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Keys to de-escalating endocrine emergencies
It’s a fine line between compensated and decompensated endocrine conditions, and often, there is an underlying non–endocrine component complicating the diagnosis.
That’s according to Marilyn Tan, MD, a clinical assistant professor of medicine at Stanford (Calif.) University, where she is chief of the endocrinology clinic. She spoke about endocrinology emergencies during a case-based, rapid-fire session at HM17.
“Endocrine emergencies are usually due to an excess or a deficiency of a hormone,” Dr. Tan said, noting that these can take time to bring into balance. This is one reason Dr. Tan counseled not waiting for laboratory results before administering treatment.
To diagnose and treat diabetic ketoacidosis, combined with a hyperosmolar hyperglycemic state, Dr. Tan recommended checking hypoglycemia levels, which she said are often mild, and to check anion gap, pH, and ketones. It’s also important to be generous with IV fluids, to administer insulin only if the ketoacidosis level is greater than 3.3 mEq/L, and to not take the patient off an insulin drip too early or inappropriately. To prevent readmissions, the patient on discharge should have adequate diabetes supplies, education on their condition, and timely follow-up, Dr. Tan recommended.
For patients experiencing a thyroid storm, Dr. Tan advised that thyroid function tests are a poor surrogate for predicting who will decompensate. The clinical distinction is made by documentation of acute organ dysfunction. Reducing T3 to T4 conversion means propylthiouracil is preferred over methimazole.
Ongoing management of a myxedema coma means monitoring the clinical parameters of the patient’s mental status, cardiac and pulmonary functions, while keeping the levothyroxine dose steady and checking lab values every 1-2 days to ensure the patient is progressing.
Suspect pituitary apoplexy in cases of hypertension, major surgery, trauma, anticoagulation, pregnancy, or if there is a large sellar mass. If choosing to image a patient, Dr. Tan recommended using an MRI rather than a CT scan, which she said is less sensitive. Immediate hydrocortisone treatment must be administered, she said. About 90% of cases of acute hypercalcemia are caused by hyperparathyroidism in the outpatient setting, and malignancy in the inpatient setting, Dr. Tan said. Also, these patients tend to be volume depleted, so assessment of their ability to tolerate hydration is essential.
Regarding all endocrine emergencies, Dr. Tan said, “When in doubt, be more aggressive with treatment.”
Dr. Tan had no relevant financial disclosures.
It’s a fine line between compensated and decompensated endocrine conditions, and often, there is an underlying non–endocrine component complicating the diagnosis.
That’s according to Marilyn Tan, MD, a clinical assistant professor of medicine at Stanford (Calif.) University, where she is chief of the endocrinology clinic. She spoke about endocrinology emergencies during a case-based, rapid-fire session at HM17.
“Endocrine emergencies are usually due to an excess or a deficiency of a hormone,” Dr. Tan said, noting that these can take time to bring into balance. This is one reason Dr. Tan counseled not waiting for laboratory results before administering treatment.
To diagnose and treat diabetic ketoacidosis, combined with a hyperosmolar hyperglycemic state, Dr. Tan recommended checking hypoglycemia levels, which she said are often mild, and to check anion gap, pH, and ketones. It’s also important to be generous with IV fluids, to administer insulin only if the ketoacidosis level is greater than 3.3 mEq/L, and to not take the patient off an insulin drip too early or inappropriately. To prevent readmissions, the patient on discharge should have adequate diabetes supplies, education on their condition, and timely follow-up, Dr. Tan recommended.
For patients experiencing a thyroid storm, Dr. Tan advised that thyroid function tests are a poor surrogate for predicting who will decompensate. The clinical distinction is made by documentation of acute organ dysfunction. Reducing T3 to T4 conversion means propylthiouracil is preferred over methimazole.
Ongoing management of a myxedema coma means monitoring the clinical parameters of the patient’s mental status, cardiac and pulmonary functions, while keeping the levothyroxine dose steady and checking lab values every 1-2 days to ensure the patient is progressing.
Suspect pituitary apoplexy in cases of hypertension, major surgery, trauma, anticoagulation, pregnancy, or if there is a large sellar mass. If choosing to image a patient, Dr. Tan recommended using an MRI rather than a CT scan, which she said is less sensitive. Immediate hydrocortisone treatment must be administered, she said. About 90% of cases of acute hypercalcemia are caused by hyperparathyroidism in the outpatient setting, and malignancy in the inpatient setting, Dr. Tan said. Also, these patients tend to be volume depleted, so assessment of their ability to tolerate hydration is essential.
Regarding all endocrine emergencies, Dr. Tan said, “When in doubt, be more aggressive with treatment.”
Dr. Tan had no relevant financial disclosures.
It’s a fine line between compensated and decompensated endocrine conditions, and often, there is an underlying non–endocrine component complicating the diagnosis.
That’s according to Marilyn Tan, MD, a clinical assistant professor of medicine at Stanford (Calif.) University, where she is chief of the endocrinology clinic. She spoke about endocrinology emergencies during a case-based, rapid-fire session at HM17.
“Endocrine emergencies are usually due to an excess or a deficiency of a hormone,” Dr. Tan said, noting that these can take time to bring into balance. This is one reason Dr. Tan counseled not waiting for laboratory results before administering treatment.
To diagnose and treat diabetic ketoacidosis, combined with a hyperosmolar hyperglycemic state, Dr. Tan recommended checking hypoglycemia levels, which she said are often mild, and to check anion gap, pH, and ketones. It’s also important to be generous with IV fluids, to administer insulin only if the ketoacidosis level is greater than 3.3 mEq/L, and to not take the patient off an insulin drip too early or inappropriately. To prevent readmissions, the patient on discharge should have adequate diabetes supplies, education on their condition, and timely follow-up, Dr. Tan recommended.
For patients experiencing a thyroid storm, Dr. Tan advised that thyroid function tests are a poor surrogate for predicting who will decompensate. The clinical distinction is made by documentation of acute organ dysfunction. Reducing T3 to T4 conversion means propylthiouracil is preferred over methimazole.
Ongoing management of a myxedema coma means monitoring the clinical parameters of the patient’s mental status, cardiac and pulmonary functions, while keeping the levothyroxine dose steady and checking lab values every 1-2 days to ensure the patient is progressing.
Suspect pituitary apoplexy in cases of hypertension, major surgery, trauma, anticoagulation, pregnancy, or if there is a large sellar mass. If choosing to image a patient, Dr. Tan recommended using an MRI rather than a CT scan, which she said is less sensitive. Immediate hydrocortisone treatment must be administered, she said. About 90% of cases of acute hypercalcemia are caused by hyperparathyroidism in the outpatient setting, and malignancy in the inpatient setting, Dr. Tan said. Also, these patients tend to be volume depleted, so assessment of their ability to tolerate hydration is essential.
Regarding all endocrine emergencies, Dr. Tan said, “When in doubt, be more aggressive with treatment.”
Dr. Tan had no relevant financial disclosures.
Highlights of Day 4
Sometimes the final day of a convention is nothing more than the “getaway day.”
But not at HM17. Not this year.
