Larry Beresford

Teaching trainees to identify and manage sepsis using an online game known as “Septris” earned hospitalists at Stanford University Medical Center in Palo Alto, Calif., a Research, Innovation, and Clinical Vignette category award at HM13.¹

“We took third-year medical students and residents in medicine, surgery, and emergency medicine—people who would be sepsis first responders on the floor—and gave them pre- and post-tests that documented improvements in both attitudes and knowledge,” says lead author Lisa Shieh, MD, PhD, Stanford’s medical director of quality in the department of medicine. All participants said they enjoyed playing the game, she reported.

Septris was developed by a multidisciplinary group of physicians, educational technology specialists, and programmers at Stanford. The game offers a case-based interactive learning environment drawn from evidence-based treatment algorithms. Players make treatment decisions and watch as the patient outcome rises or declines. The game’s rapid pace underscores the importance of early diagnosis and treatment.

“We tried to make our game as engaging and real-life as possible,” Dr. Shieh says.

The Stanford team is in touch with the Society of Critical Care Medicine’s Surviving Sepsis Campaign (www.survivingsepsis.org) and with other medical groups internationally. Thousands of players have accessed the game online for free (http://cme.stanford.edu/septris/game/SepsisTetris.html), with a nominal fee for CME credit. It is best played on an iPad or iPhone, Dr. Shieh says.

Larry Beresford is a freelance writer in Alameda, Calif.

Teaching trainees to identify and manage sepsis using an online game known as “Septris” earned hospitalists at Stanford University Medical Center in Palo Alto, Calif., a Research, Innovation, and Clinical Vignette category award at HM13.¹

“We took third-year medical students and residents in medicine, surgery, and emergency medicine—people who would be sepsis first responders on the floor—and gave them pre- and post-tests that documented improvements in both attitudes and knowledge,” says lead author Lisa Shieh, MD, PhD, Stanford’s medical director of quality in the department of medicine. All participants said they enjoyed playing the game, she reported.

Septris was developed by a multidisciplinary group of physicians, educational technology specialists, and programmers at Stanford. The game offers a case-based interactive learning environment drawn from evidence-based treatment algorithms. Players make treatment decisions and watch as the patient outcome rises or declines. The game’s rapid pace underscores the importance of early diagnosis and treatment.

“We tried to make our game as engaging and real-life as possible,” Dr. Shieh says.

The Stanford team is in touch with the Society of Critical Care Medicine’s Surviving Sepsis Campaign (www.survivingsepsis.org) and with other medical groups internationally. Thousands of players have accessed the game online for free (http://cme.stanford.edu/septris/game/SepsisTetris.html), with a nominal fee for CME credit. It is best played on an iPad or iPhone, Dr. Shieh says.

Larry Beresford is a freelance writer in Alameda, Calif.

Teaching trainees to identify and manage sepsis using an online game known as “Septris” earned hospitalists at Stanford University Medical Center in Palo Alto, Calif., a Research, Innovation, and Clinical Vignette category award at HM13.¹

“We took third-year medical students and residents in medicine, surgery, and emergency medicine—people who would be sepsis first responders on the floor—and gave them pre- and post-tests that documented improvements in both attitudes and knowledge,” says lead author Lisa Shieh, MD, PhD, Stanford’s medical director of quality in the department of medicine. All participants said they enjoyed playing the game, she reported.

Septris was developed by a multidisciplinary group of physicians, educational technology specialists, and programmers at Stanford. The game offers a case-based interactive learning environment drawn from evidence-based treatment algorithms. Players make treatment decisions and watch as the patient outcome rises or declines. The game’s rapid pace underscores the importance of early diagnosis and treatment.

“We tried to make our game as engaging and real-life as possible,” Dr. Shieh says.

The Stanford team is in touch with the Society of Critical Care Medicine’s Surviving Sepsis Campaign (www.survivingsepsis.org) and with other medical groups internationally. Thousands of players have accessed the game online for free (http://cme.stanford.edu/septris/game/SepsisTetris.html), with a nominal fee for CME credit. It is best played on an iPad or iPhone, Dr. Shieh says.

Larry Beresford is a freelance writer in Alameda, Calif.

600%

The increased likelihood of 30-day hospital readmission for hospitalized Medicare patients who have 10 or more chronic conditions, compared with those who have only one to four chronic conditions.⁴ These patients with multiple chronic conditions represent only 8.9% of Medicare beneficiaries but account for 50% of all rehospitalizations. The numbers are drawn from a 5% sample of Medicare fee-for-service beneficiaries during the first nine months of 2008. Those with five to nine chronic conditions had 2.5 times the odds for being readmitted.

Larry Beresford is a freelance writer in Alameda, Calif.

1. Shieh L, Pummer E, Tsui J, et al. Septris: improving sepsis recognition and management through a mobile educational game [abstract]. J Hosp Med. 2013;8(Suppl 1):1053.
2. Mitchell SE, Gardiner PM, Sadikova E, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2014;29(2):349-355.
3. Daniels KR, Lee GC, Frei CR. Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010. Am J Infect Control. 2014;42(1):17-22.
4. Berkowitz SA. Anderson GF. Medicare beneficiaries most likely to be readmitted. J Hosp Med. 2013;8(11):639-641.

