Innovations in Healthcare

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a plan of care for the patient, making one hospital visit, one home visit, and three phone calls, says Joyce Schwarz, the hospital’s vice president of quality and the project’s director.

The hospital received a $300,000 grant under the New Jersey Health Initiative from the Robert Wood Johnson Foundation to use an evidence-based intervention to improve care transitions and reduce readmissions, acting as a bridge between hospital personnel and community physicians.

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a plan of care for the patient, making one hospital visit, one home visit, and three phone calls, says Joyce Schwarz, the hospital’s vice president of quality and the project’s director.

The hospital received a $300,000 grant under the New Jersey Health Initiative from the Robert Wood Johnson Foundation to use an evidence-based intervention to improve care transitions and reduce readmissions, acting as a bridge between hospital personnel and community physicians.

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a plan of care for the patient, making one hospital visit, one home visit, and three phone calls, says Joyce Schwarz, the hospital’s vice president of quality and the project’s director.

The hospital received a $300,000 grant under the New Jersey Health Initiative from the Robert Wood Johnson Foundation to use an evidence-based intervention to improve care transitions and reduce readmissions, acting as a bridge between hospital personnel and community physicians.

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J Hosp Med. 2011;6:81-87). Strategies the team studied included controlling admissions when possible to achieve more level occupancy, with a mean of 2.6% of admissions moved to a different day of the week.

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J Hosp Med. 2011;6:81-87). Strategies the team studied included controlling admissions when possible to achieve more level occupancy, with a mean of 2.6% of admissions moved to a different day of the week.

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J Hosp Med. 2011;6:81-87). Strategies the team studied included controlling admissions when possible to achieve more level occupancy, with a mean of 2.6% of admissions moved to a different day of the week.

Academic hospitalists will find new opportunities to learn, network, and showcase their own insights at HM12, SHM’s annual meeting April 1-4 in San Diego.

This year, poster presenters will have even more time to present cutting-edge topics in hospital medicine. The popular Research, Innovation, and Clinical Vignettes (RIV) poster sessions will be split into two days.

The Research and Innovations poster reception will be held 5 to 7 p.m. April 2, while the Vignettes poster session will be held during lunch the next day. However, some things about the receptions won’t change: Sessions will be held in the exhibit hall.

The move to two poster receptions was in response to previous attendee feedback. As the numbers of attendees and poster presenters has grown, visiting all the posters and having meaningful conversations with the presenters became increasingly difficult. Now attendees—both academic and community-based hospitalist—can take their time and soak in more of the best thinking in the specialty.

If you’re thinking about submitting a poster for any of the three categories, now is the time to act: The submission deadline for abstracts is Dec. 2.

Poster sessions aren’t the only new chances for academic hospitalists to find valuable face time at HM12, either. This year’s program includes new opportunities to collaborate and connect with other academic hospitalists—and hospitalists from other backgrounds as well.

And the HM12 schedule will feature valuable courses specifically chosen for the unique needs and challenges of the academic hospitalist’s career.

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

Academic hospitalists will find new opportunities to learn, network, and showcase their own insights at HM12, SHM’s annual meeting April 1-4 in San Diego.

This year, poster presenters will have even more time to present cutting-edge topics in hospital medicine. The popular Research, Innovation, and Clinical Vignettes (RIV) poster sessions will be split into two days.

The Research and Innovations poster reception will be held 5 to 7 p.m. April 2, while the Vignettes poster session will be held during lunch the next day. However, some things about the receptions won’t change: Sessions will be held in the exhibit hall.

The move to two poster receptions was in response to previous attendee feedback. As the numbers of attendees and poster presenters has grown, visiting all the posters and having meaningful conversations with the presenters became increasingly difficult. Now attendees—both academic and community-based hospitalist—can take their time and soak in more of the best thinking in the specialty.

If you’re thinking about submitting a poster for any of the three categories, now is the time to act: The submission deadline for abstracts is Dec. 2.

Poster sessions aren’t the only new chances for academic hospitalists to find valuable face time at HM12, either. This year’s program includes new opportunities to collaborate and connect with other academic hospitalists—and hospitalists from other backgrounds as well.

And the HM12 schedule will feature valuable courses specifically chosen for the unique needs and challenges of the academic hospitalist’s career.

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

Academic hospitalists will find new opportunities to learn, network, and showcase their own insights at HM12, SHM’s annual meeting April 1-4 in San Diego.

This year, poster presenters will have even more time to present cutting-edge topics in hospital medicine. The popular Research, Innovation, and Clinical Vignettes (RIV) poster sessions will be split into two days.

The Research and Innovations poster reception will be held 5 to 7 p.m. April 2, while the Vignettes poster session will be held during lunch the next day. However, some things about the receptions won’t change: Sessions will be held in the exhibit hall.

The move to two poster receptions was in response to previous attendee feedback. As the numbers of attendees and poster presenters has grown, visiting all the posters and having meaningful conversations with the presenters became increasingly difficult. Now attendees—both academic and community-based hospitalist—can take their time and soak in more of the best thinking in the specialty.

If you’re thinking about submitting a poster for any of the three categories, now is the time to act: The submission deadline for abstracts is Dec. 2.

Poster sessions aren’t the only new chances for academic hospitalists to find valuable face time at HM12, either. This year’s program includes new opportunities to collaborate and connect with other academic hospitalists—and hospitalists from other backgrounds as well.

And the HM12 schedule will feature valuable courses specifically chosen for the unique needs and challenges of the academic hospitalist’s career.

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

Steve Jobs was right. Challenges create opportunity. What are the opportunities in hospital medicine today? Take a lesson from the iPhone: Give them what they need when they need it.

I was in a restaurant in Denver the night I saw the news on the TV. “Steve Jobs dead at the age of 56.” Was I surprised? Yes…and no. Everyone knew he was seriously ill; he acknowledged as much when he stepped down as Apple CEO. While not unexpected, his death was still surprising and an emotional jolt.

I quickly finished my meal and went back to my hotel room, where I turned on CNN. I sat back and watched Anderson Cooper talk about Jobs’ life and legacy. Apple co-founder Steve Wozniak was on the telephone with Cooper. Wozniak said when he heard the news, he felt numb, much like he did when he heard about the deaths of John Lennon or President Kennedy.

I felt the same way. I never knew Steve Jobs, but Steve Jobs knew me. He influenced my life in ways unimaginable.

A Revolutionary Persona

On the flight to Denver, I passed time watching a movie produced by Pixar, the movie studio he founded. When I landed, I used an app on my iPhone to find this restaurant, which was close to my hotel and had great reviews. I am typing this month’s column on my Macintosh laptop. How did I let someone I never knew get so close to me and have so much influence on my life?

This is Steve Jobs’ legacy. He did what others couldn’t do. He didn’t invent the personal computer, but he made one that was easy to use. He didn’t create animation, but he showed Hollywood how to create more intriguing movies faster and cheaper. (The smartest thing Disney did was to buy out Pixar before Pixar grew big enough to buy them.)

He revolutionized the music industry. Remember when Napster had the music industry on its heels? Recording labels were suing people and college kids were going to jail for downloading pirated songs. Seemed crazy to send kids off to jail for lifting a few songs, but it was happening. Then came the iPod and iTunes. Not only could I pay 99 cents for a song, I could carry my entire music library in my pocket. Duh … why didn’t I think of that? And he did it all while living with pancreatic neuroendocrine cancer!

