Larry Beresford

Estimated total number of saved lives from 2011 to 2013 as a result of reductions in the incidence of hospital-acquired conditions (HACs) in U.S. hospitals, compared with HAC rates in 2010, according to the U.S. Department of Health and Human Services (HHS). In 1999, the Institute of Medicine estimated that as many as 98,000 deaths per year resulted from avoidable hospital errors, such as central line-associated blood stream infections, adverse drug events, falls, and bedsores. Rates of avoidable medical errors fell by 17% between 2010 and 2013, (HHS) reports, which resulted in 1.3 million fewer HACs than expected and overall savings of $12 billion for the healthcare system.

Estimated total number of saved lives from 2011 to 2013 as a result of reductions in the incidence of hospital-acquired conditions (HACs) in U.S. hospitals, compared with HAC rates in 2010, according to the U.S. Department of Health and Human Services (HHS). In 1999, the Institute of Medicine estimated that as many as 98,000 deaths per year resulted from avoidable hospital errors, such as central line-associated blood stream infections, adverse drug events, falls, and bedsores. Rates of avoidable medical errors fell by 17% between 2010 and 2013, (HHS) reports, which resulted in 1.3 million fewer HACs than expected and overall savings of $12 billion for the healthcare system.

Estimated total number of saved lives from 2011 to 2013 as a result of reductions in the incidence of hospital-acquired conditions (HACs) in U.S. hospitals, compared with HAC rates in 2010, according to the U.S. Department of Health and Human Services (HHS). In 1999, the Institute of Medicine estimated that as many as 98,000 deaths per year resulted from avoidable hospital errors, such as central line-associated blood stream infections, adverse drug events, falls, and bedsores. Rates of avoidable medical errors fell by 17% between 2010 and 2013, (HHS) reports, which resulted in 1.3 million fewer HACs than expected and overall savings of $12 billion for the healthcare system.

The recent rise of specialty hospitalists, particularly in the surgery and oncology fields, has benefitted hospitals and patients alike. Consider the growing ranks of oncology hospitalists, a small but quickly expanding HM specialty that has applied hospitalist principles to inpatient cancer and end-of-life care.

One such program at M.D. Anderson Cancer Center in Houston has attracted nine hospital-based physicians, four advanced-practice nurses, and two pharmacists since its launch in 2006. More doctors and nurse practitioners are being recruited, and the group is piloting an observation unit geared toward symptom management for an average of five oncology patients per day.

Although most inpatients cared for M.D. Anderson hospitalists are being treated for cancer, many have general medical needs, such as managing diabetes or high blood pressure, explains hospitalist Maria-Claudia Campagna, MD, FHM, assistant professor in the division of internal medicine at MD Anderson. Other patients, including those who don't yet have a confirmed cancer diagnosis, and family members of cancer patients may also be seen by the hospitalists. MD Anderson also has an established palliative-care service.

Increasingly, hospitals have employed specialty hospitalist teams, staffed by general oncologists or internal medicine hospitalists skilled at complex cancer care to care for inpatients with cancer, and the trend shows no signs of slowing.

Likewise, the practice of employing surgical hospitalists in non-trauma centers is gaining steam. Some non-trauma hospitals have reported improved patient outcomes and greater  efficiency with surgical hospitalists.

A retrospective review of emergency surgical operations performed over five years at Sutter Medical Center, in Sacramento, Calif., found that an acute-care surgery model resulted in fewer overall complications, shorter lengths of stay, and lower hospital costs.

This approach by Surgical Affiliates Management Group, Inc. of Sacramento—the group contracted to perform the surgeries at SMC—combines elements of trauma, critical care, emergency surgical medicine, and elective general surgery, and it could be applied to emergency general surgeries at other hospitals that lack a trauma service without jeopardizing quality of care, the authors state.

Visit our website for more information on specialty hospitalist programs.