600%

The increased likelihood of 30-day hospital readmission for hospitalized Medicare patients who have 10 or more chronic conditions, compared with those who have only one to four chronic conditions.⁴ These patients with multiple chronic conditions represent only 8.9% of Medicare beneficiaries but account for 50% of all rehospitalizations. The numbers are drawn from a 5% sample of Medicare fee-for-service beneficiaries during the first nine months of 2008. Those with five to nine chronic conditions had 2.5 times the odds for being readmitted.

Larry Beresford is a freelance writer in Alameda, Calif.

1. Shieh L, Pummer E, Tsui J, et al. Septris: improving sepsis recognition and management through a mobile educational game [abstract]. J Hosp Med. 2013;8(Suppl 1):1053.
2. Mitchell SE, Gardiner PM, Sadikova E, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2014;29(2):349-355.
3. Daniels KR, Lee GC, Frei CR. Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010. Am J Infect Control. 2014;42(1):17-22.
4. Berkowitz SA. Anderson GF. Medicare beneficiaries most likely to be readmitted. J Hosp Med. 2013;8(11):639-641.

600%

The increased likelihood of 30-day hospital readmission for hospitalized Medicare patients who have 10 or more chronic conditions, compared with those who have only one to four chronic conditions.⁴ These patients with multiple chronic conditions represent only 8.9% of Medicare beneficiaries but account for 50% of all rehospitalizations. The numbers are drawn from a 5% sample of Medicare fee-for-service beneficiaries during the first nine months of 2008. Those with five to nine chronic conditions had 2.5 times the odds for being readmitted.

Larry Beresford is a freelance writer in Alameda, Calif.

1. Shieh L, Pummer E, Tsui J, et al. Septris: improving sepsis recognition and management through a mobile educational game [abstract]. J Hosp Med. 2013;8(Suppl 1):1053.
2. Mitchell SE, Gardiner PM, Sadikova E, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2014;29(2):349-355.
3. Daniels KR, Lee GC, Frei CR. Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010. Am J Infect Control. 2014;42(1):17-22.
4. Berkowitz SA. Anderson GF. Medicare beneficiaries most likely to be readmitted. J Hosp Med. 2013;8(11):639-641.

Increase in the number of “top performer” hospitals in 2012 accreditation surveys conducted by the Joint Commission. Those 1,099 hospitals making the list had to receive a composite score of 95% or above for selected accountability measures.

Increase in the number of “top performer” hospitals in 2012 accreditation surveys conducted by the Joint Commission. Those 1,099 hospitals making the list had to receive a composite score of 95% or above for selected accountability measures.

Increase in the number of “top performer” hospitals in 2012 accreditation surveys conducted by the Joint Commission. Those 1,099 hospitals making the list had to receive a composite score of 95% or above for selected accountability measures.

Basic Principles for Pediatric Hospital Medicine Published A recent policy statement from the American Academy of Pediatrics (AAP), published online in Pediatrics, urges recognition of the expanded roles and responsibilities of pediatric hospitalists and offers basic principles for pediatric hospital medicine (PHM) programs, including focusing on the unique culture of each program within its parent institution and the importance of coordinated, patient-centered care.⁴

The article outlines settings available for PHM programs, optimal processes for care transitions, and the need for leadership and goal setting.

“It is implicit in all the aforementioned recommendations that the overarching goal is always to provide the best possible care for children and protect the safety of children in the hospital setting,” the authors note.

AAP’s Section on Hospital Medicine supports a policy of voluntary referrals to pediatric hospital medicine programs.

Basic Principles for Pediatric Hospital Medicine Published A recent policy statement from the American Academy of Pediatrics (AAP), published online in Pediatrics, urges recognition of the expanded roles and responsibilities of pediatric hospitalists and offers basic principles for pediatric hospital medicine (PHM) programs, including focusing on the unique culture of each program within its parent institution and the importance of coordinated, patient-centered care.⁴

The article outlines settings available for PHM programs, optimal processes for care transitions, and the need for leadership and goal setting.

“It is implicit in all the aforementioned recommendations that the overarching goal is always to provide the best possible care for children and protect the safety of children in the hospital setting,” the authors note.

AAP’s Section on Hospital Medicine supports a policy of voluntary referrals to pediatric hospital medicine programs.

Basic Principles for Pediatric Hospital Medicine Published A recent policy statement from the American Academy of Pediatrics (AAP), published online in Pediatrics, urges recognition of the expanded roles and responsibilities of pediatric hospitalists and offers basic principles for pediatric hospital medicine (PHM) programs, including focusing on the unique culture of each program within its parent institution and the importance of coordinated, patient-centered care.⁴

The article outlines settings available for PHM programs, optimal processes for care transitions, and the need for leadership and goal setting.

“It is implicit in all the aforementioned recommendations that the overarching goal is always to provide the best possible care for children and protect the safety of children in the hospital setting,” the authors note.

AAP’s Section on Hospital Medicine supports a policy of voluntary referrals to pediatric hospital medicine programs.

