Larry Beresford

The Canadian Society of Hospital Medicine is spearheading an initiative called the Core Competencies in Hospitalist Medicine Document Project, which could be used to clarify what the field is, update certification processes, and define its future growth.

Neither the Royal College of Physicians and Surgeons of Canada nor the College of Family Physicians of Canada is likely to pursue board certification for a subspecialty in hospital medicine, says Peter Jamieson, MD, CCFP, FCFP, a hospitalist at Foothills Medical Center in Calgary, Alberta.

“If you think about hospital medicine as a construct—and take the focus off the person and put it instead onto the patient and onto the work, then you can describe the necessary competencies,” Dr. Jamieson says. “What are the preparation, the evaluation, and all of the associated functions? We want to be clear about what this job really is. We don’t have to be defined by training in a particular specialty.”

Writing and reviewing the competencies has been assigned to large physician working groups, with a well-defined process for validation, Dr. Jamieson says.

“Next steps will include elaborating the evaluation criteria, the learning objectives, and those sorts of things. That’s all going on right now,” he explains. “Our objective is to have all of them in a publishable format within the next year or so. Then we’ll need to get the regulatory folks to agree that this represents a subset of practice and a discrete and obtainable set of skills.

“As time goes by, it will become more and more obvious that hospital medicine is a discrete set of skills—not that any doctor couldn’t obtain those skills, but in order to obtain and maintain them you will need some training through a professional development pathway that creates and maintains the professional competencies.” TH

The Canadian Society of Hospital Medicine is spearheading an initiative called the Core Competencies in Hospitalist Medicine Document Project, which could be used to clarify what the field is, update certification processes, and define its future growth.

Neither the Royal College of Physicians and Surgeons of Canada nor the College of Family Physicians of Canada is likely to pursue board certification for a subspecialty in hospital medicine, says Peter Jamieson, MD, CCFP, FCFP, a hospitalist at Foothills Medical Center in Calgary, Alberta.

“If you think about hospital medicine as a construct—and take the focus off the person and put it instead onto the patient and onto the work, then you can describe the necessary competencies,” Dr. Jamieson says. “What are the preparation, the evaluation, and all of the associated functions? We want to be clear about what this job really is. We don’t have to be defined by training in a particular specialty.”

Writing and reviewing the competencies has been assigned to large physician working groups, with a well-defined process for validation, Dr. Jamieson says.

“Next steps will include elaborating the evaluation criteria, the learning objectives, and those sorts of things. That’s all going on right now,” he explains. “Our objective is to have all of them in a publishable format within the next year or so. Then we’ll need to get the regulatory folks to agree that this represents a subset of practice and a discrete and obtainable set of skills.

“As time goes by, it will become more and more obvious that hospital medicine is a discrete set of skills—not that any doctor couldn’t obtain those skills, but in order to obtain and maintain them you will need some training through a professional development pathway that creates and maintains the professional competencies.” TH

The Canadian Society of Hospital Medicine is spearheading an initiative called the Core Competencies in Hospitalist Medicine Document Project, which could be used to clarify what the field is, update certification processes, and define its future growth.

Neither the Royal College of Physicians and Surgeons of Canada nor the College of Family Physicians of Canada is likely to pursue board certification for a subspecialty in hospital medicine, says Peter Jamieson, MD, CCFP, FCFP, a hospitalist at Foothills Medical Center in Calgary, Alberta.

“If you think about hospital medicine as a construct—and take the focus off the person and put it instead onto the patient and onto the work, then you can describe the necessary competencies,” Dr. Jamieson says. “What are the preparation, the evaluation, and all of the associated functions? We want to be clear about what this job really is. We don’t have to be defined by training in a particular specialty.”

Writing and reviewing the competencies has been assigned to large physician working groups, with a well-defined process for validation, Dr. Jamieson says.

“Next steps will include elaborating the evaluation criteria, the learning objectives, and those sorts of things. That’s all going on right now,” he explains. “Our objective is to have all of them in a publishable format within the next year or so. Then we’ll need to get the regulatory folks to agree that this represents a subset of practice and a discrete and obtainable set of skills.