The finale of the 2017 annual meeting is capped off, as has become tradition, by a speech from the dean of hospital medicine: Robert Wachter, MD, MHM. The last time Dr. Wachter gave his address from a Vegas stage, it ended with him in head-to-toe Elton John regalia. While there’s no guarantee of a wardrobe reprisal, the annual address from the man who helped name the specialty promises to entertain and inform, said HM17 course director Lenny Feldman, MD, SFHM.
However, Dr. Wachter’s words – this year titled “Planning for the Future in a World of Constant Change: What Should Hospitalists Do?” – aren’t the final day’s only lure.
Two of this year’s newest educational tracks – Health Policy and Medical Education – debut today and offer five courses focusing on niche areas interesting to many hospitalists. Also today is the annual Potpurri track, which highlights off-beat topics such as “Case-Based Approach to Difficult Conversations” and “The History of Medicine: Discoveries that Shaped Our Profession.”
“These sessions are unique but have a wide range of appeal,” Dr. Feldman said. “Attendees are going to have a great time delving into these topics.”
Sometimes the final day of a convention is nothing more than the “getaway day.”
But not at HM17. Not this year.
The finale of the 2017 annual meeting is capped off, as has become tradition, by a speech from the dean of hospital medicine: Robert Wachter, MD, MHM. The last time Dr. Wachter gave his address from a Vegas stage, it ended with him in head-to-toe Elton John regalia. While there’s no guarantee of a wardrobe reprisal, the annual address from the man who helped name the specialty promises to entertain and inform, said HM17 course director Lenny Feldman, MD, SFHM.
However, Dr. Wachter’s words – this year titled “Planning for the Future in a World of Constant Change: What Should Hospitalists Do?” – aren’t the final day’s only lure.
Two of this year’s newest educational tracks – Health Policy and Medical Education – debut today and offer five courses focusing on niche areas interesting to many hospitalists. Also today is the annual Potpurri track, which highlights off-beat topics such as “Case-Based Approach to Difficult Conversations” and “The History of Medicine: Discoveries that Shaped Our Profession.”
“These sessions are unique but have a wide range of appeal,” Dr. Feldman said. “Attendees are going to have a great time delving into these topics.”
Sometimes the final day of a convention is nothing more than the “getaway day.”
But not at HM17. Not this year.
The finale of the 2017 annual meeting is capped off, as has become tradition, by a speech from the dean of hospital medicine: Robert Wachter, MD, MHM. The last time Dr. Wachter gave his address from a Vegas stage, it ended with him in head-to-toe Elton John regalia. While there’s no guarantee of a wardrobe reprisal, the annual address from the man who helped name the specialty promises to entertain and inform, said HM17 course director Lenny Feldman, MD, SFHM.
However, Dr. Wachter’s words – this year titled “Planning for the Future in a World of Constant Change: What Should Hospitalists Do?” – aren’t the final day’s only lure.
Two of this year’s newest educational tracks – Health Policy and Medical Education – debut today and offer five courses focusing on niche areas interesting to many hospitalists. Also today is the annual Potpurri track, which highlights off-beat topics such as “Case-Based Approach to Difficult Conversations” and “The History of Medicine: Discoveries that Shaped Our Profession.”
“These sessions are unique but have a wide range of appeal,” Dr. Feldman said. “Attendees are going to have a great time delving into these topics.”
Hope and change
Robert M. Wachter, MD, MHM, has given the last plenary address at every SHM annual meeting since 2007. The talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy. Then there was the time when he broke into an Elton John parody.
Where does that point of view come from? Well, as the dean of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli-sci major becomes an academic physician.”
That’s a needed perspective this year, as the level of political upheaval in the United States has added to the tumult in the health care field. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles that doctors face when using electronic health records (EHRs) are among the topics that he will address in his this final discussion.
“While [President Donald] Trump brings massive uncertainly, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” said Dr. Wachter, whose address is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Healthcare?”
Dr. Wachter, chair of the department of medicine at the University of California, San Francisco, said that the Trump administration is a once-in-a-lifetime anomaly that understandably has made both physicians and patients nervous – particularly at a time when health care reform appeared to be stabilizing.
The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path doesn’t include a ton of change, but at least it had a predictable path.”
The defeat of Republicans’ plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA) showed that the divide over health care extends even to intraparty discussions.
“The implosion of the AHCA shows how difficult health reform is and how quickly the ACA became the de facto standard,” Dr. Wachter said. “It is now that status quo that is so difficult to change.”
Dr. Wachter, who famously helped coined the term “hospitalist” in the 1996 New England Journal of Medicine paper that propelled the nascent specialty, said that one big challenge to HM is determining the future of how hospitals get paid – and how they pay their workers (335[7]:514-7).
“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or [if] their payments go way down,” he predicted.
What that means for the daily schedules of hospitalists remains to be seen, but Dr. Wachter doesn’t expect much in the short term.
“The job will be the same,” he said. “Take care of patients well, make them happy, satisfy your bosses and colleagues, and do it for less money. The biggest shift is likely to be that more and more people/systems – doing the same thing – will find that they don’t need as many hospital days, which means that we’ll have fewer patients and fewer hospitals. But we knew that.”
Dr. Wachter is more interested to see what will happen in postacute and other nonhospital facilities, how quickly technology continues to disrupt, and who hospitalists will work for (be it staffing companies, medical groups, or “something new”).
The veteran physician in him says not to get too distracted “by all of the zigs and zags,” he noted, while the political idealist in him says not to ever forget that the “core values and imperatives remain.”
If the past decade of wise words ending SHM’s annual meeting are any indication, Dr. Wachter’s message of trepidation and concern will end on a high note for attendees.
Robert M. Wachter, MD, MHM, has given the last plenary address at every SHM annual meeting since 2007. The talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy. Then there was the time when he broke into an Elton John parody.
Where does that point of view come from? Well, as the dean of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli-sci major becomes an academic physician.”
That’s a needed perspective this year, as the level of political upheaval in the United States has added to the tumult in the health care field. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles that doctors face when using electronic health records (EHRs) are among the topics that he will address in his this final discussion.
“While [President Donald] Trump brings massive uncertainly, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” said Dr. Wachter, whose address is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Healthcare?”
Dr. Wachter, chair of the department of medicine at the University of California, San Francisco, said that the Trump administration is a once-in-a-lifetime anomaly that understandably has made both physicians and patients nervous – particularly at a time when health care reform appeared to be stabilizing.
The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path doesn’t include a ton of change, but at least it had a predictable path.”
The defeat of Republicans’ plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA) showed that the divide over health care extends even to intraparty discussions.
“The implosion of the AHCA shows how difficult health reform is and how quickly the ACA became the de facto standard,” Dr. Wachter said. “It is now that status quo that is so difficult to change.”
Dr. Wachter, who famously helped coined the term “hospitalist” in the 1996 New England Journal of Medicine paper that propelled the nascent specialty, said that one big challenge to HM is determining the future of how hospitals get paid – and how they pay their workers (335[7]:514-7).
“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or [if] their payments go way down,” he predicted.
What that means for the daily schedules of hospitalists remains to be seen, but Dr. Wachter doesn’t expect much in the short term.
“The job will be the same,” he said. “Take care of patients well, make them happy, satisfy your bosses and colleagues, and do it for less money. The biggest shift is likely to be that more and more people/systems – doing the same thing – will find that they don’t need as many hospital days, which means that we’ll have fewer patients and fewer hospitals. But we knew that.”