The recent rise of specialty hospitalists, particularly in the surgery and oncology fields, has benefitted hospitals and patients alike. Consider the growing ranks of oncology hospitalists, a small but quickly expanding HM specialty that has applied hospitalist principles to inpatient cancer and end-of-life care.

One such program at M.D. Anderson Cancer Center in Houston has attracted nine hospital-based physicians, four advanced-practice nurses, and two pharmacists since its launch in 2006. More doctors and nurse practitioners are being recruited, and the group is piloting an observation unit geared toward symptom management for an average of five oncology patients per day.

Although most inpatients cared for M.D. Anderson hospitalists are being treated for cancer, many have general medical needs, such as managing diabetes or high blood pressure, explains hospitalist Maria-Claudia Campagna, MD, FHM, assistant professor in the division of internal medicine at MD Anderson. Other patients, including those who don't yet have a confirmed cancer diagnosis, and family members of cancer patients may also be seen by the hospitalists. MD Anderson also has an established palliative-care service.

Increasingly, hospitals have employed specialty hospitalist teams, staffed by general oncologists or internal medicine hospitalists skilled at complex cancer care to care for inpatients with cancer, and the trend shows no signs of slowing.

Likewise, the practice of employing surgical hospitalists in non-trauma centers is gaining steam. Some non-trauma hospitals have reported improved patient outcomes and greater  efficiency with surgical hospitalists.

A retrospective review of emergency surgical operations performed over five years at Sutter Medical Center, in Sacramento, Calif., found that an acute-care surgery model resulted in fewer overall complications, shorter lengths of stay, and lower hospital costs.

This approach by Surgical Affiliates Management Group, Inc. of Sacramento—the group contracted to perform the surgeries at SMC—combines elements of trauma, critical care, emergency surgical medicine, and elective general surgery, and it could be applied to emergency general surgeries at other hospitals that lack a trauma service without jeopardizing quality of care, the authors state.

Visit our website for more information on specialty hospitalist programs.

The recent rise of specialty hospitalists, particularly in the surgery and oncology fields, has benefitted hospitals and patients alike. Consider the growing ranks of oncology hospitalists, a small but quickly expanding HM specialty that has applied hospitalist principles to inpatient cancer and end-of-life care.

One such program at M.D. Anderson Cancer Center in Houston has attracted nine hospital-based physicians, four advanced-practice nurses, and two pharmacists since its launch in 2006. More doctors and nurse practitioners are being recruited, and the group is piloting an observation unit geared toward symptom management for an average of five oncology patients per day.

Although most inpatients cared for M.D. Anderson hospitalists are being treated for cancer, many have general medical needs, such as managing diabetes or high blood pressure, explains hospitalist Maria-Claudia Campagna, MD, FHM, assistant professor in the division of internal medicine at MD Anderson. Other patients, including those who don't yet have a confirmed cancer diagnosis, and family members of cancer patients may also be seen by the hospitalists. MD Anderson also has an established palliative-care service.

Increasingly, hospitals have employed specialty hospitalist teams, staffed by general oncologists or internal medicine hospitalists skilled at complex cancer care to care for inpatients with cancer, and the trend shows no signs of slowing.

Likewise, the practice of employing surgical hospitalists in non-trauma centers is gaining steam. Some non-trauma hospitals have reported improved patient outcomes and greater  efficiency with surgical hospitalists.

A retrospective review of emergency surgical operations performed over five years at Sutter Medical Center, in Sacramento, Calif., found that an acute-care surgery model resulted in fewer overall complications, shorter lengths of stay, and lower hospital costs.

This approach by Surgical Affiliates Management Group, Inc. of Sacramento—the group contracted to perform the surgeries at SMC—combines elements of trauma, critical care, emergency surgical medicine, and elective general surgery, and it could be applied to emergency general surgeries at other hospitals that lack a trauma service without jeopardizing quality of care, the authors state.

Visit our website for more information on specialty hospitalist programs.

Bob Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, talks about Accountable Care Organizations, trends in managed care, his new book, and why hospitalists need to think, at times, like Machiavelli.

