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Leadership. 2017 Hospital Medicine Revised Core Competencies
Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Distinguish between management and leadership.
Describe hospitalist responsibilities and opportunities to provide active leadership.
Explain the attributes and effects of modeling positive and negative behaviors.
Explain the importance of finding mentor(s) and serving as a mentor.
Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.
Describe the key elements of a message.
Name the key elements of strategic planning processes.
Explain factors that predict the success or failure of strategic plans.
Describe styles of leadership.
Explain the attributes of effective leadership.
Articulate the business and financial motivators that affect decision-making.
Explain the specific factors that effect positive change.
Explain effective negotiation and conflict resolution techniques.b.
SKILLS
Hospitalists should be able to:
Tailor messages to specific target audiences.
Develop effective communication skills using multiple modalities.
Plan and conduct an effective meeting.
Construct program mission and vision statements.
Develop personal, team, and program goals and identify indicators of achievement.
Establish, measure, and report key performance metrics.
Use established metrics to assess progress and set new goals for performance and outcomes.
Analyze personal leadership style.
Demonstrate the ability to effectively work with colleagues who have various leadership styles.
Develop budgets to support goals using accepted financial principles.
Translate performance into measurable financial outcomes.
Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.
Demonstrate effective and creative problem-solving techniques.
Resolve conflicts with specific negotiation techniques.
Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.
Advocate for financial and other resources needed to support goals and initiatives.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Practice active listening techniques.
Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.
Recognize the importance and influence of positive role modeling.
Assess and address personal leadership strengths and weaknesses.
Seek and participate in opportunities for professional development.
Exemplify professionalism.
Accept responsibility and accountability for management decisions.
Build consensus in support of key decisions.
Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Distinguish between management and leadership.
Describe hospitalist responsibilities and opportunities to provide active leadership.
Explain the attributes and effects of modeling positive and negative behaviors.
Explain the importance of finding mentor(s) and serving as a mentor.
Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.
Describe the key elements of a message.
Name the key elements of strategic planning processes.
Explain factors that predict the success or failure of strategic plans.
Describe styles of leadership.
Explain the attributes of effective leadership.
Articulate the business and financial motivators that affect decision-making.
Explain the specific factors that effect positive change.
Explain effective negotiation and conflict resolution techniques.b.
SKILLS
Hospitalists should be able to:
Tailor messages to specific target audiences.
Develop effective communication skills using multiple modalities.
Plan and conduct an effective meeting.
Construct program mission and vision statements.
Develop personal, team, and program goals and identify indicators of achievement.
Establish, measure, and report key performance metrics.
Use established metrics to assess progress and set new goals for performance and outcomes.
Analyze personal leadership style.
Demonstrate the ability to effectively work with colleagues who have various leadership styles.
Develop budgets to support goals using accepted financial principles.
Translate performance into measurable financial outcomes.
Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.
Demonstrate effective and creative problem-solving techniques.
Resolve conflicts with specific negotiation techniques.
Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.
Advocate for financial and other resources needed to support goals and initiatives.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Practice active listening techniques.
Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.
Recognize the importance and influence of positive role modeling.
Assess and address personal leadership strengths and weaknesses.
Seek and participate in opportunities for professional development.
Exemplify professionalism.
Accept responsibility and accountability for management decisions.
Build consensus in support of key decisions.
Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for patients, building consensus, and balancing the needs of individual patients with the resources available to the hospital. On a daily basis, hospitalists must work in teams and exemplify essential leadership behaviors. Hospitalists lead efforts to identify, assess, and improve patient outcomes, resource use, cost-effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of healthcare.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Distinguish between management and leadership.
Describe hospitalist responsibilities and opportunities to provide active leadership.
Explain the attributes and effects of modeling positive and negative behaviors.
Explain the importance of finding mentor(s) and serving as a mentor.
Discuss how mentor relationships affect the development and advancement of the field of hospital medicine.
Describe the key elements of a message.
Name the key elements of strategic planning processes.
Explain factors that predict the success or failure of strategic plans.
Describe styles of leadership.
Explain the attributes of effective leadership.
Articulate the business and financial motivators that affect decision-making.
Explain the specific factors that effect positive change.
Explain effective negotiation and conflict resolution techniques.b.
SKILLS
Hospitalists should be able to:
Tailor messages to specific target audiences.
Develop effective communication skills using multiple modalities.
Plan and conduct an effective meeting.
Construct program mission and vision statements.
Develop personal, team, and program goals and identify indicators of achievement.
Establish, measure, and report key performance metrics.
Use established metrics to assess progress and set new goals for performance and outcomes.
Analyze personal leadership style.
Demonstrate the ability to effectively work with colleagues who have various leadership styles.
Develop budgets to support goals using accepted financial principles.
Translate performance into measurable financial outcomes.
Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.
Demonstrate effective and creative problem-solving techniques.
Resolve conflicts with specific negotiation techniques.
Provide leadership in teaching, educational scholarship, quality improvement, and other areas that serve to improve patient outcomes and advance the field of hospital medicine.
Advocate for financial and other resources needed to support goals and initiatives.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Practice active listening techniques.
Provide and seek timely, constructive feedback from peers, subordinates, and supervisors on opportunities for performance improvement.
Recognize the importance and influence of positive role modeling.
Assess and address personal leadership strengths and weaknesses.
Seek and participate in opportunities for professional development.
Exemplify professionalism.
Accept responsibility and accountability for management decisions.
Build consensus in support of key decisions.
© 2017 Society of Hospital Medicine
Management Practices. 2017 Hospital Medicine Revised Core Competencies
Management practice in hospital medicine refers to program/medical group development and growth, contract negotiation, performance measurement, and financial analysis. Hospitalists require fundamental management skills to enhance their individual success and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third-party payer contracts on hospital reimbursement.
Describe key features of healthcare reform and discuss the potential effect of high-impact areas such as value-based purchasing, care transitions, and hospital-acquired conditions on patient care and expectations for individual hospitalists and hospital medicine groups.
Describe the impact of medication formularies, utilization review requirements, third-party payer contracts, and other policies affecting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the basics of human resource management, particularly regarding managing diversity, basic employment law, recruitment and retention, and the tools used to manage personnel.
Describe federal statutory restrictions on physicians contracting with hospitals, third-party payers, and group practices.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of using physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including, but not limited to, procedure codes, relative value units, direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Implement financially sustainable changes in staffing, skill mix, and care delivery models to optimize performance.
Develop effective strategies to market the hospital medicine program.
Develop job descriptions for physician and nonphysician employees to facilitate accountability and professional development.
Develop effective strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and nonphysician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third-party payers.
Interpret hospital-generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses, and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop effective strategies for aligning hospitalist incentives with organization- and system-level goals.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
Achieve greater clinical integration between hospitalists and other healthcare providers across the care continuum.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Value the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality, and effectiveness.
Prioritize meeting or exceeding customer and colleague expectations.
Value the importance of best management practice.
Value the importance of marketing and public relations to foster sustainable practice growth.
Management practice in hospital medicine refers to program/medical group development and growth, contract negotiation, performance measurement, and financial analysis. Hospitalists require fundamental management skills to enhance their individual success and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third-party payer contracts on hospital reimbursement.
Describe key features of healthcare reform and discuss the potential effect of high-impact areas such as value-based purchasing, care transitions, and hospital-acquired conditions on patient care and expectations for individual hospitalists and hospital medicine groups.
Describe the impact of medication formularies, utilization review requirements, third-party payer contracts, and other policies affecting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the basics of human resource management, particularly regarding managing diversity, basic employment law, recruitment and retention, and the tools used to manage personnel.
Describe federal statutory restrictions on physicians contracting with hospitals, third-party payers, and group practices.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of using physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including, but not limited to, procedure codes, relative value units, direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Implement financially sustainable changes in staffing, skill mix, and care delivery models to optimize performance.
Develop effective strategies to market the hospital medicine program.
Develop job descriptions for physician and nonphysician employees to facilitate accountability and professional development.
Develop effective strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and nonphysician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third-party payers.
Interpret hospital-generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses, and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop effective strategies for aligning hospitalist incentives with organization- and system-level goals.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
Achieve greater clinical integration between hospitalists and other healthcare providers across the care continuum.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Value the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality, and effectiveness.
Prioritize meeting or exceeding customer and colleague expectations.
Value the importance of best management practice.
Value the importance of marketing and public relations to foster sustainable practice growth.
Management practice in hospital medicine refers to program/medical group development and growth, contract negotiation, performance measurement, and financial analysis. Hospitalists require fundamental management skills to enhance their individual success and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third-party payer contracts on hospital reimbursement.
Describe key features of healthcare reform and discuss the potential effect of high-impact areas such as value-based purchasing, care transitions, and hospital-acquired conditions on patient care and expectations for individual hospitalists and hospital medicine groups.
Describe the impact of medication formularies, utilization review requirements, third-party payer contracts, and other policies affecting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the basics of human resource management, particularly regarding managing diversity, basic employment law, recruitment and retention, and the tools used to manage personnel.
Describe federal statutory restrictions on physicians contracting with hospitals, third-party payers, and group practices.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of using physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including, but not limited to, procedure codes, relative value units, direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Implement financially sustainable changes in staffing, skill mix, and care delivery models to optimize performance.
Develop effective strategies to market the hospital medicine program.
Develop job descriptions for physician and nonphysician employees to facilitate accountability and professional development.
Develop effective strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and nonphysician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third-party payers.
Interpret hospital-generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses, and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop effective strategies for aligning hospitalist incentives with organization- and system-level goals.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
Achieve greater clinical integration between hospitalists and other healthcare providers across the care continuum.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Value the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality, and effectiveness.
Prioritize meeting or exceeding customer and colleague expectations.
Value the importance of best management practice.
Value the importance of marketing and public relations to foster sustainable practice growth.
© 2017 Society of Hospital Medicine
Medical Consultation and Comanagement. 2017 Hospital Medicine Revised Core Competencies
As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.1 Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define the role of a consultant.
Describe the principles of effective consultation.
Describe factors influencing compliance with consultant recommendations.
Recognize the importance of arranging appropriate follow-up.