One of the things I watched on CNN that evening was a segment from the commencement speech Jobs gave to Stanford University’s graduating class several years ago. He had just recovered from his surgery (visit http://news.stanford.edu/news/2005/june15/jobs-061505.html for the complete transcript). He described how his firing from Apple spurred creativity and resulted in innovation.

“Getting fired from Apple was the best thing that could have ever happened to me,” he said. “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.”

This made me think back to 1994, the year I graduated from medical school and about two years before Drs. Wachter and Goldman coined the term “hospitalist” in that fateful New England Journal of Medicine article.¹ In 1994, I could not have imagined the iPhone; I could not have predicted the field of hospital medicine. Don't worry if you couldn’t, either. I really think that if this is how we define innovation, we have set the bar too high. Innovation does not have to be complicated. In fact, the greatest innovations are simple. Hand your iPhone to a five-year-old and they can figure it out. Can you do that with a PC?

Challenges Ahead, Ongoing

How does this apply to hospital medicine? These are challenging times for hospitalists. American healthcare costs too much, and some people are saying hospitalists are part of the problem. Hospitalists are discharging more patients than ever from our nation’s hospitals, and more patients than ever are finding themselves readmitted within 30 days. Quality and process improvement is the mantra in healthcare today, and too many hospitalists have little understanding of what is necessary to participate in quality and process improvement.

Steve Jobs got fired from the company he created. Could hospitalists be removed from the program they started? Jobs was right. Challenges create opportunity. What are the opportunities in HM today? Take a lesson from the iPhone: Give them what they need when they need it.

For example, why do so many hospitalist programs staff in-house only during daytime hours? Patients don’t become acutely ill only during the day. Most of us will be hospitalized at some point in our lives. Will there be a hospitalist to see you when you are short of breath or having chest pain? Hospitalists need to be in house 24 hours a day, seven days a week, providing care when patients need it. I know that we don’t have enough money to pay for this and we don’t have enough hospitalists to staff 24/7, but that is the innovation part. I can assure you that while the iPhone is easy for the end-user, an incredible amount of infrastructure had to be created in order to support that easy-to-use experience for the consumer. Jobs and Apple overcame hurdles to create the iPhone. It’s our job to overcome the hurdles to provide safe, timely, and high-value care for our patients.

Steve Jobs’ legacy is Apple.

What is your legacy?

A Call for Research

Most of you are aware that Jobs died from pancreatic neuroendocrine cancer. This is a relatively rare disease, which is in dire need of additional research. Patients with rare diseases find themselves in the difficult position of trying to understand why little is being done to help them.

I, unfortunately, know something about this, as someone very close to me has this disease. Research requires funding. One way to honor Jobs’ legacy is to support pancreatic neuroendocrine cancer research. One organization I have personally supported is the Caring for Carcinoid Foundation. This foundation has contributed millions of dollars toward carcinoid and neuroendocrine tumor research.

If you want to learn more about the Caring for Carcinoid Foundation, visit www.caringforcarcinoid.org.

Dr. Li is president of SHM.

Reference

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American healthcare system. N Engl J Med. 1996;335:514-517.

Steve Jobs was right. Challenges create opportunity. What are the opportunities in hospital medicine today? Take a lesson from the iPhone: Give them what they need when they need it.

I was in a restaurant in Denver the night I saw the news on the TV. “Steve Jobs dead at the age of 56.” Was I surprised? Yes…and no. Everyone knew he was seriously ill; he acknowledged as much when he stepped down as Apple CEO. While not unexpected, his death was still surprising and an emotional jolt.

I quickly finished my meal and went back to my hotel room, where I turned on CNN. I sat back and watched Anderson Cooper talk about Jobs’ life and legacy. Apple co-founder Steve Wozniak was on the telephone with Cooper. Wozniak said when he heard the news, he felt numb, much like he did when he heard about the deaths of John Lennon or President Kennedy.

I felt the same way. I never knew Steve Jobs, but Steve Jobs knew me. He influenced my life in ways unimaginable.

A Revolutionary Persona

On the flight to Denver, I passed time watching a movie produced by Pixar, the movie studio he founded. When I landed, I used an app on my iPhone to find this restaurant, which was close to my hotel and had great reviews. I am typing this month’s column on my Macintosh laptop. How did I let someone I never knew get so close to me and have so much influence on my life?

This is Steve Jobs’ legacy. He did what others couldn’t do. He didn’t invent the personal computer, but he made one that was easy to use. He didn’t create animation, but he showed Hollywood how to create more intriguing movies faster and cheaper. (The smartest thing Disney did was to buy out Pixar before Pixar grew big enough to buy them.)

He revolutionized the music industry. Remember when Napster had the music industry on its heels? Recording labels were suing people and college kids were going to jail for downloading pirated songs. Seemed crazy to send kids off to jail for lifting a few songs, but it was happening. Then came the iPod and iTunes. Not only could I pay 99 cents for a song, I could carry my entire music library in my pocket. Duh … why didn’t I think of that? And he did it all while living with pancreatic neuroendocrine cancer!

One of the things I watched on CNN that evening was a segment from the commencement speech Jobs gave to Stanford University’s graduating class several years ago. He had just recovered from his surgery (visit http://news.stanford.edu/news/2005/june15/jobs-061505.html for the complete transcript). He described how his firing from Apple spurred creativity and resulted in innovation.

“Getting fired from Apple was the best thing that could have ever happened to me,” he said. “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.”

This made me think back to 1994, the year I graduated from medical school and about two years before Drs. Wachter and Goldman coined the term “hospitalist” in that fateful New England Journal of Medicine article.¹ In 1994, I could not have imagined the iPhone; I could not have predicted the field of hospital medicine. Don't worry if you couldn’t, either. I really think that if this is how we define innovation, we have set the bar too high. Innovation does not have to be complicated. In fact, the greatest innovations are simple. Hand your iPhone to a five-year-old and they can figure it out. Can you do that with a PC?

Challenges Ahead, Ongoing

How does this apply to hospital medicine? These are challenging times for hospitalists. American healthcare costs too much, and some people are saying hospitalists are part of the problem. Hospitalists are discharging more patients than ever from our nation’s hospitals, and more patients than ever are finding themselves readmitted within 30 days. Quality and process improvement is the mantra in healthcare today, and too many hospitalists have little understanding of what is necessary to participate in quality and process improvement.

Steve Jobs got fired from the company he created. Could hospitalists be removed from the program they started? Jobs was right. Challenges create opportunity. What are the opportunities in HM today? Take a lesson from the iPhone: Give them what they need when they need it.

For example, why do so many hospitalist programs staff in-house only during daytime hours? Patients don’t become acutely ill only during the day. Most of us will be hospitalized at some point in our lives. Will there be a hospitalist to see you when you are short of breath or having chest pain? Hospitalists need to be in house 24 hours a day, seven days a week, providing care when patients need it. I know that we don’t have enough money to pay for this and we don’t have enough hospitalists to staff 24/7, but that is the innovation part. I can assure you that while the iPhone is easy for the end-user, an incredible amount of infrastructure had to be created in order to support that easy-to-use experience for the consumer. Jobs and Apple overcame hurdles to create the iPhone. It’s our job to overcome the hurdles to provide safe, timely, and high-value care for our patients.

