center serving the central Fort Worth area.

IPC The Hospitalist Company, based in North Hollywood, Calif., has acquired the practice groups of Bruce G. Johnson, DO, PC, in Roseville, Mich.; Allen Trager, DO, PC, in Flint, Mich.; and Victor Toledano, MD, PA, in Ft. Lauderdale, Fla. IPC also completed its acquisition of Park Avenue Health Care Management, LLC; Park Avenue Medical Associates, PC; Park Avenue Medical Associates, LLC; and Geriatric Services, PC, (collectively, “Park Avenue”), all based in White Plains, N.Y. IPC now provides hospitalist services in 28 states.

Heart of Lancaster Regional Medical Center in Lititz, Pa., is now providing pediatric hospitalist services. Initially, the program will staff six pediatric hospitalists at the 148-bed facility. The facility joins Lancaster General Hospital as the second in the county to provide pediatric hospital medicine services.

Morthland College Health Services (MCHS) in West Frankfort, Ill., has assumed coverage of hospitalist services at Harrisburg Medical Center (HMC) in Harrisburg, Ill. MCHS already provides hospital medicine services at Franklin Hospital in Benton, Ill. Morthland College is a small liberal arts college founded in 2009. Harrisburg Medical Center is a 98-bed acute care hospital serving greater Saline County, Ill.

The Ob Hospitalist Group (OBHG), based in Mauldin, S.C., is providing services to Bayhealth Milford Memorial Hospital in Milford, Del. Milford Memorial has served communities in the Milford area since 1938. OBHG provides inpatient OB/GYN services to nearly 50 hospitals and clinics nationwide.

 

St. Alexius Medical Center in Bismarck, N.D., has partnered with the University of North Dakota to institute a new hospitalist fellowship program in North Dakota. The one-year program is the first of its kind in North Dakota.

HM MOVERS AND SHAKERS

John Colombo, MD, received the 2013 Horace Furness Taylor Physician Service Excellence Award from Taylor Hospital in Ridley Park, Pa. Dr. Colombo is an SHM member and chief of hospital medicine for Crozer-Keystone Health System based in Springfield, Pa. He has been on staff at Taylor Hospital since 1985.

 

 

Ron Greeno, MD, MHM, FCCP, is the new executive vice president of strategy and innovation for Brentwood, Tenn.-based Cogent Healthcare. Dr. Greeno is a founding member of SHM and Cogent, and he previously served as Cogent’s chief medical officer. He also currently serves as a senior consultant for The Cogent Group and as chair of SHM’s Public Policy Committee.

 

 

Anne Whitis, MD, received the 2013 Most Valuable Provider award from Mahaska Health Partnership (MHP) in Oskaloosa, Iowa. Dr. Whitis is medical director of the MHP hospitalist program. She also mentors medical students and volunteers at the Oskaloosa Free Clinic.

 

 

Geoffrey Lamb, MD, received a Learning Health System Planning Award from the Association of American Medical Colleges based in Washington, D.C. Dr. Lamb is a professor of medicine and the section chief of hospital medicine in the general internal medicine division at the Medical College of Wisconsin (MCW) in Milwaukee. Dr. Lamb also serves as associate director of the joint quality office for Froedtert Hospital and MCW.

 

 

Evangeline Gutierrez, MD, FHM, is the new medical director of hospitalist service for Summit Medical Group at Morristown (N.J.) Medical Center. Dr. Gutierrez previously served as medical director of Inpatient Medical Associates in Parsippany, N.J., and practiced at Overlook Medical Center for more than 10 years.

Business Moves

Sound Physicians, based in Tacoma, Wash., is now providing hospitalist services at both Christus Santa Rosa Health System in San Antonio, Texas, and John Peter Smith Hospital in Fort Worth, Texas. Christus Santa Rosa consists of four acute care hospitals, the Children’s Hospital of San Antonio, and several outpatient clinics and emergency centers in the greater San Antonio area. John Peter Smith Hospital is a 537-bed trauma center serving the central Fort Worth area.

IPC The Hospitalist Company, based in North Hollywood, Calif., has acquired the practice groups of Bruce G. Johnson, DO, PC, in Roseville, Mich.; Allen Trager, DO, PC, in Flint, Mich.; and Victor Toledano, MD, PA, in Ft. Lauderdale, Fla. IPC also completed its acquisition of Park Avenue Health Care Management, LLC; Park Avenue Medical Associates, PC; Park Avenue Medical Associates, LLC; and Geriatric Services, PC, (collectively, “Park Avenue”), all based in White Plains, N.Y. IPC now provides hospitalist services in 28 states.

