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A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

Visit our website for more information on end of life care.

A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

Visit our website for more information on end of life care.

A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

Visit our website for more information on end of life care.

An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

• Appoint a “clinician champion” to act as a liaison between doctors;




• Have vendors and hospital leadership form a multidisciplinary performance-improvement group;




• Set up an ongoing review process to monitor patient concerns in a timely manner;




• Measure and share lessons learned; and




• Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

Visit our website for more information on health information technology.

An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

• Appoint a “clinician champion” to act as a liaison between doctors;




• Have vendors and hospital leadership form a multidisciplinary performance-improvement group;




• Set up an ongoing review process to monitor patient concerns in a timely manner;




• Measure and share lessons learned; and




• Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

Visit our website for more information on health information technology.

An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

• Appoint a “clinician champion” to act as a liaison between doctors;




• Have vendors and hospital leadership form a multidisciplinary performance-improvement group;




• Set up an ongoing review process to monitor patient concerns in a timely manner;




• Measure and share lessons learned; and




• Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

Visit our website for more information on health information technology.

A new study shows that in patients with acute ischemic stroke, every 15 minutes counts when talking about the time it takes to begin intravenous tissue-type plasminogen activator (tPA) therapy.

According to a report in JAMA, patients who received tPA treatment within 4.5 hours of symptom onset and had faster onset to treatment (OTT) had reduced in-hospital mortality and symptomatic intracranial hemorrhage rates (odds ratio for each, 0.96). Each 15-minute reduction in OTT also increased rates of independent ambulation at discharge and discharge to the home.

"This study emphasizes and characterizes better than before the fundamental importance of rapid start of thrombolytic therapy for acute ischemic stroke," says lead author Jeffrey Saver, MD, professor of neurology at the Geffen School of Medicine at the University of California at Los Angeles (UCLA) and director of the UCLA Stroke Center. "[For] every 15-minute delay of start of therapy, two fewer of out of 100 patients benefit. And this means that hospital systems need to be optimized to ensure that the target of door-to-needle time for start of tPA being under 60 minutes is achieved more often."

Dr. Saver says door-to-needle times under one hour have improved in recent years to nearly 50% from 25%, but hospitals can do better.

Recommended steps to improve that figure include having ambulances provide pre-arrival notification of stroke patients, having everyone on a stroke/hospitalist team paged at once to prepare all physicians who would potentially interact with the patients, premixing thrombolytic drugs to allow for quicker use, and having a data feedback system so institutions can figure out where the obstacles are to achieving improved performance.

"This is the type of system change that occurs by evolution, not revolution," Dr. Saver adds. "You need to bring your team together, you need physician champions to take the lead, and then you need to slowly drive system change based on the data in your institution. This is not an easy task, but it’s the type of task that hospitalists are perfect for."

Visit our website for more information on stroke treatments.

A new study shows that in patients with acute ischemic stroke, every 15 minutes counts when talking about the time it takes to begin intravenous tissue-type plasminogen activator (tPA) therapy.

According to a report in JAMA, patients who received tPA treatment within 4.5 hours of symptom onset and had faster onset to treatment (OTT) had reduced in-hospital mortality and symptomatic intracranial hemorrhage rates (odds ratio for each, 0.96). Each 15-minute reduction in OTT also increased rates of independent ambulation at discharge and discharge to the home.

"This study emphasizes and characterizes better than before the fundamental importance of rapid start of thrombolytic therapy for acute ischemic stroke," says lead author Jeffrey Saver, MD, professor of neurology at the Geffen School of Medicine at the University of California at Los Angeles (UCLA) and director of the UCLA Stroke Center. "[For] every 15-minute delay of start of therapy, two fewer of out of 100 patients benefit. And this means that hospital systems need to be optimized to ensure that the target of door-to-needle time for start of tPA being under 60 minutes is achieved more often."

Dr. Saver says door-to-needle times under one hour have improved in recent years to nearly 50% from 25%, but hospitals can do better.

Recommended steps to improve that figure include having ambulances provide pre-arrival notification of stroke patients, having everyone on a stroke/hospitalist team paged at once to prepare all physicians who would potentially interact with the patients, premixing thrombolytic drugs to allow for quicker use, and having a data feedback system so institutions can figure out where the obstacles are to achieving improved performance.

"This is the type of system change that occurs by evolution, not revolution," Dr. Saver adds. "You need to bring your team together, you need physician champions to take the lead, and then you need to slowly drive system change based on the data in your institution. This is not an easy task, but it’s the type of task that hospitalists are perfect for."

Visit our website for more information on stroke treatments.

A new study shows that in patients with acute ischemic stroke, every 15 minutes counts when talking about the time it takes to begin intravenous tissue-type plasminogen activator (tPA) therapy.

According to a report in JAMA, patients who received tPA treatment within 4.5 hours of symptom onset and had faster onset to treatment (OTT) had reduced in-hospital mortality and symptomatic intracranial hemorrhage rates (odds ratio for each, 0.96). Each 15-minute reduction in OTT also increased rates of independent ambulation at discharge and discharge to the home.

"This study emphasizes and characterizes better than before the fundamental importance of rapid start of thrombolytic therapy for acute ischemic stroke," says lead author Jeffrey Saver, MD, professor of neurology at the Geffen School of Medicine at the University of California at Los Angeles (UCLA) and director of the UCLA Stroke Center. "[For] every 15-minute delay of start of therapy, two fewer of out of 100 patients benefit. And this means that hospital systems need to be optimized to ensure that the target of door-to-needle time for start of tPA being under 60 minutes is achieved more often."

Dr. Saver says door-to-needle times under one hour have improved in recent years to nearly 50% from 25%, but hospitals can do better.

Recommended steps to improve that figure include having ambulances provide pre-arrival notification of stroke patients, having everyone on a stroke/hospitalist team paged at once to prepare all physicians who would potentially interact with the patients, premixing thrombolytic drugs to allow for quicker use, and having a data feedback system so institutions can figure out where the obstacles are to achieving improved performance.

"This is the type of system change that occurs by evolution, not revolution," Dr. Saver adds. "You need to bring your team together, you need physician champions to take the lead, and then you need to slowly drive system change based on the data in your institution. This is not an easy task, but it’s the type of task that hospitalists are perfect for."

Visit our website for more information on stroke treatments.

The Center for Medicare & Medicaid Innovation's Rick Gilfillan, MD, will be leaving at the end of June, just as the organization prepares to start accepting round-two grant applications for up to $1 billion in Health Care Innovation Awards. Replacing him as acting director will be Patrick Conway, MD, MSc, FAAP, SFHM, a practicing pediatric hospitalist, former director of hospital medicine at Cincinnati Children's Hospital, and HM13 keynote speaker.

Dr. Conway will continue in his current role as CMS' chief medical officer.

"We applaud Patrick Conway's appointment to the Center for Medicare & Medicaid Innovation," says SHM President Eric Howell, MD, SFHM. "His work, compassion, and vision are tremendous validations of the hospitalist model as both a change agent and as a career path. Patients across the country will be the true beneficiaries of his new work.