“As time goes by, it will become more and more obvious that hospital medicine is a discrete set of skills—not that any doctor couldn’t obtain those skills, but in order to obtain and maintain them you will need some training through a professional development pathway that creates and maintains the professional competencies.” TH

Bilal Hameed, MD, assistant professor of medicine in the Division of Gastroenterology at the University of California San Francisco, reviewed a wide range of serious and life-threatening medical complications resulting from cirrhosis during the annual UCSF Management of the Hospitalized Patient conference.

Recurring complications of cirrhosis can include ascites, acute variceal and portal hypertensive bleeds, hepatic encephalopathy, bacterial peritonitis, acute renal failure, sepsis, and a host of other infections. In many cases, options for treatment are limited as the patient develops decompensated cirrhosis.

Poor prognosis makes it important to urge these patients to get on a liver transplantation list, sooner rather than later, Dr. Hameed told hospitalists attending his small-group session. “Liver transplantation has changed this field,” he said. “Call us to see if your patient might be a candidate.”

Unlike kidney and some other transplant lists, where patients must wait for their turn, liver transplants are assigned based on need, as reflected in the patient’s Model for End-Stage Liver Disease (MELD) score, an objective clinical scale derived from blood values.

“Patients do really well on transplants, with 60% survival at 10 years,” he said. He also noted patients with advanced, decompensated disease who do not find a place on the transplant list might instead be candidates for palliative care or hospice referral.

Many conditions, such as infections, can still be managed with timely treatment, returning the patient back to baseline. “The risk of infection is very high. Starting antibiotics early can help,” Dr. Hameed said.

And for conditions where fluid volume is an issue, including spontaneous bacterial peritonitis, hypernatremia, or intrinsic renal disease, albumin is recommended as the evidence-based treatment of choice. “Please don’t over-transfuse these patients,” he said.

Jeannie Yip, MD, a nocturnist at Kaiser Foundation Hospital in Oakland, Calif., said that she frequently admits these kinds of patients to her hospital. For her, Dr. Hameed’s albumin recommendation was the most important lesson.

“I was still using IV fluids in patients coming in with volume depletion, to rule out acute renal failure. It’s always a dilemma if you have a hypotensive patient with low sodium and low blood pressure, who tells you: ‘I haven’t eaten for a week,’” she explained. “It’s been hard for me not to give them fluids. But after listening to this talk, I see that I should give albumin, instead.” TH

Bilal Hameed, MD, assistant professor of medicine in the Division of Gastroenterology at the University of California San Francisco, reviewed a wide range of serious and life-threatening medical complications resulting from cirrhosis during the annual UCSF Management of the Hospitalized Patient conference.

Recurring complications of cirrhosis can include ascites, acute variceal and portal hypertensive bleeds, hepatic encephalopathy, bacterial peritonitis, acute renal failure, sepsis, and a host of other infections. In many cases, options for treatment are limited as the patient develops decompensated cirrhosis.

Poor prognosis makes it important to urge these patients to get on a liver transplantation list, sooner rather than later, Dr. Hameed told hospitalists attending his small-group session. “Liver transplantation has changed this field,” he said. “Call us to see if your patient might be a candidate.”

Unlike kidney and some other transplant lists, where patients must wait for their turn, liver transplants are assigned based on need, as reflected in the patient’s Model for End-Stage Liver Disease (MELD) score, an objective clinical scale derived from blood values.

“Patients do really well on transplants, with 60% survival at 10 years,” he said. He also noted patients with advanced, decompensated disease who do not find a place on the transplant list might instead be candidates for palliative care or hospice referral.

Many conditions, such as infections, can still be managed with timely treatment, returning the patient back to baseline. “The risk of infection is very high. Starting antibiotics early can help,” Dr. Hameed said.

And for conditions where fluid volume is an issue, including spontaneous bacterial peritonitis, hypernatremia, or intrinsic renal disease, albumin is recommended as the evidence-based treatment of choice. “Please don’t over-transfuse these patients,” he said.