Heart of Lancaster Regional Medical Center in Lititz, Pa., is now providing pediatric hospitalist services. Initially, the program will staff six pediatric hospitalists at the 148-bed facility. The facility joins Lancaster General Hospital as the second in the county to provide pediatric hospital medicine services.

Morthland College Health Services (MCHS) in West Frankfort, Ill., has assumed coverage of hospitalist services at Harrisburg Medical Center (HMC) in Harrisburg, Ill. MCHS already provides hospital medicine services at Franklin Hospital in Benton, Ill. Morthland College is a small liberal arts college founded in 2009. Harrisburg Medical Center is a 98-bed acute care hospital serving greater Saline County, Ill.

The Ob Hospitalist Group (OBHG), based in Mauldin, S.C., is providing services to Bayhealth Milford Memorial Hospital in Milford, Del. Milford Memorial has served communities in the Milford area since 1938. OBHG provides inpatient OB/GYN services to nearly 50 hospitals and clinics nationwide.

 

St. Alexius Medical Center in Bismarck, N.D., has partnered with the University of North Dakota to institute a new hospitalist fellowship program in North Dakota. The one-year program is the first of its kind in North Dakota.

HM MOVERS AND SHAKERS

John Colombo, MD, received the 2013 Horace Furness Taylor Physician Service Excellence Award from Taylor Hospital in Ridley Park, Pa. Dr. Colombo is an SHM member and chief of hospital medicine for Crozer-Keystone Health System based in Springfield, Pa. He has been on staff at Taylor Hospital since 1985.

 

 

Ron Greeno, MD, MHM, FCCP, is the new executive vice president of strategy and innovation for Brentwood, Tenn.-based Cogent Healthcare. Dr. Greeno is a founding member of SHM and Cogent, and he previously served as Cogent’s chief medical officer. He also currently serves as a senior consultant for The Cogent Group and as chair of SHM’s Public Policy Committee.

 

 

Anne Whitis, MD, received the 2013 Most Valuable Provider award from Mahaska Health Partnership (MHP) in Oskaloosa, Iowa. Dr. Whitis is medical director of the MHP hospitalist program. She also mentors medical students and volunteers at the Oskaloosa Free Clinic.

 

 

Geoffrey Lamb, MD, received a Learning Health System Planning Award from the Association of American Medical Colleges based in Washington, D.C. Dr. Lamb is a professor of medicine and the section chief of hospital medicine in the general internal medicine division at the Medical College of Wisconsin (MCW) in Milwaukee. Dr. Lamb also serves as associate director of the joint quality office for Froedtert Hospital and MCW.

 

 

Evangeline Gutierrez, MD, FHM, is the new medical director of hospitalist service for Summit Medical Group at Morristown (N.J.) Medical Center. Dr. Gutierrez previously served as medical director of Inpatient Medical Associates in Parsippany, N.J., and practiced at Overlook Medical Center for more than 10 years.

Business Moves

Sound Physicians, based in Tacoma, Wash., is now providing hospitalist services at both Christus Santa Rosa Health System in San Antonio, Texas, and John Peter Smith Hospital in Fort Worth, Texas. Christus Santa Rosa consists of four acute care hospitals, the Children’s Hospital of San Antonio, and several outpatient clinics and emergency centers in the greater San Antonio area. John Peter Smith Hospital is a 537-bed trauma center serving the central Fort Worth area.

IPC The Hospitalist Company, based in North Hollywood, Calif., has acquired the practice groups of Bruce G. Johnson, DO, PC, in Roseville, Mich.; Allen Trager, DO, PC, in Flint, Mich.; and Victor Toledano, MD, PA, in Ft. Lauderdale, Fla. IPC also completed its acquisition of Park Avenue Health Care Management, LLC; Park Avenue Medical Associates, PC; Park Avenue Medical Associates, LLC; and Geriatric Services, PC, (collectively, “Park Avenue”), all based in White Plains, N.Y. IPC now provides hospitalist services in 28 states.

Heart of Lancaster Regional Medical Center in Lititz, Pa., is now providing pediatric hospitalist services. Initially, the program will staff six pediatric hospitalists at the 148-bed facility. The facility joins Lancaster General Hospital as the second in the county to provide pediatric hospital medicine services.