Study Suggests Medical Trainees Need More Manners

Researchers at Johns Hopkins Hospital and the University of Maryland Medical Center, both in Baltimore, identified an overall lack of “common courtesy” shown by internal medicine trainees in their interactions with patients.³ Such behavior can lead to lower patient satisfaction and worse medical outcomes, note the authors of the study, which included hospitalist Leonard Feldman, MD, FACP, FAAP, SFHM, an assistant professor of medicine at Hopkins.

The study, published in the November issue of the Journal of Hospital Medicine, followed 29 interns on rounds for three weeks and looked for five key strategies of etiquette-based communication. Researchers found that while the interns asked open-ended questions 75% of the time, they explained their role to the patient only 37% of the time and sat down to talk eye to eye during an encounter only 9% of the time.

The interns performed all five recommended behaviors only 4% of the time.

“These are things that matter to patients and are relatively easy to do,” Dr. Feldman said in a prepared statement. “They’re not being done to the extent they should be.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Rizk D, Calabrese R, Page C, Bookbinder M, Flores S, Portenoy R. A unique hospitalist/pain management collaboration to improve pain outcomes [abstract]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=793&id=104310. Accessed November 29, 2013.
2. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. supports major medical device changes for improved patient safety. Available at: http://www.nutritioncare.org/Press_Room/Press_Releases/A_S_P_E_N__Supports_Major_Medical_Device_Changes_for_Improved_Patient_Safety/. Accessed November 29, 2013.
3. Block LB, Hutzler L, Habicht R, Wu AW, et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013;8(11):631-634.
4. Mirkinson LJ, Section on Hospital Medicine. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782-786.

Study Suggests Medical Trainees Need More Manners

Researchers at Johns Hopkins Hospital and the University of Maryland Medical Center, both in Baltimore, identified an overall lack of “common courtesy” shown by internal medicine trainees in their interactions with patients.³ Such behavior can lead to lower patient satisfaction and worse medical outcomes, note the authors of the study, which included hospitalist Leonard Feldman, MD, FACP, FAAP, SFHM, an assistant professor of medicine at Hopkins.

The study, published in the November issue of the Journal of Hospital Medicine, followed 29 interns on rounds for three weeks and looked for five key strategies of etiquette-based communication. Researchers found that while the interns asked open-ended questions 75% of the time, they explained their role to the patient only 37% of the time and sat down to talk eye to eye during an encounter only 9% of the time.

The interns performed all five recommended behaviors only 4% of the time.

“These are things that matter to patients and are relatively easy to do,” Dr. Feldman said in a prepared statement. “They’re not being done to the extent they should be.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Rizk D, Calabrese R, Page C, Bookbinder M, Flores S, Portenoy R. A unique hospitalist/pain management collaboration to improve pain outcomes [abstract]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=793&id=104310. Accessed November 29, 2013.
2. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. supports major medical device changes for improved patient safety. Available at: http://www.nutritioncare.org/Press_Room/Press_Releases/A_S_P_E_N__Supports_Major_Medical_Device_Changes_for_Improved_Patient_Safety/. Accessed November 29, 2013.
3. Block LB, Hutzler L, Habicht R, Wu AW, et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013;8(11):631-634.
4. Mirkinson LJ, Section on Hospital Medicine. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782-786.

Study Suggests Medical Trainees Need More Manners

Researchers at Johns Hopkins Hospital and the University of Maryland Medical Center, both in Baltimore, identified an overall lack of “common courtesy” shown by internal medicine trainees in their interactions with patients.³ Such behavior can lead to lower patient satisfaction and worse medical outcomes, note the authors of the study, which included hospitalist Leonard Feldman, MD, FACP, FAAP, SFHM, an assistant professor of medicine at Hopkins.

The study, published in the November issue of the Journal of Hospital Medicine, followed 29 interns on rounds for three weeks and looked for five key strategies of etiquette-based communication. Researchers found that while the interns asked open-ended questions 75% of the time, they explained their role to the patient only 37% of the time and sat down to talk eye to eye during an encounter only 9% of the time.

The interns performed all five recommended behaviors only 4% of the time.

“These are things that matter to patients and are relatively easy to do,” Dr. Feldman said in a prepared statement. “They’re not being done to the extent they should be.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Rizk D, Calabrese R, Page C, Bookbinder M, Flores S, Portenoy R. A unique hospitalist/pain management collaboration to improve pain outcomes [abstract]. Available at: http://www.shmabstracts.com/abstract.asp?MeetingID=793&id=104310. Accessed November 29, 2013.
2. American Society for Parenteral and Enteral Nutrition. A.S.P.E.N. supports major medical device changes for improved patient safety. Available at: http://www.nutritioncare.org/Press_Room/Press_Releases/A_S_P_E_N__Supports_Major_Medical_Device_Changes_for_Improved_Patient_Safety/. Accessed November 29, 2013.
3. Block LB, Hutzler L, Habicht R, Wu AW, et al. Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter. J Hosp Med. 2013;8(11):631-634.
4. Mirkinson LJ, Section on Hospital Medicine. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782-786.