Jeannie Yip, MD, a nocturnist at Kaiser Foundation Hospital in Oakland, Calif., said that she frequently admits these kinds of patients to her hospital. For her, Dr. Hameed’s albumin recommendation was the most important lesson.

“I was still using IV fluids in patients coming in with volume depletion, to rule out acute renal failure. It’s always a dilemma if you have a hypotensive patient with low sodium and low blood pressure, who tells you: ‘I haven’t eaten for a week,’” she explained. “It’s been hard for me not to give them fluids. But after listening to this talk, I see that I should give albumin, instead.” TH

Bilal Hameed, MD, assistant professor of medicine in the Division of Gastroenterology at the University of California San Francisco, reviewed a wide range of serious and life-threatening medical complications resulting from cirrhosis during the annual UCSF Management of the Hospitalized Patient conference.

Recurring complications of cirrhosis can include ascites, acute variceal and portal hypertensive bleeds, hepatic encephalopathy, bacterial peritonitis, acute renal failure, sepsis, and a host of other infections. In many cases, options for treatment are limited as the patient develops decompensated cirrhosis.

Poor prognosis makes it important to urge these patients to get on a liver transplantation list, sooner rather than later, Dr. Hameed told hospitalists attending his small-group session. “Liver transplantation has changed this field,” he said. “Call us to see if your patient might be a candidate.”

Unlike kidney and some other transplant lists, where patients must wait for their turn, liver transplants are assigned based on need, as reflected in the patient’s Model for End-Stage Liver Disease (MELD) score, an objective clinical scale derived from blood values.

“Patients do really well on transplants, with 60% survival at 10 years,” he said. He also noted patients with advanced, decompensated disease who do not find a place on the transplant list might instead be candidates for palliative care or hospice referral.

Many conditions, such as infections, can still be managed with timely treatment, returning the patient back to baseline. “The risk of infection is very high. Starting antibiotics early can help,” Dr. Hameed said.

And for conditions where fluid volume is an issue, including spontaneous bacterial peritonitis, hypernatremia, or intrinsic renal disease, albumin is recommended as the evidence-based treatment of choice. “Please don’t over-transfuse these patients,” he said.

Jeannie Yip, MD, a nocturnist at Kaiser Foundation Hospital in Oakland, Calif., said that she frequently admits these kinds of patients to her hospital. For her, Dr. Hameed’s albumin recommendation was the most important lesson.

“I was still using IV fluids in patients coming in with volume depletion, to rule out acute renal failure. It’s always a dilemma if you have a hypotensive patient with low sodium and low blood pressure, who tells you: ‘I haven’t eaten for a week,’” she explained. “It’s been hard for me not to give them fluids. But after listening to this talk, I see that I should give albumin, instead.” TH

Half of U.S. physicians are experiencing some of the symptoms of burnout, with even higher rates for general internists. Implementation of the electronic health record (EHR) has been cited as the biggest driver of physician job dissatisfaction, Christine Sinsky, MD, a former hospitalist and currently vice president of professional satisfaction at the American Medical Association (AMA), told attendees at the 19th Management of the Hospitalized Patient Conference, presented by the University of California-San Francisco.¹

Dr. Sinsky deemed physician discontent “the canary in the coal mine” for a dysfunctional healthcare system. After visiting 23 high-functioning medical teams, Dr. Sinsky said she had found that 70% to 80% of physician work output could be considered waste, defined as work that doesn’t need to be done and doesn’t add value to the patient. The AMA, she said, has made a commitment to addressing physicians’ dissatisfaction and burnout.

Dr. Sinsky offered a number of suggestions for physicians and the larger system. Among them was the suggestion for medical teams to employ a documentation specialist, or scribe, to accompany physicians on patient rounds to help with the clerical tasks that divert physicians from patient care. She also cited David Reuben, MD, a gerontologist at UCLA whose JAMA IM study documented his training of physician “practice partners,” often medical or nursing students, who help queue up orders in the EHR, and the improved patient satisfaction that resulted.²

“Be bold,” she advised hospitalists. “The patient care delivery modes of the future can’t be met with staffing models from the past.” TH

References

1. Friedberg M, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Santa Monica, Calif.: RAND Corporation, 2013. http://www.rand.org/pubs/research_reports/RR439. Also available in print form.
2. Reuben DB, Knudsen J, Senelick W, Glazier E, Koretz BK. The effect of a physician partner program on physician efficiency and patient satisfaction. JAMA Intern Med. 2014;174(7):1190–1193.