Morthland College Health Services (MCHS) in West Frankfort, Ill., has assumed coverage of hospitalist services at Harrisburg Medical Center (HMC) in Harrisburg, Ill. MCHS already provides hospital medicine services at Franklin Hospital in Benton, Ill. Morthland College is a small liberal arts college founded in 2009. Harrisburg Medical Center is a 98-bed acute care hospital serving greater Saline County, Ill.

The Ob Hospitalist Group (OBHG), based in Mauldin, S.C., is providing services to Bayhealth Milford Memorial Hospital in Milford, Del. Milford Memorial has served communities in the Milford area since 1938. OBHG provides inpatient OB/GYN services to nearly 50 hospitals and clinics nationwide.

 

St. Alexius Medical Center in Bismarck, N.D., has partnered with the University of North Dakota to institute a new hospitalist fellowship program in North Dakota. The one-year program is the first of its kind in North Dakota.

SHM’s Project BOOST is accepting applications for its 2014 cohort, giving hospitalists and hospital-based team members time to complete the application and receive buy-in from hospital executives to participate in the program.

And this year is the best year yet to make the case to hospital leadership for using Project BOOST to reduce hospital readmissions. More than 180 hospitals throughout the U.S. have used Project BOOST to systematically tackle readmissions.

Last year, the first peer-reviewed research on Project BOOST, published in the Journal of Hospital Medicine, showed that the program reduced 30-day readmissions to 12.7% from 14.7% among 11 hospitals participating in the study. In addition, media and government agencies taking a hard look at readmissions rates have also used Project BOOST as an example of programs that can reduce readmissions and avoid Medicare penalties.¹

Accepted Project BOOST sites begin the yearlong program with an in-person training conference with other BOOST sites. After the training, participants utilize a comprehensive toolkit to begin implementing their own programs, followed by ongoing mentoring with national experts in reducing readmissions and collaboration with other hospitals tackling similar challenges.

Details, educational resources, and free on-demand webinars are available at www.hospitalmedicine.org/projectboost.

---

Brendon Shank is SHM’s associate vice president of communications.

Reference

1. James J. Medicare hospital readmissions reduction program. Health Affairs website. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102. Published November 12, 2013. Accessed January 31, 2014.

SHM’s Project BOOST is accepting applications for its 2014 cohort, giving hospitalists and hospital-based team members time to complete the application and receive buy-in from hospital executives to participate in the program.

And this year is the best year yet to make the case to hospital leadership for using Project BOOST to reduce hospital readmissions. More than 180 hospitals throughout the U.S. have used Project BOOST to systematically tackle readmissions.

Last year, the first peer-reviewed research on Project BOOST, published in the Journal of Hospital Medicine, showed that the program reduced 30-day readmissions to 12.7% from 14.7% among 11 hospitals participating in the study. In addition, media and government agencies taking a hard look at readmissions rates have also used Project BOOST as an example of programs that can reduce readmissions and avoid Medicare penalties.¹

Accepted Project BOOST sites begin the yearlong program with an in-person training conference with other BOOST sites. After the training, participants utilize a comprehensive toolkit to begin implementing their own programs, followed by ongoing mentoring with national experts in reducing readmissions and collaboration with other hospitals tackling similar challenges.

Details, educational resources, and free on-demand webinars are available at www.hospitalmedicine.org/projectboost.

---

Brendon Shank is SHM’s associate vice president of communications.

Reference

1. James J. Medicare hospital readmissions reduction program. Health Affairs website. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102. Published November 12, 2013. Accessed January 31, 2014.

SHM’s Project BOOST is accepting applications for its 2014 cohort, giving hospitalists and hospital-based team members time to complete the application and receive buy-in from hospital executives to participate in the program.

And this year is the best year yet to make the case to hospital leadership for using Project BOOST to reduce hospital readmissions. More than 180 hospitals throughout the U.S. have used Project BOOST to systematically tackle readmissions.