Bob Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, talks about Accountable Care Organizations, trends in managed care, his new book, and why hospitalists need to think, at times, like Machiavelli.

Bob Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, talks about Accountable Care Organizations, trends in managed care, his new book, and why hospitalists need to think, at times, like Machiavelli.

69%: the percentage of hospitals that had perfect compliance with the Leapfrog Group employer coalition’s safe practices for hand hygiene in its 2013 annual quality survey of 1,437 U.S. hospitals.

The CDC estimates 2 million patients annually acquire hospital-acquired infections (HAIs), often spread by contaminated hands of healthcare workers.

Urban hospitals performed better than rural hospitals in compliance with Leapfrog’s standard.

69%: the percentage of hospitals that had perfect compliance with the Leapfrog Group employer coalition’s safe practices for hand hygiene in its 2013 annual quality survey of 1,437 U.S. hospitals.

The CDC estimates 2 million patients annually acquire hospital-acquired infections (HAIs), often spread by contaminated hands of healthcare workers.

Urban hospitals performed better than rural hospitals in compliance with Leapfrog’s standard.

69%: the percentage of hospitals that had perfect compliance with the Leapfrog Group employer coalition’s safe practices for hand hygiene in its 2013 annual quality survey of 1,437 U.S. hospitals.

The CDC estimates 2 million patients annually acquire hospital-acquired infections (HAIs), often spread by contaminated hands of healthcare workers.

Urban hospitals performed better than rural hospitals in compliance with Leapfrog’s standard.

$167 billion: Amount of federal Medicaid reimbursement payments that hospitals will forego between 2013 and 2022 in states that have opted not to expand their state programs under the 2010 Affordable Care Act.

For every $1 a state spends on expanding Medicaid, $13.41 in federal funding flows into the state, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

$167 billion: Amount of federal Medicaid reimbursement payments that hospitals will forego between 2013 and 2022 in states that have opted not to expand their state programs under the 2010 Affordable Care Act.

For every $1 a state spends on expanding Medicaid, $13.41 in federal funding flows into the state, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

$167 billion: Amount of federal Medicaid reimbursement payments that hospitals will forego between 2013 and 2022 in states that have opted not to expand their state programs under the 2010 Affordable Care Act.

For every $1 a state spends on expanding Medicaid, $13.41 in federal funding flows into the state, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

UpToDate, a leading clinical decision support resource for physicians, in July added palliative care as the newest of its 22 medical specialties. The palliative care section covers a variety of topics focused on improving symptoms and providing best quality of life for patients with serious illnesses. The new service resulted from two years of extensive collaboration by a team of 100 leading palliative care specialists from around the world, led by Harvard Medical School palliative care physicians J. Andrew Billings, MD, and Susan D. Block, MD, reviewing and grading the body of research and scientific literature on palliative care.

UpToDate, a leading clinical decision support resource for physicians, in July added palliative care as the newest of its 22 medical specialties. The palliative care section covers a variety of topics focused on improving symptoms and providing best quality of life for patients with serious illnesses. The new service resulted from two years of extensive collaboration by a team of 100 leading palliative care specialists from around the world, led by Harvard Medical School palliative care physicians J. Andrew Billings, MD, and Susan D. Block, MD, reviewing and grading the body of research and scientific literature on palliative care.

UpToDate, a leading clinical decision support resource for physicians, in July added palliative care as the newest of its 22 medical specialties. The palliative care section covers a variety of topics focused on improving symptoms and providing best quality of life for patients with serious illnesses. The new service resulted from two years of extensive collaboration by a team of 100 leading palliative care specialists from around the world, led by Harvard Medical School palliative care physicians J. Andrew Billings, MD, and Susan D. Block, MD, reviewing and grading the body of research and scientific literature on palliative care.