The American Society for Parenteral and Enteral Nutrition (ASPEN), the Global Enteral Device Supplier Association (GEDSA) and a number of other quality-oriented groups, including the FDA, Centers for Medicare & Medicaid Services (CMS), and the Joint Commission, are working to address tubing misconnections for medical device small-bore connectors—used for enteral, luer, neuro-cranial, respiratory, and other medical tubing equipment.²

Misconnections, although rare, can be harmful or even fatal to patients. The task force conducted a panel discussion Oct. 22 in Washington, D.C., focused on redesign issues, and is collaborating with the International Standards Organization to develop new small-bore connector standards.

GEDSA’s “Stay Connected” is an education campaign to inform and prepare the healthcare community for impending changes in standards for small-bore connectors. For more information, visit www.stayconnected2014.org.

The American Society for Parenteral and Enteral Nutrition (ASPEN), the Global Enteral Device Supplier Association (GEDSA) and a number of other quality-oriented groups, including the FDA, Centers for Medicare & Medicaid Services (CMS), and the Joint Commission, are working to address tubing misconnections for medical device small-bore connectors—used for enteral, luer, neuro-cranial, respiratory, and other medical tubing equipment.²

Misconnections, although rare, can be harmful or even fatal to patients. The task force conducted a panel discussion Oct. 22 in Washington, D.C., focused on redesign issues, and is collaborating with the International Standards Organization to develop new small-bore connector standards.

GEDSA’s “Stay Connected” is an education campaign to inform and prepare the healthcare community for impending changes in standards for small-bore connectors. For more information, visit www.stayconnected2014.org.

The American Society for Parenteral and Enteral Nutrition (ASPEN), the Global Enteral Device Supplier Association (GEDSA) and a number of other quality-oriented groups, including the FDA, Centers for Medicare & Medicaid Services (CMS), and the Joint Commission, are working to address tubing misconnections for medical device small-bore connectors—used for enteral, luer, neuro-cranial, respiratory, and other medical tubing equipment.²

Misconnections, although rare, can be harmful or even fatal to patients. The task force conducted a panel discussion Oct. 22 in Washington, D.C., focused on redesign issues, and is collaborating with the International Standards Organization to develop new small-bore connector standards.

GEDSA’s “Stay Connected” is an education campaign to inform and prepare the healthcare community for impending changes in standards for small-bore connectors. For more information, visit www.stayconnected2014.org.

A collaboration between hospitalists and the pain department at Beth Israel Medical Center in New York City is helping hospitalists address moderate to severe pain and complicating factors in their patients.

“The idea was to impart knowledge from a small group of experts to the hospitalists who manage pain in the majority of hospitalized patients,” says Dahlia Rizk, DO, chief of hospital medicine at Beth Israel and lead author on a poster that described the program and was presented at HM13 in Washington, D.C.¹

Dr. Rizk first approached Russell Portenoy, MD, internationally recognized chair of the Department of Pain Management and Palliative Care at Beth Israel, to draw upon his specialized knowledge. Grant funding supported protected time for two hospitalist champions and a nurse practitioner; they reviewed charts on participating units and conducted focus groups with hospitalists to identify barriers to effective pain management. Barriers were compiled into a 56-item menu and shaped the curriculum for weekly training sessions presented by the pain service.

Dr. Portenoy and the project team also established a metric for “high sustained pain,” patients reporting three or more days of three or more episodes of moderate to severe pain, according to the hospital’s standardized pain assessment scale. The information was captured in a computerized, tablet-based “Live View” tool that shows all of the patients on a unit and their incidences of high sustained pain over a week. The tool is used for rounding on patients and identifying those needing an immediate interdisciplinary focus.

Project results, Dr. Rizk reported, include improvements in high sustained pain scores on six of seven participating units and average reductions in the number of identified barriers to pain. Hospitalists reported increased comfort with adjusting pain therapies, while patient satisfaction scores with pain management also increased.

“Not everyone has access to an expert like Dr. Portenoy, but we’ve now done the root cause analysis and barriers list,” Dr. Rizk says. “I also think this approach could be applied more widely to other problem areas. We plan to try something similar with geriatrics.”

For more information about the collaborative and its pain problem list, contact Dr. Rizk at DRizk@chpnet.org.

A collaboration between hospitalists and the pain department at Beth Israel Medical Center in New York City is helping hospitalists address moderate to severe pain and complicating factors in their patients.

“The idea was to impart knowledge from a small group of experts to the hospitalists who manage pain in the majority of hospitalized patients,” says Dahlia Rizk, DO, chief of hospital medicine at Beth Israel and lead author on a poster that described the program and was presented at HM13 in Washington, D.C.¹

Dr. Rizk first approached Russell Portenoy, MD, internationally recognized chair of the Department of Pain Management and Palliative Care at Beth Israel, to draw upon his specialized knowledge. Grant funding supported protected time for two hospitalist champions and a nurse practitioner; they reviewed charts on participating units and conducted focus groups with hospitalists to identify barriers to effective pain management. Barriers were compiled into a 56-item menu and shaped the curriculum for weekly training sessions presented by the pain service.

Dr. Portenoy and the project team also established a metric for “high sustained pain,” patients reporting three or more days of three or more episodes of moderate to severe pain, according to the hospital’s standardized pain assessment scale. The information was captured in a computerized, tablet-based “Live View” tool that shows all of the patients on a unit and their incidences of high sustained pain over a week. The tool is used for rounding on patients and identifying those needing an immediate interdisciplinary focus.