Last year, the first peer-reviewed research on Project BOOST, published in the Journal of Hospital Medicine, showed that the program reduced 30-day readmissions to 12.7% from 14.7% among 11 hospitals participating in the study. In addition, media and government agencies taking a hard look at readmissions rates have also used Project BOOST as an example of programs that can reduce readmissions and avoid Medicare penalties.¹

Accepted Project BOOST sites begin the yearlong program with an in-person training conference with other BOOST sites. After the training, participants utilize a comprehensive toolkit to begin implementing their own programs, followed by ongoing mentoring with national experts in reducing readmissions and collaboration with other hospitals tackling similar challenges.

Details, educational resources, and free on-demand webinars are available at www.hospitalmedicine.org/projectboost.

---

Brendon Shank is SHM’s associate vice president of communications.

Reference

1. James J. Medicare hospital readmissions reduction program. Health Affairs website. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102. Published November 12, 2013. Accessed January 31, 2014.

Clinical question: What antibiotic-resistant bacteria are the greatest threats for the next 10 years?

Background: Two million people suffer antibiotic-resistant infections yearly, and 23,000 die each year as a result. Most of these infections occur in the community, but deaths usually occur in healthcare settings. Cost estimates vary but may be as high as $20 billion in excess direct healthcare costs.

Study design: The CDC used several different surveys and databanks, including the National Antimicrobial Resistance Monitoring System, to collect data. The threat level for antibiotic-resistant bacteria was determined using several factors: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Setting: United States.

Synopsis: The CDC has three classifications of antibiotic-resistant bacteria: urgent, serious, and concerning. Urgent threats are high-consequence, antibiotic-resistant threats because of significant risks identified across several criteria. These threats might not currently be widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. They include carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and Clostridium difficile (does not have true resistance, but is a consequence of antibiotic overuse).

Serious threats are significant antibiotic-resistant threats. These threats will worsen, and might become urgent without ongoing public health monitoring and prevention activities. They include multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida (a fungus), extended-spectrum ß-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhimurium, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumonia, and drug-resistant tuberculosis.

Concerning threats are bacteria for which the threat of antibiotic resistance is low, and/or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness.

Threats in this category require monitoring and, in some cases, rapid incident or outbreak response. These include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus.

Research has shown patients with resistant infections have significantly longer hospital stays, delayed recuperation, long-term disability, and higher mortality. As resistance to current antibiotics occurs, providers are forced to use antibiotics that are more toxic, more expensive, and less effective.

The CDC recommends four core actions to fight antibiotic resistance:

• Preventing infections from occurring and preventing resistant bacteria from spreading (immunization, infection control, screening, treatment, and education);
• Tracking resistant bacteria;
• Improving the use of antibiotics (antibiotic stewardship); and
• Promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.

Bottom line: Antibiotics are a limited resource. The more antibiotics are used today, the less likely they will continue to be effective in the future. The CDC lists 18 antibiotic-resistant organisms as urgent, serious, or concerning and recommends actions to combat the spread of current organisms and emergence of new antibiotic organisms.

Citation: Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. CDC website. September 16, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed Nov. 30, 2013.

Clinical question: What antibiotic-resistant bacteria are the greatest threats for the next 10 years?

Background: Two million people suffer antibiotic-resistant infections yearly, and 23,000 die each year as a result. Most of these infections occur in the community, but deaths usually occur in healthcare settings. Cost estimates vary but may be as high as $20 billion in excess direct healthcare costs.

Study design: The CDC used several different surveys and databanks, including the National Antimicrobial Resistance Monitoring System, to collect data. The threat level for antibiotic-resistant bacteria was determined using several factors: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Setting: United States.

Synopsis: The CDC has three classifications of antibiotic-resistant bacteria: urgent, serious, and concerning. Urgent threats are high-consequence, antibiotic-resistant threats because of significant risks identified across several criteria. These threats might not currently be widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. They include carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and Clostridium difficile (does not have true resistance, but is a consequence of antibiotic overuse).

Serious threats are significant antibiotic-resistant threats. These threats will worsen, and might become urgent without ongoing public health monitoring and prevention activities. They include multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida (a fungus), extended-spectrum ß-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhimurium, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumonia, and drug-resistant tuberculosis.

Concerning threats are bacteria for which the threat of antibiotic resistance is low, and/or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness.

Threats in this category require monitoring and, in some cases, rapid incident or outbreak response. These include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus.

Research has shown patients with resistant infections have significantly longer hospital stays, delayed recuperation, long-term disability, and higher mortality. As resistance to current antibiotics occurs, providers are forced to use antibiotics that are more toxic, more expensive, and less effective.