Dr. Wachter is more interested to see what will happen in postacute and other nonhospital facilities, how quickly technology continues to disrupt, and who hospitalists will work for (be it staffing companies, medical groups, or “something new”).
The veteran physician in him says not to get too distracted “by all of the zigs and zags,” he noted, while the political idealist in him says not to ever forget that the “core values and imperatives remain.”
If the past decade of wise words ending SHM’s annual meeting are any indication, Dr. Wachter’s message of trepidation and concern will end on a high note for attendees.
Robert M. Wachter, MD, MHM, has given the last plenary address at every SHM annual meeting since 2007. The talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy. Then there was the time when he broke into an Elton John parody.
Where does that point of view come from? Well, as the dean of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli-sci major becomes an academic physician.”
That’s a needed perspective this year, as the level of political upheaval in the United States has added to the tumult in the health care field. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles that doctors face when using electronic health records (EHRs) are among the topics that he will address in his this final discussion.
“While [President Donald] Trump brings massive uncertainly, the shift to value and the increasing importance of building a strong culture, a method to continuously improve, and a way to use the EHR to make things better is unlikely to go away,” said Dr. Wachter, whose address is titled, “Mergers, MACRA, and Mission-Creep: Can Hospitalists Thrive in the New World of Healthcare?”
Dr. Wachter, chair of the department of medicine at the University of California, San Francisco, said that the Trump administration is a once-in-a-lifetime anomaly that understandably has made both physicians and patients nervous – particularly at a time when health care reform appeared to be stabilizing.
The new president “adds an amazing wild card, at every level,” he said. “If it weren’t for his administration, I think we’d be on a fairly stable, predictable path. Not that that path doesn’t include a ton of change, but at least it had a predictable path.”
The defeat of Republicans’ plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA) showed that the divide over health care extends even to intraparty discussions.
“The implosion of the AHCA shows how difficult health reform is and how quickly the ACA became the de facto standard,” Dr. Wachter said. “It is now that status quo that is so difficult to change.”
Dr. Wachter, who famously helped coined the term “hospitalist” in the 1996 New England Journal of Medicine paper that propelled the nascent specialty, said that one big challenge to HM is determining the future of how hospitals get paid – and how they pay their workers (335[7]:514-7).
“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or [if] their payments go way down,” he predicted.
What that means for the daily schedules of hospitalists remains to be seen, but Dr. Wachter doesn’t expect much in the short term.
“The job will be the same,” he said. “Take care of patients well, make them happy, satisfy your bosses and colleagues, and do it for less money. The biggest shift is likely to be that more and more people/systems – doing the same thing – will find that they don’t need as many hospital days, which means that we’ll have fewer patients and fewer hospitals. But we knew that.”
Dr. Wachter is more interested to see what will happen in postacute and other nonhospital facilities, how quickly technology continues to disrupt, and who hospitalists will work for (be it staffing companies, medical groups, or “something new”).
The veteran physician in him says not to get too distracted “by all of the zigs and zags,” he noted, while the political idealist in him says not to ever forget that the “core values and imperatives remain.”
If the past decade of wise words ending SHM’s annual meeting are any indication, Dr. Wachter’s message of trepidation and concern will end on a high note for attendees.
Welcome to the third and final day of HM17!
Welcome to the third and final day of HM17!
Although it is the shortest day of the conference, day 3 is full of quality content, starting at 7:40 a.m. with a mini-track.
If you are interested in hearing about the impact of November’s election on health care reform, join me at the Health Policy Mini-Track starting first thing in the morning. The mini-track will begin with a session called “Hot Topics in Health Policy for Hospitalists” and will be followed by a panel of visitors from our nation’s capital who will weigh in on events in D.C. that will have an impact on our careers.
There are also three workshops in the morning including one on negotiation that I hope to attend. The second set of workshops includes one with the provocative title of “Cutting Out Things We Do for No Reason.”
And while there are too many great sessions to be able to call out each one, the prize for most creative title clearly goes to “Take Your PICC: Choosing the Right Vascular Access.”
The day, and the meeting, ends as it traditionally does with a talk by the venerable Bob Wachter, MD, MHM, who will treat us to a discussion on “Planning for the Future in a World of Constant Change: What Should Hospitalists Do?” We may even see some of his famed humor and wit as we have in past years. Everyone who has ever heard Bob speak knows that this is a session that should not be missed!
Your afternoon is free to travel home or to hit the casinos one last time.
As I begin my year as SHM President, I continue to be energized by the opportunity to meet so many of you at our Annual Meeting and to be part of an organization that continues to have such a positive impact on our nation’s health care system.
The coming year will see a continued reshaping of our delivery system, driven by emerging federal policy including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and anticipated changes in the Affordable Care Act. It will continue to be a priority for SHM to make sure that the voice of Hospital Medicine is heard loud and clear as decisions are made that will affect our patients and our careers. I will be asking our members to help ensure that we have a prominent place in these decision making processes. We will continue to strive to make sure that our patients get the care they deserve and that we continue to help build and maintain a sustainable health care delivery system.
This year, you will also see a focused effort to strengthen our system of state and local chapters. The vitality of these local organizations is important to our efforts to effectively serve our members by engaging them along with their colleagues.
And, of course, SHM will continue to be the only organization created to represent our nation’s hospitalists and to be totally committed to providing our members with clinical and administrative education, dedicated publications, leadership training, research opportunities, and advocacy.
I hope you enjoyed what turned out to be the largest and best Annual Meeting in our history. And I hope to see you at Hospital Medicine 2018 in Orlando.
Welcome to the third and final day of HM17!
Although it is the shortest day of the conference, day 3 is full of quality content, starting at 7:40 a.m. with a mini-track.
If you are interested in hearing about the impact of November’s election on health care reform, join me at the Health Policy Mini-Track starting first thing in the morning. The mini-track will begin with a session called “Hot Topics in Health Policy for Hospitalists” and will be followed by a panel of visitors from our nation’s capital who will weigh in on events in D.C. that will have an impact on our careers.
There are also three workshops in the morning including one on negotiation that I hope to attend. The second set of workshops includes one with the provocative title of “Cutting Out Things We Do for No Reason.”
And while there are too many great sessions to be able to call out each one, the prize for most creative title clearly goes to “Take Your PICC: Choosing the Right Vascular Access.”
The day, and the meeting, ends as it traditionally does with a talk by the venerable Bob Wachter, MD, MHM, who will treat us to a discussion on “Planning for the Future in a World of Constant Change: What Should Hospitalists Do?” We may even see some of his famed humor and wit as we have in past years. Everyone who has ever heard Bob speak knows that this is a session that should not be missed!
Your afternoon is free to travel home or to hit the casinos one last time.
As I begin my year as SHM President, I continue to be energized by the opportunity to meet so many of you at our Annual Meeting and to be part of an organization that continues to have such a positive impact on our nation’s health care system.
The coming year will see a continued reshaping of our delivery system, driven by emerging federal policy including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and anticipated changes in the Affordable Care Act. It will continue to be a priority for SHM to make sure that the voice of Hospital Medicine is heard loud and clear as decisions are made that will affect our patients and our careers. I will be asking our members to help ensure that we have a prominent place in these decision making processes. We will continue to strive to make sure that our patients get the care they deserve and that we continue to help build and maintain a sustainable health care delivery system.