Hospitals and Health Networks in July presented its 16^th annual list of Most Wired Hospitals and Health Systems. Rigorous criteria were used to identify 375 hospitals that use technology to link up disparate care providers and patients. "Most Wired" hospitals are more likely to share critical information electronically with specialists, to use bar codes for matching medications to patients at the bedside, to use IT to reduce the likelihood of medical errors, to better manage care transitions, and to adopt and meaningfully use certified electronic health records.

Meanwhile, Eric Wicklund, editor of mHealth News, called for nominations of the best wireless hospitals, which are moving toward a wireless landscape for mobile health technology and engaging an ever more connected consumer population.

“I’ve already got a few on my own list,” he writes, asking his readers to submit examples of programs and projects that are doing it right and using mobile health to make a difference.

MHADegree.org, a resource for students and professionals in health administration, named the top 50 most social media-friendly hospitals for 2013, led by Mayo Clinic in Rochester, Minn., and Cleveland Clinic in Cleveland, Ohio.

Hospitals and Health Networks in July presented its 16^th annual list of Most Wired Hospitals and Health Systems. Rigorous criteria were used to identify 375 hospitals that use technology to link up disparate care providers and patients. "Most Wired" hospitals are more likely to share critical information electronically with specialists, to use bar codes for matching medications to patients at the bedside, to use IT to reduce the likelihood of medical errors, to better manage care transitions, and to adopt and meaningfully use certified electronic health records.

Meanwhile, Eric Wicklund, editor of mHealth News, called for nominations of the best wireless hospitals, which are moving toward a wireless landscape for mobile health technology and engaging an ever more connected consumer population.

“I’ve already got a few on my own list,” he writes, asking his readers to submit examples of programs and projects that are doing it right and using mobile health to make a difference.

MHADegree.org, a resource for students and professionals in health administration, named the top 50 most social media-friendly hospitals for 2013, led by Mayo Clinic in Rochester, Minn., and Cleveland Clinic in Cleveland, Ohio.

Hospitals and Health Networks in July presented its 16^th annual list of Most Wired Hospitals and Health Systems. Rigorous criteria were used to identify 375 hospitals that use technology to link up disparate care providers and patients. "Most Wired" hospitals are more likely to share critical information electronically with specialists, to use bar codes for matching medications to patients at the bedside, to use IT to reduce the likelihood of medical errors, to better manage care transitions, and to adopt and meaningfully use certified electronic health records.

Meanwhile, Eric Wicklund, editor of mHealth News, called for nominations of the best wireless hospitals, which are moving toward a wireless landscape for mobile health technology and engaging an ever more connected consumer population.

“I’ve already got a few on my own list,” he writes, asking his readers to submit examples of programs and projects that are doing it right and using mobile health to make a difference.

MHADegree.org, a resource for students and professionals in health administration, named the top 50 most social media-friendly hospitals for 2013, led by Mayo Clinic in Rochester, Minn., and Cleveland Clinic in Cleveland, Ohio.

Steven Z. Pantilat, MD, SFHM, medical director of the University of California San Francisco School of Medicine palliative care service, explains palliative care is not end-of-life care, and the role hospitalists should play in palliative cases.

 

 

Steven Z. Pantilat, MD, SFHM, medical director of the University of California San Francisco School of Medicine palliative care service, explains palliative care is not end-of-life care, and the role hospitalists should play in palliative cases.

 

 

Steven Z. Pantilat, MD, SFHM, medical director of the University of California San Francisco School of Medicine palliative care service, explains palliative care is not end-of-life care, and the role hospitalists should play in palliative cases.

 

 

Hospital medicine guru Bob Wachter, MD, MHM, offers an optimistic view of hospitalists’ role in healthcare as reform measures continue to reshape the landscape. Addressing hospitalists at a recurring conference that he founded 18 years ago—“Management of the Hospitalized Patient”—Dr. Wachter said hospitalists should have more leverage than other healthcare providers in controlling their fate, since hospitalists emerged from efforts to cut healthcare costs and promote value, efficiency, and quality.