The CDC recommends four core actions to fight antibiotic resistance:

• Preventing infections from occurring and preventing resistant bacteria from spreading (immunization, infection control, screening, treatment, and education);
• Tracking resistant bacteria;
• Improving the use of antibiotics (antibiotic stewardship); and
• Promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.

Bottom line: Antibiotics are a limited resource. The more antibiotics are used today, the less likely they will continue to be effective in the future. The CDC lists 18 antibiotic-resistant organisms as urgent, serious, or concerning and recommends actions to combat the spread of current organisms and emergence of new antibiotic organisms.

Citation: Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. CDC website. September 16, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed Nov. 30, 2013.

Clinical question: What antibiotic-resistant bacteria are the greatest threats for the next 10 years?

Background: Two million people suffer antibiotic-resistant infections yearly, and 23,000 die each year as a result. Most of these infections occur in the community, but deaths usually occur in healthcare settings. Cost estimates vary but may be as high as $20 billion in excess direct healthcare costs.

Study design: The CDC used several different surveys and databanks, including the National Antimicrobial Resistance Monitoring System, to collect data. The threat level for antibiotic-resistant bacteria was determined using several factors: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.

Setting: United States.

Synopsis: The CDC has three classifications of antibiotic-resistant bacteria: urgent, serious, and concerning. Urgent threats are high-consequence, antibiotic-resistant threats because of significant risks identified across several criteria. These threats might not currently be widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. They include carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and Clostridium difficile (does not have true resistance, but is a consequence of antibiotic overuse).

Serious threats are significant antibiotic-resistant threats. These threats will worsen, and might become urgent without ongoing public health monitoring and prevention activities. They include multidrug-resistant Acinetobacter, drug-resistant Campylobacter, fluconazole-resistant Candida (a fungus), extended-spectrum ß-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa, drug-resistant non-typhoidal Salmonella, drug-resistant Salmonella Typhimurium, drug-resistant Shigella, methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumonia, and drug-resistant tuberculosis.

Concerning threats are bacteria for which the threat of antibiotic resistance is low, and/or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness.

Threats in this category require monitoring and, in some cases, rapid incident or outbreak response. These include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus, and clindamycin-resistant Group B Streptococcus.

Research has shown patients with resistant infections have significantly longer hospital stays, delayed recuperation, long-term disability, and higher mortality. As resistance to current antibiotics occurs, providers are forced to use antibiotics that are more toxic, more expensive, and less effective.

The CDC recommends four core actions to fight antibiotic resistance:

• Preventing infections from occurring and preventing resistant bacteria from spreading (immunization, infection control, screening, treatment, and education);
• Tracking resistant bacteria;
• Improving the use of antibiotics (antibiotic stewardship); and
• Promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.

Bottom line: Antibiotics are a limited resource. The more antibiotics are used today, the less likely they will continue to be effective in the future. The CDC lists 18 antibiotic-resistant organisms as urgent, serious, or concerning and recommends actions to combat the spread of current organisms and emergence of new antibiotic organisms.

Citation: Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. CDC website. September 16, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed Nov. 30, 2013.

A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.

In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]; unit-level performance reports; and unit co-management by nurse and physician directors.

Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.

"Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together," says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.

According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.

Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.

Visit our website for more information about improving inpatient care coordination.

 

 

A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.

In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]; unit-level performance reports; and unit co-management by nurse and physician directors.

Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.

"Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together," says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.

According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.

Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.

Visit our website for more information about improving inpatient care coordination.

 

 

A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.

In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]; unit-level performance reports; and unit co-management by nurse and physician directors.

Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.

"Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together," says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.

According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.

Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.

Visit our website for more information about improving inpatient care coordination.

 

 

How's this for a quality-improvement success story? In 2011, three Minnesota-based institutions—the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association, and Stratis Health—launched the Reducing Avoidable Readmissions Effectively (RARE) campaign to reduce avoidable hospital readmissions across the state. So far, the campaign's 82 participating hospitals and 100 community partners have prevented 6,211 readmissions between Jan. 1, 2011 and June 30, 2013.

The efforts were recognized last month when RARE was named a recipient of the 2013 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality.

Launched in 2002 by National Quality Forum and Joint Commission, the award honors John M. Eisenberg, MD, MBA, a former administrator of the Agency for Healthcare Research and Quality and an advocate for patient safety and healthcare quality. SHM won the John M. Eisenberg Innovation in Patient Safety and Quality award in 2011 for its mentored-implementation program.