SKILLS
Hospitalists should be able to:
Determine their scope as a consultant or a partner participating in comanagement.
Assess the urgency of the consultation and the nature of the question posed by the requesting physician.
Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.
Provide concise and specific evidence-based recommendations for risk assessment and management.
Use a patient-centered approach when making recommendations.
Communicate recommendations in an expedient and efficient manner.
Transmit written communication legibly and include contact information.
Communicate effectively with patients and families to convey recommendations and treatment plans.
Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.
Anticipate potential complications and provide recommendations to prevent complications.
Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients.
ATTITUDES
Hospitalists should be able to:
Respond promptly to the requesting physician’s need for consultation.
Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.
Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.
1. Auerbach AD, Wachter RM, Cheng Q, Maselli J, McDermott M, Vittinghoff E, et al. Comanagement of surgical patients between neurosurgeons and hospitalists. Arch Intern Med. 2010;170(22):2004-2010.
As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.1 Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define the role of a consultant.
Describe the principles of effective consultation.
Describe factors influencing compliance with consultant recommendations.
Recognize the importance of arranging appropriate follow-up.
SKILLS
Hospitalists should be able to:
Determine their scope as a consultant or a partner participating in comanagement.
Assess the urgency of the consultation and the nature of the question posed by the requesting physician.
Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.
Provide concise and specific evidence-based recommendations for risk assessment and management.
Use a patient-centered approach when making recommendations.
Communicate recommendations in an expedient and efficient manner.
Transmit written communication legibly and include contact information.
Communicate effectively with patients and families to convey recommendations and treatment plans.
Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.
Anticipate potential complications and provide recommendations to prevent complications.
Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients.
ATTITUDES
Hospitalists should be able to:
Respond promptly to the requesting physician’s need for consultation.
Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.
Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.
As consultants, hospitalists provide expert medical opinion regarding the care of patients scheduled for surgery or who may be admitted to other medical and surgical services. Additionally, hospitalists may also be asked to participate in active comanagement of such patients, especially those with multiple or serious medical comorbidities. Comanagement of surgical patients between surgeons and hospitalists reduces hospital costs and improves healthcare professionals’ perceptions of care quality.1 Effective and frequent communication between the hospitalist and the requesting clinical service ensures safe and quality care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define the role of a consultant.
Describe the principles of effective consultation.
Describe factors influencing compliance with consultant recommendations.
Recognize the importance of arranging appropriate follow-up.
SKILLS
Hospitalists should be able to:
Determine their scope as a consultant or a partner participating in comanagement.
Assess the urgency of the consultation and the nature of the question posed by the requesting physician.
Obtain an independent relevant history, perform a physical examination, and review the medical record to inform clinical impression.
Provide concise and specific evidence-based recommendations for risk assessment and management.
Use a patient-centered approach when making recommendations.
Communicate recommendations in an expedient and efficient manner.
Transmit written communication legibly and include contact information.
Communicate effectively with patients and families to convey recommendations and treatment plans.
Provide timely and appropriate follow-up, including review of pertinent findings and laboratory data, and ensure that critical recommendations have been followed.
Anticipate potential complications and provide recommendations to prevent complications.
Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety, improve care quality, and optimize resource use for all medical and surgical patients.
ATTITUDES
Hospitalists should be able to:
Respond promptly to the requesting physician’s need for consultation.
Lead by example by performing consultations in a collegial, professional, and nonconfrontational manner.
Acknowledge when the role as a consultant in the patient’s care is complete, document final recommendations, and maintain availability.
1. Auerbach AD, Wachter RM, Cheng Q, Maselli J, McDermott M, Vittinghoff E, et al. Comanagement of surgical patients between neurosurgeons and hospitalists. Arch Intern Med. 2010;170(22):2004-2010.
1. Auerbach AD, Wachter RM, Cheng Q, Maselli J, McDermott M, Vittinghoff E, et al. Comanagement of surgical patients between neurosurgeons and hospitalists. Arch Intern Med. 2010;170(22):2004-2010.
© 2017 Society of Hospital Medicine
Nutrition and the Hospitalized Patient. 2017 Hospital Medicine Revised Core Competencies
Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, increased risk of readmission, and overall increased morbidity and mortality.1,2 Malnutrition is reported in up to 50% of hospitalized patients. Although early screening for nutritional risk allows for appropriate intervention in the hospital setting as well as planning for appropriate home services and follow-up for outpatient nutritional care, malnutrition is underrecognized and undertreated.3In malnourished patients, nutritional intervention has been shown to reduce clinical complications, length of stay, readmission rates, and mortality.4 Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate, or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe methods of screening for malnutrition.
Describe the consequences of malnutrition on bodily function, illness, and outcomes.
Explain when a nutrition evaluation by a registered dietitian is required.
Differentiate among various modified diets and nutritional supplements and explain the indications for each.
Explain the indications and contraindications for enteral nutrition.
Describe the indications for parenteral nutrition.
Describe potential complications associated with enteral and parenteral nutrition.
Recognize that specialized nutritional supplementation may be required in certain patient populations, which include patients with extensive wounds or increased catabolic needs.
Explain the risk factors for and the clinical features of the refeeding syndrome.
SKILLS
Hospitalists should be able to:
Use objective criteria, including history, physical examination findings, and laboratory results, to diagnose and categorize the severity of malnutrition and identify patients who are at increased risk.
Identify the symptoms or signs of medical conditions that are associated with or secondary to malnutrition and formulate an evidence-based treatment plan.
Implement individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, on the basis of the patient’s medical condition.
Treat electrolyte abnormalities associated with the refeeding syndrome.
Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.
Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.
Coordinate follow-up nutrition care as part of discharge plans for those patients requiring nutritional support.
Lead, coordinate, and/or participate in initiatives to improve awareness and documentation efforts that appropriately categorize the patient with malnutrition and determine the impact this may have on risk-adjusted mortality and value-based purchasing.
Lead, coordinate, and/or participate in multidisciplinary initiatives to optimize resource use.
Lead, coordinate, and/or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.
Lead, coordinate, and/or participate in efforts to develop strategies to minimize institution complication rates.
ATTITUDES
Hospitalists should be able to:
Recognize the importance of adequate nutrition in hospitalized patients.
Work collaboratively with clinical nutrition staff, which may include nursing, pharmacists, and dieticians, to implement the nutrition care plan.
Engage in a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.
1. Allaudeen N, Vidyarthi A, Maselli J, Auerbach A. Redefining readmission risk factors for general medicine patients. J Hosp Med. 2011;6(2):54-60.
2. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322-330.
3. Mitchell MA, Duerksen DR, Rahman A. Are housestaff identifying malnourished hospitalized medicine patients? Appl Physiol Nutr Metab. 2014;39(10):1192-1195.
4. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet. 2013;113(9):1219-1237.
Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, increased risk of readmission, and overall increased morbidity and mortality.1,2 Malnutrition is reported in up to 50% of hospitalized patients. Although early screening for nutritional risk allows for appropriate intervention in the hospital setting as well as planning for appropriate home services and follow-up for outpatient nutritional care, malnutrition is underrecognized and undertreated.3In malnourished patients, nutritional intervention has been shown to reduce clinical complications, length of stay, readmission rates, and mortality.4 Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate, or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe methods of screening for malnutrition.
Describe the consequences of malnutrition on bodily function, illness, and outcomes.
Explain when a nutrition evaluation by a registered dietitian is required.
Differentiate among various modified diets and nutritional supplements and explain the indications for each.
Explain the indications and contraindications for enteral nutrition.
Describe the indications for parenteral nutrition.
Describe potential complications associated with enteral and parenteral nutrition.
Recognize that specialized nutritional supplementation may be required in certain patient populations, which include patients with extensive wounds or increased catabolic needs.
Explain the risk factors for and the clinical features of the refeeding syndrome.
SKILLS
Hospitalists should be able to:
Use objective criteria, including history, physical examination findings, and laboratory results, to diagnose and categorize the severity of malnutrition and identify patients who are at increased risk.
Identify the symptoms or signs of medical conditions that are associated with or secondary to malnutrition and formulate an evidence-based treatment plan.
Implement individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, on the basis of the patient’s medical condition.
Treat electrolyte abnormalities associated with the refeeding syndrome.
Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.
Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.
Coordinate follow-up nutrition care as part of discharge plans for those patients requiring nutritional support.
Lead, coordinate, and/or participate in initiatives to improve awareness and documentation efforts that appropriately categorize the patient with malnutrition and determine the impact this may have on risk-adjusted mortality and value-based purchasing.
Lead, coordinate, and/or participate in multidisciplinary initiatives to optimize resource use.
Lead, coordinate, and/or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.
Lead, coordinate, and/or participate in efforts to develop strategies to minimize institution complication rates.
ATTITUDES
Hospitalists should be able to:
Recognize the importance of adequate nutrition in hospitalized patients.
Work collaboratively with clinical nutrition staff, which may include nursing, pharmacists, and dieticians, to implement the nutrition care plan.
Engage in a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.
Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, increased risk of readmission, and overall increased morbidity and mortality.1,2 Malnutrition is reported in up to 50% of hospitalized patients. Although early screening for nutritional risk allows for appropriate intervention in the hospital setting as well as planning for appropriate home services and follow-up for outpatient nutritional care, malnutrition is underrecognized and undertreated.3In malnourished patients, nutritional intervention has been shown to reduce clinical complications, length of stay, readmission rates, and mortality.4 Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate, or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe methods of screening for malnutrition.
Describe the consequences of malnutrition on bodily function, illness, and outcomes.
Explain when a nutrition evaluation by a registered dietitian is required.
Differentiate among various modified diets and nutritional supplements and explain the indications for each.
Explain the indications and contraindications for enteral nutrition.
Describe the indications for parenteral nutrition.
Describe potential complications associated with enteral and parenteral nutrition.
Recognize that specialized nutritional supplementation may be required in certain patient populations, which include patients with extensive wounds or increased catabolic needs.
Explain the risk factors for and the clinical features of the refeeding syndrome.
SKILLS
Hospitalists should be able to:
Use objective criteria, including history, physical examination findings, and laboratory results, to diagnose and categorize the severity of malnutrition and identify patients who are at increased risk.