Half of U.S. physicians are experiencing some of the symptoms of burnout, with even higher rates for general internists. Implementation of the electronic health record (EHR) has been cited as the biggest driver of physician job dissatisfaction, Christine Sinsky, MD, a former hospitalist and currently vice president of professional satisfaction at the American Medical Association (AMA), told attendees at the 19th Management of the Hospitalized Patient Conference, presented by the University of California-San Francisco.¹

Dr. Sinsky deemed physician discontent “the canary in the coal mine” for a dysfunctional healthcare system. After visiting 23 high-functioning medical teams, Dr. Sinsky said she had found that 70% to 80% of physician work output could be considered waste, defined as work that doesn’t need to be done and doesn’t add value to the patient. The AMA, she said, has made a commitment to addressing physicians’ dissatisfaction and burnout.

Dr. Sinsky offered a number of suggestions for physicians and the larger system. Among them was the suggestion for medical teams to employ a documentation specialist, or scribe, to accompany physicians on patient rounds to help with the clerical tasks that divert physicians from patient care. She also cited David Reuben, MD, a gerontologist at UCLA whose JAMA IM study documented his training of physician “practice partners,” often medical or nursing students, who help queue up orders in the EHR, and the improved patient satisfaction that resulted.²

“Be bold,” she advised hospitalists. “The patient care delivery modes of the future can’t be met with staffing models from the past.” TH

References

1. Friedberg M, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Santa Monica, Calif.: RAND Corporation, 2013. http://www.rand.org/pubs/research_reports/RR439. Also available in print form.
2. Reuben DB, Knudsen J, Senelick W, Glazier E, Koretz BK. The effect of a physician partner program on physician efficiency and patient satisfaction. JAMA Intern Med. 2014;174(7):1190–1193.

Half of U.S. physicians are experiencing some of the symptoms of burnout, with even higher rates for general internists. Implementation of the electronic health record (EHR) has been cited as the biggest driver of physician job dissatisfaction, Christine Sinsky, MD, a former hospitalist and currently vice president of professional satisfaction at the American Medical Association (AMA), told attendees at the 19th Management of the Hospitalized Patient Conference, presented by the University of California-San Francisco.¹

Dr. Sinsky deemed physician discontent “the canary in the coal mine” for a dysfunctional healthcare system. After visiting 23 high-functioning medical teams, Dr. Sinsky said she had found that 70% to 80% of physician work output could be considered waste, defined as work that doesn’t need to be done and doesn’t add value to the patient. The AMA, she said, has made a commitment to addressing physicians’ dissatisfaction and burnout.

Dr. Sinsky offered a number of suggestions for physicians and the larger system. Among them was the suggestion for medical teams to employ a documentation specialist, or scribe, to accompany physicians on patient rounds to help with the clerical tasks that divert physicians from patient care. She also cited David Reuben, MD, a gerontologist at UCLA whose JAMA IM study documented his training of physician “practice partners,” often medical or nursing students, who help queue up orders in the EHR, and the improved patient satisfaction that resulted.²

“Be bold,” she advised hospitalists. “The patient care delivery modes of the future can’t be met with staffing models from the past.” TH

References

1. Friedberg M, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Santa Monica, Calif.: RAND Corporation, 2013. http://www.rand.org/pubs/research_reports/RR439. Also available in print form.
2. Reuben DB, Knudsen J, Senelick W, Glazier E, Koretz BK. The effect of a physician partner program on physician efficiency and patient satisfaction. JAMA Intern Med. 2014;174(7):1190–1193.

The delicate balance involved in providing hospitalized patients with needed anticoagulant, anti-platelet, and thrombolytic therapies for stroke and possible cardiac complications while minimizing bleed risks was explored by several speakers at the University of California San Francisco’s annual Management of the Hospitalized Patient Conference.