According to ICSI project manager Kathy Cummins, RN, MA, hospitals involved in RARE aren't given specific instructions on how to reduce readmissions, but are encouraged to focus their efforts on these areas:

Comprehensive discharge planning;

Medication management;

Patient and family engagement;

Transition-care support; and

Transition communications.

While the campaign provides guidance and technical support, each hospital comes up with its own strategies for achieving these goals. Ms. Cummins, for example, describes how one hospital that was tasked with reducing readmissions without adding staff had paramedics use their downtime to visit recently discharged patients. The paramedics now check in to see if patients are exhibiting warning signs of illness and make sure they’re taking their prescribed medications.

SHM board member Howard Epstein, MD, FHM, ICSI's chief health systems officer, says the RARE campaign targets issues hospitalists have long struggled with.

"Hospitalists don't want to see their patients readmitted to the hospital," Dr. Epstein says. "It doesn't look good on their part, and it's not the best thing for their patients. The [RARE] campaign galvanized the system to support what hospitalists have been demanding for many years."

Stephanie C. Mackiewicz is a freelance author in California.

Visit our website for more information about the RARE campaign.

 

How's this for a quality-improvement success story? In 2011, three Minnesota-based institutions—the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association, and Stratis Health—launched the Reducing Avoidable Readmissions Effectively (RARE) campaign to reduce avoidable hospital readmissions across the state. So far, the campaign's 82 participating hospitals and 100 community partners have prevented 6,211 readmissions between Jan. 1, 2011 and June 30, 2013.

The efforts were recognized last month when RARE was named a recipient of the 2013 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality.

Launched in 2002 by National Quality Forum and Joint Commission, the award honors John M. Eisenberg, MD, MBA, a former administrator of the Agency for Healthcare Research and Quality and an advocate for patient safety and healthcare quality. SHM won the John M. Eisenberg Innovation in Patient Safety and Quality award in 2011 for its mentored-implementation program.

According to ICSI project manager Kathy Cummins, RN, MA, hospitals involved in RARE aren't given specific instructions on how to reduce readmissions, but are encouraged to focus their efforts on these areas:

Comprehensive discharge planning;

Medication management;

Patient and family engagement;

Transition-care support; and

Transition communications.

While the campaign provides guidance and technical support, each hospital comes up with its own strategies for achieving these goals. Ms. Cummins, for example, describes how one hospital that was tasked with reducing readmissions without adding staff had paramedics use their downtime to visit recently discharged patients. The paramedics now check in to see if patients are exhibiting warning signs of illness and make sure they’re taking their prescribed medications.

SHM board member Howard Epstein, MD, FHM, ICSI's chief health systems officer, says the RARE campaign targets issues hospitalists have long struggled with.

"Hospitalists don't want to see their patients readmitted to the hospital," Dr. Epstein says. "It doesn't look good on their part, and it's not the best thing for their patients. The [RARE] campaign galvanized the system to support what hospitalists have been demanding for many years."

Stephanie C. Mackiewicz is a freelance author in California.

Visit our website for more information about the RARE campaign.

 

How's this for a quality-improvement success story? In 2011, three Minnesota-based institutions—the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association, and Stratis Health—launched the Reducing Avoidable Readmissions Effectively (RARE) campaign to reduce avoidable hospital readmissions across the state. So far, the campaign's 82 participating hospitals and 100 community partners have prevented 6,211 readmissions between Jan. 1, 2011 and June 30, 2013.

The efforts were recognized last month when RARE was named a recipient of the 2013 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality.

Launched in 2002 by National Quality Forum and Joint Commission, the award honors John M. Eisenberg, MD, MBA, a former administrator of the Agency for Healthcare Research and Quality and an advocate for patient safety and healthcare quality. SHM won the John M. Eisenberg Innovation in Patient Safety and Quality award in 2011 for its mentored-implementation program.

According to ICSI project manager Kathy Cummins, RN, MA, hospitals involved in RARE aren't given specific instructions on how to reduce readmissions, but are encouraged to focus their efforts on these areas:

Comprehensive discharge planning;

Medication management;

Patient and family engagement;

Transition-care support; and

Transition communications.