Project results, Dr. Rizk reported, include improvements in high sustained pain scores on six of seven participating units and average reductions in the number of identified barriers to pain. Hospitalists reported increased comfort with adjusting pain therapies, while patient satisfaction scores with pain management also increased.

“Not everyone has access to an expert like Dr. Portenoy, but we’ve now done the root cause analysis and barriers list,” Dr. Rizk says. “I also think this approach could be applied more widely to other problem areas. We plan to try something similar with geriatrics.”

For more information about the collaborative and its pain problem list, contact Dr. Rizk at DRizk@chpnet.org.

A collaboration between hospitalists and the pain department at Beth Israel Medical Center in New York City is helping hospitalists address moderate to severe pain and complicating factors in their patients.

“The idea was to impart knowledge from a small group of experts to the hospitalists who manage pain in the majority of hospitalized patients,” says Dahlia Rizk, DO, chief of hospital medicine at Beth Israel and lead author on a poster that described the program and was presented at HM13 in Washington, D.C.¹

Dr. Rizk first approached Russell Portenoy, MD, internationally recognized chair of the Department of Pain Management and Palliative Care at Beth Israel, to draw upon his specialized knowledge. Grant funding supported protected time for two hospitalist champions and a nurse practitioner; they reviewed charts on participating units and conducted focus groups with hospitalists to identify barriers to effective pain management. Barriers were compiled into a 56-item menu and shaped the curriculum for weekly training sessions presented by the pain service.

Dr. Portenoy and the project team also established a metric for “high sustained pain,” patients reporting three or more days of three or more episodes of moderate to severe pain, according to the hospital’s standardized pain assessment scale. The information was captured in a computerized, tablet-based “Live View” tool that shows all of the patients on a unit and their incidences of high sustained pain over a week. The tool is used for rounding on patients and identifying those needing an immediate interdisciplinary focus.

Project results, Dr. Rizk reported, include improvements in high sustained pain scores on six of seven participating units and average reductions in the number of identified barriers to pain. Hospitalists reported increased comfort with adjusting pain therapies, while patient satisfaction scores with pain management also increased.

“Not everyone has access to an expert like Dr. Portenoy, but we’ve now done the root cause analysis and barriers list,” Dr. Rizk says. “I also think this approach could be applied more widely to other problem areas. We plan to try something similar with geriatrics.”

For more information about the collaborative and its pain problem list, contact Dr. Rizk at DRizk@chpnet.org.

How would hospitalists feel if patients or families asked them to wash their hands when they entered the hospital room? A new campaign called "Infection Prevention and You," engages patients to help hospitals overcome one of the most persistent barriers to preventing hospital-acquired infections (HAIs)—healthcare professionals failing to practice proper hand hygiene.

Launched by the Association for Professionals in Infection Control and Epidemiology (APIC), the organization"s executives contend that everyone plays a role in infection prevention.

"We know that washing hands is important, and so many things have been tried," says Carol McLay, DrPH, MPH, RN, CIC, infection prevention consultant and chair of APIC's Communications Committee. "Patient empowerment is one of the newer approaches. Studies have shown that patients really like the idea, but often are afraid to speak up."

Dr. McLay says hand-washing advocacy is one piece of a larger campaign for preventing HAIs across settings of care.

"I would hope that physicians, including hospitalists, would view it as an opportunity to do the right thing, to serve as effective role models, and to say to their patients, 'Your health is important to me,'" she says.

"The aspiration of having anyone and everyone speak up and ask providers to apply hand hygiene is laudable," says hospitalist Ethan Cumbler, MD, FACP, who has spearheaded a multidisciplinary hand hygiene initiative at University of Colorado Hospital in Aurora. But he says it is naive to expect all providers to respond positively to being corrected in this way. "At first, we may bristle at being challenged on hand hygiene, but when we consider what kind of physicians we want to be, and what kind of culture we want to work in, I believe it is a challenge we will come to appreciate," Dr. Cumbler says.

Visit our website for more information about hospitalists and infection prevention.

How would hospitalists feel if patients or families asked them to wash their hands when they entered the hospital room? A new campaign called "Infection Prevention and You," engages patients to help hospitals overcome one of the most persistent barriers to preventing hospital-acquired infections (HAIs)—healthcare professionals failing to practice proper hand hygiene.

Launched by the Association for Professionals in Infection Control and Epidemiology (APIC), the organization"s executives contend that everyone plays a role in infection prevention.

"We know that washing hands is important, and so many things have been tried," says Carol McLay, DrPH, MPH, RN, CIC, infection prevention consultant and chair of APIC's Communications Committee. "Patient empowerment is one of the newer approaches. Studies have shown that patients really like the idea, but often are afraid to speak up."

Dr. McLay says hand-washing advocacy is one piece of a larger campaign for preventing HAIs across settings of care.

"I would hope that physicians, including hospitalists, would view it as an opportunity to do the right thing, to serve as effective role models, and to say to their patients, 'Your health is important to me,'" she says.