"Hospitalists should continue to look toward the CMS Innovation Center as a leader in transforming healthcare."

The center was created by the 2010 Affordable Care Act to offer solutions to healthcare cost and delivery problems. Its first round of 107 innovations awards, averaging $8.4 million each over three years, was announced in 2012 and included several that focused on preventing hospitalizations, avoidable rehospitalizations, and ED visits. One award went to David Meltzer, MD, PhD, FHM, of the University of Chicago to test a model in which the same doctor would see selected high-risk patients both in and out of the hospital.

Round two "provides hospitalists—who have an exceptionally broad perspective—with a unique opportunity to share new approaches to delivering the best patient care at an affordable cost," Dr. Conway told The Hospitalist.

Visit our website for more information on CMS Innovation Center initiatives.

The Center for Medicare & Medicaid Innovation's Rick Gilfillan, MD, will be leaving at the end of June, just as the organization prepares to start accepting round-two grant applications for up to $1 billion in Health Care Innovation Awards. Replacing him as acting director will be Patrick Conway, MD, MSc, FAAP, SFHM, a practicing pediatric hospitalist, former director of hospital medicine at Cincinnati Children's Hospital, and HM13 keynote speaker.

Dr. Conway will continue in his current role as CMS' chief medical officer.

"We applaud Patrick Conway's appointment to the Center for Medicare & Medicaid Innovation," says SHM President Eric Howell, MD, SFHM. "His work, compassion, and vision are tremendous validations of the hospitalist model as both a change agent and as a career path. Patients across the country will be the true beneficiaries of his new work.

"Hospitalists should continue to look toward the CMS Innovation Center as a leader in transforming healthcare."

The center was created by the 2010 Affordable Care Act to offer solutions to healthcare cost and delivery problems. Its first round of 107 innovations awards, averaging $8.4 million each over three years, was announced in 2012 and included several that focused on preventing hospitalizations, avoidable rehospitalizations, and ED visits. One award went to David Meltzer, MD, PhD, FHM, of the University of Chicago to test a model in which the same doctor would see selected high-risk patients both in and out of the hospital.

Round two "provides hospitalists—who have an exceptionally broad perspective—with a unique opportunity to share new approaches to delivering the best patient care at an affordable cost," Dr. Conway told The Hospitalist.

Visit our website for more information on CMS Innovation Center initiatives.

The Center for Medicare & Medicaid Innovation's Rick Gilfillan, MD, will be leaving at the end of June, just as the organization prepares to start accepting round-two grant applications for up to $1 billion in Health Care Innovation Awards. Replacing him as acting director will be Patrick Conway, MD, MSc, FAAP, SFHM, a practicing pediatric hospitalist, former director of hospital medicine at Cincinnati Children's Hospital, and HM13 keynote speaker.

Dr. Conway will continue in his current role as CMS' chief medical officer.

"We applaud Patrick Conway's appointment to the Center for Medicare & Medicaid Innovation," says SHM President Eric Howell, MD, SFHM. "His work, compassion, and vision are tremendous validations of the hospitalist model as both a change agent and as a career path. Patients across the country will be the true beneficiaries of his new work.

"Hospitalists should continue to look toward the CMS Innovation Center as a leader in transforming healthcare."

The center was created by the 2010 Affordable Care Act to offer solutions to healthcare cost and delivery problems. Its first round of 107 innovations awards, averaging $8.4 million each over three years, was announced in 2012 and included several that focused on preventing hospitalizations, avoidable rehospitalizations, and ED visits. One award went to David Meltzer, MD, PhD, FHM, of the University of Chicago to test a model in which the same doctor would see selected high-risk patients both in and out of the hospital.

Round two "provides hospitalists—who have an exceptionally broad perspective—with a unique opportunity to share new approaches to delivering the best patient care at an affordable cost," Dr. Conway told The Hospitalist.

Visit our website for more information on CMS Innovation Center initiatives.

Clinical question: What are the effects of the 2011 resident duty-hour requirements on first-year residents’ well-being and patient safety?

Background: In an effort to reduce adverse consequences associated with extended shift length and sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) released a new set of duty-hour requirements effective July 2011. To date, little is known about the effects of the 2011 reforms on resident and patient outcomes.

Study design: Prospective, longitudinal cohort with pre-post analysis.

Setting: Residency programs from university- and community-based medical centers.

Synopsis: Fifty-one residency programs from 10 university-based and four community-based GME institutions were included. Incoming interns during the 2009, 2010, and 2011 academic years were invited to participate, and 58% (n=2,323) agreed to take part. Participants completed online surveys two months before starting their first residency (intern) year and at three, six, nine, and 12 months of internship. Questions addressed work hours, sleep, medical errors, depressive symptoms, and subjective well-being.

No significant differences in baseline findings were found between the pre-implementation cohort (interns entering in 2009 and 2010) and the post-implementation cohort (interns starting in 2011, following the new duty-hour requirements). Interns in the post-implementation cohort worked fewer hours than those in the pre-implementation cohort (mean hours per week 64.3 vs. 67.0, P<0.001). There were no significant changes in reported hours of sleep, depressive symptom score, or well-being score between the pre- and post-implementation cohorts. The percentage of respondents who reported committing a serious medical error increased in the post-implementation group (23.3% vs. 19.9%, P=0.007).

Limitations include the self-reported nature of the responses and the modest participation rate. The authors concluded that although the 2011 reforms decreased the total number of hours worked, additional strategies could be needed to achieve the desired effects on intern well-being and patient safety.

Bottom line: Following implementation of the 2011 ACGME duty-hour reforms, interns from diverse specialties and institutions experienced reductions in self-reported work hours, without any associated improvements in sleep, depressive symptoms, or well-being and with an increase in reported medical errors.

Citation: Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173(8):657-662.

Clinical question: What are the effects of the 2011 resident duty-hour requirements on first-year residents’ well-being and patient safety?

Background: In an effort to reduce adverse consequences associated with extended shift length and sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) released a new set of duty-hour requirements effective July 2011. To date, little is known about the effects of the 2011 reforms on resident and patient outcomes.

Study design: Prospective, longitudinal cohort with pre-post analysis.

Setting: Residency programs from university- and community-based medical centers.

Synopsis: Fifty-one residency programs from 10 university-based and four community-based GME institutions were included. Incoming interns during the 2009, 2010, and 2011 academic years were invited to participate, and 58% (n=2,323) agreed to take part. Participants completed online surveys two months before starting their first residency (intern) year and at three, six, nine, and 12 months of internship. Questions addressed work hours, sleep, medical errors, depressive symptoms, and subjective well-being.

No significant differences in baseline findings were found between the pre-implementation cohort (interns entering in 2009 and 2010) and the post-implementation cohort (interns starting in 2011, following the new duty-hour requirements). Interns in the post-implementation cohort worked fewer hours than those in the pre-implementation cohort (mean hours per week 64.3 vs. 67.0, P<0.001). There were no significant changes in reported hours of sleep, depressive symptom score, or well-being score between the pre- and post-implementation cohorts. The percentage of respondents who reported committing a serious medical error increased in the post-implementation group (23.3% vs. 19.9%, P=0.007).