Steve Jobs’ legacy is Apple.

What is your legacy?

A Call for Research

Most of you are aware that Jobs died from pancreatic neuroendocrine cancer. This is a relatively rare disease, which is in dire need of additional research. Patients with rare diseases find themselves in the difficult position of trying to understand why little is being done to help them.

I, unfortunately, know something about this, as someone very close to me has this disease. Research requires funding. One way to honor Jobs’ legacy is to support pancreatic neuroendocrine cancer research. One organization I have personally supported is the Caring for Carcinoid Foundation. This foundation has contributed millions of dollars toward carcinoid and neuroendocrine tumor research.

If you want to learn more about the Caring for Carcinoid Foundation, visit www.caringforcarcinoid.org.

Dr. Li is president of SHM.

Reference

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American healthcare system. N Engl J Med. 1996;335:514-517.

Steve Jobs was right. Challenges create opportunity. What are the opportunities in hospital medicine today? Take a lesson from the iPhone: Give them what they need when they need it.

I was in a restaurant in Denver the night I saw the news on the TV. “Steve Jobs dead at the age of 56.” Was I surprised? Yes…and no. Everyone knew he was seriously ill; he acknowledged as much when he stepped down as Apple CEO. While not unexpected, his death was still surprising and an emotional jolt.

I quickly finished my meal and went back to my hotel room, where I turned on CNN. I sat back and watched Anderson Cooper talk about Jobs’ life and legacy. Apple co-founder Steve Wozniak was on the telephone with Cooper. Wozniak said when he heard the news, he felt numb, much like he did when he heard about the deaths of John Lennon or President Kennedy.

I felt the same way. I never knew Steve Jobs, but Steve Jobs knew me. He influenced my life in ways unimaginable.

A Revolutionary Persona

On the flight to Denver, I passed time watching a movie produced by Pixar, the movie studio he founded. When I landed, I used an app on my iPhone to find this restaurant, which was close to my hotel and had great reviews. I am typing this month’s column on my Macintosh laptop. How did I let someone I never knew get so close to me and have so much influence on my life?

This is Steve Jobs’ legacy. He did what others couldn’t do. He didn’t invent the personal computer, but he made one that was easy to use. He didn’t create animation, but he showed Hollywood how to create more intriguing movies faster and cheaper. (The smartest thing Disney did was to buy out Pixar before Pixar grew big enough to buy them.)

He revolutionized the music industry. Remember when Napster had the music industry on its heels? Recording labels were suing people and college kids were going to jail for downloading pirated songs. Seemed crazy to send kids off to jail for lifting a few songs, but it was happening. Then came the iPod and iTunes. Not only could I pay 99 cents for a song, I could carry my entire music library in my pocket. Duh … why didn’t I think of that? And he did it all while living with pancreatic neuroendocrine cancer!

One of the things I watched on CNN that evening was a segment from the commencement speech Jobs gave to Stanford University’s graduating class several years ago. He had just recovered from his surgery (visit http://news.stanford.edu/news/2005/june15/jobs-061505.html for the complete transcript). He described how his firing from Apple spurred creativity and resulted in innovation.

“Getting fired from Apple was the best thing that could have ever happened to me,” he said. “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.”

This made me think back to 1994, the year I graduated from medical school and about two years before Drs. Wachter and Goldman coined the term “hospitalist” in that fateful New England Journal of Medicine article.¹ In 1994, I could not have imagined the iPhone; I could not have predicted the field of hospital medicine. Don't worry if you couldn’t, either. I really think that if this is how we define innovation, we have set the bar too high. Innovation does not have to be complicated. In fact, the greatest innovations are simple. Hand your iPhone to a five-year-old and they can figure it out. Can you do that with a PC?

Challenges Ahead, Ongoing

How does this apply to hospital medicine? These are challenging times for hospitalists. American healthcare costs too much, and some people are saying hospitalists are part of the problem. Hospitalists are discharging more patients than ever from our nation’s hospitals, and more patients than ever are finding themselves readmitted within 30 days. Quality and process improvement is the mantra in healthcare today, and too many hospitalists have little understanding of what is necessary to participate in quality and process improvement.

Steve Jobs got fired from the company he created. Could hospitalists be removed from the program they started? Jobs was right. Challenges create opportunity. What are the opportunities in HM today? Take a lesson from the iPhone: Give them what they need when they need it.

For example, why do so many hospitalist programs staff in-house only during daytime hours? Patients don’t become acutely ill only during the day. Most of us will be hospitalized at some point in our lives. Will there be a hospitalist to see you when you are short of breath or having chest pain? Hospitalists need to be in house 24 hours a day, seven days a week, providing care when patients need it. I know that we don’t have enough money to pay for this and we don’t have enough hospitalists to staff 24/7, but that is the innovation part. I can assure you that while the iPhone is easy for the end-user, an incredible amount of infrastructure had to be created in order to support that easy-to-use experience for the consumer. Jobs and Apple overcame hurdles to create the iPhone. It’s our job to overcome the hurdles to provide safe, timely, and high-value care for our patients.

Steve Jobs’ legacy is Apple.

What is your legacy?

A Call for Research

Most of you are aware that Jobs died from pancreatic neuroendocrine cancer. This is a relatively rare disease, which is in dire need of additional research. Patients with rare diseases find themselves in the difficult position of trying to understand why little is being done to help them.

I, unfortunately, know something about this, as someone very close to me has this disease. Research requires funding. One way to honor Jobs’ legacy is to support pancreatic neuroendocrine cancer research. One organization I have personally supported is the Caring for Carcinoid Foundation. This foundation has contributed millions of dollars toward carcinoid and neuroendocrine tumor research.

If you want to learn more about the Caring for Carcinoid Foundation, visit www.caringforcarcinoid.org.

Dr. Li is president of SHM.

Reference

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American healthcare system. N Engl J Med. 1996;335:514-517.

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

A pilot project that transferred “boarded” patients from one hospital’s ED to an inpatient bed at another nearby hospital in the same health system suggests that the concept could save hospitals millions.

“Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach” was the subject of an oral presentation at HM11 in Dallas. Lead researcher Diego Martinez-Vasquez, MD, MPH, FACP, CPE, medical director for clinical resource utilization at Franklin Square Hospital Center in Baltimore, conducted the research in the University of Maryland medical system.

In the project, 265 patients who consented were transferred 1.3 miles to a sister hospital. Without “boarders”—admitted patients held in the ED—Dr. Martinez-Vasquez’s team found that the referring hospital could have regained enough capacity for an additional 2.9 patients per day. The project also showed median net revenue of $520,000 for the referring hospital and $1.9 million for the accepting hospital.

“The hospitalist group at the receiving hospital was the instrument that facilitated this program,” Dr. Martinez-Vasquez says. “But really what kept my attention was that healthcare systems sometimes don’t use resources effectively. So when I looked at the problem that this particular hospital was having regarding increased boarding time and decreased treatment capacity, I said, ‘Well, one way to resolve this issue is to develop a process that connects two system hospitals and their bed resources.’ ”

A pilot project that transferred “boarded” patients from one hospital’s ED to an inpatient bed at another nearby hospital in the same health system suggests that the concept could save hospitals millions.

“Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach” was the subject of an oral presentation at HM11 in Dallas. Lead researcher Diego Martinez-Vasquez, MD, MPH, FACP, CPE, medical director for clinical resource utilization at Franklin Square Hospital Center in Baltimore, conducted the research in the University of Maryland medical system.

In the project, 265 patients who consented were transferred 1.3 miles to a sister hospital. Without “boarders”—admitted patients held in the ED—Dr. Martinez-Vasquez’s team found that the referring hospital could have regained enough capacity for an additional 2.9 patients per day. The project also showed median net revenue of $520,000 for the referring hospital and $1.9 million for the accepting hospital.

“The hospitalist group at the receiving hospital was the instrument that facilitated this program,” Dr. Martinez-Vasquez says. “But really what kept my attention was that healthcare systems sometimes don’t use resources effectively. So when I looked at the problem that this particular hospital was having regarding increased boarding time and decreased treatment capacity, I said, ‘Well, one way to resolve this issue is to develop a process that connects two system hospitals and their bed resources.’ ”

A pilot project that transferred “boarded” patients from one hospital’s ED to an inpatient bed at another nearby hospital in the same health system suggests that the concept could save hospitals millions.

“Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach” was the subject of an oral presentation at HM11 in Dallas. Lead researcher Diego Martinez-Vasquez, MD, MPH, FACP, CPE, medical director for clinical resource utilization at Franklin Square Hospital Center in Baltimore, conducted the research in the University of Maryland medical system.

In the project, 265 patients who consented were transferred 1.3 miles to a sister hospital. Without “boarders”—admitted patients held in the ED—Dr. Martinez-Vasquez’s team found that the referring hospital could have regained enough capacity for an additional 2.9 patients per day. The project also showed median net revenue of $520,000 for the referring hospital and $1.9 million for the accepting hospital.

“The hospitalist group at the receiving hospital was the instrument that facilitated this program,” Dr. Martinez-Vasquez says. “But really what kept my attention was that healthcare systems sometimes don’t use resources effectively. So when I looked at the problem that this particular hospital was having regarding increased boarding time and decreased treatment capacity, I said, ‘Well, one way to resolve this issue is to develop a process that connects two system hospitals and their bed resources.’ ”

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

Click here to listen to ENA President AnnMarie Papa.

Click here to listen to Dr. Simone.

Click here to listen to ENA President AnnMarie Papa.

Click here to listen to Dr. Simone.

Click here to listen to ENA President AnnMarie Papa.

Click here to listen to Dr. Simone.

An abstract presented at HM11, “Purposeful Visits for Hospitalized Elderly Patients,” describes a service at the University of Colorado Hospital (UCH) in Denver that has shown improvements in participating patients’ mood, agitation, and orientation.

The purposeful-visit program was started, says senior author Ethan Cumbler, MD, a hospitalist at UCH and director of its Acute Care for the Elderly Service, because hospitals often are a profoundly unfriendly environment, especially for vulnerable, chronically ill patients. “It’s a social and intellectual desert where patients don’t get the stimulation they would receive at home,” he adds.

The program was established to leverage professional resources by training a core cadre of four to six volunteers in communication techniques (e.g. open-ended questioning), says the hospital’s recreational therapist, William Mramor, CTRS, MS. Charge nurses help identify patients and topics to explore, and the volunteers use a prepared script to help guide interactions, Mramor says.

“The purposeful visit directly addresses issues of patients’ feelings and promotes a patient-centered hospital experience,” he says.

Based on assessments using a five-point scale, with scores ranging from “worsening” (1 or 2) to “improving” (4 or 5), patient mood was rated 3.94 by the volunteers and 3.65 by the nurses. Slightly lower scores were recorded for patient agitation and patient orientation but in every case showed improvement.

“What distinguishes these purposeful visits is their goal of enhancing patients’ memory, decreasing their loneliness, and helping them understand the value of reconnecting to things they enjoy,” says Dr. Cumbler. —LB

Technology

New E-Pillbox Actively Monitors Med-Recon, Fights Readmissions

Electronic pillboxes are nothing new, but some hospitalists might not have seen the latest one.

Earlier this year, the FDA approved PillStation, a traditional pillbox married to a software system that uploads data to the system’s maker, SentiCare Inc., which then monitors how well a patient is following their medication regimen. The four-year-old medical firm is pitching the product to hospitals and accountable-care organizations (ACOs), among other potential clients.

And in a sales pitch practically tailored to HM, SentiCare bills itself as a medication adherence system that can help fight readmissions, particularly in cases of chronic disease or congestive heart failure. The device actually takes photographs of the pills to be taken and can record whether a patient has removed them from the device.

“Hospitals need to dramatically reduce their readmissions rates,” Yogendra Jain, chief technology officer and cofounder of SentiCare, wrote in an email to The Hospitalist. “One critical factor is medication and hospital discharge instruction adherence. Through its embedded camera, PillStation can confirm that from day one of departing the hospital... medications are loaded correctly and that the patient is taking it on time.”—RQ

Quality

Home Healthcare Has Fewer Rehospitalizations

A recent study by Avalere Health, a healthcare advisory firm based in Washington, D.C., found that providing home healthcare after hospital discharge for patients with three common conditions resulted in fewer hospital readmissions than for similar patients receiving other post-acute services. Those comparable services included long-term acute-care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospices.

“We tried to control for hospital DRG, severity of illness, and comorbidities,” says Emil Parker, Avalere’s director of post-acute and long-term-care practice, although he acknowledges the complexities of risk adjustment.

In comparing Medicare spending and rehospitalization rates after initial hospital visits for patients with diabetes, COPD, and congestive heart failure from 2006 to 2009, the study estimated that referrals to home healthcare resulted in $670 million in Medicare savings from 20,426 fewer readmissions.

“Hospitalists should think about the continuum of institutional support for patients discharged from the hospital with significant support needs,” Parker says. “Our study shows that in this population, provision of home healthcare is cost-effective and benefits patients by improving the continuity of their care.” —LB

Patient Safety

L.A. Hospitals Add HM for Medicaid Patients

In June, Anthem Blue Cross of Woodland Hills, Calif., began offering covered hospitalist services to its adult managed-care members covered by Medi-Cal, the Medicaid program for California residents, at 24 hospitals in Los Angeles County. The service is designed to take advantage of the existing hospitalist presence in those hospitals, which is provided by ApolloMed, a Glendale, Calif.-based medical management services company.

The hospitalist service is designed to enhance quality of care during hospitalization, reduce costs, and plan for more timely discharges and transitions to outpatient care. ApolloMed plans to add more hospitals in the region to the program, as well as additional post-discharge outpatient clinics. —LB

Technology

By the Numbers: 5.9

The percentage of total national health expenditures spent on medical devices in 2009, according to a report released in June by the Advanced Medical Technology Association.

The report highlights that while technology is washing over medicine, and HM in particular, with the adoption of electronic health records, portable ultrasounds, and tablet computing, the $147 billion spent on medical devices in 2009 represented just 5.9% of the $2.5 trillion in national health spending.