“These are dynamic issues and they’re moving all the time,” said Tracy Minichiello, MD, a former hospitalist who now runs the Anticoagulation and Thrombosis Service at the San Francisco VA Medical Center. Dosing and monitoring choices for physicians have grown more complicated with the new oral anticoagulants (apixaban, dabigatran, and rivaroxaban), and she said another balancing act is emerging in hospitals trying to avoid unnecessary and wasteful treatments.

“There is interest on both sides of that question,” Dr. Minichiello said, adding the stakes are high. “We don’t want to miss the diagnosis of pulmonary embolisms, which can be difficult to catch. But now there’s more discussion of the other side of the issue—over-diagnosis and over-treatment—where we’re also trying to avoid, for example, overuse of CT scans.”

Another major thrust of Dr. Minichiello’s presentations involved bridging therapies, the application of a parenteral, short-acting anticoagulant therapy during the temporary interruption of warfarin anticoagulation for an invasive procedure. Bridging decreases stroke and embolism risk, but with an increased risk for bleeding.

“Full intensity bridging therapy for anticoagulation potentially can do more harm than good,” she said, noting a dearth of data to support mortality benefits of bridging therapy.

Literature increasingly recommends hospitalists be more selective about the use of bridging therapies that might have been employed reflexively in the past, she noted.

“[Hospitalists] must be mindful of the risks and benefits,” she said.

Physicians should also think twice about concomitant antiplatelet therapy like aspirin with anticoagulants. “We need to work collaboratively with our cardiology colleagues when a patient is on two or three of these therapies,” she said. “Recommendations in this area are in evolution.”

Elise Bouchard, MD, an internist at Centre Maria-Chapdelaine in Dolbeau-Mistassini, Quebec, attended Dr. Minichiello’s breakout session on challenging cases.

“I learned that we shouldn’t use aspirin with Coumadin or other anticoagulants, except for cases like acute coronary syndrome,” Dr. Bouchard said. She also explained a number of her patients with cancer, for example, need anticoagulation treatment and hate getting another injection, so she tries when possible to offer the oral anticoagulants.

Dr. Minichiello works with hospitalists at the San Francisco VA who seek consults around procedures, anticoagulant choices, and when to restart treatments.

“Most hospitalists don’t have access to a service like ours, although they might be able to call on a hematology consult service [or pharmacist],” she said. She suggested hospitalists trying to develop their own evidenced-based protocols use websites like the University of Washington’s anticoagulation service website, or the American Society of Health System Pharmacists’ anticoagulation resource center. TH

The delicate balance involved in providing hospitalized patients with needed anticoagulant, anti-platelet, and thrombolytic therapies for stroke and possible cardiac complications while minimizing bleed risks was explored by several speakers at the University of California San Francisco’s annual Management of the Hospitalized Patient Conference.

“These are dynamic issues and they’re moving all the time,” said Tracy Minichiello, MD, a former hospitalist who now runs the Anticoagulation and Thrombosis Service at the San Francisco VA Medical Center. Dosing and monitoring choices for physicians have grown more complicated with the new oral anticoagulants (apixaban, dabigatran, and rivaroxaban), and she said another balancing act is emerging in hospitals trying to avoid unnecessary and wasteful treatments.

“There is interest on both sides of that question,” Dr. Minichiello said, adding the stakes are high. “We don’t want to miss the diagnosis of pulmonary embolisms, which can be difficult to catch. But now there’s more discussion of the other side of the issue—over-diagnosis and over-treatment—where we’re also trying to avoid, for example, overuse of CT scans.”

Another major thrust of Dr. Minichiello’s presentations involved bridging therapies, the application of a parenteral, short-acting anticoagulant therapy during the temporary interruption of warfarin anticoagulation for an invasive procedure. Bridging decreases stroke and embolism risk, but with an increased risk for bleeding.

“Full intensity bridging therapy for anticoagulation potentially can do more harm than good,” she said, noting a dearth of data to support mortality benefits of bridging therapy.

Literature increasingly recommends hospitalists be more selective about the use of bridging therapies that might have been employed reflexively in the past, she noted.