Limitations include the self-reported nature of the responses and the modest participation rate. The authors concluded that although the 2011 reforms decreased the total number of hours worked, additional strategies could be needed to achieve the desired effects on intern well-being and patient safety.

Bottom line: Following implementation of the 2011 ACGME duty-hour reforms, interns from diverse specialties and institutions experienced reductions in self-reported work hours, without any associated improvements in sleep, depressive symptoms, or well-being and with an increase in reported medical errors.

Citation: Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173(8):657-662.

Clinical question: What are the effects of the 2011 resident duty-hour requirements on first-year residents’ well-being and patient safety?

Background: In an effort to reduce adverse consequences associated with extended shift length and sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) released a new set of duty-hour requirements effective July 2011. To date, little is known about the effects of the 2011 reforms on resident and patient outcomes.

Study design: Prospective, longitudinal cohort with pre-post analysis.

Setting: Residency programs from university- and community-based medical centers.

Synopsis: Fifty-one residency programs from 10 university-based and four community-based GME institutions were included. Incoming interns during the 2009, 2010, and 2011 academic years were invited to participate, and 58% (n=2,323) agreed to take part. Participants completed online surveys two months before starting their first residency (intern) year and at three, six, nine, and 12 months of internship. Questions addressed work hours, sleep, medical errors, depressive symptoms, and subjective well-being.

No significant differences in baseline findings were found between the pre-implementation cohort (interns entering in 2009 and 2010) and the post-implementation cohort (interns starting in 2011, following the new duty-hour requirements). Interns in the post-implementation cohort worked fewer hours than those in the pre-implementation cohort (mean hours per week 64.3 vs. 67.0, P<0.001). There were no significant changes in reported hours of sleep, depressive symptom score, or well-being score between the pre- and post-implementation cohorts. The percentage of respondents who reported committing a serious medical error increased in the post-implementation group (23.3% vs. 19.9%, P=0.007).

Limitations include the self-reported nature of the responses and the modest participation rate. The authors concluded that although the 2011 reforms decreased the total number of hours worked, additional strategies could be needed to achieve the desired effects on intern well-being and patient safety.

Bottom line: Following implementation of the 2011 ACGME duty-hour reforms, interns from diverse specialties and institutions experienced reductions in self-reported work hours, without any associated improvements in sleep, depressive symptoms, or well-being and with an increase in reported medical errors.

Citation: Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173(8):657-662.

Click here to listen to excerpts of Dr. Chretien's interview with The Hospitalist

Click here to listen to excerpts of Dr. Chretien's interview with The Hospitalist

Click here to listen to excerpts of Dr. Chretien's interview with The Hospitalist

“You focus on the patient that’s in front of you. You focus on trying to solve the issues that are at hand. You deal with the logistical questions that come up between patients.”

—James Hudspeth, MD, Boston Medical Center

“At some point, a disaster is so large that it would overwhelm any system, no matter how many resources were available. ”

—Dan Hale, MD, Floating Hospital for Children at Tufts Medical Center, Boston

Dan Hale, MD, a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston, was doing discharge paperwork when he started getting text messages he couldn’t quite interpret.

“Are you OK?” “Do you need anything?” friends were asking him. Then he heard a page for all anesthesiologists to report to the OR. Immediately, he knew something terrible must have happened. He soon learned about the bombings at the Boston Marathon. He rushed to the pediatric ED to see how he could help.

James Hudspeth, MD, a hospitalist at Boston Medical Center, was meeting with the program director for internal medicine when he read a text message that bombs had just gone off near the finish line. They went online for local news coverage; soon thereafter, a cap on admissions was lifted. Dr. Hudspeth started expediting discharges to make room for what might be coming the hospital’s way.

Sushrut Jangi, MD, a hospitalist at Beth Israel Deaconess Medical Center, was in a medical tent gathering information for an article on treating the health problems of marathoners that he was writing for The Boston Globe when he heard the blasts. Doctors and medical staff there worried about the possibility of a bomb in the tent, he said, but they were instructed to stay with their patients. Dr. Jangi had expected to work as a journalist for the day, but his doctoring skills were needed.

Hospitalists who were working in downtown Boston on April 15, when two bombs exploded 17 seconds apart, all experienced the tragedy in their own ways. But their accounts also resonate within some of the same themes.

They found themselves unsure of their roles, as most of the work inevitably fell to surgeons and trauma specialists. They described the importance of good leadership in times of crisis. And they say that hospitalists should be incorporated to a greater extent into disaster plans.

Dr. Jangi said that before the bombs went off, the medical tent was almost filled with runners who were “quite ill”—hypothermic and shaking, high sodium levels, disoriented. When the blasts occurred, the main instruction was, “Don’t leave your patients behind.” Those who were well enough were released from the tent, and the bomb-blast victims were essentially “whisked through.”

“We just kind of cleared the way and got them into ambulances as soon as possible. We just didn’t have the capacity to take care of such severe injury,” he said. “Why should we? We weren’t expecting a war zone.”

In the tent, Dr. Jangi wrote in an essay for the New England Journal of Medicine, “Many of us barely laid our hands on anyone. We had no trauma surgeons or supplies of blood products; tourniquets had already been applied; CPR had already been performed. Though some patients required bandages, sutures, and dressings, many of us watched these passing victims in a kind of idle horror, with no idea how to help.”

Dr. Hale was not involved in the treatment of bombing victims as the attending of record, but he said that he had a “bird’s-eye view” of the response in the pediatric ED. One child had shrapnel injuries and a ruptured tympanic membrane and was worked on by the team “professionally and efficiently,” Dr. Hale said.

When reports of a possible third bomb blast, at a library, came in, he saw the physician leaders go from team to team, making sure they were prepared.

“There were clear leaders communicating what to do,” said Dr. Hale, a firefighter in his hometown of Kittery in southern Maine. “As patients came in, it was extremely orderly. I saw very few clinical staff who were rattled.”

For his own part, in addition to his medical training, his training as a firefighter helped keep him calm, he said.

At Boston Medical Center, about a mile and a half from the blasts, the admissions that had been worked up over the course of the afternoon were essentially taken all at once so that there was room in the ED, said Dr. Hudspeth, who also does medical work in Haiti and was in New York on 9/11, though not as a doctor.

Focusing, he said, was “definitely a challenge.” Even though he had faith in hospital security, there was still “some notion of ‘You never know exactly what’s going to happen.’”

“You focus on the patient that’s in front of you. You focus on trying to solve the issues that are at hand. You deal with the logistical questions that come up between patients,” he said. “By and large, just put your nose to the grindstone.”

The doctors said that hospitalists had an unclear role in the response effort and hope to have their roles clarified so that they can better put to use their expertise in internal medicine. If hospitalists are monitoring general medical issues, that will help take some of the pressure off the trauma team.