The trade group also reported that the average annual rate for medical device spending increased 7.5% in the 20-year period that ended in 2009. That outpaced the average annual rate for overall national heath expenditures, which ticked up 7% over the same time period. —RQ

An abstract presented at HM11, “Purposeful Visits for Hospitalized Elderly Patients,” describes a service at the University of Colorado Hospital (UCH) in Denver that has shown improvements in participating patients’ mood, agitation, and orientation.

The purposeful-visit program was started, says senior author Ethan Cumbler, MD, a hospitalist at UCH and director of its Acute Care for the Elderly Service, because hospitals often are a profoundly unfriendly environment, especially for vulnerable, chronically ill patients. “It’s a social and intellectual desert where patients don’t get the stimulation they would receive at home,” he adds.

The program was established to leverage professional resources by training a core cadre of four to six volunteers in communication techniques (e.g. open-ended questioning), says the hospital’s recreational therapist, William Mramor, CTRS, MS. Charge nurses help identify patients and topics to explore, and the volunteers use a prepared script to help guide interactions, Mramor says.

“The purposeful visit directly addresses issues of patients’ feelings and promotes a patient-centered hospital experience,” he says.

Based on assessments using a five-point scale, with scores ranging from “worsening” (1 or 2) to “improving” (4 or 5), patient mood was rated 3.94 by the volunteers and 3.65 by the nurses. Slightly lower scores were recorded for patient agitation and patient orientation but in every case showed improvement.

“What distinguishes these purposeful visits is their goal of enhancing patients’ memory, decreasing their loneliness, and helping them understand the value of reconnecting to things they enjoy,” says Dr. Cumbler. —LB

Technology

New E-Pillbox Actively Monitors Med-Recon, Fights Readmissions

Electronic pillboxes are nothing new, but some hospitalists might not have seen the latest one.

Earlier this year, the FDA approved PillStation, a traditional pillbox married to a software system that uploads data to the system’s maker, SentiCare Inc., which then monitors how well a patient is following their medication regimen. The four-year-old medical firm is pitching the product to hospitals and accountable-care organizations (ACOs), among other potential clients.

And in a sales pitch practically tailored to HM, SentiCare bills itself as a medication adherence system that can help fight readmissions, particularly in cases of chronic disease or congestive heart failure. The device actually takes photographs of the pills to be taken and can record whether a patient has removed them from the device.

“Hospitals need to dramatically reduce their readmissions rates,” Yogendra Jain, chief technology officer and cofounder of SentiCare, wrote in an email to The Hospitalist. “One critical factor is medication and hospital discharge instruction adherence. Through its embedded camera, PillStation can confirm that from day one of departing the hospital... medications are loaded correctly and that the patient is taking it on time.”—RQ

Quality

Home Healthcare Has Fewer Rehospitalizations

A recent study by Avalere Health, a healthcare advisory firm based in Washington, D.C., found that providing home healthcare after hospital discharge for patients with three common conditions resulted in fewer hospital readmissions than for similar patients receiving other post-acute services. Those comparable services included long-term acute-care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospices.

“We tried to control for hospital DRG, severity of illness, and comorbidities,” says Emil Parker, Avalere’s director of post-acute and long-term-care practice, although he acknowledges the complexities of risk adjustment.

In comparing Medicare spending and rehospitalization rates after initial hospital visits for patients with diabetes, COPD, and congestive heart failure from 2006 to 2009, the study estimated that referrals to home healthcare resulted in $670 million in Medicare savings from 20,426 fewer readmissions.

“Hospitalists should think about the continuum of institutional support for patients discharged from the hospital with significant support needs,” Parker says. “Our study shows that in this population, provision of home healthcare is cost-effective and benefits patients by improving the continuity of their care.” —LB

Patient Safety

L.A. Hospitals Add HM for Medicaid Patients

In June, Anthem Blue Cross of Woodland Hills, Calif., began offering covered hospitalist services to its adult managed-care members covered by Medi-Cal, the Medicaid program for California residents, at 24 hospitals in Los Angeles County. The service is designed to take advantage of the existing hospitalist presence in those hospitals, which is provided by ApolloMed, a Glendale, Calif.-based medical management services company.

The hospitalist service is designed to enhance quality of care during hospitalization, reduce costs, and plan for more timely discharges and transitions to outpatient care. ApolloMed plans to add more hospitals in the region to the program, as well as additional post-discharge outpatient clinics. —LB

Technology

By the Numbers: 5.9

The percentage of total national health expenditures spent on medical devices in 2009, according to a report released in June by the Advanced Medical Technology Association.

The report highlights that while technology is washing over medicine, and HM in particular, with the adoption of electronic health records, portable ultrasounds, and tablet computing, the $147 billion spent on medical devices in 2009 represented just 5.9% of the $2.5 trillion in national health spending.

The trade group also reported that the average annual rate for medical device spending increased 7.5% in the 20-year period that ended in 2009. That outpaced the average annual rate for overall national heath expenditures, which ticked up 7% over the same time period. —RQ

An abstract presented at HM11, “Purposeful Visits for Hospitalized Elderly Patients,” describes a service at the University of Colorado Hospital (UCH) in Denver that has shown improvements in participating patients’ mood, agitation, and orientation.

The purposeful-visit program was started, says senior author Ethan Cumbler, MD, a hospitalist at UCH and director of its Acute Care for the Elderly Service, because hospitals often are a profoundly unfriendly environment, especially for vulnerable, chronically ill patients. “It’s a social and intellectual desert where patients don’t get the stimulation they would receive at home,” he adds.

The program was established to leverage professional resources by training a core cadre of four to six volunteers in communication techniques (e.g. open-ended questioning), says the hospital’s recreational therapist, William Mramor, CTRS, MS. Charge nurses help identify patients and topics to explore, and the volunteers use a prepared script to help guide interactions, Mramor says.

“The purposeful visit directly addresses issues of patients’ feelings and promotes a patient-centered hospital experience,” he says.

Based on assessments using a five-point scale, with scores ranging from “worsening” (1 or 2) to “improving” (4 or 5), patient mood was rated 3.94 by the volunteers and 3.65 by the nurses. Slightly lower scores were recorded for patient agitation and patient orientation but in every case showed improvement.

“What distinguishes these purposeful visits is their goal of enhancing patients’ memory, decreasing their loneliness, and helping them understand the value of reconnecting to things they enjoy,” says Dr. Cumbler. —LB

Technology

New E-Pillbox Actively Monitors Med-Recon, Fights Readmissions

Electronic pillboxes are nothing new, but some hospitalists might not have seen the latest one.

Earlier this year, the FDA approved PillStation, a traditional pillbox married to a software system that uploads data to the system’s maker, SentiCare Inc., which then monitors how well a patient is following their medication regimen. The four-year-old medical firm is pitching the product to hospitals and accountable-care organizations (ACOs), among other potential clients.

And in a sales pitch practically tailored to HM, SentiCare bills itself as a medication adherence system that can help fight readmissions, particularly in cases of chronic disease or congestive heart failure. The device actually takes photographs of the pills to be taken and can record whether a patient has removed them from the device.