Identify the symptoms or signs of medical conditions that are associated with or secondary to malnutrition and formulate an evidence-based treatment plan.
Implement individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, on the basis of the patient’s medical condition.
Treat electrolyte abnormalities associated with the refeeding syndrome.
Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.
Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.
Coordinate follow-up nutrition care as part of discharge plans for those patients requiring nutritional support.
Lead, coordinate, and/or participate in initiatives to improve awareness and documentation efforts that appropriately categorize the patient with malnutrition and determine the impact this may have on risk-adjusted mortality and value-based purchasing.
Lead, coordinate, and/or participate in multidisciplinary initiatives to optimize resource use.
Lead, coordinate, and/or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.
Lead, coordinate, and/or participate in efforts to develop strategies to minimize institution complication rates.
ATTITUDES
Hospitalists should be able to:
Recognize the importance of adequate nutrition in hospitalized patients.
Work collaboratively with clinical nutrition staff, which may include nursing, pharmacists, and dieticians, to implement the nutrition care plan.
Engage in a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.
1. Allaudeen N, Vidyarthi A, Maselli J, Auerbach A. Redefining readmission risk factors for general medicine patients. J Hosp Med. 2011;6(2):54-60.
2. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322-330.
3. Mitchell MA, Duerksen DR, Rahman A. Are housestaff identifying malnourished hospitalized medicine patients? Appl Physiol Nutr Metab. 2014;39(10):1192-1195.
4. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet. 2013;113(9):1219-1237.
1. Allaudeen N, Vidyarthi A, Maselli J, Auerbach A. Redefining readmission risk factors for general medicine patients. J Hosp Med. 2011;6(2):54-60.
2. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322-330.
3. Mitchell MA, Duerksen DR, Rahman A. Are housestaff identifying malnourished hospitalized medicine patients? Appl Physiol Nutr Metab. 2014;39(10):1192-1195.
4. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet. 2013;113(9):1219-1237.
© 2017 Society of Hospital Medicine
Palliative Care. 2017 Hospital Medicine Revised Core Competencies
Palliative care refers to the comprehensive care of patients and families who are living with serious illness. It focuses on providing patients with relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any stage of illness and should be provided simultaneously with other medical treatments, including disease-modifying and life-prolonging therapies. Palliative care is provided by interprofessional teams, including physicians, nurse practitioners, physician assistants, nurses, social workers, case managers, and chaplains.
Seriously ill patients are frequently hospitalized, and thus all hospitalists—as frontline physicians who coordinate care for these patients—are key members of the interprofessional team who provide primary or generalist palliative care. In addition, in hospitals where palliative care consultation services are available, hospitalists are optimally positioned to refer to and collaborate with these specialty palliative care consultants. In hospitals where no or limited specialty palliative care services are available, hospitalists have an even more central role in providing palliative care. Hospitalists also have a key role in leading and contributing to systems and quality improvement efforts related to palliative care.
Key roles for hospitalists involved in palliative care are (1) leading discussions of goals of care and advance care planning, including completing appropriate documentation of patients’ wishes; (2) screening and implementing treatment for common physical symptoms, including pain, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation; and (3) referring patients to community services to provide support around serious illness after hospital discharge, including hospice and community palliative care services when available. A complete list of core competencies for hospitalists in palliative care follows.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define palliative care, including primary (or generalist) and specialty palliative care, and explain effective strategies for describing the benefits of palliative care to colleagues, specialists, patients, and families.
Explain the role of palliative care throughout the course of illness, how it can be provided alongside all other appropriate medical treatments, and appropriate referral to local resources that provide palliative care in the hospital and community.
Recognize when specialty palliative care consultation, when it is available, should be sought for refractory or complex patient or family palliative care needs.
Identify the factors that contribute to prognosis in common serious illnesses (eg, cancer, congestive heart failure, chronic obstructive pulmonary disease, end stage renal disease, dementia, and multimorbidity), including how to identify patients who may benefit from palliative care and how to broadly estimate prognosis (eg, months to years, weeks to months, days to weeks, hours to days).
Describe signs and symptoms of the last 24 hours of life and how to discuss these observations with families.
Describe data on efficacy and burdens of life support interventions in seriously ill patients, such as tube feeding in advanced dementia and cardiopulmonary resuscitation.
Explain the ethical principles involved with caring for patients at the end of life, including the right of competent patients or their surrogates to refuse medical treatments, including life-sustaining therapies, and the principle of “double effect.”
Describe specific legal considerations related to surrogate decision-making and advance planning in the state in which the hospitalist practices.
Describe the purpose and mechanics of advance directives, including physician or medical orders for life-sustaining treatment (POLST/MOLST) forms available in the state in which the hospitalist practices, durable medical power of attorney forms, and other declarations of patient wishes and treatment preferences.
Describe the basic tenets of hospice care and the Medicare hospice benefit and explain the process of initiating direct referrals to these programs in various settings (ie, home, skilled nursing facility, inpatient).
Describe the role of the hospitalist after a patient dies in the hospital, including pronouncing of death, completing the death certificate, requesting an autopsy, notifying the family and primary care physician, contacting the organ donor network, and providing the family with hospital contact information for questions and bereavement resources.
SKILLS
Hospitalists should be able to:
Perform a comprehensive patient assessment to screen patients for palliative care needs, including (1) pain and other common symptoms (eg, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, constipation); (2) psychosocial and spiritual support of the patient and family; (3) advance care planning communication about prognosis and goals of care; and (4) needs for support on hospital discharge or bereavement.
Work in interdisciplinary teams, including nursing, social work, case management, therapy, and spiritual care, to formulate specific patient-centered palliative care plans to address identified patient and family needs.
Build therapeutic relationships with seriously ill patients and their families as a basis of support for coping and creating collaborative patient- and family-centered care plans.
In seriously ill and/or actively dying patients, provide first-line treatment for common symptoms such as nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation.
Provide counseling on advance care planning, advance care directives, POLST/MOLST forms, and code status, including the outcomes of cardiopulmonary resusitation and other life-sustaining interventions in seriously ill patients.
Lead culturally sensitive communications about prognosis and goals of care among patients, families, and other members of the healthcare team, including family meetings and discussions in urgent situations to ensure that patients receive treatments that match their goals.
Coordinate goals of care and treatment plan among the treatment team, including primary care physicians and inpatient and outpatient specialty consultants.
Consult specialty palliative care and/or hospital ethics service when there is conflict among patients, families, and/or healthcare providers regarding the appropriate healthcare agent for decision-making and provision of life-sustaining interventions.
Identify when hospice may be the appropriate care model given a patient’s prognosis and goals of care, and describe the hospice care philosophy and care model to a patient and family.
Implement protocols and multidisciplinary care plans to ensure patient comfort and adequate family support when life-prolonging measures such as mechanical ventilation, vasopressor support, or other intensive care measures are withdrawn or withheld.
Ensure that the hospital palliative care plan is honored upon discharge, including communicating this plan with primary care and other outpatient providers and establishing home supportive services if needed.
Implement best practices for self-care and coping with the stress of caring for the seriously ill.
ATTITUDES
Hospitalists should be able to:
Appreciate that palliative care is appropriate at any stage of a serious illness and that it should be provided to all seriously ill patients.
Appreciate that hospitalists have a key role in ensuring that the palliative care needs of seriously ill patients are addressed.
Recognize the importance of empathic communication, building a therapeutic relationship with patients and families, and developing patient- and family-centered treatment plans.
Recognize the impact that social, cultural, and spiritual factors have on preferences for care in the setting of serious illness.
Appreciate the roles of, and collaboration with, other members of the healthcare team, including nursing and social services, pharmacy, psychology, and spiritual care, in providing palliative care.
Lead, coordinate, and/or participate in quality improvement initiatives to improve the care of seriously ill patients, such as symptom identification and management systems and improved advance care planning and goals of care approaches.
Lead, coordinate, and/or participate in efforts to establish or support existing multidisciplinary palliative care teams.
Palliative care refers to the comprehensive care of patients and families who are living with serious illness. It focuses on providing patients with relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any stage of illness and should be provided simultaneously with other medical treatments, including disease-modifying and life-prolonging therapies. Palliative care is provided by interprofessional teams, including physicians, nurse practitioners, physician assistants, nurses, social workers, case managers, and chaplains.
Seriously ill patients are frequently hospitalized, and thus all hospitalists—as frontline physicians who coordinate care for these patients—are key members of the interprofessional team who provide primary or generalist palliative care. In addition, in hospitals where palliative care consultation services are available, hospitalists are optimally positioned to refer to and collaborate with these specialty palliative care consultants. In hospitals where no or limited specialty palliative care services are available, hospitalists have an even more central role in providing palliative care. Hospitalists also have a key role in leading and contributing to systems and quality improvement efforts related to palliative care.
Key roles for hospitalists involved in palliative care are (1) leading discussions of goals of care and advance care planning, including completing appropriate documentation of patients’ wishes; (2) screening and implementing treatment for common physical symptoms, including pain, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation; and (3) referring patients to community services to provide support around serious illness after hospital discharge, including hospice and community palliative care services when available. A complete list of core competencies for hospitalists in palliative care follows.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define palliative care, including primary (or generalist) and specialty palliative care, and explain effective strategies for describing the benefits of palliative care to colleagues, specialists, patients, and families.
Explain the role of palliative care throughout the course of illness, how it can be provided alongside all other appropriate medical treatments, and appropriate referral to local resources that provide palliative care in the hospital and community.
Recognize when specialty palliative care consultation, when it is available, should be sought for refractory or complex patient or family palliative care needs.
Identify the factors that contribute to prognosis in common serious illnesses (eg, cancer, congestive heart failure, chronic obstructive pulmonary disease, end stage renal disease, dementia, and multimorbidity), including how to identify patients who may benefit from palliative care and how to broadly estimate prognosis (eg, months to years, weeks to months, days to weeks, hours to days).
Describe signs and symptoms of the last 24 hours of life and how to discuss these observations with families.
Describe data on efficacy and burdens of life support interventions in seriously ill patients, such as tube feeding in advanced dementia and cardiopulmonary resuscitation.