This year, you will also see a focused effort to strengthen our system of state and local chapters. The vitality of these local organizations is important to our efforts to effectively serve our members by engaging them along with their colleagues.
And, of course, SHM will continue to be the only organization created to represent our nation’s hospitalists and to be totally committed to providing our members with clinical and administrative education, dedicated publications, leadership training, research opportunities, and advocacy.
I hope you enjoyed what turned out to be the largest and best Annual Meeting in our history. And I hope to see you at Hospital Medicine 2018 in Orlando.
Welcome to the third and final day of HM17!
Although it is the shortest day of the conference, day 3 is full of quality content, starting at 7:40 a.m. with a mini-track.
If you are interested in hearing about the impact of November’s election on health care reform, join me at the Health Policy Mini-Track starting first thing in the morning. The mini-track will begin with a session called “Hot Topics in Health Policy for Hospitalists” and will be followed by a panel of visitors from our nation’s capital who will weigh in on events in D.C. that will have an impact on our careers.
There are also three workshops in the morning including one on negotiation that I hope to attend. The second set of workshops includes one with the provocative title of “Cutting Out Things We Do for No Reason.”
And while there are too many great sessions to be able to call out each one, the prize for most creative title clearly goes to “Take Your PICC: Choosing the Right Vascular Access.”
The day, and the meeting, ends as it traditionally does with a talk by the venerable Bob Wachter, MD, MHM, who will treat us to a discussion on “Planning for the Future in a World of Constant Change: What Should Hospitalists Do?” We may even see some of his famed humor and wit as we have in past years. Everyone who has ever heard Bob speak knows that this is a session that should not be missed!
Your afternoon is free to travel home or to hit the casinos one last time.
As I begin my year as SHM President, I continue to be energized by the opportunity to meet so many of you at our Annual Meeting and to be part of an organization that continues to have such a positive impact on our nation’s health care system.
The coming year will see a continued reshaping of our delivery system, driven by emerging federal policy including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and anticipated changes in the Affordable Care Act. It will continue to be a priority for SHM to make sure that the voice of Hospital Medicine is heard loud and clear as decisions are made that will affect our patients and our careers. I will be asking our members to help ensure that we have a prominent place in these decision making processes. We will continue to strive to make sure that our patients get the care they deserve and that we continue to help build and maintain a sustainable health care delivery system.
This year, you will also see a focused effort to strengthen our system of state and local chapters. The vitality of these local organizations is important to our efforts to effectively serve our members by engaging them along with their colleagues.
And, of course, SHM will continue to be the only organization created to represent our nation’s hospitalists and to be totally committed to providing our members with clinical and administrative education, dedicated publications, leadership training, research opportunities, and advocacy.
I hope you enjoyed what turned out to be the largest and best Annual Meeting in our history. And I hope to see you at Hospital Medicine 2018 in Orlando.
Stump the Professor event entertains, educates
Gurpreet Dhaliwal, MD, professor of medicine at the University of California, San Francisco, joked that participating in a “Stump the Professor” event is “like taking an oral exam in front of 300 or 400 people.”
Dr. Dhaliwal passed his “exam” with flying colors on Wednesday at HM17, correctly making a diagnosis of a case of leptospirosis described by his co-presenter Daniel Brotman, MD, SFHM, professor of medicine and director of the hospitalist program at Johns Hopkins University, Baltimore.
While the format is intended to be fun and entertaining, he said that there is no doubt that learning is taking place – both by him and by the audience.
“The most important goal by far and away is to put our most important procedure on display, which is thinking,” he said. “We don’t always make our thinking explicit, and we don’t often open it to scrutiny. So the goal of this session is to do both.”
Talking through his uncertainty can be one of the most interesting aspects of the session, Dr. Dhaliwal told attendees.
“If I can’t say something insightful, let me try to capture my uncertainty and crystallize that for you so you recognize that as a real part of medicine,” he said.
The HM17 audience seemed to enjoy trying to solve the case and thinking through the clinical reasoning as Dr. Dhaliwal did the same. The diagnosis of leptospirosis in Wednesday’s case surprised the audience, many of whom shook their heads in amazement.
“I pick cases based on being dramatic and/or unusual enough to provide some clinical excitement and diagnostic challenge,” he said.
An “important bonus,” Dr. Dhaliwal said, is that the audience would learn something about the disease that’s being discussed.
“I suspect I learn the most, especially if I get the case wrong,” he told attendees. “After living it on stage, there’s a lot that I upload in my memory for the next time I see something like this in real life.”
He said he’s probably batting about 0.500 on getting the cases right.
“I’ve had plenty of experiences where I’ve pulled the rabbit out of the hat at the last minute, and it’s been glorious, and I’ve had plenty of experiences where I’ve fallen flat on my face, and I didn’t have a prayer of knowing it, either, because my thinking was off, my knowledge was deficient, or it was something I had never heard of before,” he said. “The one thing that’s always rewarding is that people are always very appreciative that I shared my thinking, whether it’s a flash of insight or a total stumble or an uncertainty that I have.”
It might seem that the event has more of a potential downside than upside: If he gets a case right, he’s doing what he should do; if he gets one wrong, it might be embarrassing. He doesn’t see it that way, he told the crowd.
“It’s a total joy to be up here,” Dr. Dhaliwal said. “There’s no doubt that standing in front of a crowd induces a little bit of anxiety, but it is a lot of fun to do. And I had mentors who did this, and then I started to learn it myself, and at some point, you get past the anxiety of being right or wrong, and you just enjoy being up there.”
Gurpreet Dhaliwal, MD, professor of medicine at the University of California, San Francisco, joked that participating in a “Stump the Professor” event is “like taking an oral exam in front of 300 or 400 people.”
Dr. Dhaliwal passed his “exam” with flying colors on Wednesday at HM17, correctly making a diagnosis of a case of leptospirosis described by his co-presenter Daniel Brotman, MD, SFHM, professor of medicine and director of the hospitalist program at Johns Hopkins University, Baltimore.
While the format is intended to be fun and entertaining, he said that there is no doubt that learning is taking place – both by him and by the audience.
“The most important goal by far and away is to put our most important procedure on display, which is thinking,” he said. “We don’t always make our thinking explicit, and we don’t often open it to scrutiny. So the goal of this session is to do both.”
Talking through his uncertainty can be one of the most interesting aspects of the session, Dr. Dhaliwal told attendees.
“If I can’t say something insightful, let me try to capture my uncertainty and crystallize that for you so you recognize that as a real part of medicine,” he said.
The HM17 audience seemed to enjoy trying to solve the case and thinking through the clinical reasoning as Dr. Dhaliwal did the same. The diagnosis of leptospirosis in Wednesday’s case surprised the audience, many of whom shook their heads in amazement.
“I pick cases based on being dramatic and/or unusual enough to provide some clinical excitement and diagnostic challenge,” he said.
An “important bonus,” Dr. Dhaliwal said, is that the audience would learn something about the disease that’s being discussed.
“I suspect I learn the most, especially if I get the case wrong,” he told attendees. “After living it on stage, there’s a lot that I upload in my memory for the next time I see something like this in real life.”
He said he’s probably batting about 0.500 on getting the cases right.