“We’ve gone through an interesting 15 years where hospitals needed to build hospital medicine programs,” said Dr. Wachter, chief of the division of hospital medicine at the University of California at San Francisco, to conference attendees in San Francisco in October. “In the beginning, we were young and had to try to lead, even though we didn’t understand how organizations worked. We had a good voice at the table even before we were ready for it. Now we’re more mature and better leaders, but the problems are harder.”

Asked to name the reform trends most important to hospitalists, Dr. Wachter replied, “Cost pressures, one, two, and three. The system is going to push us to deliver higher-value care at lower cost, with greater standardization and elimination of waste.”

That means adhering to medical guidelines, avoiding unnecessary care, and managing hospital lengths of stay. Likewise, Dr. Wachter anticipates that clinicians will be pushed to practice at the top of their licensure, with new and interesting roles for nurse practitioners and physician assistants.

“But I think the market for hospitalists is good. Those hospitals that survive will all have hospitalists,” he said.

How can hospitalists prepare for healthcare reform?

“Some of it is to make yourself indispensable, so that when hard decisions come up about whether to spend resources on you or something else [in the hospital], people will say, ‘We get a lot of bang for our buck spending on hospitalists,’” Dr. Wachter added. “And now and then, you’ll need to pull out your copy of Machiavelli,” he noted, referring to the Italian diplomat’s classic book, The Prince, for its maxims on the art of retaining and wielding political power.

Dr. Wachter also has a particular interest in healthcare information technology (IT) and how it is reshaping medical practice, having taken a sabbatical to write a book on the subject, The Digital Doctor: Hope, Hype & Harm at the Dawn of Medicine’s Computer Age, scheduled for publication on March 15.

Acknowledging the problems many hospitalists have experienced with electronic health records, Dr. Wachter predicts some positive changes.

“I think it will get better pretty quickly. Many of us were quite naïve to think that IT would make care safer. We didn’t give enough attention to how technology changes everything, from workflow to personal relationships,” he said. “Now that these systems are in place, we need to ask: Are they really doing the things we want and not doing the things we don’t want? And how do we leverage these systems to get maximum value?”

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Larry Beresford is a freelance writer in Alameda, Calif.

Hospital medicine guru Bob Wachter, MD, MHM, offers an optimistic view of hospitalists’ role in healthcare as reform measures continue to reshape the landscape. Addressing hospitalists at a recurring conference that he founded 18 years ago—“Management of the Hospitalized Patient”—Dr. Wachter said hospitalists should have more leverage than other healthcare providers in controlling their fate, since hospitalists emerged from efforts to cut healthcare costs and promote value, efficiency, and quality.

“We’ve gone through an interesting 15 years where hospitals needed to build hospital medicine programs,” said Dr. Wachter, chief of the division of hospital medicine at the University of California at San Francisco, to conference attendees in San Francisco in October. “In the beginning, we were young and had to try to lead, even though we didn’t understand how organizations worked. We had a good voice at the table even before we were ready for it. Now we’re more mature and better leaders, but the problems are harder.”

Asked to name the reform trends most important to hospitalists, Dr. Wachter replied, “Cost pressures, one, two, and three. The system is going to push us to deliver higher-value care at lower cost, with greater standardization and elimination of waste.”

That means adhering to medical guidelines, avoiding unnecessary care, and managing hospital lengths of stay. Likewise, Dr. Wachter anticipates that clinicians will be pushed to practice at the top of their licensure, with new and interesting roles for nurse practitioners and physician assistants.

“But I think the market for hospitalists is good. Those hospitals that survive will all have hospitalists,” he said.

How can hospitalists prepare for healthcare reform?

“Some of it is to make yourself indispensable, so that when hard decisions come up about whether to spend resources on you or something else [in the hospital], people will say, ‘We get a lot of bang for our buck spending on hospitalists,’” Dr. Wachter added. “And now and then, you’ll need to pull out your copy of Machiavelli,” he noted, referring to the Italian diplomat’s classic book, The Prince, for its maxims on the art of retaining and wielding political power.