Explain the ethical principles involved with caring for patients at the end of life, including the right of competent patients or their surrogates to refuse medical treatments, including life-sustaining therapies, and the principle of “double effect.”
Describe specific legal considerations related to surrogate decision-making and advance planning in the state in which the hospitalist practices.
Describe the purpose and mechanics of advance directives, including physician or medical orders for life-sustaining treatment (POLST/MOLST) forms available in the state in which the hospitalist practices, durable medical power of attorney forms, and other declarations of patient wishes and treatment preferences.
Describe the basic tenets of hospice care and the Medicare hospice benefit and explain the process of initiating direct referrals to these programs in various settings (ie, home, skilled nursing facility, inpatient).
Describe the role of the hospitalist after a patient dies in the hospital, including pronouncing of death, completing the death certificate, requesting an autopsy, notifying the family and primary care physician, contacting the organ donor network, and providing the family with hospital contact information for questions and bereavement resources.
SKILLS
Hospitalists should be able to:
Perform a comprehensive patient assessment to screen patients for palliative care needs, including (1) pain and other common symptoms (eg, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, constipation); (2) psychosocial and spiritual support of the patient and family; (3) advance care planning communication about prognosis and goals of care; and (4) needs for support on hospital discharge or bereavement.
Work in interdisciplinary teams, including nursing, social work, case management, therapy, and spiritual care, to formulate specific patient-centered palliative care plans to address identified patient and family needs.
Build therapeutic relationships with seriously ill patients and their families as a basis of support for coping and creating collaborative patient- and family-centered care plans.
In seriously ill and/or actively dying patients, provide first-line treatment for common symptoms such as nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation.
Provide counseling on advance care planning, advance care directives, POLST/MOLST forms, and code status, including the outcomes of cardiopulmonary resusitation and other life-sustaining interventions in seriously ill patients.
Lead culturally sensitive communications about prognosis and goals of care among patients, families, and other members of the healthcare team, including family meetings and discussions in urgent situations to ensure that patients receive treatments that match their goals.
Coordinate goals of care and treatment plan among the treatment team, including primary care physicians and inpatient and outpatient specialty consultants.
Consult specialty palliative care and/or hospital ethics service when there is conflict among patients, families, and/or healthcare providers regarding the appropriate healthcare agent for decision-making and provision of life-sustaining interventions.
Identify when hospice may be the appropriate care model given a patient’s prognosis and goals of care, and describe the hospice care philosophy and care model to a patient and family.
Implement protocols and multidisciplinary care plans to ensure patient comfort and adequate family support when life-prolonging measures such as mechanical ventilation, vasopressor support, or other intensive care measures are withdrawn or withheld.
Ensure that the hospital palliative care plan is honored upon discharge, including communicating this plan with primary care and other outpatient providers and establishing home supportive services if needed.
Implement best practices for self-care and coping with the stress of caring for the seriously ill.
ATTITUDES
Hospitalists should be able to:
Appreciate that palliative care is appropriate at any stage of a serious illness and that it should be provided to all seriously ill patients.
Appreciate that hospitalists have a key role in ensuring that the palliative care needs of seriously ill patients are addressed.
Recognize the importance of empathic communication, building a therapeutic relationship with patients and families, and developing patient- and family-centered treatment plans.
Recognize the impact that social, cultural, and spiritual factors have on preferences for care in the setting of serious illness.
Appreciate the roles of, and collaboration with, other members of the healthcare team, including nursing and social services, pharmacy, psychology, and spiritual care, in providing palliative care.
Lead, coordinate, and/or participate in quality improvement initiatives to improve the care of seriously ill patients, such as symptom identification and management systems and improved advance care planning and goals of care approaches.
Lead, coordinate, and/or participate in efforts to establish or support existing multidisciplinary palliative care teams.
Palliative care refers to the comprehensive care of patients and families who are living with serious illness. It focuses on providing patients with relief from the symptoms and stress of serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any stage of illness and should be provided simultaneously with other medical treatments, including disease-modifying and life-prolonging therapies. Palliative care is provided by interprofessional teams, including physicians, nurse practitioners, physician assistants, nurses, social workers, case managers, and chaplains.
Seriously ill patients are frequently hospitalized, and thus all hospitalists—as frontline physicians who coordinate care for these patients—are key members of the interprofessional team who provide primary or generalist palliative care. In addition, in hospitals where palliative care consultation services are available, hospitalists are optimally positioned to refer to and collaborate with these specialty palliative care consultants. In hospitals where no or limited specialty palliative care services are available, hospitalists have an even more central role in providing palliative care. Hospitalists also have a key role in leading and contributing to systems and quality improvement efforts related to palliative care.
Key roles for hospitalists involved in palliative care are (1) leading discussions of goals of care and advance care planning, including completing appropriate documentation of patients’ wishes; (2) screening and implementing treatment for common physical symptoms, including pain, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation; and (3) referring patients to community services to provide support around serious illness after hospital discharge, including hospice and community palliative care services when available. A complete list of core competencies for hospitalists in palliative care follows.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define palliative care, including primary (or generalist) and specialty palliative care, and explain effective strategies for describing the benefits of palliative care to colleagues, specialists, patients, and families.
Explain the role of palliative care throughout the course of illness, how it can be provided alongside all other appropriate medical treatments, and appropriate referral to local resources that provide palliative care in the hospital and community.
Recognize when specialty palliative care consultation, when it is available, should be sought for refractory or complex patient or family palliative care needs.
Identify the factors that contribute to prognosis in common serious illnesses (eg, cancer, congestive heart failure, chronic obstructive pulmonary disease, end stage renal disease, dementia, and multimorbidity), including how to identify patients who may benefit from palliative care and how to broadly estimate prognosis (eg, months to years, weeks to months, days to weeks, hours to days).
Describe signs and symptoms of the last 24 hours of life and how to discuss these observations with families.
Describe data on efficacy and burdens of life support interventions in seriously ill patients, such as tube feeding in advanced dementia and cardiopulmonary resuscitation.
Explain the ethical principles involved with caring for patients at the end of life, including the right of competent patients or their surrogates to refuse medical treatments, including life-sustaining therapies, and the principle of “double effect.”
Describe specific legal considerations related to surrogate decision-making and advance planning in the state in which the hospitalist practices.
Describe the purpose and mechanics of advance directives, including physician or medical orders for life-sustaining treatment (POLST/MOLST) forms available in the state in which the hospitalist practices, durable medical power of attorney forms, and other declarations of patient wishes and treatment preferences.
Describe the basic tenets of hospice care and the Medicare hospice benefit and explain the process of initiating direct referrals to these programs in various settings (ie, home, skilled nursing facility, inpatient).
Describe the role of the hospitalist after a patient dies in the hospital, including pronouncing of death, completing the death certificate, requesting an autopsy, notifying the family and primary care physician, contacting the organ donor network, and providing the family with hospital contact information for questions and bereavement resources.
SKILLS
Hospitalists should be able to:
Perform a comprehensive patient assessment to screen patients for palliative care needs, including (1) pain and other common symptoms (eg, nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, constipation); (2) psychosocial and spiritual support of the patient and family; (3) advance care planning communication about prognosis and goals of care; and (4) needs for support on hospital discharge or bereavement.
Work in interdisciplinary teams, including nursing, social work, case management, therapy, and spiritual care, to formulate specific patient-centered palliative care plans to address identified patient and family needs.
Build therapeutic relationships with seriously ill patients and their families as a basis of support for coping and creating collaborative patient- and family-centered care plans.
In seriously ill and/or actively dying patients, provide first-line treatment for common symptoms such as nausea and vomiting, dyspnea, anxiety, depression, confusion and delirium, and constipation.
Provide counseling on advance care planning, advance care directives, POLST/MOLST forms, and code status, including the outcomes of cardiopulmonary resusitation and other life-sustaining interventions in seriously ill patients.
Lead culturally sensitive communications about prognosis and goals of care among patients, families, and other members of the healthcare team, including family meetings and discussions in urgent situations to ensure that patients receive treatments that match their goals.
Coordinate goals of care and treatment plan among the treatment team, including primary care physicians and inpatient and outpatient specialty consultants.
Consult specialty palliative care and/or hospital ethics service when there is conflict among patients, families, and/or healthcare providers regarding the appropriate healthcare agent for decision-making and provision of life-sustaining interventions.
Identify when hospice may be the appropriate care model given a patient’s prognosis and goals of care, and describe the hospice care philosophy and care model to a patient and family.
Implement protocols and multidisciplinary care plans to ensure patient comfort and adequate family support when life-prolonging measures such as mechanical ventilation, vasopressor support, or other intensive care measures are withdrawn or withheld.
Ensure that the hospital palliative care plan is honored upon discharge, including communicating this plan with primary care and other outpatient providers and establishing home supportive services if needed.
Implement best practices for self-care and coping with the stress of caring for the seriously ill.
ATTITUDES
Hospitalists should be able to:
Appreciate that palliative care is appropriate at any stage of a serious illness and that it should be provided to all seriously ill patients.
Appreciate that hospitalists have a key role in ensuring that the palliative care needs of seriously ill patients are addressed.
Recognize the importance of empathic communication, building a therapeutic relationship with patients and families, and developing patient- and family-centered treatment plans.
Recognize the impact that social, cultural, and spiritual factors have on preferences for care in the setting of serious illness.
Appreciate the roles of, and collaboration with, other members of the healthcare team, including nursing and social services, pharmacy, psychology, and spiritual care, in providing palliative care.
Lead, coordinate, and/or participate in quality improvement initiatives to improve the care of seriously ill patients, such as symptom identification and management systems and improved advance care planning and goals of care approaches.
Lead, coordinate, and/or participate in efforts to establish or support existing multidisciplinary palliative care teams.
© 2017 Society of Hospital Medicine
Patient Education. 2017 Hospital Medicine Revised Core Competencies
The Institute of Medicine has defined patient-centered care as 1 of the 6 aims for healthcare improvements in the 21st century. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Self-management education has been shown to improve patient outcomes in chronic disease. For example, disease-specific patient education improves Health-Related Quality of Life scores in patients with chronic obstructive pulmonary disease, reduces glycosylated hemoglobin levels and blood pressure in patients with diabetes mellitus, and decreases the number of attacks in patients with asthma.1,2 Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in healthcare decisions and management.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe the guiding principles for patient education.