“I’ve had plenty of experiences where I’ve pulled the rabbit out of the hat at the last minute, and it’s been glorious, and I’ve had plenty of experiences where I’ve fallen flat on my face, and I didn’t have a prayer of knowing it, either, because my thinking was off, my knowledge was deficient, or it was something I had never heard of before,” he said. “The one thing that’s always rewarding is that people are always very appreciative that I shared my thinking, whether it’s a flash of insight or a total stumble or an uncertainty that I have.”
It might seem that the event has more of a potential downside than upside: If he gets a case right, he’s doing what he should do; if he gets one wrong, it might be embarrassing. He doesn’t see it that way, he told the crowd.
“It’s a total joy to be up here,” Dr. Dhaliwal said. “There’s no doubt that standing in front of a crowd induces a little bit of anxiety, but it is a lot of fun to do. And I had mentors who did this, and then I started to learn it myself, and at some point, you get past the anxiety of being right or wrong, and you just enjoy being up there.”
Gurpreet Dhaliwal, MD, professor of medicine at the University of California, San Francisco, joked that participating in a “Stump the Professor” event is “like taking an oral exam in front of 300 or 400 people.”
Dr. Dhaliwal passed his “exam” with flying colors on Wednesday at HM17, correctly making a diagnosis of a case of leptospirosis described by his co-presenter Daniel Brotman, MD, SFHM, professor of medicine and director of the hospitalist program at Johns Hopkins University, Baltimore.
While the format is intended to be fun and entertaining, he said that there is no doubt that learning is taking place – both by him and by the audience.
“The most important goal by far and away is to put our most important procedure on display, which is thinking,” he said. “We don’t always make our thinking explicit, and we don’t often open it to scrutiny. So the goal of this session is to do both.”
Talking through his uncertainty can be one of the most interesting aspects of the session, Dr. Dhaliwal told attendees.
“If I can’t say something insightful, let me try to capture my uncertainty and crystallize that for you so you recognize that as a real part of medicine,” he said.
The HM17 audience seemed to enjoy trying to solve the case and thinking through the clinical reasoning as Dr. Dhaliwal did the same. The diagnosis of leptospirosis in Wednesday’s case surprised the audience, many of whom shook their heads in amazement.
“I pick cases based on being dramatic and/or unusual enough to provide some clinical excitement and diagnostic challenge,” he said.
An “important bonus,” Dr. Dhaliwal said, is that the audience would learn something about the disease that’s being discussed.
“I suspect I learn the most, especially if I get the case wrong,” he told attendees. “After living it on stage, there’s a lot that I upload in my memory for the next time I see something like this in real life.”
He said he’s probably batting about 0.500 on getting the cases right.
“I’ve had plenty of experiences where I’ve pulled the rabbit out of the hat at the last minute, and it’s been glorious, and I’ve had plenty of experiences where I’ve fallen flat on my face, and I didn’t have a prayer of knowing it, either, because my thinking was off, my knowledge was deficient, or it was something I had never heard of before,” he said. “The one thing that’s always rewarding is that people are always very appreciative that I shared my thinking, whether it’s a flash of insight or a total stumble or an uncertainty that I have.”
It might seem that the event has more of a potential downside than upside: If he gets a case right, he’s doing what he should do; if he gets one wrong, it might be embarrassing. He doesn’t see it that way, he told the crowd.
“It’s a total joy to be up here,” Dr. Dhaliwal said. “There’s no doubt that standing in front of a crowd induces a little bit of anxiety, but it is a lot of fun to do. And I had mentors who did this, and then I started to learn it myself, and at some point, you get past the anxiety of being right or wrong, and you just enjoy being up there.”
RIV winners celebrated for their creative use of data
This year’s RIV innovation winners reflect a nascent trend of applying informatics to quality improvement and patient safety initiatives.
“One striking thing is that all three winners used either EHR or Big Data and large collaboratives to achieve their goals,” Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, and moderator of the winners’ panel, said in an interview. This year’s winners included a sleep-promoting “nudge” system that Dr. Fang said she expects will help improve sleep and lower rates of delirium and a source code that connects disparate data systems for daily updates on where quality can be improved. The third winner used what Dr. Fang, a hospitalist and the medical director of the anticoagulation clinic at the University of California, San Francisco, called a “classic quality improvement collaborative,” which simplifies the decision tree around venous thromboembolism (VTE) prophylaxis for better patient outcomes.
Calling uninterrupted sleep the “sine qua non” of patient care, RIV award recipient Vineet Arora, MD, an associate professor of medicine at the University of Chicago, described the rationale for her RIV award-winning SIESTA (Sleep for Inpatients: Empowering Staff to Act) program. She and her colleagues surveyed hospitalists, nurses, residents, and patients to determine the most common sleep disrupters in their institution and devised “nudges” to alter how staff performed various tasks that otherwise might interfere with patient sleep. Rather than use overt incentives, nudges are changes in what Dr. Arora called the “choice architecture” of people’s behavior.
Based on survey feedback, Dr. Arora and her colleagues worked with their electronic health record (EHR) vendor to consolidate the performance of certain tasks that were affecting patient sleep. Reminders were added to daily nursing huddles to prompt them to look for ways they could decrease patient interruptions, and empowerment coaching was offered to nurses to encourage patient advocacy when physicians had given orders that would interfere with patients’ sleep.
When tested and measured over the course of a year, SIESTA’s EHR innovations resulted in six fewer nighttime disruptions than before the intervention, compared with controls, a statistically significant difference. The nursing-based interventions resulted in one less nocturnal interruption on average, also a significant change.
“If every patient were admitted into a SIESTA unit, 84% would say they were not disrupted by medications, compared to 57%. For interruptions for vitals, it would be 17% vs. 41%,” Dr. Arora said. In terms of the Hospital Consumer Assessment of Healthcare Providers and Systems) data, this translates into as much as a 25th-percentile performance improvement for hospitals in related domains, according to Dr. Arora.
Nader Najafi, MD, an assistant clinical professor of medicine at UCSF, and his colleagues created Murmur, an open-source code data aggregator, which can be customized to solve a variety of quality improvement issues. RIV award winner Dr. Najafi applied the code to determine how systems failures in their institution were contributing to avoidable inpatient days, for example. At a daily appointed time, Murmur would determine which staff members were scheduled to work that day. Each provider would then receive a brief, customized survey about patients for that day on their cell phone. The data were then collected to create instant reports of where the delays in discharge were occurring.
Testing by gastroenterologists was pinpointed as a “huge source of delays, something we had never been able to quantify before, “ Dr. Najafi said. This led to brainstorming sessions with the department for solutions.
To reduce rates of hospital-associated VTE, 35 California hospitals with varying numbers of beds and locations collaborated on a project led by RIV award recipient Ian Jenkins, MD, SFHM, a health sciences clinical professor at the University of California, San Diego. Key components of the intervention were mentoring at the sites by VTE prophylaxis experts, group webinars in best practices, and a “measure-vention.” Teams were taught how to rate patient risk for VTE and apply specific protocols according to risk rating using the SHM-mentored implementation model. Real-time monitoring of the intervention was used to make any necessary adjustments. When before-and-after data were compared, following the 18-month period during which the intervention was measured, Dr. Jenkins said an average of 330 VTEs were averted annually. “We found the results very gratifying,” said Dr. Jenkins.