While the campaign provides guidance and technical support, each hospital comes up with its own strategies for achieving these goals. Ms. Cummins, for example, describes how one hospital that was tasked with reducing readmissions without adding staff had paramedics use their downtime to visit recently discharged patients. The paramedics now check in to see if patients are exhibiting warning signs of illness and make sure they’re taking their prescribed medications.

SHM board member Howard Epstein, MD, FHM, ICSI's chief health systems officer, says the RARE campaign targets issues hospitalists have long struggled with.

"Hospitalists don't want to see their patients readmitted to the hospital," Dr. Epstein says. "It doesn't look good on their part, and it's not the best thing for their patients. The [RARE] campaign galvanized the system to support what hospitalists have been demanding for many years."

Stephanie C. Mackiewicz is a freelance author in California.

Visit our website for more information about the RARE campaign.

 

A new white paper from the Society of Hospital Medicine (SHM) is the specialty's first formal blueprint on best practices for running a hospital medicine group (HMG).

"The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists" report published this week in the Journal of Hospital Medicine, is the culmination of a two-year effort to give group leaders and hospital executives a self-assessment tool, says former SHM President John Nelson, MD, MHM, a practicing hospitalist and principal in Nelson Flores Hospital Medicine Consultants in Bellevue, Wash.

Dr. Nelson, one of the report's authors, says the 10 guiding principles and 47 individual characteristics are a launching point for group leaders, C-suite administrators, and others to discuss what ideals apply to their respective practices.

"It's like reading any other thing about how to get fit, how to eat a healthy diet, how to lead a good life," he adds. "It's pretty hard to rigidly pursue everything that an expert or well—considered document might recommend, but you tend to adapt it to your own circumstances and some things resonate."

Culled from more than 200 stakeholders, the report's 10 principles focus on:

Effective leadership;


Engaged hospitalists;


Adequate resources;


Effective planning and management infrastructure;


HMG alignment with hospitals and/or health systems;


Consideration of key clinical issues;


Recruitment and retention;


Thoughtful and rational approach to clinical activities; and


A practice model that is patient- and family-centered, team-based, and that emphasizes effective communication and care coordination.

Dr. Nelson says it's important for group leaders and hospital executives not to negatively view their practice in light of the report. Because characteristics recommended by the paper won’t necessarily apply everywhere, he suggests instead that readers pick out a handful of principles that apply most specifically to them.

"Two or three might be the right number to zero in on, but those are likely to be different for different groups," he adds. "I don't think there's any way for this to be used in the same manner at each group."

Likewise, Patrick Cawley, MD, MHM, chief executive officer at the Medical University of South Carolina (MUSC) Medical Center in Charleston, S.C. and author of the paper, says it shouldn't be viewed as a scientific conclusion, but as an aspirational approach to improvement.

"We feel that hospital medicine can be better than it is today," says Dr. Cawley, a former SHM president, "by laying out a road map not only [for HMGs] but [also for] hospital medicine leaders and hospital leaders about the things they should concentrate on raises the bar for everybody."

Dr. Cawley says the report is a first step for physicians and executives looking to benchmark their practices. In the future, SHM could follow up with other assessment tools that help groups improve themselves further.

"There are leaders and hospitals trying to improve their group. They're looking for something to measure themselves against," he adds. "This is instantly available for them, and we think this will be self-fulfilling. If people aren't using it, we haven't done our job right."

Richard Quinn is a freelance author in New Jersey.

Visit our website for more information on hospital medicine improvement initiatives.

 

A new white paper from the Society of Hospital Medicine (SHM) is the specialty's first formal blueprint on best practices for running a hospital medicine group (HMG).

"The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists" report published this week in the Journal of Hospital Medicine, is the culmination of a two-year effort to give group leaders and hospital executives a self-assessment tool, says former SHM President John Nelson, MD, MHM, a practicing hospitalist and principal in Nelson Flores Hospital Medicine Consultants in Bellevue, Wash.

Dr. Nelson, one of the report's authors, says the 10 guiding principles and 47 individual characteristics are a launching point for group leaders, C-suite administrators, and others to discuss what ideals apply to their respective practices.

"It's like reading any other thing about how to get fit, how to eat a healthy diet, how to lead a good life," he adds. "It's pretty hard to rigidly pursue everything that an expert or well—considered document might recommend, but you tend to adapt it to your own circumstances and some things resonate."