“Hospitals need to dramatically reduce their readmissions rates,” Yogendra Jain, chief technology officer and cofounder of SentiCare, wrote in an email to The Hospitalist. “One critical factor is medication and hospital discharge instruction adherence. Through its embedded camera, PillStation can confirm that from day one of departing the hospital... medications are loaded correctly and that the patient is taking it on time.”—RQ

Quality

Home Healthcare Has Fewer Rehospitalizations

A recent study by Avalere Health, a healthcare advisory firm based in Washington, D.C., found that providing home healthcare after hospital discharge for patients with three common conditions resulted in fewer hospital readmissions than for similar patients receiving other post-acute services. Those comparable services included long-term acute-care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospices.

“We tried to control for hospital DRG, severity of illness, and comorbidities,” says Emil Parker, Avalere’s director of post-acute and long-term-care practice, although he acknowledges the complexities of risk adjustment.

In comparing Medicare spending and rehospitalization rates after initial hospital visits for patients with diabetes, COPD, and congestive heart failure from 2006 to 2009, the study estimated that referrals to home healthcare resulted in $670 million in Medicare savings from 20,426 fewer readmissions.

“Hospitalists should think about the continuum of institutional support for patients discharged from the hospital with significant support needs,” Parker says. “Our study shows that in this population, provision of home healthcare is cost-effective and benefits patients by improving the continuity of their care.” —LB

Patient Safety

L.A. Hospitals Add HM for Medicaid Patients

In June, Anthem Blue Cross of Woodland Hills, Calif., began offering covered hospitalist services to its adult managed-care members covered by Medi-Cal, the Medicaid program for California residents, at 24 hospitals in Los Angeles County. The service is designed to take advantage of the existing hospitalist presence in those hospitals, which is provided by ApolloMed, a Glendale, Calif.-based medical management services company.

The hospitalist service is designed to enhance quality of care during hospitalization, reduce costs, and plan for more timely discharges and transitions to outpatient care. ApolloMed plans to add more hospitals in the region to the program, as well as additional post-discharge outpatient clinics. —LB

Technology

By the Numbers: 5.9

The percentage of total national health expenditures spent on medical devices in 2009, according to a report released in June by the Advanced Medical Technology Association.

The report highlights that while technology is washing over medicine, and HM in particular, with the adoption of electronic health records, portable ultrasounds, and tablet computing, the $147 billion spent on medical devices in 2009 represented just 5.9% of the $2.5 trillion in national health spending.

The trade group also reported that the average annual rate for medical device spending increased 7.5% in the 20-year period that ended in 2009. That outpaced the average annual rate for overall national heath expenditures, which ticked up 7% over the same time period. —RQ

In his June 3 blog post at CIO.com, Tom Kaneshige asks: “Can the iPad cure what ails us?” He goes on to describe new applications for iPads in Texas hospitals, including the remote monitoring of patients’ EKGs by nurses roaming the hospital.

“The big revolution in tablet computing for hospitalists, which has been right around the corner for the past decade, hasn’t quite arrived yet,” says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California San Francisco Medical Center. “But I think we’re getting close, even though I’m not convinced that the iPad will be the vehicle.”

One of the hallmarks of such a technological revolution will be to free up hospitalists and other workers from computer work stations, where they are increasingly removed from face-to-face interactions. “Something gets lost in the name of efficiency,” Dr. Cucina says.

Hurdles to the tablet revolution include:

• Short battery life and the lack of rechargeable batteries. “Doctors need to be on the floor longer than eight hours,” Dr. Cucina says.
• Interacting with a tablet using thumbs and a touchscreen is fundamentally different from using a laptop, and applications should recognize the differences.
• Wireless access to secure electronic health records (EHR) throughout the hospital. “This is more of a cost issue than a technical problem,” Dr. Cucina explains. “It’s also incumbent upon us as physicians to develop good security practices with our tablets.”
• The skills to use the screen in the presence of others—in other words, What is the proper etiquette in front of care team members, patients, their families, etc.?

Hospitalists Look to Partner with New Quality Institute

Don’t be surprised if HM eventually gets a piece of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore.

The center, funded through a $10 million gift from Johns Hopkins Medicine board of trustees chairman C. Michael Armstrong, will become the umbrella arm in charge of reducing preventable harm and improving healthcare quality.

Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center’s HM division, already sees that as hospitalist turf and could easily see HM partnering with the new institute. Dr. Howell, who already has reached out to the institute’s head, checklist guru Peter Pronovost, MD, PhD, wrote in an email to The Hospitalist: “Hospitalists at Hopkins have a long tradition of exactly this type of work.”

Dr. Howell points to recent HM-driven research and initiatives to reduce “red alerts,” the term for ambulance diversions in the ICU, and streamlining the admission process to allow outpatient doctors to bypass the ED for patients for whom hospitalist admission is needed. At Howard County General Hospital, a suburb about 15 miles southwest of Baltimore, the HM group is running all rapid response team (RRT) events.

“In short,” Dr. Howell writes, “the Armstrong Institute will find hospitalists to be a willing partner.”

Hospitalists Must Prepare for Primary-Care Shortfalls

The Milwaukee-based American Society for Quality (ASQ) recently surveyed healthcare quality professionals about anticipated shortages of primary-care physicians (PCPs) and other medical staff, particularly as more Americans gain health insurance under the Accountable Care Act and Medicare). The trend is real, says Joseph Fortuna, MD, chair of ASQ’s Health Care Division, and hospitalists will face challenges in discharging patients who lack a defined PCP.

Survey respondents highlighted some strategies for dealing with the primary-care shortage, including the EHR for improving efficiency, teamwork, and checklists. Dr. Fortuna suggests HM groups:

• Work with PCPs and federally qualified health centers to enhance integrated relationships and improve handoffs. Local public health departments will be important collaborators.
• Define quality not just clinically, but also in terms of financial, operational, and cultural domains, using techniques of change management, root cause analysis, and other quality tools.
• Be involved in patient-centered medical homes as “catalysts, coordinators, and facilitators.”

HM Group Redesigns Workflow to Comply with ACGME Rules and Improve Continuity

As academic HM groups react to the new Accreditation Council for Graduation Medical Education (ACGME) guidelines on how long residents can work, they might want to keep the Toyota Production System (TPS) in mind.

Diana Mancini, MD, a hospitalist at Denver Health Medical Center and associate program director of the University of Colorado Internal Medicine Residency, presented data in the Research, Innovations, and Clinical Vignettes competition at HM11 that showed how the use of continuous workflow and standardized tasks—hallmarks of TPS—helped redesign the medicine ward system to both comply with the ACGME rules and improve continuity of care.

The project replaced the traditional call system, and its corresponding floats and moonlighters, with a shift system comprised of two teams of six interns and three residents. At night, one intern worked a “continuity shift.” Using administrative data, Dr. Mancini and colleagues projected that 89% of patients admitted on a continuity shift would be discharged by the end of that intern’s five consecutive shifts. And, by dividing admissions among two teams, the “bolus” effect was halved, she says.

“The continuity shift is crucial for both the patient safety/continuity and educational content/value for the housestaff,” Dr. Mancini wrote in an email. “With the new work hours coming ... the hours would have to be adjusted … but the continuity could most certainly be maintained.”