"The aspiration of having anyone and everyone speak up and ask providers to apply hand hygiene is laudable," says hospitalist Ethan Cumbler, MD, FACP, who has spearheaded a multidisciplinary hand hygiene initiative at University of Colorado Hospital in Aurora. But he says it is naive to expect all providers to respond positively to being corrected in this way. "At first, we may bristle at being challenged on hand hygiene, but when we consider what kind of physicians we want to be, and what kind of culture we want to work in, I believe it is a challenge we will come to appreciate," Dr. Cumbler says.

Visit our website for more information about hospitalists and infection prevention.

How would hospitalists feel if patients or families asked them to wash their hands when they entered the hospital room? A new campaign called "Infection Prevention and You," engages patients to help hospitals overcome one of the most persistent barriers to preventing hospital-acquired infections (HAIs)—healthcare professionals failing to practice proper hand hygiene.

Launched by the Association for Professionals in Infection Control and Epidemiology (APIC), the organization"s executives contend that everyone plays a role in infection prevention.

"We know that washing hands is important, and so many things have been tried," says Carol McLay, DrPH, MPH, RN, CIC, infection prevention consultant and chair of APIC's Communications Committee. "Patient empowerment is one of the newer approaches. Studies have shown that patients really like the idea, but often are afraid to speak up."

Dr. McLay says hand-washing advocacy is one piece of a larger campaign for preventing HAIs across settings of care.

"I would hope that physicians, including hospitalists, would view it as an opportunity to do the right thing, to serve as effective role models, and to say to their patients, 'Your health is important to me,'" she says.

"The aspiration of having anyone and everyone speak up and ask providers to apply hand hygiene is laudable," says hospitalist Ethan Cumbler, MD, FACP, who has spearheaded a multidisciplinary hand hygiene initiative at University of Colorado Hospital in Aurora. But he says it is naive to expect all providers to respond positively to being corrected in this way. "At first, we may bristle at being challenged on hand hygiene, but when we consider what kind of physicians we want to be, and what kind of culture we want to work in, I believe it is a challenge we will come to appreciate," Dr. Cumbler says.

Visit our website for more information about hospitalists and infection prevention.

Glycemic control in hospitalized patients is possible without having to achieve the much-debated standard of intensive glycemic control. That’s what Irl Hirsch, MD, professor of medicine at the University of Washington in Seattle, said in a presentation on management of diabetes in the hospitalized patient at the UCSF conference.

“We instituted intravenous insulin protocols throughout our hospital in 1992,” before recent medical controversies about IGC, Dr. Hirsch said. Eventually, a target weight dimension of 100 to 180 mg/dL of blood glucose became the hospital standard.

The number of hospitalized patients with diabetes increased 93% between 1988 and 2009. Many hospitalists encounter diabetics and order insulin for them every day, Dr. Hirsch said. Although hyperglycemia, which is seen in 78% of hospitalized patients with diabetes and 26% of those without, is linked to mortality regardless of diabetic status, mortality is greater in patients with diabetes, especially in those newly diagnosed with hyperglycemia, Dr. Hirsch said.¹ Hypoglycemia often is overlooked due to

Doctors need to find a safe middle ground, he said, noting that intensive insulin therapy has not been shown to improve major outcomes, including ICU mortality. “The real danger is that we can’t get glucose under tight control without risking hypoglycemia,” he said. “We’ve had almost no hypoglycemia in our hospital for the past couple of years.”

In his talk, Dr. Hirsch took particular issue with the persistence of “sliding scale” approaches to titrating insulin therapy in hospitalized patients, basing the amount of insulin on current glucose level but not taking into consideration how long previous insulin treatments might be active or whether the insulin is “stacking” in the patient’s bloodstream. “The sliding scale doesn’t work. It’s dangerous, and that’s why I’m on this crusade,” he stated. Over time, basal bolus administration works better, Dr. Hirsch said, adding that continued improvements in the technology of continuous glucose monitoring will help to put an end to the controversy. TH

Larry Beresford is a freelance writer in San Franscisco.

Reference

1. Kosiborod M, Inzucchi S, Clark B, et al. National patterns of glucose control among patients hospitalized with acute myocardial infarction. J Am Coll Cardiol. 2007;49:1018–1183:1283A.

Glycemic control in hospitalized patients is possible without having to achieve the much-debated standard of intensive glycemic control. That’s what Irl Hirsch, MD, professor of medicine at the University of Washington in Seattle, said in a presentation on management of diabetes in the hospitalized patient at the UCSF conference.

“We instituted intravenous insulin protocols throughout our hospital in 1992,” before recent medical controversies about IGC, Dr. Hirsch said. Eventually, a target weight dimension of 100 to 180 mg/dL of blood glucose became the hospital standard.

The number of hospitalized patients with diabetes increased 93% between 1988 and 2009. Many hospitalists encounter diabetics and order insulin for them every day, Dr. Hirsch said. Although hyperglycemia, which is seen in 78% of hospitalized patients with diabetes and 26% of those without, is linked to mortality regardless of diabetic status, mortality is greater in patients with diabetes, especially in those newly diagnosed with hyperglycemia, Dr. Hirsch said.¹ Hypoglycemia often is overlooked due to

Doctors need to find a safe middle ground, he said, noting that intensive insulin therapy has not been shown to improve major outcomes, including ICU mortality. “The real danger is that we can’t get glucose under tight control without risking hypoglycemia,” he said. “We’ve had almost no hypoglycemia in our hospital for the past couple of years.”