Identify institutional resources for patient education materials and programs.
Summarize the evidence for the primacy of patient education as a means to improve the quality of healthcare.
Discuss the contextual factors that influence a patient’s readiness to learn new information.
Describe the role of patient education in the management of chronic diseases, which may include diabetes mellitus, congestive heart failure, and asthma.
Explain the effect of the patient’s sociocultural background on his or her health beliefs and behavior.
Describe different methods of delivering patient education.
Describe patient characteristics that influence the utility and appropriateness of patient education materials, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.
Recognize the importance of early identification of barriers to patient education such as low health literacy and language fluency.
SKILLS
Hospitalists should be able to:
Deliver effective patient education in a manner best suited to the patient’s level of literacy and understanding.
Identify and assist patients and families who require additional education about their medical illnesses.
Use and/or develop methods and materials to fully inform patients and families.
Communicate effectively with patients from diverse backgrounds.
Determine patient and family understanding of illness severity, prognosis, and goals of care.
Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow-up.
Ensure that patients understand anticipated therapies, procedures, and/or surgery.
Use methods that confirm the comprehension and retention of new information by patients and families, such as “Teach Back” and “Show Back.”
Advocate for the incorporation of patient wishes into care plans.
Lead, coordinate, and/or participate in the development of team-based approaches to patient education.
Lead, coordinate, and/or participate in the development of effective quality measures sensitive to the effects of patient education.
ATTITUDES
Hospitalists should be able to:
Value the potential for patient education to improve the quality of healthcare.
Encourage patients to ask questions, keep accurate medication lists, and obtain test results.
Convey diagnosis, prognosis, treatment, and support options available for patients and families in a clear, concise, compassionate, culturally sensitive, and timely manner.
Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.
1. Tan JY, Chen JX, Liu XL, Zhang Q, Zhang M, Mei LJ, et al. A meta-analysis on the impact of disease-specific education programs on health outcomes for patients with chronic obstructive pulmonary disease. Geriatr Nurs. 2012;33(4):280-296.
2. Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164(15):1641-1649.
The Institute of Medicine has defined patient-centered care as 1 of the 6 aims for healthcare improvements in the 21st century. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Self-management education has been shown to improve patient outcomes in chronic disease. For example, disease-specific patient education improves Health-Related Quality of Life scores in patients with chronic obstructive pulmonary disease, reduces glycosylated hemoglobin levels and blood pressure in patients with diabetes mellitus, and decreases the number of attacks in patients with asthma.1,2 Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in healthcare decisions and management.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe the guiding principles for patient education.
Identify institutional resources for patient education materials and programs.
Summarize the evidence for the primacy of patient education as a means to improve the quality of healthcare.
Discuss the contextual factors that influence a patient’s readiness to learn new information.
Describe the role of patient education in the management of chronic diseases, which may include diabetes mellitus, congestive heart failure, and asthma.
Explain the effect of the patient’s sociocultural background on his or her health beliefs and behavior.
Describe different methods of delivering patient education.
Describe patient characteristics that influence the utility and appropriateness of patient education materials, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.
Recognize the importance of early identification of barriers to patient education such as low health literacy and language fluency.
SKILLS
Hospitalists should be able to:
Deliver effective patient education in a manner best suited to the patient’s level of literacy and understanding.
Identify and assist patients and families who require additional education about their medical illnesses.
Use and/or develop methods and materials to fully inform patients and families.
Communicate effectively with patients from diverse backgrounds.
Determine patient and family understanding of illness severity, prognosis, and goals of care.
Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow-up.
Ensure that patients understand anticipated therapies, procedures, and/or surgery.
Use methods that confirm the comprehension and retention of new information by patients and families, such as “Teach Back” and “Show Back.”
Advocate for the incorporation of patient wishes into care plans.
Lead, coordinate, and/or participate in the development of team-based approaches to patient education.
Lead, coordinate, and/or participate in the development of effective quality measures sensitive to the effects of patient education.
ATTITUDES
Hospitalists should be able to:
Value the potential for patient education to improve the quality of healthcare.
Encourage patients to ask questions, keep accurate medication lists, and obtain test results.
Convey diagnosis, prognosis, treatment, and support options available for patients and families in a clear, concise, compassionate, culturally sensitive, and timely manner.
Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.
The Institute of Medicine has defined patient-centered care as 1 of the 6 aims for healthcare improvements in the 21st century. Patient-centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure, and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Self-management education has been shown to improve patient outcomes in chronic disease. For example, disease-specific patient education improves Health-Related Quality of Life scores in patients with chronic obstructive pulmonary disease, reduces glycosylated hemoglobin levels and blood pressure in patients with diabetes mellitus, and decreases the number of attacks in patients with asthma.1,2 Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in healthcare decisions and management.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe the guiding principles for patient education.
Identify institutional resources for patient education materials and programs.
Summarize the evidence for the primacy of patient education as a means to improve the quality of healthcare.
Discuss the contextual factors that influence a patient’s readiness to learn new information.
Describe the role of patient education in the management of chronic diseases, which may include diabetes mellitus, congestive heart failure, and asthma.
Explain the effect of the patient’s sociocultural background on his or her health beliefs and behavior.
Describe different methods of delivering patient education.
Describe patient characteristics that influence the utility and appropriateness of patient education materials, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.
Recognize the importance of early identification of barriers to patient education such as low health literacy and language fluency.
SKILLS
Hospitalists should be able to:
Deliver effective patient education in a manner best suited to the patient’s level of literacy and understanding.
Identify and assist patients and families who require additional education about their medical illnesses.
Use and/or develop methods and materials to fully inform patients and families.
Communicate effectively with patients from diverse backgrounds.
Determine patient and family understanding of illness severity, prognosis, and goals of care.
Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow-up.
Ensure that patients understand anticipated therapies, procedures, and/or surgery.
Use methods that confirm the comprehension and retention of new information by patients and families, such as “Teach Back” and “Show Back.”
Advocate for the incorporation of patient wishes into care plans.
Lead, coordinate, and/or participate in the development of team-based approaches to patient education.
Lead, coordinate, and/or participate in the development of effective quality measures sensitive to the effects of patient education.
ATTITUDES
Hospitalists should be able to:
Value the potential for patient education to improve the quality of healthcare.
Encourage patients to ask questions, keep accurate medication lists, and obtain test results.
Convey diagnosis, prognosis, treatment, and support options available for patients and families in a clear, concise, compassionate, culturally sensitive, and timely manner.
Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.
1. Tan JY, Chen JX, Liu XL, Zhang Q, Zhang M, Mei LJ, et al. A meta-analysis on the impact of disease-specific education programs on health outcomes for patients with chronic obstructive pulmonary disease. Geriatr Nurs. 2012;33(4):280-296.
2. Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164(15):1641-1649.
1. Tan JY, Chen JX, Liu XL, Zhang Q, Zhang M, Mei LJ, et al. A meta-analysis on the impact of disease-specific education programs on health outcomes for patients with chronic obstructive pulmonary disease. Geriatr Nurs. 2012;33(4):280-296.
2. Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164(15):1641-1649.
© 2017 Society of Hospital Medicine
Patient Handoff. 2017 Hospital Medicine Revised Core Competencies
Patient handoff (also known as handover or sign-out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Poor handoffs are associated with high rates of self-reported medical errors and adverse events.1-3 Effective and timely handoffs are essential to maintain high-quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between healthcare providers.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe the key elements of a high-quality patient handoff (shift change or service change).
Explain the components and strategies that are critical for successful communication during handoffs.
List barriers to effective handoff and strategies to mitigate them to improve patient safety.
Describe the factors that influence handoff detail, components, and strategies.
Explain the strengths and limitations of various handoff communication strategies and procedures.
SKILLS
Hospitalists should be able to:
Communicate effectively and efficiently during patient handoff and use appropriate verbal and/or written modalities.
Demonstrate the use of read-back when communicating tasks.
Construct standardized patient summaries for oral and written delivery that permit customization by incorporating the unique characteristics of the patient and his/her diagnosis and treatment plan, healthcare provider, and timing of the handoff.
Evaluate all medications for accuracy regarding indication, dosing, and planned duration before handoff.
Use “if-then” statements for outstanding critical tasks, anticipated events, and any potential complications.
Synthesize clinical information efficiently and request clarification if necessary at the time of handoff receipt.
Update written and verbal handoffs with the most recent clinical information needed for effective transfer of care.
Limit interruptions during handoffs.
Identify the sickest patients and prioritize those for discussion during verbal handoff.
Communicate with patients and families to explain the handoff process and provide advance notification of the change in clinical care team members assuming care for the patient.
Engage stakeholders in institutional initiatives to streamline the incorporation of patient handoffs within clinical workflows and continuously assess the quality of handoffs.
Lead, coordinate, and/or participate in initiatives to develop and implement new protocols to improve and optimize handoffs.
Lead, coordinate, and/or participate in evaluation of new strategies or information systems designed to improve handoffs.
ATTITUDES
Hospitalists should be able to:
Recognize the importance and impact of handoff quality on patient safety.
Appreciate the value of real-time interactive dialogue between clinicians during handoffs.
Endorse handoffs as a priority at which time the focus is on transfer of patient care.
Develop and maintain a culture of continued clinician availability should questions arise after the patient handoff.
Adopt an attitude of professional responsibility for all patients who have been received during a handoff.
1. Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY. Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. 2009;53(6):701-710.
2. Kitch BT, Cooper JB, Zapol WM, Marder JE, Karson A, Hutter M, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563-570.
3. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121(11):866-872.
Patient handoff (also known as handover or sign-out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Poor handoffs are associated with high rates of self-reported medical errors and adverse events.1-3 Effective and timely handoffs are essential to maintain high-quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between healthcare providers.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe the key elements of a high-quality patient handoff (shift change or service change).
Explain the components and strategies that are critical for successful communication during handoffs.
List barriers to effective handoff and strategies to mitigate them to improve patient safety.
Describe the factors that influence handoff detail, components, and strategies.
Explain the strengths and limitations of various handoff communication strategies and procedures.