“We know the [general] medicine stuff very well—that is our bread and butter,” said Dr. Hudspeth, who added that steps are being taken as part of Boston Medical Center’s post-response analysis to determine hospitalists’ role in future disaster responses.

They also said they felt fortunate that the bombings had occurred where they did, with so many hospitals close to the scene. It kept the system from becoming overwhelmed. Even so, “at some point, a disaster is so large that it would overwhelm any system, no matter how many resources were available,” Dr. Hale added.

Dr. Jangi said that he thinks his residency training helped him when he found himself having to provide care in a high-pressure situation in the medical tent.

“During residency, there are a lot of situations where you’re responsible for making a decision on your feet,” he said. “That’s a skill that you’re not really exposed to until you do it and that type of fast decision-making. I felt myself drawing on that. Not that I resuscitated anyone in the tent, but I felt more comfortable with uncertainty, with doing your duty in a situation of uncertainty. And I don’t know—maybe if I hadn’t gone through that, I would have just run out of there.”

He said the experience has helped make him more committed as a doctor.

“It makes it easier to remember what my duty is more, and it just gives me more empathy for suffering in general—I feel that very strongly,” he said. “It’s possible that this experience could have numbed me, but it didn’t. It’s made me more acute to the idea of people suffering.”

Tom Collins is a freelance writer in South Florida.

Reference

1. Under the Medical Tent at the Boston Marathon. N Engl J Med. 2013;368:1953-1955.

“You focus on the patient that’s in front of you. You focus on trying to solve the issues that are at hand. You deal with the logistical questions that come up between patients.”

—James Hudspeth, MD, Boston Medical Center

“At some point, a disaster is so large that it would overwhelm any system, no matter how many resources were available. ”

—Dan Hale, MD, Floating Hospital for Children at Tufts Medical Center, Boston

Dan Hale, MD, a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston, was doing discharge paperwork when he started getting text messages he couldn’t quite interpret.

“Are you OK?” “Do you need anything?” friends were asking him. Then he heard a page for all anesthesiologists to report to the OR. Immediately, he knew something terrible must have happened. He soon learned about the bombings at the Boston Marathon. He rushed to the pediatric ED to see how he could help.

James Hudspeth, MD, a hospitalist at Boston Medical Center, was meeting with the program director for internal medicine when he read a text message that bombs had just gone off near the finish line. They went online for local news coverage; soon thereafter, a cap on admissions was lifted. Dr. Hudspeth started expediting discharges to make room for what might be coming the hospital’s way.

Sushrut Jangi, MD, a hospitalist at Beth Israel Deaconess Medical Center, was in a medical tent gathering information for an article on treating the health problems of marathoners that he was writing for The Boston Globe when he heard the blasts. Doctors and medical staff there worried about the possibility of a bomb in the tent, he said, but they were instructed to stay with their patients. Dr. Jangi had expected to work as a journalist for the day, but his doctoring skills were needed.

Hospitalists who were working in downtown Boston on April 15, when two bombs exploded 17 seconds apart, all experienced the tragedy in their own ways. But their accounts also resonate within some of the same themes.

They found themselves unsure of their roles, as most of the work inevitably fell to surgeons and trauma specialists. They described the importance of good leadership in times of crisis. And they say that hospitalists should be incorporated to a greater extent into disaster plans.

Dr. Jangi said that before the bombs went off, the medical tent was almost filled with runners who were “quite ill”—hypothermic and shaking, high sodium levels, disoriented. When the blasts occurred, the main instruction was, “Don’t leave your patients behind.” Those who were well enough were released from the tent, and the bomb-blast victims were essentially “whisked through.”

“We just kind of cleared the way and got them into ambulances as soon as possible. We just didn’t have the capacity to take care of such severe injury,” he said. “Why should we? We weren’t expecting a war zone.”

In the tent, Dr. Jangi wrote in an essay for the New England Journal of Medicine, “Many of us barely laid our hands on anyone. We had no trauma surgeons or supplies of blood products; tourniquets had already been applied; CPR had already been performed. Though some patients required bandages, sutures, and dressings, many of us watched these passing victims in a kind of idle horror, with no idea how to help.”

Dr. Hale was not involved in the treatment of bombing victims as the attending of record, but he said that he had a “bird’s-eye view” of the response in the pediatric ED. One child had shrapnel injuries and a ruptured tympanic membrane and was worked on by the team “professionally and efficiently,” Dr. Hale said.

When reports of a possible third bomb blast, at a library, came in, he saw the physician leaders go from team to team, making sure they were prepared.

“There were clear leaders communicating what to do,” said Dr. Hale, a firefighter in his hometown of Kittery in southern Maine. “As patients came in, it was extremely orderly. I saw very few clinical staff who were rattled.”

For his own part, in addition to his medical training, his training as a firefighter helped keep him calm, he said.

At Boston Medical Center, about a mile and a half from the blasts, the admissions that had been worked up over the course of the afternoon were essentially taken all at once so that there was room in the ED, said Dr. Hudspeth, who also does medical work in Haiti and was in New York on 9/11, though not as a doctor.

Focusing, he said, was “definitely a challenge.” Even though he had faith in hospital security, there was still “some notion of ‘You never know exactly what’s going to happen.’”

“You focus on the patient that’s in front of you. You focus on trying to solve the issues that are at hand. You deal with the logistical questions that come up between patients,” he said. “By and large, just put your nose to the grindstone.”

The doctors said that hospitalists had an unclear role in the response effort and hope to have their roles clarified so that they can better put to use their expertise in internal medicine. If hospitalists are monitoring general medical issues, that will help take some of the pressure off the trauma team.

“We know the [general] medicine stuff very well—that is our bread and butter,” said Dr. Hudspeth, who added that steps are being taken as part of Boston Medical Center’s post-response analysis to determine hospitalists’ role in future disaster responses.

They also said they felt fortunate that the bombings had occurred where they did, with so many hospitals close to the scene. It kept the system from becoming overwhelmed. Even so, “at some point, a disaster is so large that it would overwhelm any system, no matter how many resources were available,” Dr. Hale added.

Dr. Jangi said that he thinks his residency training helped him when he found himself having to provide care in a high-pressure situation in the medical tent.

“During residency, there are a lot of situations where you’re responsible for making a decision on your feet,” he said. “That’s a skill that you’re not really exposed to until you do it and that type of fast decision-making. I felt myself drawing on that. Not that I resuscitated anyone in the tent, but I felt more comfortable with uncertainty, with doing your duty in a situation of uncertainty. And I don’t know—maybe if I hadn’t gone through that, I would have just run out of there.”

He said the experience has helped make him more committed as a doctor.

“It makes it easier to remember what my duty is more, and it just gives me more empathy for suffering in general—I feel that very strongly,” he said. “It’s possible that this experience could have numbed me, but it didn’t. It’s made me more acute to the idea of people suffering.”

Tom Collins is a freelance writer in South Florida.

Reference

1. Under the Medical Tent at the Boston Marathon. N Engl J Med. 2013;368:1953-1955.

“You focus on the patient that’s in front of you. You focus on trying to solve the issues that are at hand. You deal with the logistical questions that come up between patients.”