Dr. Wachter also has a particular interest in healthcare information technology (IT) and how it is reshaping medical practice, having taken a sabbatical to write a book on the subject, The Digital Doctor: Hope, Hype & Harm at the Dawn of Medicine’s Computer Age, scheduled for publication on March 15.

Acknowledging the problems many hospitalists have experienced with electronic health records, Dr. Wachter predicts some positive changes.

“I think it will get better pretty quickly. Many of us were quite naïve to think that IT would make care safer. We didn’t give enough attention to how technology changes everything, from workflow to personal relationships,” he said. “Now that these systems are in place, we need to ask: Are they really doing the things we want and not doing the things we don’t want? And how do we leverage these systems to get maximum value?”

---

Larry Beresford is a freelance writer in Alameda, Calif.

Hospital medicine guru Bob Wachter, MD, MHM, offers an optimistic view of hospitalists’ role in healthcare as reform measures continue to reshape the landscape. Addressing hospitalists at a recurring conference that he founded 18 years ago—“Management of the Hospitalized Patient”—Dr. Wachter said hospitalists should have more leverage than other healthcare providers in controlling their fate, since hospitalists emerged from efforts to cut healthcare costs and promote value, efficiency, and quality.

“We’ve gone through an interesting 15 years where hospitals needed to build hospital medicine programs,” said Dr. Wachter, chief of the division of hospital medicine at the University of California at San Francisco, to conference attendees in San Francisco in October. “In the beginning, we were young and had to try to lead, even though we didn’t understand how organizations worked. We had a good voice at the table even before we were ready for it. Now we’re more mature and better leaders, but the problems are harder.”

Asked to name the reform trends most important to hospitalists, Dr. Wachter replied, “Cost pressures, one, two, and three. The system is going to push us to deliver higher-value care at lower cost, with greater standardization and elimination of waste.”

That means adhering to medical guidelines, avoiding unnecessary care, and managing hospital lengths of stay. Likewise, Dr. Wachter anticipates that clinicians will be pushed to practice at the top of their licensure, with new and interesting roles for nurse practitioners and physician assistants.

“But I think the market for hospitalists is good. Those hospitals that survive will all have hospitalists,” he said.

How can hospitalists prepare for healthcare reform?

“Some of it is to make yourself indispensable, so that when hard decisions come up about whether to spend resources on you or something else [in the hospital], people will say, ‘We get a lot of bang for our buck spending on hospitalists,’” Dr. Wachter added. “And now and then, you’ll need to pull out your copy of Machiavelli,” he noted, referring to the Italian diplomat’s classic book, The Prince, for its maxims on the art of retaining and wielding political power.

Dr. Wachter also has a particular interest in healthcare information technology (IT) and how it is reshaping medical practice, having taken a sabbatical to write a book on the subject, The Digital Doctor: Hope, Hype & Harm at the Dawn of Medicine’s Computer Age, scheduled for publication on March 15.

Acknowledging the problems many hospitalists have experienced with electronic health records, Dr. Wachter predicts some positive changes.

“I think it will get better pretty quickly. Many of us were quite naïve to think that IT would make care safer. We didn’t give enough attention to how technology changes everything, from workflow to personal relationships,” he said. “Now that these systems are in place, we need to ask: Are they really doing the things we want and not doing the things we don’t want? And how do we leverage these systems to get maximum value?”

---

Larry Beresford is a freelance writer in Alameda, Calif.

The need to relieve patients’ suffering should not be the reason for withdrawing life-sustaining interventions in the ICU, Steven Z. Pantilat, MD, MHM, medical director of the University of California San Francisco (UCSF) School of Medicine palliative care service, told attendees at the “Management of the Hospitalized Patient” conference in San Francisco.