“These projects all reflect a broader trend in hospital medicine where we are using the wealth of data we have now for quality improvement and for outcomes research,” Dr. Fang said in the interview.
There were no relevant disclosures.
This year’s RIV innovation winners reflect a nascent trend of applying informatics to quality improvement and patient safety initiatives.
“One striking thing is that all three winners used either EHR or Big Data and large collaboratives to achieve their goals,” Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, and moderator of the winners’ panel, said in an interview. This year’s winners included a sleep-promoting “nudge” system that Dr. Fang said she expects will help improve sleep and lower rates of delirium and a source code that connects disparate data systems for daily updates on where quality can be improved. The third winner used what Dr. Fang, a hospitalist and the medical director of the anticoagulation clinic at the University of California, San Francisco, called a “classic quality improvement collaborative,” which simplifies the decision tree around venous thromboembolism (VTE) prophylaxis for better patient outcomes.
Calling uninterrupted sleep the “sine qua non” of patient care, RIV award recipient Vineet Arora, MD, an associate professor of medicine at the University of Chicago, described the rationale for her RIV award-winning SIESTA (Sleep for Inpatients: Empowering Staff to Act) program. She and her colleagues surveyed hospitalists, nurses, residents, and patients to determine the most common sleep disrupters in their institution and devised “nudges” to alter how staff performed various tasks that otherwise might interfere with patient sleep. Rather than use overt incentives, nudges are changes in what Dr. Arora called the “choice architecture” of people’s behavior.
Based on survey feedback, Dr. Arora and her colleagues worked with their electronic health record (EHR) vendor to consolidate the performance of certain tasks that were affecting patient sleep. Reminders were added to daily nursing huddles to prompt them to look for ways they could decrease patient interruptions, and empowerment coaching was offered to nurses to encourage patient advocacy when physicians had given orders that would interfere with patients’ sleep.
When tested and measured over the course of a year, SIESTA’s EHR innovations resulted in six fewer nighttime disruptions than before the intervention, compared with controls, a statistically significant difference. The nursing-based interventions resulted in one less nocturnal interruption on average, also a significant change.
“If every patient were admitted into a SIESTA unit, 84% would say they were not disrupted by medications, compared to 57%. For interruptions for vitals, it would be 17% vs. 41%,” Dr. Arora said. In terms of the Hospital Consumer Assessment of Healthcare Providers and Systems) data, this translates into as much as a 25th-percentile performance improvement for hospitals in related domains, according to Dr. Arora.
Nader Najafi, MD, an assistant clinical professor of medicine at UCSF, and his colleagues created Murmur, an open-source code data aggregator, which can be customized to solve a variety of quality improvement issues. RIV award winner Dr. Najafi applied the code to determine how systems failures in their institution were contributing to avoidable inpatient days, for example. At a daily appointed time, Murmur would determine which staff members were scheduled to work that day. Each provider would then receive a brief, customized survey about patients for that day on their cell phone. The data were then collected to create instant reports of where the delays in discharge were occurring.
Testing by gastroenterologists was pinpointed as a “huge source of delays, something we had never been able to quantify before, “ Dr. Najafi said. This led to brainstorming sessions with the department for solutions.
To reduce rates of hospital-associated VTE, 35 California hospitals with varying numbers of beds and locations collaborated on a project led by RIV award recipient Ian Jenkins, MD, SFHM, a health sciences clinical professor at the University of California, San Diego. Key components of the intervention were mentoring at the sites by VTE prophylaxis experts, group webinars in best practices, and a “measure-vention.” Teams were taught how to rate patient risk for VTE and apply specific protocols according to risk rating using the SHM-mentored implementation model. Real-time monitoring of the intervention was used to make any necessary adjustments. When before-and-after data were compared, following the 18-month period during which the intervention was measured, Dr. Jenkins said an average of 330 VTEs were averted annually. “We found the results very gratifying,” said Dr. Jenkins.
“These projects all reflect a broader trend in hospital medicine where we are using the wealth of data we have now for quality improvement and for outcomes research,” Dr. Fang said in the interview.
There were no relevant disclosures.
This year’s RIV innovation winners reflect a nascent trend of applying informatics to quality improvement and patient safety initiatives.
“One striking thing is that all three winners used either EHR or Big Data and large collaboratives to achieve their goals,” Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, and moderator of the winners’ panel, said in an interview. This year’s winners included a sleep-promoting “nudge” system that Dr. Fang said she expects will help improve sleep and lower rates of delirium and a source code that connects disparate data systems for daily updates on where quality can be improved. The third winner used what Dr. Fang, a hospitalist and the medical director of the anticoagulation clinic at the University of California, San Francisco, called a “classic quality improvement collaborative,” which simplifies the decision tree around venous thromboembolism (VTE) prophylaxis for better patient outcomes.
Calling uninterrupted sleep the “sine qua non” of patient care, RIV award recipient Vineet Arora, MD, an associate professor of medicine at the University of Chicago, described the rationale for her RIV award-winning SIESTA (Sleep for Inpatients: Empowering Staff to Act) program. She and her colleagues surveyed hospitalists, nurses, residents, and patients to determine the most common sleep disrupters in their institution and devised “nudges” to alter how staff performed various tasks that otherwise might interfere with patient sleep. Rather than use overt incentives, nudges are changes in what Dr. Arora called the “choice architecture” of people’s behavior.
Based on survey feedback, Dr. Arora and her colleagues worked with their electronic health record (EHR) vendor to consolidate the performance of certain tasks that were affecting patient sleep. Reminders were added to daily nursing huddles to prompt them to look for ways they could decrease patient interruptions, and empowerment coaching was offered to nurses to encourage patient advocacy when physicians had given orders that would interfere with patients’ sleep.
When tested and measured over the course of a year, SIESTA’s EHR innovations resulted in six fewer nighttime disruptions than before the intervention, compared with controls, a statistically significant difference. The nursing-based interventions resulted in one less nocturnal interruption on average, also a significant change.
“If every patient were admitted into a SIESTA unit, 84% would say they were not disrupted by medications, compared to 57%. For interruptions for vitals, it would be 17% vs. 41%,” Dr. Arora said. In terms of the Hospital Consumer Assessment of Healthcare Providers and Systems) data, this translates into as much as a 25th-percentile performance improvement for hospitals in related domains, according to Dr. Arora.
Nader Najafi, MD, an assistant clinical professor of medicine at UCSF, and his colleagues created Murmur, an open-source code data aggregator, which can be customized to solve a variety of quality improvement issues. RIV award winner Dr. Najafi applied the code to determine how systems failures in their institution were contributing to avoidable inpatient days, for example. At a daily appointed time, Murmur would determine which staff members were scheduled to work that day. Each provider would then receive a brief, customized survey about patients for that day on their cell phone. The data were then collected to create instant reports of where the delays in discharge were occurring.
Testing by gastroenterologists was pinpointed as a “huge source of delays, something we had never been able to quantify before, “ Dr. Najafi said. This led to brainstorming sessions with the department for solutions.