SKILLS
Hospitalists should be able to:
Communicate effectively and efficiently during patient handoff and use appropriate verbal and/or written modalities.
Demonstrate the use of read-back when communicating tasks.
Construct standardized patient summaries for oral and written delivery that permit customization by incorporating the unique characteristics of the patient and his/her diagnosis and treatment plan, healthcare provider, and timing of the handoff.
Evaluate all medications for accuracy regarding indication, dosing, and planned duration before handoff.
Use “if-then” statements for outstanding critical tasks, anticipated events, and any potential complications.
Synthesize clinical information efficiently and request clarification if necessary at the time of handoff receipt.
Update written and verbal handoffs with the most recent clinical information needed for effective transfer of care.
Limit interruptions during handoffs.
Identify the sickest patients and prioritize those for discussion during verbal handoff.
Communicate with patients and families to explain the handoff process and provide advance notification of the change in clinical care team members assuming care for the patient.
Engage stakeholders in institutional initiatives to streamline the incorporation of patient handoffs within clinical workflows and continuously assess the quality of handoffs.
Lead, coordinate, and/or participate in initiatives to develop and implement new protocols to improve and optimize handoffs.
Lead, coordinate, and/or participate in evaluation of new strategies or information systems designed to improve handoffs.
ATTITUDES
Hospitalists should be able to:
Recognize the importance and impact of handoff quality on patient safety.
Appreciate the value of real-time interactive dialogue between clinicians during handoffs.
Endorse handoffs as a priority at which time the focus is on transfer of patient care.
Develop and maintain a culture of continued clinician availability should questions arise after the patient handoff.
Adopt an attitude of professional responsibility for all patients who have been received during a handoff.
Patient handoff (also known as handover or sign-out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Poor handoffs are associated with high rates of self-reported medical errors and adverse events.1-3 Effective and timely handoffs are essential to maintain high-quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between healthcare providers.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe the key elements of a high-quality patient handoff (shift change or service change).
Explain the components and strategies that are critical for successful communication during handoffs.
List barriers to effective handoff and strategies to mitigate them to improve patient safety.
Describe the factors that influence handoff detail, components, and strategies.
Explain the strengths and limitations of various handoff communication strategies and procedures.
SKILLS
Hospitalists should be able to:
Communicate effectively and efficiently during patient handoff and use appropriate verbal and/or written modalities.
Demonstrate the use of read-back when communicating tasks.
Construct standardized patient summaries for oral and written delivery that permit customization by incorporating the unique characteristics of the patient and his/her diagnosis and treatment plan, healthcare provider, and timing of the handoff.
Evaluate all medications for accuracy regarding indication, dosing, and planned duration before handoff.
Use “if-then” statements for outstanding critical tasks, anticipated events, and any potential complications.
Synthesize clinical information efficiently and request clarification if necessary at the time of handoff receipt.
Update written and verbal handoffs with the most recent clinical information needed for effective transfer of care.
Limit interruptions during handoffs.
Identify the sickest patients and prioritize those for discussion during verbal handoff.
Communicate with patients and families to explain the handoff process and provide advance notification of the change in clinical care team members assuming care for the patient.
Engage stakeholders in institutional initiatives to streamline the incorporation of patient handoffs within clinical workflows and continuously assess the quality of handoffs.
Lead, coordinate, and/or participate in initiatives to develop and implement new protocols to improve and optimize handoffs.
Lead, coordinate, and/or participate in evaluation of new strategies or information systems designed to improve handoffs.
ATTITUDES
Hospitalists should be able to:
Recognize the importance and impact of handoff quality on patient safety.
Appreciate the value of real-time interactive dialogue between clinicians during handoffs.
Endorse handoffs as a priority at which time the focus is on transfer of patient care.
Develop and maintain a culture of continued clinician availability should questions arise after the patient handoff.
Adopt an attitude of professional responsibility for all patients who have been received during a handoff.
1. Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY. Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. 2009;53(6):701-710.
2. Kitch BT, Cooper JB, Zapol WM, Marder JE, Karson A, Hutter M, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563-570.
3. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121(11):866-872.
1. Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY. Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. 2009;53(6):701-710.
2. Kitch BT, Cooper JB, Zapol WM, Marder JE, Karson A, Hutter M, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563-570.
3. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121(11):866-872.
© 2017 Society of Hospital Medicine
Patient Safety. 2017 Hospital Medicine Revised Core Competencies
The National Patient Safety Foundation defines safety as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare. Hospitalized patients are at risk for a variety of adverse events. Hospitalists anticipate complications from medical assessment and treatment and take steps to reduce their incidence or severity. Application of individual and system failure analysis can improve patient safety. Hospitalists lead and participate in multidisciplinary interventions to mitigate system and process failures and to assess the effects of recommended interventions across the continuum of care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate medical errors, adverse events, and preventable adverse events.
Identify the most common safety problems and their causes in different hospitalized patient populations.
Explain the role of human factors in device, procedure, and technology-related errors.
Explain how redundant systems may reduce the likelihood of medical errors.
Specify clinical practices and interventions that improve the safe use of high-alert medications.
Summarize methods of system and process evaluation of patient safety.
Describe the elements of well-functioning patient safety-focused teams.
Distinguish retrospective and prospective methods of evaluating medical errors.
Describe the components of Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
Describe principles of medical error disclosure.
Discuss the significance of sentinel events and “near misses” and their relationship to voluntary and mandatory reporting regulations.
Describe the risk management issues of patient safety efforts.
Judge the effect of patient volume on the quality, efficiency, and safety of healthcare services.
SKILLS
Hospitalists should be able to:
Prevent iatrogenic complications and proactively reduce risks of hospitalization.
Formulate age- and disease-specific safety practices, which may include but are not limited to reduction of incidence and severity of falls, decubitus ulcers, delirium, hospital-acquired infections, venous thromboembolism, malnutrition, and medication adverse events.
Develop, implement, and evaluate practice guidelines and care pathways as part of an interdisciplinary quality improvement initiative.
Gather, record, and transfer patient information by adhering to timely, accurate, and confidential mechanisms.
Prioritize patient safety evaluation and improvement efforts on the basis of the impact, improvability, and general applicability of the proposed evaluations and interventions.
Develop systems that promote patient safety and reduce the likelihood of adverse events.
Contribute to and interpret retrospective RCA and prospective healthcare FMEA multidisciplinary risk evaluations.
Appropriately engage in standardized communication practices such as Situation-Background-Assessment-Recommendation (SBAR).
Facilitate practices that reduce the likelihood of hospital-acquired infection.
Use evaluation methods and resources to define problems and recommend interventions.
Employ continuous quality improvement techniques to identify, construct, implement, and evaluate patient safety issues.
Lead, coordinate, and/or participate in multidisciplinary teams to improve the delivery of safe patient care.
Lead, coordinate, and/or participate in the development, use, and dissemination of local, regional, or national clinical practice guidelines and patient safety alerts pertaining to the prevention of complications in hospitalized patients.
Lead, coordinate, and/or participate in efforts to advance the culture of patient safety in the hospital.
ATTITUDES
Hospitalists should be able to:
Appreciate that adverse drug events must be monitored and that steps must be taken to reduce their incidence.
Exemplify safe medication prescribing and administration practices.
Advocate for and foster a nonpunitive error-reporting environment.
Internalize and promote behaviors that minimize workforce fatigue, occupational illness, and burnout.
Use evidence-based evaluation methods and resources when defining problems and designing interventions to lead efforts to reduce recurrent error.
The National Patient Safety Foundation defines safety as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare. Hospitalized patients are at risk for a variety of adverse events. Hospitalists anticipate complications from medical assessment and treatment and take steps to reduce their incidence or severity. Application of individual and system failure analysis can improve patient safety. Hospitalists lead and participate in multidisciplinary interventions to mitigate system and process failures and to assess the effects of recommended interventions across the continuum of care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate medical errors, adverse events, and preventable adverse events.
Identify the most common safety problems and their causes in different hospitalized patient populations.
Explain the role of human factors in device, procedure, and technology-related errors.
Explain how redundant systems may reduce the likelihood of medical errors.
Specify clinical practices and interventions that improve the safe use of high-alert medications.
Summarize methods of system and process evaluation of patient safety.
Describe the elements of well-functioning patient safety-focused teams.
Distinguish retrospective and prospective methods of evaluating medical errors.
Describe the components of Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
Describe principles of medical error disclosure.
Discuss the significance of sentinel events and “near misses” and their relationship to voluntary and mandatory reporting regulations.
Describe the risk management issues of patient safety efforts.
Judge the effect of patient volume on the quality, efficiency, and safety of healthcare services.
SKILLS
Hospitalists should be able to:
Prevent iatrogenic complications and proactively reduce risks of hospitalization.
Formulate age- and disease-specific safety practices, which may include but are not limited to reduction of incidence and severity of falls, decubitus ulcers, delirium, hospital-acquired infections, venous thromboembolism, malnutrition, and medication adverse events.
Develop, implement, and evaluate practice guidelines and care pathways as part of an interdisciplinary quality improvement initiative.
Gather, record, and transfer patient information by adhering to timely, accurate, and confidential mechanisms.
Prioritize patient safety evaluation and improvement efforts on the basis of the impact, improvability, and general applicability of the proposed evaluations and interventions.
Develop systems that promote patient safety and reduce the likelihood of adverse events.
Contribute to and interpret retrospective RCA and prospective healthcare FMEA multidisciplinary risk evaluations.
Appropriately engage in standardized communication practices such as Situation-Background-Assessment-Recommendation (SBAR).
Facilitate practices that reduce the likelihood of hospital-acquired infection.
Use evaluation methods and resources to define problems and recommend interventions.
Employ continuous quality improvement techniques to identify, construct, implement, and evaluate patient safety issues.
Lead, coordinate, and/or participate in multidisciplinary teams to improve the delivery of safe patient care.
Lead, coordinate, and/or participate in the development, use, and dissemination of local, regional, or national clinical practice guidelines and patient safety alerts pertaining to the prevention of complications in hospitalized patients.
Lead, coordinate, and/or participate in efforts to advance the culture of patient safety in the hospital.