Patients in the ICU experience a lot of suffering, Dr. Pantilat said during a session on communication about serious illness. He underscored the importance of treating patients in the ICU as human beings, giving attention to their comfort and dignity, and addressing them by name.

“I’m not always sure they can hear me,” he said, “but there’s a humanizing element to it, as much to remind myself as for the patient’s benefit.”

Dr. Pantilat emphasized the importance of family conferences in communicating with patients and families, sometimes in advance of when important treatment decisions need to be made. The meeting should be documented in the EHR, with the note easy to retrieve.

“Resist launching in with what you know [about their case] until you ask what they know,” he advised. Dr. Pantilat tries to avoid expressions like “there’s nothing more we can do.”

“[It’s] better to say, ‘I wish there was something we could do to make her lungs get better.’ Or, ‘I worry that your mother’s getting worse,’” he said.

He asks families what the patient was like before getting ill. And he always says, “We’ll take really good care of her.”

Many health professionals still associate palliative care with end-of-life care or withdrawing treatment, he said, rather than its self-defined role of relieving suffering and promoting quality of life for any seriously ill patient. Even so, he sees the hospitalists’ role in palliative care in the hospital growing.

“They are taking care of hospitalized patients who are sick; they are having lots of goals-of-care conversations; they are treating a lot of pain, a lot of dyspnea and nausea, and making referrals to hospice,” he noted. “So we know they are providing palliative care.”

Many hospitalists also work in more formal ways as palliative care consultants.

ICU patients represent 30% of referrals to his service at UCSF, which has initiatives underway to integrate palliative care into the practice of ICU nurses and into the work of the medical center’s advanced heart failure team.

Training in palliative care also is becoming a bigger part of medical education and residency programs, although medical residency graduates could benefit from additional training.

“This is a subtle and difficult skill to get right, particularly the communication piece,” Dr. Pantilat said. “People need practice and more training, just as you’d want to get better at putting in central lines or intubating patients.”

For the hospitalist, providing palliative care and “addressing issues of seriously ill patients around decision-making, talking about prognosis, treating their symptoms, [and] addressing their spiritual concerns, it’s good for the patient. It’s good for the family. It’s actually good for the hospitalist, as well. It’s very rewarding work,” Dr. Pantilat said. “Here’s this opportunity to do something incredibly meaningful that makes a huge difference. And, through your work, renew yourself and renew your commitment to your work while doing it. That’s a rare opportunity in the middle of a busy day.”

The need to relieve patients’ suffering should not be the reason for withdrawing life-sustaining interventions in the ICU, Steven Z. Pantilat, MD, MHM, medical director of the University of California San Francisco (UCSF) School of Medicine palliative care service, told attendees at the “Management of the Hospitalized Patient” conference in San Francisco.

Patients in the ICU experience a lot of suffering, Dr. Pantilat said during a session on communication about serious illness. He underscored the importance of treating patients in the ICU as human beings, giving attention to their comfort and dignity, and addressing them by name.

“I’m not always sure they can hear me,” he said, “but there’s a humanizing element to it, as much to remind myself as for the patient’s benefit.”

Dr. Pantilat emphasized the importance of family conferences in communicating with patients and families, sometimes in advance of when important treatment decisions need to be made. The meeting should be documented in the EHR, with the note easy to retrieve.

“Resist launching in with what you know [about their case] until you ask what they know,” he advised. Dr. Pantilat tries to avoid expressions like “there’s nothing more we can do.”

“[It’s] better to say, ‘I wish there was something we could do to make her lungs get better.’ Or, ‘I worry that your mother’s getting worse,’” he said.

He asks families what the patient was like before getting ill. And he always says, “We’ll take really good care of her.”

Many health professionals still associate palliative care with end-of-life care or withdrawing treatment, he said, rather than its self-defined role of relieving suffering and promoting quality of life for any seriously ill patient. Even so, he sees the hospitalists’ role in palliative care in the hospital growing.