“[Hospitalists] must be mindful of the risks and benefits,” she said.

Physicians should also think twice about concomitant antiplatelet therapy like aspirin with anticoagulants. “We need to work collaboratively with our cardiology colleagues when a patient is on two or three of these therapies,” she said. “Recommendations in this area are in evolution.”

Elise Bouchard, MD, an internist at Centre Maria-Chapdelaine in Dolbeau-Mistassini, Quebec, attended Dr. Minichiello’s breakout session on challenging cases.

“I learned that we shouldn’t use aspirin with Coumadin or other anticoagulants, except for cases like acute coronary syndrome,” Dr. Bouchard said. She also explained a number of her patients with cancer, for example, need anticoagulation treatment and hate getting another injection, so she tries when possible to offer the oral anticoagulants.

Dr. Minichiello works with hospitalists at the San Francisco VA who seek consults around procedures, anticoagulant choices, and when to restart treatments.

“Most hospitalists don’t have access to a service like ours, although they might be able to call on a hematology consult service [or pharmacist],” she said. She suggested hospitalists trying to develop their own evidenced-based protocols use websites like the University of Washington’s anticoagulation service website, or the American Society of Health System Pharmacists’ anticoagulation resource center. TH

The delicate balance involved in providing hospitalized patients with needed anticoagulant, anti-platelet, and thrombolytic therapies for stroke and possible cardiac complications while minimizing bleed risks was explored by several speakers at the University of California San Francisco’s annual Management of the Hospitalized Patient Conference.

“These are dynamic issues and they’re moving all the time,” said Tracy Minichiello, MD, a former hospitalist who now runs the Anticoagulation and Thrombosis Service at the San Francisco VA Medical Center. Dosing and monitoring choices for physicians have grown more complicated with the new oral anticoagulants (apixaban, dabigatran, and rivaroxaban), and she said another balancing act is emerging in hospitals trying to avoid unnecessary and wasteful treatments.

“There is interest on both sides of that question,” Dr. Minichiello said, adding the stakes are high. “We don’t want to miss the diagnosis of pulmonary embolisms, which can be difficult to catch. But now there’s more discussion of the other side of the issue—over-diagnosis and over-treatment—where we’re also trying to avoid, for example, overuse of CT scans.”

Another major thrust of Dr. Minichiello’s presentations involved bridging therapies, the application of a parenteral, short-acting anticoagulant therapy during the temporary interruption of warfarin anticoagulation for an invasive procedure. Bridging decreases stroke and embolism risk, but with an increased risk for bleeding.

“Full intensity bridging therapy for anticoagulation potentially can do more harm than good,” she said, noting a dearth of data to support mortality benefits of bridging therapy.

Literature increasingly recommends hospitalists be more selective about the use of bridging therapies that might have been employed reflexively in the past, she noted.

“[Hospitalists] must be mindful of the risks and benefits,” she said.

Physicians should also think twice about concomitant antiplatelet therapy like aspirin with anticoagulants. “We need to work collaboratively with our cardiology colleagues when a patient is on two or three of these therapies,” she said. “Recommendations in this area are in evolution.”

Elise Bouchard, MD, an internist at Centre Maria-Chapdelaine in Dolbeau-Mistassini, Quebec, attended Dr. Minichiello’s breakout session on challenging cases.

“I learned that we shouldn’t use aspirin with Coumadin or other anticoagulants, except for cases like acute coronary syndrome,” Dr. Bouchard said. She also explained a number of her patients with cancer, for example, need anticoagulation treatment and hate getting another injection, so she tries when possible to offer the oral anticoagulants.

Dr. Minichiello works with hospitalists at the San Francisco VA who seek consults around procedures, anticoagulant choices, and when to restart treatments.