In his talk, Dr. Hirsch took particular issue with the persistence of “sliding scale” approaches to titrating insulin therapy in hospitalized patients, basing the amount of insulin on current glucose level but not taking into consideration how long previous insulin treatments might be active or whether the insulin is “stacking” in the patient’s bloodstream. “The sliding scale doesn’t work. It’s dangerous, and that’s why I’m on this crusade,” he stated. Over time, basal bolus administration works better, Dr. Hirsch said, adding that continued improvements in the technology of continuous glucose monitoring will help to put an end to the controversy. TH

Larry Beresford is a freelance writer in San Franscisco.

Reference

1. Kosiborod M, Inzucchi S, Clark B, et al. National patterns of glucose control among patients hospitalized with acute myocardial infarction. J Am Coll Cardiol. 2007;49:1018–1183:1283A.

Glycemic control in hospitalized patients is possible without having to achieve the much-debated standard of intensive glycemic control. That’s what Irl Hirsch, MD, professor of medicine at the University of Washington in Seattle, said in a presentation on management of diabetes in the hospitalized patient at the UCSF conference.

“We instituted intravenous insulin protocols throughout our hospital in 1992,” before recent medical controversies about IGC, Dr. Hirsch said. Eventually, a target weight dimension of 100 to 180 mg/dL of blood glucose became the hospital standard.

The number of hospitalized patients with diabetes increased 93% between 1988 and 2009. Many hospitalists encounter diabetics and order insulin for them every day, Dr. Hirsch said. Although hyperglycemia, which is seen in 78% of hospitalized patients with diabetes and 26% of those without, is linked to mortality regardless of diabetic status, mortality is greater in patients with diabetes, especially in those newly diagnosed with hyperglycemia, Dr. Hirsch said.¹ Hypoglycemia often is overlooked due to

Doctors need to find a safe middle ground, he said, noting that intensive insulin therapy has not been shown to improve major outcomes, including ICU mortality. “The real danger is that we can’t get glucose under tight control without risking hypoglycemia,” he said. “We’ve had almost no hypoglycemia in our hospital for the past couple of years.”

In his talk, Dr. Hirsch took particular issue with the persistence of “sliding scale” approaches to titrating insulin therapy in hospitalized patients, basing the amount of insulin on current glucose level but not taking into consideration how long previous insulin treatments might be active or whether the insulin is “stacking” in the patient’s bloodstream. “The sliding scale doesn’t work. It’s dangerous, and that’s why I’m on this crusade,” he stated. Over time, basal bolus administration works better, Dr. Hirsch said, adding that continued improvements in the technology of continuous glucose monitoring will help to put an end to the controversy. TH

Larry Beresford is a freelance writer in San Franscisco.

Reference

1. Kosiborod M, Inzucchi S, Clark B, et al. National patterns of glucose control among patients hospitalized with acute myocardial infarction. J Am Coll Cardiol. 2007;49:1018–1183:1283A.

At the Kaiser Permanente Medical Center in San Rafael, Calif., the 20 members of the hospitalist group were encouraged to study together in preparation for the October 2012 HPM boards. The group undertook weekly study sessions for the five months leading up to the exam. Sixteen hospitalists sat for the exam, along with oncologists, nephrologists, pulmonologists, and primary care physicians from the medical center.

All passed.

“For years, our hospitalist group has been doing actual rounding with the palliative care team on their own patients,” says Shideh Shadan, MD, the hospitalist group leader. “Everyone was on board with palliative care. It is now part of our daily care, and all we had to do was to sit down and study for the exam.”

Most of Kaiser’s HMO medical centers have designated interdisciplinary palliative care consultation teams. The one at San Rafael includes nurses, social workers, chaplains, and a part-time physician who is a hospitalist, Clay Angel, MD. Dr. Angel agrees that a cultural transformation has come about at Kaiser San Rafael through this collaboration. The two services are separate but closely connected.

“In hospital medicine, if you keep farming out what you do to specialists—if you’re not embracing palliative care as a hospitalist—you lose part of your practice,” he says.

Dr. Shadan says the study group “helped us to be more cohesive and more comfortable going to each other to ask for help. Palliative care is part of what we do—part of hospital medicine and of providing good care.”

Meanwhile, North Hollywood, Calif.-based IPC The Hospitalist Company, which is well-established in post-acute and long-term-care settings beyond the hospital walls, is now starting to explore palliative care approaches at the local level in a few of its 35 markets. Heather Zinzella-Cox, MD, who was part of a panel presentation on palliative care at HM13, is hospitalist practice group leader for IPC-Delaware. She also works part time as an associate medical director for a community hospice and helped to develop an inpatient palliative care team at a local community hospital.

“For me, as a post-acute hospitalist, every patient I see, I think about whether palliative care might benefit them,” says Dr. Zinzella-Cox, who is board certified in pain and in hospice and palliative medicine.

She says hospitalists need tools for identifying appropriate palliative care patients, along with training for how to communicate with them around goals of care, including simple language to help cue these conversations. She notes a “significant voltage drop” in information at the time of discharge, and the most careful discharge plans can fall apart in a hurry after the patient goes home.