—James Hudspeth, MD, Boston Medical Center

“At some point, a disaster is so large that it would overwhelm any system, no matter how many resources were available. ”

—Dan Hale, MD, Floating Hospital for Children at Tufts Medical Center, Boston

Dan Hale, MD, a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston, was doing discharge paperwork when he started getting text messages he couldn’t quite interpret.

“Are you OK?” “Do you need anything?” friends were asking him. Then he heard a page for all anesthesiologists to report to the OR. Immediately, he knew something terrible must have happened. He soon learned about the bombings at the Boston Marathon. He rushed to the pediatric ED to see how he could help.

James Hudspeth, MD, a hospitalist at Boston Medical Center, was meeting with the program director for internal medicine when he read a text message that bombs had just gone off near the finish line. They went online for local news coverage; soon thereafter, a cap on admissions was lifted. Dr. Hudspeth started expediting discharges to make room for what might be coming the hospital’s way.

Sushrut Jangi, MD, a hospitalist at Beth Israel Deaconess Medical Center, was in a medical tent gathering information for an article on treating the health problems of marathoners that he was writing for The Boston Globe when he heard the blasts. Doctors and medical staff there worried about the possibility of a bomb in the tent, he said, but they were instructed to stay with their patients. Dr. Jangi had expected to work as a journalist for the day, but his doctoring skills were needed.

Hospitalists who were working in downtown Boston on April 15, when two bombs exploded 17 seconds apart, all experienced the tragedy in their own ways. But their accounts also resonate within some of the same themes.

They found themselves unsure of their roles, as most of the work inevitably fell to surgeons and trauma specialists. They described the importance of good leadership in times of crisis. And they say that hospitalists should be incorporated to a greater extent into disaster plans.

Dr. Jangi said that before the bombs went off, the medical tent was almost filled with runners who were “quite ill”—hypothermic and shaking, high sodium levels, disoriented. When the blasts occurred, the main instruction was, “Don’t leave your patients behind.” Those who were well enough were released from the tent, and the bomb-blast victims were essentially “whisked through.”

“We just kind of cleared the way and got them into ambulances as soon as possible. We just didn’t have the capacity to take care of such severe injury,” he said. “Why should we? We weren’t expecting a war zone.”

In the tent, Dr. Jangi wrote in an essay for the New England Journal of Medicine, “Many of us barely laid our hands on anyone. We had no trauma surgeons or supplies of blood products; tourniquets had already been applied; CPR had already been performed. Though some patients required bandages, sutures, and dressings, many of us watched these passing victims in a kind of idle horror, with no idea how to help.”

Dr. Hale was not involved in the treatment of bombing victims as the attending of record, but he said that he had a “bird’s-eye view” of the response in the pediatric ED. One child had shrapnel injuries and a ruptured tympanic membrane and was worked on by the team “professionally and efficiently,” Dr. Hale said.

When reports of a possible third bomb blast, at a library, came in, he saw the physician leaders go from team to team, making sure they were prepared.

“There were clear leaders communicating what to do,” said Dr. Hale, a firefighter in his hometown of Kittery in southern Maine. “As patients came in, it was extremely orderly. I saw very few clinical staff who were rattled.”

For his own part, in addition to his medical training, his training as a firefighter helped keep him calm, he said.

At Boston Medical Center, about a mile and a half from the blasts, the admissions that had been worked up over the course of the afternoon were essentially taken all at once so that there was room in the ED, said Dr. Hudspeth, who also does medical work in Haiti and was in New York on 9/11, though not as a doctor.

Focusing, he said, was “definitely a challenge.” Even though he had faith in hospital security, there was still “some notion of ‘You never know exactly what’s going to happen.’”

“You focus on the patient that’s in front of you. You focus on trying to solve the issues that are at hand. You deal with the logistical questions that come up between patients,” he said. “By and large, just put your nose to the grindstone.”

The doctors said that hospitalists had an unclear role in the response effort and hope to have their roles clarified so that they can better put to use their expertise in internal medicine. If hospitalists are monitoring general medical issues, that will help take some of the pressure off the trauma team.

“We know the [general] medicine stuff very well—that is our bread and butter,” said Dr. Hudspeth, who added that steps are being taken as part of Boston Medical Center’s post-response analysis to determine hospitalists’ role in future disaster responses.

They also said they felt fortunate that the bombings had occurred where they did, with so many hospitals close to the scene. It kept the system from becoming overwhelmed. Even so, “at some point, a disaster is so large that it would overwhelm any system, no matter how many resources were available,” Dr. Hale added.

Dr. Jangi said that he thinks his residency training helped him when he found himself having to provide care in a high-pressure situation in the medical tent.

“During residency, there are a lot of situations where you’re responsible for making a decision on your feet,” he said. “That’s a skill that you’re not really exposed to until you do it and that type of fast decision-making. I felt myself drawing on that. Not that I resuscitated anyone in the tent, but I felt more comfortable with uncertainty, with doing your duty in a situation of uncertainty. And I don’t know—maybe if I hadn’t gone through that, I would have just run out of there.”

He said the experience has helped make him more committed as a doctor.

“It makes it easier to remember what my duty is more, and it just gives me more empathy for suffering in general—I feel that very strongly,” he said. “It’s possible that this experience could have numbed me, but it didn’t. It’s made me more acute to the idea of people suffering.”

Tom Collins is a freelance writer in South Florida.

Reference

1. Under the Medical Tent at the Boston Marathon. N Engl J Med. 2013;368:1953-1955.

What I’d like to highlight is how pediatric hospitalists can follow their adult hospitalist brothers and sisters into the role of being leaders … in how to handle challenges that their hospitals face.

—Weijen Chang, MD, SFHM, FAAP

Next month, readers of The Hospitalist will see a new face alongside the monthly “Pediatric HM Literature” column. Weijen Chang, MD, SFHM, FAAP, has been selected its new pediatric editor. Next month Dr. Chang takes over for Mark Shen, MD, SFHM, the magazine's pediatric editor since 2010.

Dr. Chang attended Duke University’s medicine-pediatrics residency program in Durham, N.C., after graduating from New York Medical College in Valhalla, N.Y. He serves as health sciences associate clinical professor of medicine and pediatrics at the University of California at San Diego (UCSD) School of Medicine, and serves as a hospitalist at both UCSD Medical Center and Rady Children’s Hospital, just across town from UCSD.

As pediatric editor, Dr. Chang hopes to help grow the field of pediatric hospital medicine, just as adult HM has grown over the last decade.

“In the past 10 years of HM being in existence, I think adult hospitalists have gone from being a fill-in-type player to really being leaders in their institutions,” he says, “and I think pediatric hospitalists are beginning to fill that role. What I’d like to highlight is how pediatric hospitalists can follow their adult hospitalist brothers and sisters into the role of being leaders … in how to handle challenges that their hospitals face.”