ATTITUDES
Hospitalists should be able to:
Appreciate that adverse drug events must be monitored and that steps must be taken to reduce their incidence.
Exemplify safe medication prescribing and administration practices.
Advocate for and foster a nonpunitive error-reporting environment.
Internalize and promote behaviors that minimize workforce fatigue, occupational illness, and burnout.
Use evidence-based evaluation methods and resources when defining problems and designing interventions to lead efforts to reduce recurrent error.
The National Patient Safety Foundation defines safety as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare. Hospitalized patients are at risk for a variety of adverse events. Hospitalists anticipate complications from medical assessment and treatment and take steps to reduce their incidence or severity. Application of individual and system failure analysis can improve patient safety. Hospitalists lead and participate in multidisciplinary interventions to mitigate system and process failures and to assess the effects of recommended interventions across the continuum of care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate medical errors, adverse events, and preventable adverse events.
Identify the most common safety problems and their causes in different hospitalized patient populations.
Explain the role of human factors in device, procedure, and technology-related errors.
Explain how redundant systems may reduce the likelihood of medical errors.
Specify clinical practices and interventions that improve the safe use of high-alert medications.
Summarize methods of system and process evaluation of patient safety.
Describe the elements of well-functioning patient safety-focused teams.
Distinguish retrospective and prospective methods of evaluating medical errors.
Describe the components of Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
Describe principles of medical error disclosure.
Discuss the significance of sentinel events and “near misses” and their relationship to voluntary and mandatory reporting regulations.
Describe the risk management issues of patient safety efforts.
Judge the effect of patient volume on the quality, efficiency, and safety of healthcare services.
SKILLS
Hospitalists should be able to:
Prevent iatrogenic complications and proactively reduce risks of hospitalization.
Formulate age- and disease-specific safety practices, which may include but are not limited to reduction of incidence and severity of falls, decubitus ulcers, delirium, hospital-acquired infections, venous thromboembolism, malnutrition, and medication adverse events.
Develop, implement, and evaluate practice guidelines and care pathways as part of an interdisciplinary quality improvement initiative.
Gather, record, and transfer patient information by adhering to timely, accurate, and confidential mechanisms.
Prioritize patient safety evaluation and improvement efforts on the basis of the impact, improvability, and general applicability of the proposed evaluations and interventions.
Develop systems that promote patient safety and reduce the likelihood of adverse events.
Contribute to and interpret retrospective RCA and prospective healthcare FMEA multidisciplinary risk evaluations.
Appropriately engage in standardized communication practices such as Situation-Background-Assessment-Recommendation (SBAR).
Facilitate practices that reduce the likelihood of hospital-acquired infection.
Use evaluation methods and resources to define problems and recommend interventions.
Employ continuous quality improvement techniques to identify, construct, implement, and evaluate patient safety issues.
Lead, coordinate, and/or participate in multidisciplinary teams to improve the delivery of safe patient care.
Lead, coordinate, and/or participate in the development, use, and dissemination of local, regional, or national clinical practice guidelines and patient safety alerts pertaining to the prevention of complications in hospitalized patients.
Lead, coordinate, and/or participate in efforts to advance the culture of patient safety in the hospital.
ATTITUDES
Hospitalists should be able to:
Appreciate that adverse drug events must be monitored and that steps must be taken to reduce their incidence.
Exemplify safe medication prescribing and administration practices.
Advocate for and foster a nonpunitive error-reporting environment.
Internalize and promote behaviors that minimize workforce fatigue, occupational illness, and burnout.
Use evidence-based evaluation methods and resources when defining problems and designing interventions to lead efforts to reduce recurrent error.
© 2017 Society of Hospital Medicine
Practice-Based Learning and Improvement. 2017 Hospital Medicine Revised Core Competencies
Practice-based learning and improvement (PBLI) is a means of evaluating individual and system practice patterns and incorporating the best available evidence to improve patient care. PBLI is recognized as a critical skill for all clinicians by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Internal Medicine (ABIM), the American Board of Pediatrics (ABP), and the American Academy of Family Physicians (AAFP). As the practice of hospital medicine rapidly evolves, hospitalists apply the most up-to-date knowledge to their care of inpatients. Hospitalists use a PBLI approach to lead, coordinate, and participate in initiatives to improve hospital processes and clinical care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe systematic methods of analyzing practice experience.
Explain key concepts of practice-based improvement methodology, which include the plan-do-study-act (PDSA) model.
Define the role of multidisciplinary teams and team leaders in improving patient care.
Describe how the critical appraisal and assimilation of scientific evidence applies to PBLI.
Describe how information technology can be used to identify opportunities to improve patient care.
SKILLS
Hospitalists should be able to:
Translate information about a general population into management of subpopulations or individual patients.
Critically assess individual and system practice patterns and experience to identify areas for improvement and minimize heterogeneity of practice.
Design practice interventions to improve quality, efficiency, and consistency of patient care using standard PBLI methodology and tools.
Critically assess medical information to support self-directed learning.
Critically appraise and apply the reports of new medical evidence.
Identify and use high-quality, evidence-based information resources to inform clinical decisions.
Use health information systems efficiently to manage and improve care at the individual and system levels.
ATTITUDES
Hospitalists should be able to:
Advocate for the use of PBLI in clinical practice and in system improvement projects.
Create an environment conducive to self-evaluation and improvement and seek to incorporate formative feedback into daily practice.
Advocate for investment in information technology that can harness up-to-date clinical resources.
Facilitate and encourage self-directed learning among healthcare professionals and trainees.
Promote self-improvement and care standardization using best evidence and practice.
Practice-based learning and improvement (PBLI) is a means of evaluating individual and system practice patterns and incorporating the best available evidence to improve patient care. PBLI is recognized as a critical skill for all clinicians by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Internal Medicine (ABIM), the American Board of Pediatrics (ABP), and the American Academy of Family Physicians (AAFP). As the practice of hospital medicine rapidly evolves, hospitalists apply the most up-to-date knowledge to their care of inpatients. Hospitalists use a PBLI approach to lead, coordinate, and participate in initiatives to improve hospital processes and clinical care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe systematic methods of analyzing practice experience.
Explain key concepts of practice-based improvement methodology, which include the plan-do-study-act (PDSA) model.
Define the role of multidisciplinary teams and team leaders in improving patient care.
Describe how the critical appraisal and assimilation of scientific evidence applies to PBLI.
Describe how information technology can be used to identify opportunities to improve patient care.
SKILLS
Hospitalists should be able to:
Translate information about a general population into management of subpopulations or individual patients.
Critically assess individual and system practice patterns and experience to identify areas for improvement and minimize heterogeneity of practice.
Design practice interventions to improve quality, efficiency, and consistency of patient care using standard PBLI methodology and tools.
Critically assess medical information to support self-directed learning.
Critically appraise and apply the reports of new medical evidence.
Identify and use high-quality, evidence-based information resources to inform clinical decisions.
Use health information systems efficiently to manage and improve care at the individual and system levels.
ATTITUDES
Hospitalists should be able to:
Advocate for the use of PBLI in clinical practice and in system improvement projects.
Create an environment conducive to self-evaluation and improvement and seek to incorporate formative feedback into daily practice.
Advocate for investment in information technology that can harness up-to-date clinical resources.
Facilitate and encourage self-directed learning among healthcare professionals and trainees.
Promote self-improvement and care standardization using best evidence and practice.
Practice-based learning and improvement (PBLI) is a means of evaluating individual and system practice patterns and incorporating the best available evidence to improve patient care. PBLI is recognized as a critical skill for all clinicians by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Internal Medicine (ABIM), the American Board of Pediatrics (ABP), and the American Academy of Family Physicians (AAFP). As the practice of hospital medicine rapidly evolves, hospitalists apply the most up-to-date knowledge to their care of inpatients. Hospitalists use a PBLI approach to lead, coordinate, and participate in initiatives to improve hospital processes and clinical care.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe systematic methods of analyzing practice experience.
Explain key concepts of practice-based improvement methodology, which include the plan-do-study-act (PDSA) model.
Define the role of multidisciplinary teams and team leaders in improving patient care.
Describe how the critical appraisal and assimilation of scientific evidence applies to PBLI.
Describe how information technology can be used to identify opportunities to improve patient care.
SKILLS
Hospitalists should be able to:
Translate information about a general population into management of subpopulations or individual patients.
Critically assess individual and system practice patterns and experience to identify areas for improvement and minimize heterogeneity of practice.
Design practice interventions to improve quality, efficiency, and consistency of patient care using standard PBLI methodology and tools.
Critically assess medical information to support self-directed learning.
Critically appraise and apply the reports of new medical evidence.
Identify and use high-quality, evidence-based information resources to inform clinical decisions.
Use health information systems efficiently to manage and improve care at the individual and system levels.
ATTITUDES
Hospitalists should be able to:
Advocate for the use of PBLI in clinical practice and in system improvement projects.
Create an environment conducive to self-evaluation and improvement and seek to incorporate formative feedback into daily practice.
Advocate for investment in information technology that can harness up-to-date clinical resources.
Facilitate and encourage self-directed learning among healthcare professionals and trainees.
Promote self-improvement and care standardization using best evidence and practice.
© 2017 Society of Hospital Medicine
Prevention of Healthcare-Associated Infections and Antimicrobial Resistance. 2017 Hospital Medicine Revised Core Competencies
Healthcare-associated infections (HAIs) impose a significant burden on the healthcare system in the Unites States, both economically and in terms of patient outcomes. On any given day, approximately 1 in 25 patients in US acute care hospitals has at least 1 HAI, and more than 700,000 HAIs occur annually in hospitalized patients.1 More than half of HAIs occur outside the intensive care unit.1 HAIs are among the leading causes of preventable death. These infections often lead to increases in length of hospitalization and excess direct and indirect hospital costs. The overall annual direct medical cost of HAIs to US hospitals is $28 to $45 billon.2 The central aim of infection control is to prevent HAIs and the emergence of resistant organisms. Hospitalists work in concert with other members of the healthcare organization to reduce HAIs, develop institutional initiatives for prevention, and promote and implement evidence-based infection control measures.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe acceptable methods of hand hygiene technique and timing in relationship to patient contact in various circumstances.