Feds Delay Deadline for Stage 2 “Meaningful Use” Application Process

If your HM group is among the first cohort that reaches Stage 1 attestation this year for meaningful use of electronic health records (EHR), you may get more time to reach Stage 2. The federal Health Information Technology (HIT) policy committee has voted for a 12-month delay in implementing the criteria for that second stage, agreeing with those who say the current deadline of October 2013 “poses a nearly insurmountable timing challenge.”

The HIT is pushing to delay the deadline until 2014, which would mean providers have three years to verify that they have met Stage 1 meaningful use requirements, according to Government HealthIT. A cadre of medical trade groups, led by the AMA, is now pushing the Department of Health and Human Services to adopt the new timeline.

The ultimate decision rests with the Centers for Medicaid & Medicare Services (CMS).

By the numbers

Number of months without a central-line-associated bloodstream infection (BSI) on the eight-bed ICU at Beaufort Memorial Hospital, a 197-bed community hospital in Beaufort, S.C.

The hospital, which had a higher rate of BSIs than the national average in 2005, created a team to reduce its BSIs, led by infection-prevention specialist Beverly Yoder, RN, and involving hospitalists. Beaufort joined the Institute for Healthcare Improvement’s 100K Lives Campaign and the South Carolina Hospital Association’s Stop BSI Project.

The team implemented a central-line “bundle” of quality practices, then simplified the bundle and incorporated it into its EHR. The unit celebrated its 30-month achievement with a luncheon in June.

For information, contact critical-care director Diane Razo, RN, MSN, PCCN, at [email protected]. (For more information about central-line infection prevention, visit SHM's Resource Room (www.hospitalmedicine.org/resource)

In his June 3 blog post at CIO.com, Tom Kaneshige asks: “Can the iPad cure what ails us?” He goes on to describe new applications for iPads in Texas hospitals, including the remote monitoring of patients’ EKGs by nurses roaming the hospital.

“The big revolution in tablet computing for hospitalists, which has been right around the corner for the past decade, hasn’t quite arrived yet,” says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California San Francisco Medical Center. “But I think we’re getting close, even though I’m not convinced that the iPad will be the vehicle.”

One of the hallmarks of such a technological revolution will be to free up hospitalists and other workers from computer work stations, where they are increasingly removed from face-to-face interactions. “Something gets lost in the name of efficiency,” Dr. Cucina says.

Hurdles to the tablet revolution include:

• Short battery life and the lack of rechargeable batteries. “Doctors need to be on the floor longer than eight hours,” Dr. Cucina says.
• Interacting with a tablet using thumbs and a touchscreen is fundamentally different from using a laptop, and applications should recognize the differences.
• Wireless access to secure electronic health records (EHR) throughout the hospital. “This is more of a cost issue than a technical problem,” Dr. Cucina explains. “It’s also incumbent upon us as physicians to develop good security practices with our tablets.”
• The skills to use the screen in the presence of others—in other words, What is the proper etiquette in front of care team members, patients, their families, etc.?

Hospitalists Look to Partner with New Quality Institute

Don’t be surprised if HM eventually gets a piece of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore.

The center, funded through a $10 million gift from Johns Hopkins Medicine board of trustees chairman C. Michael Armstrong, will become the umbrella arm in charge of reducing preventable harm and improving healthcare quality.

Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center’s HM division, already sees that as hospitalist turf and could easily see HM partnering with the new institute. Dr. Howell, who already has reached out to the institute’s head, checklist guru Peter Pronovost, MD, PhD, wrote in an email to The Hospitalist: “Hospitalists at Hopkins have a long tradition of exactly this type of work.”

Dr. Howell points to recent HM-driven research and initiatives to reduce “red alerts,” the term for ambulance diversions in the ICU, and streamlining the admission process to allow outpatient doctors to bypass the ED for patients for whom hospitalist admission is needed. At Howard County General Hospital, a suburb about 15 miles southwest of Baltimore, the HM group is running all rapid response team (RRT) events.

“In short,” Dr. Howell writes, “the Armstrong Institute will find hospitalists to be a willing partner.”

Hospitalists Must Prepare for Primary-Care Shortfalls

The Milwaukee-based American Society for Quality (ASQ) recently surveyed healthcare quality professionals about anticipated shortages of primary-care physicians (PCPs) and other medical staff, particularly as more Americans gain health insurance under the Accountable Care Act and Medicare). The trend is real, says Joseph Fortuna, MD, chair of ASQ’s Health Care Division, and hospitalists will face challenges in discharging patients who lack a defined PCP.

Survey respondents highlighted some strategies for dealing with the primary-care shortage, including the EHR for improving efficiency, teamwork, and checklists. Dr. Fortuna suggests HM groups:

• Work with PCPs and federally qualified health centers to enhance integrated relationships and improve handoffs. Local public health departments will be important collaborators.
• Define quality not just clinically, but also in terms of financial, operational, and cultural domains, using techniques of change management, root cause analysis, and other quality tools.
• Be involved in patient-centered medical homes as “catalysts, coordinators, and facilitators.”

HM Group Redesigns Workflow to Comply with ACGME Rules and Improve Continuity

As academic HM groups react to the new Accreditation Council for Graduation Medical Education (ACGME) guidelines on how long residents can work, they might want to keep the Toyota Production System (TPS) in mind.

Diana Mancini, MD, a hospitalist at Denver Health Medical Center and associate program director of the University of Colorado Internal Medicine Residency, presented data in the Research, Innovations, and Clinical Vignettes competition at HM11 that showed how the use of continuous workflow and standardized tasks—hallmarks of TPS—helped redesign the medicine ward system to both comply with the ACGME rules and improve continuity of care.

The project replaced the traditional call system, and its corresponding floats and moonlighters, with a shift system comprised of two teams of six interns and three residents. At night, one intern worked a “continuity shift.” Using administrative data, Dr. Mancini and colleagues projected that 89% of patients admitted on a continuity shift would be discharged by the end of that intern’s five consecutive shifts. And, by dividing admissions among two teams, the “bolus” effect was halved, she says.

“The continuity shift is crucial for both the patient safety/continuity and educational content/value for the housestaff,” Dr. Mancini wrote in an email. “With the new work hours coming ... the hours would have to be adjusted … but the continuity could most certainly be maintained.”

Feds Delay Deadline for Stage 2 “Meaningful Use” Application Process

If your HM group is among the first cohort that reaches Stage 1 attestation this year for meaningful use of electronic health records (EHR), you may get more time to reach Stage 2. The federal Health Information Technology (HIT) policy committee has voted for a 12-month delay in implementing the criteria for that second stage, agreeing with those who say the current deadline of October 2013 “poses a nearly insurmountable timing challenge.”

The HIT is pushing to delay the deadline until 2014, which would mean providers have three years to verify that they have met Stage 1 meaningful use requirements, according to Government HealthIT. A cadre of medical trade groups, led by the AMA, is now pushing the Department of Health and Human Services to adopt the new timeline.

The ultimate decision rests with the Centers for Medicaid & Medicare Services (CMS).

By the numbers

Number of months without a central-line-associated bloodstream infection (BSI) on the eight-bed ICU at Beaufort Memorial Hospital, a 197-bed community hospital in Beaufort, S.C.