Danielle Scheurer, MD, MSCR, SFHM, The Hospitalist’s physician editor, echoed Dr. Change’s enthusiasm. “We are thrilled to have Weijen Chang as our new pediatric editor,” Dr. Scheurer says. “He is a long-time member of Team Hospitalist, active SHM member, and a respected mentor in the pediatric hospitalist community. He will bring insight and depth to the pediatric HM community. We are lucky to be able to recruit him to this position.”

Dr. Chang says he’s looking forward to his new role and new contacts he will be making. He recently joined SHM’s Pediatrics Committee, and will continue engagement with Team Hospitalist, the magazine’s editorial advisory board.

“I’m really excited to get the chance to contact other pediatric hospitalists around the country to gauge opinions about various issues that we face,” Dr. Chang says. “For me, the most exciting part is having an excuse to call people to see what’s going on in their institutions. As hospitalists, we’re so focused on what happens within our walls that we don’t get to see what’s happening elsewhere.”

Michael O’Neal is a freelance writer in New York.

What I’d like to highlight is how pediatric hospitalists can follow their adult hospitalist brothers and sisters into the role of being leaders … in how to handle challenges that their hospitals face.

—Weijen Chang, MD, SFHM, FAAP

Next month, readers of The Hospitalist will see a new face alongside the monthly “Pediatric HM Literature” column. Weijen Chang, MD, SFHM, FAAP, has been selected its new pediatric editor. Next month Dr. Chang takes over for Mark Shen, MD, SFHM, the magazine's pediatric editor since 2010.

Dr. Chang attended Duke University’s medicine-pediatrics residency program in Durham, N.C., after graduating from New York Medical College in Valhalla, N.Y. He serves as health sciences associate clinical professor of medicine and pediatrics at the University of California at San Diego (UCSD) School of Medicine, and serves as a hospitalist at both UCSD Medical Center and Rady Children’s Hospital, just across town from UCSD.

As pediatric editor, Dr. Chang hopes to help grow the field of pediatric hospital medicine, just as adult HM has grown over the last decade.

“In the past 10 years of HM being in existence, I think adult hospitalists have gone from being a fill-in-type player to really being leaders in their institutions,” he says, “and I think pediatric hospitalists are beginning to fill that role. What I’d like to highlight is how pediatric hospitalists can follow their adult hospitalist brothers and sisters into the role of being leaders … in how to handle challenges that their hospitals face.”

Danielle Scheurer, MD, MSCR, SFHM, The Hospitalist’s physician editor, echoed Dr. Change’s enthusiasm. “We are thrilled to have Weijen Chang as our new pediatric editor,” Dr. Scheurer says. “He is a long-time member of Team Hospitalist, active SHM member, and a respected mentor in the pediatric hospitalist community. He will bring insight and depth to the pediatric HM community. We are lucky to be able to recruit him to this position.”

Dr. Chang says he’s looking forward to his new role and new contacts he will be making. He recently joined SHM’s Pediatrics Committee, and will continue engagement with Team Hospitalist, the magazine’s editorial advisory board.

“I’m really excited to get the chance to contact other pediatric hospitalists around the country to gauge opinions about various issues that we face,” Dr. Chang says. “For me, the most exciting part is having an excuse to call people to see what’s going on in their institutions. As hospitalists, we’re so focused on what happens within our walls that we don’t get to see what’s happening elsewhere.”

Michael O’Neal is a freelance writer in New York.

What I’d like to highlight is how pediatric hospitalists can follow their adult hospitalist brothers and sisters into the role of being leaders … in how to handle challenges that their hospitals face.

—Weijen Chang, MD, SFHM, FAAP

Next month, readers of The Hospitalist will see a new face alongside the monthly “Pediatric HM Literature” column. Weijen Chang, MD, SFHM, FAAP, has been selected its new pediatric editor. Next month Dr. Chang takes over for Mark Shen, MD, SFHM, the magazine's pediatric editor since 2010.

Dr. Chang attended Duke University’s medicine-pediatrics residency program in Durham, N.C., after graduating from New York Medical College in Valhalla, N.Y. He serves as health sciences associate clinical professor of medicine and pediatrics at the University of California at San Diego (UCSD) School of Medicine, and serves as a hospitalist at both UCSD Medical Center and Rady Children’s Hospital, just across town from UCSD.

As pediatric editor, Dr. Chang hopes to help grow the field of pediatric hospital medicine, just as adult HM has grown over the last decade.

“In the past 10 years of HM being in existence, I think adult hospitalists have gone from being a fill-in-type player to really being leaders in their institutions,” he says, “and I think pediatric hospitalists are beginning to fill that role. What I’d like to highlight is how pediatric hospitalists can follow their adult hospitalist brothers and sisters into the role of being leaders … in how to handle challenges that their hospitals face.”

Danielle Scheurer, MD, MSCR, SFHM, The Hospitalist’s physician editor, echoed Dr. Change’s enthusiasm. “We are thrilled to have Weijen Chang as our new pediatric editor,” Dr. Scheurer says. “He is a long-time member of Team Hospitalist, active SHM member, and a respected mentor in the pediatric hospitalist community. He will bring insight and depth to the pediatric HM community. We are lucky to be able to recruit him to this position.”

Dr. Chang says he’s looking forward to his new role and new contacts he will be making. He recently joined SHM’s Pediatrics Committee, and will continue engagement with Team Hospitalist, the magazine’s editorial advisory board.

“I’m really excited to get the chance to contact other pediatric hospitalists around the country to gauge opinions about various issues that we face,” Dr. Chang says. “For me, the most exciting part is having an excuse to call people to see what’s going on in their institutions. As hospitalists, we’re so focused on what happens within our walls that we don’t get to see what’s happening elsewhere.”

Michael O’Neal is a freelance writer in New York.

Mark Shapiro, MD

Mark Shapiro, MD, has been appointed chief of medicine at Sharp Memorial Hospital in San Diego. A hospitalist with Sharp Rees-Stealy Medical Group since 2006, Dr. Shapiro recently began work as a physician collaborator with PracticingExcellence.com, a Web-based physician-learning platform expected to launch this fall.

John Davidyock, MD, SFHM, is the new section chief of hospital medicine at Temple University Hospital in Philadelphia. Dr. Davidyock also is vice chair of patient safety and quality improvement, and assistant professor of medicine at the Temple University School of Medicine. Dr. Davidyock has been a Senior Fellow of Hospital Medicine since 2012.

Rana Tan, MD, chief hospitalist at Harrison Medical Center in Bremerton, Wash., recently received the 2013 Summit Award for excellence in hospital medicine from Tacoma, Wash.-based Sound Physicians. Dr. Tan has served as chief hospitalist at Harrison Medical Center since 2010 and has been with Sound Physicians since 2005. She oversees 16 hospitalists on her team at Harrison.

Gary J. Carver, MD, is the new director of hospital medicine at Coshocton (Ohio) Hospital. He previously worked as Coshocton Hospital’s chief of staff and sat on the board of trustees.