To reduce rates of hospital-associated VTE, 35 California hospitals with varying numbers of beds and locations collaborated on a project led by RIV award recipient Ian Jenkins, MD, SFHM, a health sciences clinical professor at the University of California, San Diego. Key components of the intervention were mentoring at the sites by VTE prophylaxis experts, group webinars in best practices, and a “measure-vention.” Teams were taught how to rate patient risk for VTE and apply specific protocols according to risk rating using the SHM-mentored implementation model. Real-time monitoring of the intervention was used to make any necessary adjustments. When before-and-after data were compared, following the 18-month period during which the intervention was measured, Dr. Jenkins said an average of 330 VTEs were averted annually. “We found the results very gratifying,” said Dr. Jenkins.
“These projects all reflect a broader trend in hospital medicine where we are using the wealth of data we have now for quality improvement and for outcomes research,” Dr. Fang said in the interview.
There were no relevant disclosures.
VIDEO: Hospitalists can help improve antibiotic stewardship
Hospitalists can – and should – help curb unnecessary antibiotic use, according to an expert who spoke at HM17.
Nearly three-quarters of patients who have been diagnosed with community acquired pneumonia are receiving antibiotics for longer periods than necessary, either because the severity of their illness doesn’t warrant them or because they do not have pneumonia, according to Valerie M. Vaughn, MD, a research scientist in the division of hospital medicine and the Patient Safety Enhancement Program at Michigan Medicine, Ann Arbor.
“As hospitalists, we have a role to play in antibiotic stewardship,” Dr. Vaughn said in this interview recorded at the meeting.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Hospitalists can – and should – help curb unnecessary antibiotic use, according to an expert who spoke at HM17.
Nearly three-quarters of patients who have been diagnosed with community acquired pneumonia are receiving antibiotics for longer periods than necessary, either because the severity of their illness doesn’t warrant them or because they do not have pneumonia, according to Valerie M. Vaughn, MD, a research scientist in the division of hospital medicine and the Patient Safety Enhancement Program at Michigan Medicine, Ann Arbor.
“As hospitalists, we have a role to play in antibiotic stewardship,” Dr. Vaughn said in this interview recorded at the meeting.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Hospitalists can – and should – help curb unnecessary antibiotic use, according to an expert who spoke at HM17.
Nearly three-quarters of patients who have been diagnosed with community acquired pneumonia are receiving antibiotics for longer periods than necessary, either because the severity of their illness doesn’t warrant them or because they do not have pneumonia, according to Valerie M. Vaughn, MD, a research scientist in the division of hospital medicine and the Patient Safety Enhancement Program at Michigan Medicine, Ann Arbor.
“As hospitalists, we have a role to play in antibiotic stewardship,” Dr. Vaughn said in this interview recorded at the meeting.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
VIDEO: How informatics can help your hospital prevent infections
Hospitalists have a powerful tool to help them fight outbreaks of Clostridium difficile and other infectious agents: electronic health record data.
Sara Murray, MD, an assistant professor of medicine at the University of California, San Francisco, and her colleagues, used EHR data to map temporal and spatial coordinates to determine where patients in their hospital were at highest risk for C. difficile. Patients who’d had a CT scan on a particular machine in the emergency department within 24 hours of an infected person having been scanned there had a threefold higher risk of infection, they found. This information helped the hospital’s infection control team to create a more effective sterilization plan for that specific machine.
“The takeaway is that we should be leveraging our EHR data to inform our quality improvement efforts,” Dr. Murray said in this video interview, recorded during HM17.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Hospitalists have a powerful tool to help them fight outbreaks of Clostridium difficile and other infectious agents: electronic health record data.
Sara Murray, MD, an assistant professor of medicine at the University of California, San Francisco, and her colleagues, used EHR data to map temporal and spatial coordinates to determine where patients in their hospital were at highest risk for C. difficile. Patients who’d had a CT scan on a particular machine in the emergency department within 24 hours of an infected person having been scanned there had a threefold higher risk of infection, they found. This information helped the hospital’s infection control team to create a more effective sterilization plan for that specific machine.
“The takeaway is that we should be leveraging our EHR data to inform our quality improvement efforts,” Dr. Murray said in this video interview, recorded during HM17.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Hospitalists have a powerful tool to help them fight outbreaks of Clostridium difficile and other infectious agents: electronic health record data.
Sara Murray, MD, an assistant professor of medicine at the University of California, San Francisco, and her colleagues, used EHR data to map temporal and spatial coordinates to determine where patients in their hospital were at highest risk for C. difficile. Patients who’d had a CT scan on a particular machine in the emergency department within 24 hours of an infected person having been scanned there had a threefold higher risk of infection, they found. This information helped the hospital’s infection control team to create a more effective sterilization plan for that specific machine.
“The takeaway is that we should be leveraging our EHR data to inform our quality improvement efforts,” Dr. Murray said in this video interview, recorded during HM17.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Foresight and hard work – not inevitability – shaped HM, CEO says
So, the changing currents in medicine made it inevitable that the hospital medicine movement – and SHM – would have happened no matter what, right?
Not so much, said Laurence Wellikson, MD, MHM, chief executive officer of the Society of Hospital Medicine.
“How did Netflix pop up and not Blockbuster? Why did Sears not become Amazon?” he asked. “I think that SHM is very proud that we – very early on, when there were just a couple hundred hospitalists – saw the potential for this specialty.” At the same time, he said, “many of the other medical associations that were hundreds of years old not only did not see the potential for our specialty but, in many ways, were [also] somewhat contrary to the kinds of things that all of you have been doing over the last 20 years.”
He acknowledged that there were some “winds at our back” – it was clear that many physicians were wanting to leave the hospital – but he said the hospital medicine movement and the society nonetheless had to push up against resistance to change.
The movement continues to grow, he noted. As proof, there are 57,000 hospitalists, according to American Hospital Association surveys, and 15,000 SHM members.
In a note of caution, he recognized the many roles hospitalists are being asked to fill – from patient-safety projects to perioperative work – and said “hospitalists are more likely to say ‘yes’ when they should probably say ‘maybe.’ ” At the same time, he praised hospitalists for their openness to new ways of thinking and their willingness to partner.
Despite uncertainty, he said the future of health care is right up SHM’s alley.
“The future fits what hospital medicine is all about: We’re about value, we’re about creating the new future,” he said. “We’re about being accountable for what we do, being measured, and improving off those measures. ... We understand that we need to give up some of our autonomy and be in an integrated process to benefit from the expertise and the energies of other people.”
He touted the vital role that hospitalists will play.
“As we stand here today, we are not just large. We are not just the fastest-growing medical specialty of all time,” he said. “We are the answer to many of the questions going forward.”
So, the changing currents in medicine made it inevitable that the hospital medicine movement – and SHM – would have happened no matter what, right?
Not so much, said Laurence Wellikson, MD, MHM, chief executive officer of the Society of Hospital Medicine.
“How did Netflix pop up and not Blockbuster? Why did Sears not become Amazon?” he asked. “I think that SHM is very proud that we – very early on, when there were just a couple hundred hospitalists – saw the potential for this specialty.” At the same time, he said, “many of the other medical associations that were hundreds of years old not only did not see the potential for our specialty but, in many ways, were [also] somewhat contrary to the kinds of things that all of you have been doing over the last 20 years.”
He acknowledged that there were some “winds at our back” – it was clear that many physicians were wanting to leave the hospital – but he said the hospital medicine movement and the society nonetheless had to push up against resistance to change.