IPC’s national practice group does not have a current policy or initiative for palliative care; however, there may be opportunities for further integrating palliative care with hospital medicine, says hospitalist Thomas Mathew, MD.

Larry Beresford is a freelance writer in San Francisco.

At the Kaiser Permanente Medical Center in San Rafael, Calif., the 20 members of the hospitalist group were encouraged to study together in preparation for the October 2012 HPM boards. The group undertook weekly study sessions for the five months leading up to the exam. Sixteen hospitalists sat for the exam, along with oncologists, nephrologists, pulmonologists, and primary care physicians from the medical center.

All passed.

“For years, our hospitalist group has been doing actual rounding with the palliative care team on their own patients,” says Shideh Shadan, MD, the hospitalist group leader. “Everyone was on board with palliative care. It is now part of our daily care, and all we had to do was to sit down and study for the exam.”

Most of Kaiser’s HMO medical centers have designated interdisciplinary palliative care consultation teams. The one at San Rafael includes nurses, social workers, chaplains, and a part-time physician who is a hospitalist, Clay Angel, MD. Dr. Angel agrees that a cultural transformation has come about at Kaiser San Rafael through this collaboration. The two services are separate but closely connected.

“In hospital medicine, if you keep farming out what you do to specialists—if you’re not embracing palliative care as a hospitalist—you lose part of your practice,” he says.

Dr. Shadan says the study group “helped us to be more cohesive and more comfortable going to each other to ask for help. Palliative care is part of what we do—part of hospital medicine and of providing good care.”

Meanwhile, North Hollywood, Calif.-based IPC The Hospitalist Company, which is well-established in post-acute and long-term-care settings beyond the hospital walls, is now starting to explore palliative care approaches at the local level in a few of its 35 markets. Heather Zinzella-Cox, MD, who was part of a panel presentation on palliative care at HM13, is hospitalist practice group leader for IPC-Delaware. She also works part time as an associate medical director for a community hospice and helped to develop an inpatient palliative care team at a local community hospital.

“For me, as a post-acute hospitalist, every patient I see, I think about whether palliative care might benefit them,” says Dr. Zinzella-Cox, who is board certified in pain and in hospice and palliative medicine.

She says hospitalists need tools for identifying appropriate palliative care patients, along with training for how to communicate with them around goals of care, including simple language to help cue these conversations. She notes a “significant voltage drop” in information at the time of discharge, and the most careful discharge plans can fall apart in a hurry after the patient goes home.

IPC’s national practice group does not have a current policy or initiative for palliative care; however, there may be opportunities for further integrating palliative care with hospital medicine, says hospitalist Thomas Mathew, MD.

Larry Beresford is a freelance writer in San Francisco.

At the Kaiser Permanente Medical Center in San Rafael, Calif., the 20 members of the hospitalist group were encouraged to study together in preparation for the October 2012 HPM boards. The group undertook weekly study sessions for the five months leading up to the exam. Sixteen hospitalists sat for the exam, along with oncologists, nephrologists, pulmonologists, and primary care physicians from the medical center.

All passed.

“For years, our hospitalist group has been doing actual rounding with the palliative care team on their own patients,” says Shideh Shadan, MD, the hospitalist group leader. “Everyone was on board with palliative care. It is now part of our daily care, and all we had to do was to sit down and study for the exam.”

Most of Kaiser’s HMO medical centers have designated interdisciplinary palliative care consultation teams. The one at San Rafael includes nurses, social workers, chaplains, and a part-time physician who is a hospitalist, Clay Angel, MD. Dr. Angel agrees that a cultural transformation has come about at Kaiser San Rafael through this collaboration. The two services are separate but closely connected.

“In hospital medicine, if you keep farming out what you do to specialists—if you’re not embracing palliative care as a hospitalist—you lose part of your practice,” he says.

Dr. Shadan says the study group “helped us to be more cohesive and more comfortable going to each other to ask for help. Palliative care is part of what we do—part of hospital medicine and of providing good care.”

Meanwhile, North Hollywood, Calif.-based IPC The Hospitalist Company, which is well-established in post-acute and long-term-care settings beyond the hospital walls, is now starting to explore palliative care approaches at the local level in a few of its 35 markets. Heather Zinzella-Cox, MD, who was part of a panel presentation on palliative care at HM13, is hospitalist practice group leader for IPC-Delaware. She also works part time as an associate medical director for a community hospice and helped to develop an inpatient palliative care team at a local community hospital.

“For me, as a post-acute hospitalist, every patient I see, I think about whether palliative care might benefit them,” says Dr. Zinzella-Cox, who is board certified in pain and in hospice and palliative medicine.

She says hospitalists need tools for identifying appropriate palliative care patients, along with training for how to communicate with them around goals of care, including simple language to help cue these conversations. She notes a “significant voltage drop” in information at the time of discharge, and the most careful discharge plans can fall apart in a hurry after the patient goes home.

IPC’s national practice group does not have a current policy or initiative for palliative care; however, there may be opportunities for further integrating palliative care with hospital medicine, says hospitalist Thomas Mathew, MD.

Larry Beresford is a freelance writer in San Francisco.