Thomas McIlraith, MD, SFHM, CLHM, received SHM’s Certificate of Leadership in Hospital Medicine at HM13 in May. Dr. McIlraith is chairman of hospital medicine at Mercy Medical Group in Sacramento, Calif. He is responsible for 24/7 operations at four hospitals and a department of 60 hospitalist physicians. In addition, he is a member of the Mercy Medical Group board of directors. He also is a clinical instructor at the University of California at Davis.

Sameh Naseib, MD, SFHM, CLHM, also received SHM’s Certificate of Leadership in Hospital Medicine at HM13 in May. Dr. Naseib is inpatient medical director at Beaver Medical Group in Redlands, Calif., where he supervises the hospitalist programs at San Gorgonio Memorial and Redlands Community hospitals.

Business Moves

Sound Physicians has announced new contracts for hospitalist services at San Joaquin Community Hospital, a 254-bed facility in Bakersfield, Calif., and at Kona Community Hospital, a 94-bed hospital in Kealakekua, Hawaii.

Emeryville, Calif.–based CEP America, a private physician-staffing firm, is providing hospitalist services at both Palomar Medical Center in Escondido, Calif., and Pomerado Hospital in Poway, Calif. CEP’s added services are in addition to the emergency medicine services the group has provided at the two hospitals for more than a decade.

Apollo Medical Holdings Inc. (ApolloMed), based in Glendale, Calif., is providing hospitalist services to Pacifica Hospital of the Valley in Sun Valley, Calif. Pacifica is a 242-bed acute-care hospital that serves several communities throughout the San Fernando Valley. ApolloMed provides physician services at 29 hospitals throughout southern and central California.

Michael O'Neal is a freelance writer in New York.

Mark Shapiro, MD

Mark Shapiro, MD, has been appointed chief of medicine at Sharp Memorial Hospital in San Diego. A hospitalist with Sharp Rees-Stealy Medical Group since 2006, Dr. Shapiro recently began work as a physician collaborator with PracticingExcellence.com, a Web-based physician-learning platform expected to launch this fall.

John Davidyock, MD, SFHM, is the new section chief of hospital medicine at Temple University Hospital in Philadelphia. Dr. Davidyock also is vice chair of patient safety and quality improvement, and assistant professor of medicine at the Temple University School of Medicine. Dr. Davidyock has been a Senior Fellow of Hospital Medicine since 2012.

Rana Tan, MD, chief hospitalist at Harrison Medical Center in Bremerton, Wash., recently received the 2013 Summit Award for excellence in hospital medicine from Tacoma, Wash.-based Sound Physicians. Dr. Tan has served as chief hospitalist at Harrison Medical Center since 2010 and has been with Sound Physicians since 2005. She oversees 16 hospitalists on her team at Harrison.

Gary J. Carver, MD, is the new director of hospital medicine at Coshocton (Ohio) Hospital. He previously worked as Coshocton Hospital’s chief of staff and sat on the board of trustees.

Thomas McIlraith, MD, SFHM, CLHM, received SHM’s Certificate of Leadership in Hospital Medicine at HM13 in May. Dr. McIlraith is chairman of hospital medicine at Mercy Medical Group in Sacramento, Calif. He is responsible for 24/7 operations at four hospitals and a department of 60 hospitalist physicians. In addition, he is a member of the Mercy Medical Group board of directors. He also is a clinical instructor at the University of California at Davis.

Sameh Naseib, MD, SFHM, CLHM, also received SHM’s Certificate of Leadership in Hospital Medicine at HM13 in May. Dr. Naseib is inpatient medical director at Beaver Medical Group in Redlands, Calif., where he supervises the hospitalist programs at San Gorgonio Memorial and Redlands Community hospitals.

Business Moves

Sound Physicians has announced new contracts for hospitalist services at San Joaquin Community Hospital, a 254-bed facility in Bakersfield, Calif., and at Kona Community Hospital, a 94-bed hospital in Kealakekua, Hawaii.

Emeryville, Calif.–based CEP America, a private physician-staffing firm, is providing hospitalist services at both Palomar Medical Center in Escondido, Calif., and Pomerado Hospital in Poway, Calif. CEP’s added services are in addition to the emergency medicine services the group has provided at the two hospitals for more than a decade.

Apollo Medical Holdings Inc. (ApolloMed), based in Glendale, Calif., is providing hospitalist services to Pacifica Hospital of the Valley in Sun Valley, Calif. Pacifica is a 242-bed acute-care hospital that serves several communities throughout the San Fernando Valley. ApolloMed provides physician services at 29 hospitals throughout southern and central California.

Michael O'Neal is a freelance writer in New York.

Mark Shapiro, MD

Mark Shapiro, MD, has been appointed chief of medicine at Sharp Memorial Hospital in San Diego. A hospitalist with Sharp Rees-Stealy Medical Group since 2006, Dr. Shapiro recently began work as a physician collaborator with PracticingExcellence.com, a Web-based physician-learning platform expected to launch this fall.

John Davidyock, MD, SFHM, is the new section chief of hospital medicine at Temple University Hospital in Philadelphia. Dr. Davidyock also is vice chair of patient safety and quality improvement, and assistant professor of medicine at the Temple University School of Medicine. Dr. Davidyock has been a Senior Fellow of Hospital Medicine since 2012.

Rana Tan, MD, chief hospitalist at Harrison Medical Center in Bremerton, Wash., recently received the 2013 Summit Award for excellence in hospital medicine from Tacoma, Wash.-based Sound Physicians. Dr. Tan has served as chief hospitalist at Harrison Medical Center since 2010 and has been with Sound Physicians since 2005. She oversees 16 hospitalists on her team at Harrison.

Gary J. Carver, MD, is the new director of hospital medicine at Coshocton (Ohio) Hospital. He previously worked as Coshocton Hospital’s chief of staff and sat on the board of trustees.

Thomas McIlraith, MD, SFHM, CLHM, received SHM’s Certificate of Leadership in Hospital Medicine at HM13 in May. Dr. McIlraith is chairman of hospital medicine at Mercy Medical Group in Sacramento, Calif. He is responsible for 24/7 operations at four hospitals and a department of 60 hospitalist physicians. In addition, he is a member of the Mercy Medical Group board of directors. He also is a clinical instructor at the University of California at Davis.

Sameh Naseib, MD, SFHM, CLHM, also received SHM’s Certificate of Leadership in Hospital Medicine at HM13 in May. Dr. Naseib is inpatient medical director at Beaver Medical Group in Redlands, Calif., where he supervises the hospitalist programs at San Gorgonio Memorial and Redlands Community hospitals.

Business Moves

Sound Physicians has announced new contracts for hospitalist services at San Joaquin Community Hospital, a 254-bed facility in Bakersfield, Calif., and at Kona Community Hospital, a 94-bed hospital in Kealakekua, Hawaii.

Emeryville, Calif.–based CEP America, a private physician-staffing firm, is providing hospitalist services at both Palomar Medical Center in Escondido, Calif., and Pomerado Hospital in Poway, Calif. CEP’s added services are in addition to the emergency medicine services the group has provided at the two hospitals for more than a decade.