The hospital, which had a higher rate of BSIs than the national average in 2005, created a team to reduce its BSIs, led by infection-prevention specialist Beverly Yoder, RN, and involving hospitalists. Beaufort joined the Institute for Healthcare Improvement’s 100K Lives Campaign and the South Carolina Hospital Association’s Stop BSI Project.

The team implemented a central-line “bundle” of quality practices, then simplified the bundle and incorporated it into its EHR. The unit celebrated its 30-month achievement with a luncheon in June.

For information, contact critical-care director Diane Razo, RN, MSN, PCCN, at [email protected]. (For more information about central-line infection prevention, visit SHM's Resource Room (www.hospitalmedicine.org/resource)

In his June 3 blog post at CIO.com, Tom Kaneshige asks: “Can the iPad cure what ails us?” He goes on to describe new applications for iPads in Texas hospitals, including the remote monitoring of patients’ EKGs by nurses roaming the hospital.

“The big revolution in tablet computing for hospitalists, which has been right around the corner for the past decade, hasn’t quite arrived yet,” says Russ Cucina, MD, MS, hospitalist and medical director of information technology at the University of California San Francisco Medical Center. “But I think we’re getting close, even though I’m not convinced that the iPad will be the vehicle.”

One of the hallmarks of such a technological revolution will be to free up hospitalists and other workers from computer work stations, where they are increasingly removed from face-to-face interactions. “Something gets lost in the name of efficiency,” Dr. Cucina says.

Hurdles to the tablet revolution include:

• Short battery life and the lack of rechargeable batteries. “Doctors need to be on the floor longer than eight hours,” Dr. Cucina says.
• Interacting with a tablet using thumbs and a touchscreen is fundamentally different from using a laptop, and applications should recognize the differences.
• Wireless access to secure electronic health records (EHR) throughout the hospital. “This is more of a cost issue than a technical problem,” Dr. Cucina explains. “It’s also incumbent upon us as physicians to develop good security practices with our tablets.”
• The skills to use the screen in the presence of others—in other words, What is the proper etiquette in front of care team members, patients, their families, etc.?

Hospitalists Look to Partner with New Quality Institute

Don’t be surprised if HM eventually gets a piece of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine in Baltimore.

The center, funded through a $10 million gift from Johns Hopkins Medicine board of trustees chairman C. Michael Armstrong, will become the umbrella arm in charge of reducing preventable harm and improving healthcare quality.

Eric Howell, MD, SFHM, associate professor of medicine at Johns Hopkins University and director of Johns Hopkins Bayview Medical Center’s HM division, already sees that as hospitalist turf and could easily see HM partnering with the new institute. Dr. Howell, who already has reached out to the institute’s head, checklist guru Peter Pronovost, MD, PhD, wrote in an email to The Hospitalist: “Hospitalists at Hopkins have a long tradition of exactly this type of work.”

Dr. Howell points to recent HM-driven research and initiatives to reduce “red alerts,” the term for ambulance diversions in the ICU, and streamlining the admission process to allow outpatient doctors to bypass the ED for patients for whom hospitalist admission is needed. At Howard County General Hospital, a suburb about 15 miles southwest of Baltimore, the HM group is running all rapid response team (RRT) events.

“In short,” Dr. Howell writes, “the Armstrong Institute will find hospitalists to be a willing partner.”

Hospitalists Must Prepare for Primary-Care Shortfalls

The Milwaukee-based American Society for Quality (ASQ) recently surveyed healthcare quality professionals about anticipated shortages of primary-care physicians (PCPs) and other medical staff, particularly as more Americans gain health insurance under the Accountable Care Act and Medicare). The trend is real, says Joseph Fortuna, MD, chair of ASQ’s Health Care Division, and hospitalists will face challenges in discharging patients who lack a defined PCP.

Survey respondents highlighted some strategies for dealing with the primary-care shortage, including the EHR for improving efficiency, teamwork, and checklists. Dr. Fortuna suggests HM groups:

• Work with PCPs and federally qualified health centers to enhance integrated relationships and improve handoffs. Local public health departments will be important collaborators.
• Define quality not just clinically, but also in terms of financial, operational, and cultural domains, using techniques of change management, root cause analysis, and other quality tools.
• Be involved in patient-centered medical homes as “catalysts, coordinators, and facilitators.”

HM Group Redesigns Workflow to Comply with ACGME Rules and Improve Continuity

As academic HM groups react to the new Accreditation Council for Graduation Medical Education (ACGME) guidelines on how long residents can work, they might want to keep the Toyota Production System (TPS) in mind.

Diana Mancini, MD, a hospitalist at Denver Health Medical Center and associate program director of the University of Colorado Internal Medicine Residency, presented data in the Research, Innovations, and Clinical Vignettes competition at HM11 that showed how the use of continuous workflow and standardized tasks—hallmarks of TPS—helped redesign the medicine ward system to both comply with the ACGME rules and improve continuity of care.

The project replaced the traditional call system, and its corresponding floats and moonlighters, with a shift system comprised of two teams of six interns and three residents. At night, one intern worked a “continuity shift.” Using administrative data, Dr. Mancini and colleagues projected that 89% of patients admitted on a continuity shift would be discharged by the end of that intern’s five consecutive shifts. And, by dividing admissions among two teams, the “bolus” effect was halved, she says.

“The continuity shift is crucial for both the patient safety/continuity and educational content/value for the housestaff,” Dr. Mancini wrote in an email. “With the new work hours coming ... the hours would have to be adjusted … but the continuity could most certainly be maintained.”

Feds Delay Deadline for Stage 2 “Meaningful Use” Application Process

If your HM group is among the first cohort that reaches Stage 1 attestation this year for meaningful use of electronic health records (EHR), you may get more time to reach Stage 2. The federal Health Information Technology (HIT) policy committee has voted for a 12-month delay in implementing the criteria for that second stage, agreeing with those who say the current deadline of October 2013 “poses a nearly insurmountable timing challenge.”

The HIT is pushing to delay the deadline until 2014, which would mean providers have three years to verify that they have met Stage 1 meaningful use requirements, according to Government HealthIT. A cadre of medical trade groups, led by the AMA, is now pushing the Department of Health and Human Services to adopt the new timeline.

The ultimate decision rests with the Centers for Medicaid & Medicare Services (CMS).

By the numbers

Number of months without a central-line-associated bloodstream infection (BSI) on the eight-bed ICU at Beaufort Memorial Hospital, a 197-bed community hospital in Beaufort, S.C.

The hospital, which had a higher rate of BSIs than the national average in 2005, created a team to reduce its BSIs, led by infection-prevention specialist Beverly Yoder, RN, and involving hospitalists. Beaufort joined the Institute for Healthcare Improvement’s 100K Lives Campaign and the South Carolina Hospital Association’s Stop BSI Project.

The team implemented a central-line “bundle” of quality practices, then simplified the bundle and incorporated it into its EHR. The unit celebrated its 30-month achievement with a luncheon in June.

For information, contact critical-care director Diane Razo, RN, MSN, PCCN, at [email protected]. (For more information about central-line infection prevention, visit SHM's Resource Room (www.hospitalmedicine.org/resource)