Culled from more than 200 stakeholders, the report's 10 principles focus on:

Effective leadership;


Engaged hospitalists;


Adequate resources;


Effective planning and management infrastructure;


HMG alignment with hospitals and/or health systems;


Consideration of key clinical issues;


Recruitment and retention;


Thoughtful and rational approach to clinical activities; and


A practice model that is patient- and family-centered, team-based, and that emphasizes effective communication and care coordination.

Dr. Nelson says it's important for group leaders and hospital executives not to negatively view their practice in light of the report. Because characteristics recommended by the paper won’t necessarily apply everywhere, he suggests instead that readers pick out a handful of principles that apply most specifically to them.

"Two or three might be the right number to zero in on, but those are likely to be different for different groups," he adds. "I don't think there's any way for this to be used in the same manner at each group."

Likewise, Patrick Cawley, MD, MHM, chief executive officer at the Medical University of South Carolina (MUSC) Medical Center in Charleston, S.C. and author of the paper, says it shouldn't be viewed as a scientific conclusion, but as an aspirational approach to improvement.

"We feel that hospital medicine can be better than it is today," says Dr. Cawley, a former SHM president, "by laying out a road map not only [for HMGs] but [also for] hospital medicine leaders and hospital leaders about the things they should concentrate on raises the bar for everybody."

Dr. Cawley says the report is a first step for physicians and executives looking to benchmark their practices. In the future, SHM could follow up with other assessment tools that help groups improve themselves further.

"There are leaders and hospitals trying to improve their group. They're looking for something to measure themselves against," he adds. "This is instantly available for them, and we think this will be self-fulfilling. If people aren't using it, we haven't done our job right."

Richard Quinn is a freelance author in New Jersey.

Visit our website for more information on hospital medicine improvement initiatives.

 

A new white paper from the Society of Hospital Medicine (SHM) is the specialty's first formal blueprint on best practices for running a hospital medicine group (HMG).

"The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists" report published this week in the Journal of Hospital Medicine, is the culmination of a two-year effort to give group leaders and hospital executives a self-assessment tool, says former SHM President John Nelson, MD, MHM, a practicing hospitalist and principal in Nelson Flores Hospital Medicine Consultants in Bellevue, Wash.

Dr. Nelson, one of the report's authors, says the 10 guiding principles and 47 individual characteristics are a launching point for group leaders, C-suite administrators, and others to discuss what ideals apply to their respective practices.

"It's like reading any other thing about how to get fit, how to eat a healthy diet, how to lead a good life," he adds. "It's pretty hard to rigidly pursue everything that an expert or well—considered document might recommend, but you tend to adapt it to your own circumstances and some things resonate."

Culled from more than 200 stakeholders, the report's 10 principles focus on:

Effective leadership;


Engaged hospitalists;


Adequate resources;


Effective planning and management infrastructure;


HMG alignment with hospitals and/or health systems;


Consideration of key clinical issues;


Recruitment and retention;


Thoughtful and rational approach to clinical activities; and


A practice model that is patient- and family-centered, team-based, and that emphasizes effective communication and care coordination.

Dr. Nelson says it's important for group leaders and hospital executives not to negatively view their practice in light of the report. Because characteristics recommended by the paper won’t necessarily apply everywhere, he suggests instead that readers pick out a handful of principles that apply most specifically to them.

"Two or three might be the right number to zero in on, but those are likely to be different for different groups," he adds. "I don't think there's any way for this to be used in the same manner at each group."

Likewise, Patrick Cawley, MD, MHM, chief executive officer at the Medical University of South Carolina (MUSC) Medical Center in Charleston, S.C. and author of the paper, says it shouldn't be viewed as a scientific conclusion, but as an aspirational approach to improvement.

"We feel that hospital medicine can be better than it is today," says Dr. Cawley, a former SHM president, "by laying out a road map not only [for HMGs] but [also for] hospital medicine leaders and hospital leaders about the things they should concentrate on raises the bar for everybody."

Dr. Cawley says the report is a first step for physicians and executives looking to benchmark their practices. In the future, SHM could follow up with other assessment tools that help groups improve themselves further.

"There are leaders and hospitals trying to improve their group. They're looking for something to measure themselves against," he adds. "This is instantly available for them, and we think this will be self-fulfilling. If people aren't using it, we haven't done our job right."

Richard Quinn is a freelance author in New Jersey.

Visit our website for more information on hospital medicine improvement initiatives.