Apollo Medical Holdings Inc. (ApolloMed), based in Glendale, Calif., is providing hospitalist services to Pacifica Hospital of the Valley in Sun Valley, Calif. Pacifica is a 242-bed acute-care hospital that serves several communities throughout the San Fernando Valley. ApolloMed provides physician services at 29 hospitals throughout southern and central California.

Michael O'Neal is a freelance writer in New York.

SHM announced in May the launch of a new interdisciplinary partnership, the Alliance to Advance Patient Nutrition, in conjunction with four other organizations. The alliance’s mission is to improve patient outcomes through nutrition intervention in the hospital.

Representing more than 100,000 dietitians, nurses, hospitalists, and other physicians and clinicians from across the nation, the following organizations have come together with SHM to champion for early nutrition screening, assessment, and intervention in hospitals:

• Academy of Medical-Surgical Nurses (AMSN);
• Academy of Nutrition and Dietetics (AND);
• American Society for Parenteral and Enteral Nutrition (ASPEN); and
• Abbott Nutrition.

Malnutrition increases costs, length of stay, and unfavorable outcomes. Properly addressing hospital malnutrition creates an opportunity to improve quality of care while also reducing healthcare costs. Additional clinical research finds that malnourished patients are two times more likely to develop a pressure ulcer, while patients with malnutrition have three times the rate of infection.

Yet when hospitalized patients are provided intervention via oral nutrition supplements, health economic research finds associated benefits:

Nutrition intervention can reduce hospital length of stay by an average of two days, and nutrition intervention has been shown to reduce patient hospitalization costs by 21.6%, or $4,734 per episode.

Additionally, there was a 6.7% reduction in the probability of 30-day readmission with patients who had at least one known subsequent readmission and were offered oral nutrition supplements during hospitalization.

“There is a growing body of evidence supporting the positive impact nutrition has on improving patient outcomes,” says hospitalist Melissa Parkhurst, MD, FHM, who serves as medical director for the University of Kansas Hospital’s hospitalist section and its nutrition support service. “We are seeing that early intervention can make a significant difference. As physicians, we need to work with the entire clinician team to ensure that nutrition is an integral part of our patients’ treatment plans.”

The alliance launched a website at www.malnutrition.org to provide hospital-based clinicians with the following resources:

• Research and fact sheets about malnutrition and the positive impact nutrition intervention has on patient care and outcomes;
• The Alliance Nutrition Toolkit, which facilitates clinician collaboration and nutrition integration; and
• Information about educational events, such as quick learning modules, continuing medical education (CME) programs.

The Alliance to Advance Patient Nutrition is made possible with support from Abbott’s nutrition business.

SHM announced in May the launch of a new interdisciplinary partnership, the Alliance to Advance Patient Nutrition, in conjunction with four other organizations. The alliance’s mission is to improve patient outcomes through nutrition intervention in the hospital.

Representing more than 100,000 dietitians, nurses, hospitalists, and other physicians and clinicians from across the nation, the following organizations have come together with SHM to champion for early nutrition screening, assessment, and intervention in hospitals:

• Academy of Medical-Surgical Nurses (AMSN);
• Academy of Nutrition and Dietetics (AND);
• American Society for Parenteral and Enteral Nutrition (ASPEN); and
• Abbott Nutrition.

Malnutrition increases costs, length of stay, and unfavorable outcomes. Properly addressing hospital malnutrition creates an opportunity to improve quality of care while also reducing healthcare costs. Additional clinical research finds that malnourished patients are two times more likely to develop a pressure ulcer, while patients with malnutrition have three times the rate of infection.

Yet when hospitalized patients are provided intervention via oral nutrition supplements, health economic research finds associated benefits:

Nutrition intervention can reduce hospital length of stay by an average of two days, and nutrition intervention has been shown to reduce patient hospitalization costs by 21.6%, or $4,734 per episode.

Additionally, there was a 6.7% reduction in the probability of 30-day readmission with patients who had at least one known subsequent readmission and were offered oral nutrition supplements during hospitalization.

“There is a growing body of evidence supporting the positive impact nutrition has on improving patient outcomes,” says hospitalist Melissa Parkhurst, MD, FHM, who serves as medical director for the University of Kansas Hospital’s hospitalist section and its nutrition support service. “We are seeing that early intervention can make a significant difference. As physicians, we need to work with the entire clinician team to ensure that nutrition is an integral part of our patients’ treatment plans.”

The alliance launched a website at www.malnutrition.org to provide hospital-based clinicians with the following resources:

• Research and fact sheets about malnutrition and the positive impact nutrition intervention has on patient care and outcomes;
• The Alliance Nutrition Toolkit, which facilitates clinician collaboration and nutrition integration; and
• Information about educational events, such as quick learning modules, continuing medical education (CME) programs.

The Alliance to Advance Patient Nutrition is made possible with support from Abbott’s nutrition business.

SHM announced in May the launch of a new interdisciplinary partnership, the Alliance to Advance Patient Nutrition, in conjunction with four other organizations. The alliance’s mission is to improve patient outcomes through nutrition intervention in the hospital.

Representing more than 100,000 dietitians, nurses, hospitalists, and other physicians and clinicians from across the nation, the following organizations have come together with SHM to champion for early nutrition screening, assessment, and intervention in hospitals:

• Academy of Medical-Surgical Nurses (AMSN);
• Academy of Nutrition and Dietetics (AND);
• American Society for Parenteral and Enteral Nutrition (ASPEN); and
• Abbott Nutrition.

Malnutrition increases costs, length of stay, and unfavorable outcomes. Properly addressing hospital malnutrition creates an opportunity to improve quality of care while also reducing healthcare costs. Additional clinical research finds that malnourished patients are two times more likely to develop a pressure ulcer, while patients with malnutrition have three times the rate of infection.

Yet when hospitalized patients are provided intervention via oral nutrition supplements, health economic research finds associated benefits:

Nutrition intervention can reduce hospital length of stay by an average of two days, and nutrition intervention has been shown to reduce patient hospitalization costs by 21.6%, or $4,734 per episode.

Additionally, there was a 6.7% reduction in the probability of 30-day readmission with patients who had at least one known subsequent readmission and were offered oral nutrition supplements during hospitalization.

“There is a growing body of evidence supporting the positive impact nutrition has on improving patient outcomes,” says hospitalist Melissa Parkhurst, MD, FHM, who serves as medical director for the University of Kansas Hospital’s hospitalist section and its nutrition support service. “We are seeing that early intervention can make a significant difference. As physicians, we need to work with the entire clinician team to ensure that nutrition is an integral part of our patients’ treatment plans.”

The alliance launched a website at www.malnutrition.org to provide hospital-based clinicians with the following resources:

• Research and fact sheets about malnutrition and the positive impact nutrition intervention has on patient care and outcomes;
• The Alliance Nutrition Toolkit, which facilitates clinician collaboration and nutrition integration; and
• Information about educational events, such as quick learning modules, continuing medical education (CME) programs.

The Alliance to Advance Patient Nutrition is made possible with support from Abbott’s nutrition business.