“They are taking care of hospitalized patients who are sick; they are having lots of goals-of-care conversations; they are treating a lot of pain, a lot of dyspnea and nausea, and making referrals to hospice,” he noted. “So we know they are providing palliative care.”

Many hospitalists also work in more formal ways as palliative care consultants.

ICU patients represent 30% of referrals to his service at UCSF, which has initiatives underway to integrate palliative care into the practice of ICU nurses and into the work of the medical center’s advanced heart failure team.

Training in palliative care also is becoming a bigger part of medical education and residency programs, although medical residency graduates could benefit from additional training.

“This is a subtle and difficult skill to get right, particularly the communication piece,” Dr. Pantilat said. “People need practice and more training, just as you’d want to get better at putting in central lines or intubating patients.”

For the hospitalist, providing palliative care and “addressing issues of seriously ill patients around decision-making, talking about prognosis, treating their symptoms, [and] addressing their spiritual concerns, it’s good for the patient. It’s good for the family. It’s actually good for the hospitalist, as well. It’s very rewarding work,” Dr. Pantilat said. “Here’s this opportunity to do something incredibly meaningful that makes a huge difference. And, through your work, renew yourself and renew your commitment to your work while doing it. That’s a rare opportunity in the middle of a busy day.”

The need to relieve patients’ suffering should not be the reason for withdrawing life-sustaining interventions in the ICU, Steven Z. Pantilat, MD, MHM, medical director of the University of California San Francisco (UCSF) School of Medicine palliative care service, told attendees at the “Management of the Hospitalized Patient” conference in San Francisco.

Patients in the ICU experience a lot of suffering, Dr. Pantilat said during a session on communication about serious illness. He underscored the importance of treating patients in the ICU as human beings, giving attention to their comfort and dignity, and addressing them by name.

“I’m not always sure they can hear me,” he said, “but there’s a humanizing element to it, as much to remind myself as for the patient’s benefit.”

Dr. Pantilat emphasized the importance of family conferences in communicating with patients and families, sometimes in advance of when important treatment decisions need to be made. The meeting should be documented in the EHR, with the note easy to retrieve.

“Resist launching in with what you know [about their case] until you ask what they know,” he advised. Dr. Pantilat tries to avoid expressions like “there’s nothing more we can do.”

“[It’s] better to say, ‘I wish there was something we could do to make her lungs get better.’ Or, ‘I worry that your mother’s getting worse,’” he said.

He asks families what the patient was like before getting ill. And he always says, “We’ll take really good care of her.”

Many health professionals still associate palliative care with end-of-life care or withdrawing treatment, he said, rather than its self-defined role of relieving suffering and promoting quality of life for any seriously ill patient. Even so, he sees the hospitalists’ role in palliative care in the hospital growing.

“They are taking care of hospitalized patients who are sick; they are having lots of goals-of-care conversations; they are treating a lot of pain, a lot of dyspnea and nausea, and making referrals to hospice,” he noted. “So we know they are providing palliative care.”

Many hospitalists also work in more formal ways as palliative care consultants.

ICU patients represent 30% of referrals to his service at UCSF, which has initiatives underway to integrate palliative care into the practice of ICU nurses and into the work of the medical center’s advanced heart failure team.

Training in palliative care also is becoming a bigger part of medical education and residency programs, although medical residency graduates could benefit from additional training.

“This is a subtle and difficult skill to get right, particularly the communication piece,” Dr. Pantilat said. “People need practice and more training, just as you’d want to get better at putting in central lines or intubating patients.”

For the hospitalist, providing palliative care and “addressing issues of seriously ill patients around decision-making, talking about prognosis, treating their symptoms, [and] addressing their spiritual concerns, it’s good for the patient. It’s good for the family. It’s actually good for the hospitalist, as well. It’s very rewarding work,” Dr. Pantilat said. “Here’s this opportunity to do something incredibly meaningful that makes a huge difference. And, through your work, renew yourself and renew your commitment to your work while doing it. That’s a rare opportunity in the middle of a busy day.”