Describe the prophylactic measures required for all types of isolation precautions, which include standard, contact, droplet, and airborne precautions, and list the indications for implementing each type of precaution.
List common types of HAI and describe the risk factors associated with urinary tract infections, surgical site infections, hospital-acquired pneumonia, and blood stream infections.
Identify major resources for infection control information, including hospital infection control staff, hospital infection control policies and procedures, local and state public health departments, and Centers for Disease Control guidelines.
Describe the indicated prevention measures necessary to perform hospital-based procedures in a sterile fashion.
Appreciate that specific infection control practices and engineering controls are required to protect very high-risk patient populations, which may include hematopoietic stem cell transplant and solid organ transplant recipients, from HAIs.
SKILLS
Hospitalists should be able to:
Perform consistent and optimal hand hygiene techniques at all indicated points of care.
Identify and implement indicated isolation precautions for patients with high-risk transmissible diseases or highly resistant infections.
Identify and use local hospital resources, including antibiograms and infection control officers.
Perform indicated infection control and prevention technique during all procedures.
Implement precautions and infection control practices to protect patients from acquiring HAIs.
Implement antibiotic de-escalation when possible on the basis of microbiologic culture results.
Adopt the use of care bundles when shown to reduce the incidence of HAIs.
Avoid devices that are more likely to cause HAIs if alternatives are safe, effective, and available.
Encourage removal of invasive devices, especially central venous catheters and urinary catheters, early during the hospital stay and as soon as is clinically safe to do so.
Communicate effectively the rationale and importance of infection control practices to patients, families, visitors, other healthcare providers, and hospital staff.
Communicate appropriate patient information to infection control staff regarding potentially transmissible diseases.
Lead, coordinate, and/or participate in efforts to educate other healthcare personnel and hospital staff about necessary infection control prevention measures.
Lead, coordinate, and/or participate in multidisciplinary teams that organize, implement, and study infection control protocols, guidelines, or pathways using evidence-based systematic methods.
Lead, coordinate, and/or participate in multidisciplinary efforts to develop antibiotic stewardship programs.
ATTITUDES
Hospitalists should be able to:
Serve as a role model in adherence to recommended hand hygiene and infection control practices.
Engage collaboratively with multidisciplinary teams, which may include infection control, nursing service, and infectious disease consultants, to rapidly implement and maintain isolation precautions.
Engage collaboratively with multidisciplinary teams, which may include infection control, nursing service, care coordination, long-term care facilities, home healthcare staff, and public health personnel, to plan for hospital discharge of patients with transmissible infectious diseases.
1. Magill S, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208.
2. Scott DR. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Division of Healthcare Quality Promotion; National Center for Preparedness, Detection, and Control of Infectious Diseases; Coordinating Center for Infectious Diseases Centers; Centers for Disease Control and Prevention. March 2009.
Healthcare-associated infections (HAIs) impose a significant burden on the healthcare system in the Unites States, both economically and in terms of patient outcomes. On any given day, approximately 1 in 25 patients in US acute care hospitals has at least 1 HAI, and more than 700,000 HAIs occur annually in hospitalized patients.1 More than half of HAIs occur outside the intensive care unit.1 HAIs are among the leading causes of preventable death. These infections often lead to increases in length of hospitalization and excess direct and indirect hospital costs. The overall annual direct medical cost of HAIs to US hospitals is $28 to $45 billon.2 The central aim of infection control is to prevent HAIs and the emergence of resistant organisms. Hospitalists work in concert with other members of the healthcare organization to reduce HAIs, develop institutional initiatives for prevention, and promote and implement evidence-based infection control measures.
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KNOWLEDGE
Hospitalists should be able to:
Describe acceptable methods of hand hygiene technique and timing in relationship to patient contact in various circumstances.
Describe the prophylactic measures required for all types of isolation precautions, which include standard, contact, droplet, and airborne precautions, and list the indications for implementing each type of precaution.
List common types of HAI and describe the risk factors associated with urinary tract infections, surgical site infections, hospital-acquired pneumonia, and blood stream infections.
Identify major resources for infection control information, including hospital infection control staff, hospital infection control policies and procedures, local and state public health departments, and Centers for Disease Control guidelines.
Describe the indicated prevention measures necessary to perform hospital-based procedures in a sterile fashion.
Appreciate that specific infection control practices and engineering controls are required to protect very high-risk patient populations, which may include hematopoietic stem cell transplant and solid organ transplant recipients, from HAIs.
SKILLS
Hospitalists should be able to:
Perform consistent and optimal hand hygiene techniques at all indicated points of care.
Identify and implement indicated isolation precautions for patients with high-risk transmissible diseases or highly resistant infections.
Identify and use local hospital resources, including antibiograms and infection control officers.
Perform indicated infection control and prevention technique during all procedures.
Implement precautions and infection control practices to protect patients from acquiring HAIs.
Implement antibiotic de-escalation when possible on the basis of microbiologic culture results.
Adopt the use of care bundles when shown to reduce the incidence of HAIs.
Avoid devices that are more likely to cause HAIs if alternatives are safe, effective, and available.
Encourage removal of invasive devices, especially central venous catheters and urinary catheters, early during the hospital stay and as soon as is clinically safe to do so.
Communicate effectively the rationale and importance of infection control practices to patients, families, visitors, other healthcare providers, and hospital staff.
Communicate appropriate patient information to infection control staff regarding potentially transmissible diseases.
Lead, coordinate, and/or participate in efforts to educate other healthcare personnel and hospital staff about necessary infection control prevention measures.
Lead, coordinate, and/or participate in multidisciplinary teams that organize, implement, and study infection control protocols, guidelines, or pathways using evidence-based systematic methods.
Lead, coordinate, and/or participate in multidisciplinary efforts to develop antibiotic stewardship programs.
ATTITUDES
Hospitalists should be able to:
Serve as a role model in adherence to recommended hand hygiene and infection control practices.
Engage collaboratively with multidisciplinary teams, which may include infection control, nursing service, and infectious disease consultants, to rapidly implement and maintain isolation precautions.
Engage collaboratively with multidisciplinary teams, which may include infection control, nursing service, care coordination, long-term care facilities, home healthcare staff, and public health personnel, to plan for hospital discharge of patients with transmissible infectious diseases.
Healthcare-associated infections (HAIs) impose a significant burden on the healthcare system in the Unites States, both economically and in terms of patient outcomes. On any given day, approximately 1 in 25 patients in US acute care hospitals has at least 1 HAI, and more than 700,000 HAIs occur annually in hospitalized patients.1 More than half of HAIs occur outside the intensive care unit.1 HAIs are among the leading causes of preventable death. These infections often lead to increases in length of hospitalization and excess direct and indirect hospital costs. The overall annual direct medical cost of HAIs to US hospitals is $28 to $45 billon.2 The central aim of infection control is to prevent HAIs and the emergence of resistant organisms. Hospitalists work in concert with other members of the healthcare organization to reduce HAIs, develop institutional initiatives for prevention, and promote and implement evidence-based infection control measures.
Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.
KNOWLEDGE
Hospitalists should be able to:
Describe acceptable methods of hand hygiene technique and timing in relationship to patient contact in various circumstances.
Describe the prophylactic measures required for all types of isolation precautions, which include standard, contact, droplet, and airborne precautions, and list the indications for implementing each type of precaution.
List common types of HAI and describe the risk factors associated with urinary tract infections, surgical site infections, hospital-acquired pneumonia, and blood stream infections.
Identify major resources for infection control information, including hospital infection control staff, hospital infection control policies and procedures, local and state public health departments, and Centers for Disease Control guidelines.
Describe the indicated prevention measures necessary to perform hospital-based procedures in a sterile fashion.
Appreciate that specific infection control practices and engineering controls are required to protect very high-risk patient populations, which may include hematopoietic stem cell transplant and solid organ transplant recipients, from HAIs.
SKILLS
Hospitalists should be able to:
Perform consistent and optimal hand hygiene techniques at all indicated points of care.
Identify and implement indicated isolation precautions for patients with high-risk transmissible diseases or highly resistant infections.
Identify and use local hospital resources, including antibiograms and infection control officers.
Perform indicated infection control and prevention technique during all procedures.
Implement precautions and infection control practices to protect patients from acquiring HAIs.
Implement antibiotic de-escalation when possible on the basis of microbiologic culture results.
Adopt the use of care bundles when shown to reduce the incidence of HAIs.
Avoid devices that are more likely to cause HAIs if alternatives are safe, effective, and available.
Encourage removal of invasive devices, especially central venous catheters and urinary catheters, early during the hospital stay and as soon as is clinically safe to do so.
Communicate effectively the rationale and importance of infection control practices to patients, families, visitors, other healthcare providers, and hospital staff.
Communicate appropriate patient information to infection control staff regarding potentially transmissible diseases.
Lead, coordinate, and/or participate in efforts to educate other healthcare personnel and hospital staff about necessary infection control prevention measures.
Lead, coordinate, and/or participate in multidisciplinary teams that organize, implement, and study infection control protocols, guidelines, or pathways using evidence-based systematic methods.
Lead, coordinate, and/or participate in multidisciplinary efforts to develop antibiotic stewardship programs.
ATTITUDES
Hospitalists should be able to:
Serve as a role model in adherence to recommended hand hygiene and infection control practices.
Engage collaboratively with multidisciplinary teams, which may include infection control, nursing service, and infectious disease consultants, to rapidly implement and maintain isolation precautions.
Engage collaboratively with multidisciplinary teams, which may include infection control, nursing service, care coordination, long-term care facilities, home healthcare staff, and public health personnel, to plan for hospital discharge of patients with transmissible infectious diseases.
1. Magill S, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208.
2. Scott DR. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Division of Healthcare Quality Promotion; National Center for Preparedness, Detection, and Control of Infectious Diseases; Coordinating Center for Infectious Diseases Centers; Centers for Disease Control and Prevention. March 2009.
1. Magill S, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208.
2. Scott DR. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Division of Healthcare Quality Promotion; National Center for Preparedness, Detection, and Control of Infectious Diseases; Coordinating Center for Infectious Diseases Centers; Centers for Disease Control and Prevention. March 2009.
© 2017 Society of Hospital Medicine