The movement continues to grow, he noted. As proof, there are 57,000 hospitalists, according to American Hospital Association surveys, and 15,000 SHM members.
In a note of caution, he recognized the many roles hospitalists are being asked to fill – from patient-safety projects to perioperative work – and said “hospitalists are more likely to say ‘yes’ when they should probably say ‘maybe.’ ” At the same time, he praised hospitalists for their openness to new ways of thinking and their willingness to partner.
Despite uncertainty, he said the future of health care is right up SHM’s alley.
“The future fits what hospital medicine is all about: We’re about value, we’re about creating the new future,” he said. “We’re about being accountable for what we do, being measured, and improving off those measures. ... We understand that we need to give up some of our autonomy and be in an integrated process to benefit from the expertise and the energies of other people.”
He touted the vital role that hospitalists will play.
“As we stand here today, we are not just large. We are not just the fastest-growing medical specialty of all time,” he said. “We are the answer to many of the questions going forward.”
So, the changing currents in medicine made it inevitable that the hospital medicine movement – and SHM – would have happened no matter what, right?
Not so much, said Laurence Wellikson, MD, MHM, chief executive officer of the Society of Hospital Medicine.
“How did Netflix pop up and not Blockbuster? Why did Sears not become Amazon?” he asked. “I think that SHM is very proud that we – very early on, when there were just a couple hundred hospitalists – saw the potential for this specialty.” At the same time, he said, “many of the other medical associations that were hundreds of years old not only did not see the potential for our specialty but, in many ways, were [also] somewhat contrary to the kinds of things that all of you have been doing over the last 20 years.”
He acknowledged that there were some “winds at our back” – it was clear that many physicians were wanting to leave the hospital – but he said the hospital medicine movement and the society nonetheless had to push up against resistance to change.
The movement continues to grow, he noted. As proof, there are 57,000 hospitalists, according to American Hospital Association surveys, and 15,000 SHM members.
In a note of caution, he recognized the many roles hospitalists are being asked to fill – from patient-safety projects to perioperative work – and said “hospitalists are more likely to say ‘yes’ when they should probably say ‘maybe.’ ” At the same time, he praised hospitalists for their openness to new ways of thinking and their willingness to partner.
Despite uncertainty, he said the future of health care is right up SHM’s alley.
“The future fits what hospital medicine is all about: We’re about value, we’re about creating the new future,” he said. “We’re about being accountable for what we do, being measured, and improving off those measures. ... We understand that we need to give up some of our autonomy and be in an integrated process to benefit from the expertise and the energies of other people.”
He touted the vital role that hospitalists will play.
“As we stand here today, we are not just large. We are not just the fastest-growing medical specialty of all time,” he said. “We are the answer to many of the questions going forward.”
Conway says health care payment, quality reform to continue
Keynote speaker Patrick Conway, MD, MSc, MHM, told hospitalists at HM17 Wednesday that, while there is a seemingly endless stream of punditry about the fate of the Affordable Care Act, health care will continue its trajectory to higher value, lower costs, and improved quality for patients.
“Health system transformation, innovation, delivery system reform, accountability, the work that you all do each and every day ... is a bipartisan ideal,” he said. The work “on value, the work on accountability, the work on bundled payments ... will continue and will continue to be important to you and the patients you serve.”
He also echoed Tuesday’s keynote address from Karen DeSalvo, MD, former Acting Assistant Secretary for Health in the U.S. Department of Health & Human Services, that hospital medicine needs to look at health care more holistically to help work on social issues. Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends, knows the problem first-hand as he often sees children on Medicaid who have multiple chronic conditions.
“I can tell you our system still does not have a highly reliable, whole health system for those children and their families,” he said. “Every weekend, I have a family that I can’t discharge because they don’t have the social and home-based supports for them to go home. So, they literally sit in the hospital until Monday. That makes no sense for our overall health system.”
Dr. Conway said that the gravitation away from fee-for-service toward alternative payment models would ideally lead to better patient outcomes, more coordinated care, and financial savings. He urged hospitalists to continue to help design new payment and care-delivery systems.
“You know what you’re passionate about and where you want to drive better care,” he said. “If the army of people in this room and all the places you are working [at] are the driver of better quality, better safety, coordinated care for patients ... that’s what it’s all about.”
Keynote speaker Patrick Conway, MD, MSc, MHM, told hospitalists at HM17 Wednesday that, while there is a seemingly endless stream of punditry about the fate of the Affordable Care Act, health care will continue its trajectory to higher value, lower costs, and improved quality for patients.
“Health system transformation, innovation, delivery system reform, accountability, the work that you all do each and every day ... is a bipartisan ideal,” he said. The work “on value, the work on accountability, the work on bundled payments ... will continue and will continue to be important to you and the patients you serve.”
He also echoed Tuesday’s keynote address from Karen DeSalvo, MD, former Acting Assistant Secretary for Health in the U.S. Department of Health & Human Services, that hospital medicine needs to look at health care more holistically to help work on social issues. Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends, knows the problem first-hand as he often sees children on Medicaid who have multiple chronic conditions.
“I can tell you our system still does not have a highly reliable, whole health system for those children and their families,” he said. “Every weekend, I have a family that I can’t discharge because they don’t have the social and home-based supports for them to go home. So, they literally sit in the hospital until Monday. That makes no sense for our overall health system.”
Dr. Conway said that the gravitation away from fee-for-service toward alternative payment models would ideally lead to better patient outcomes, more coordinated care, and financial savings. He urged hospitalists to continue to help design new payment and care-delivery systems.
“You know what you’re passionate about and where you want to drive better care,” he said. “If the army of people in this room and all the places you are working [at] are the driver of better quality, better safety, coordinated care for patients ... that’s what it’s all about.”
Keynote speaker Patrick Conway, MD, MSc, MHM, told hospitalists at HM17 Wednesday that, while there is a seemingly endless stream of punditry about the fate of the Affordable Care Act, health care will continue its trajectory to higher value, lower costs, and improved quality for patients.
“Health system transformation, innovation, delivery system reform, accountability, the work that you all do each and every day ... is a bipartisan ideal,” he said. The work “on value, the work on accountability, the work on bundled payments ... will continue and will continue to be important to you and the patients you serve.”
He also echoed Tuesday’s keynote address from Karen DeSalvo, MD, former Acting Assistant Secretary for Health in the U.S. Department of Health & Human Services, that hospital medicine needs to look at health care more holistically to help work on social issues. Dr. Conway, who still moonlights as a pediatric academic hospitalist on weekends, knows the problem first-hand as he often sees children on Medicaid who have multiple chronic conditions.
“I can tell you our system still does not have a highly reliable, whole health system for those children and their families,” he said. “Every weekend, I have a family that I can’t discharge because they don’t have the social and home-based supports for them to go home. So, they literally sit in the hospital until Monday. That makes no sense for our overall health system.”
Dr. Conway said that the gravitation away from fee-for-service toward alternative payment models would ideally lead to better patient outcomes, more coordinated care, and financial savings. He urged hospitalists to continue to help design new payment and care-delivery systems.
“You know what you’re passionate about and where you want to drive better care,” he said. “If the army of people in this room and all the places you are working [at] are the driver of better quality, better safety, coordinated care for patients ... that’s what it’s all about.”