“Most hospitalists don’t have access to a service like ours, although they might be able to call on a hematology consult service [or pharmacist],” she said. She suggested hospitalists trying to develop their own evidenced-based protocols use websites like the University of Washington’s anticoagulation service website, or the American Society of Health System Pharmacists’ anticoagulation resource center. TH

Estimated savings in energy costs posted by hospitals participating in the American Hospital Association’s affiliated American Society for Healthcare Engineering (ASHE) Energy to Care Program. Twenty participating hospitals received Energy to Care awards from ASHE in July for reducing their energy consumption by 10% or more. ASHE’s free program includes a benchmarking dashboard hospitals can use to track their own energy consumption, thereby saving energy and reducing costs.

Larry Beresford is a freelance writer in Alameda, Calif.

Estimated savings in energy costs posted by hospitals participating in the American Hospital Association’s affiliated American Society for Healthcare Engineering (ASHE) Energy to Care Program. Twenty participating hospitals received Energy to Care awards from ASHE in July for reducing their energy consumption by 10% or more. ASHE’s free program includes a benchmarking dashboard hospitals can use to track their own energy consumption, thereby saving energy and reducing costs.

Larry Beresford is a freelance writer in Alameda, Calif.

Estimated savings in energy costs posted by hospitals participating in the American Hospital Association’s affiliated American Society for Healthcare Engineering (ASHE) Energy to Care Program. Twenty participating hospitals received Energy to Care awards from ASHE in July for reducing their energy consumption by 10% or more. ASHE’s free program includes a benchmarking dashboard hospitals can use to track their own energy consumption, thereby saving energy and reducing costs.

Larry Beresford is a freelance writer in Alameda, Calif.

For Ami Doshi, MD, FAAP, a hospitalist at Rady Children’s Hospital San Diego, the path to establishing a comprehensive pediatric palliative care program began with her realization during medical training that doctors didn’t always adequately address the suffering of young patients with advanced disease and their families. Then, in a hospice rotation, she saw that the palliative approach could offer a better way.

During a pediatric hospital medicine fellowship at the University of California at San Diego, Dr. Doshi conducted an educational needs assessment and then created a palliative care curriculum for residents. Rady administrators supported her attending the Palliative Care Leadership Center training at UC San Francisco, with a team from Rady and Harvard Medical School’s program in Palliative Care Education and Practice.

After five years of development, the program Dr. Doshi helped to launch at Rady has grown into a division of palliative medicine, with a medical director, an inpatient consultation service, a palliative home care program coordinated by a health navigator, and a variety of models in the outpatient clinics.

“The goal is to be seamless and to treat patients across the continuum of care,” says Dr. Doshi, who is now board certified in hospice and palliative. Although she is based in the division of hospital medicine, she leads sit-down rounds with the full palliative care team and bioethics consultants every other week.

“Finding time for this work is always a challenge,” she says, adding that administrative support for physicians’ protected time is growing and that the program is ramping up its data collection to document outcomes resulting from palliative care.

For more information on the program, email her at adoshi@rchsd.org.

Larry Beresford is a freelance writer in Alameda, Calif.

For Ami Doshi, MD, FAAP, a hospitalist at Rady Children’s Hospital San Diego, the path to establishing a comprehensive pediatric palliative care program began with her realization during medical training that doctors didn’t always adequately address the suffering of young patients with advanced disease and their families. Then, in a hospice rotation, she saw that the palliative approach could offer a better way.

During a pediatric hospital medicine fellowship at the University of California at San Diego, Dr. Doshi conducted an educational needs assessment and then created a palliative care curriculum for residents. Rady administrators supported her attending the Palliative Care Leadership Center training at UC San Francisco, with a team from Rady and Harvard Medical School’s program in Palliative Care Education and Practice.

After five years of development, the program Dr. Doshi helped to launch at Rady has grown into a division of palliative medicine, with a medical director, an inpatient consultation service, a palliative home care program coordinated by a health navigator, and a variety of models in the outpatient clinics.

“The goal is to be seamless and to treat patients across the continuum of care,” says Dr. Doshi, who is now board certified in hospice and palliative. Although she is based in the division of hospital medicine, she leads sit-down rounds with the full palliative care team and bioethics consultants every other week.

“Finding time for this work is always a challenge,” she says, adding that administrative support for physicians’ protected time is growing and that the program is ramping up its data collection to document outcomes resulting from palliative care.

For more information on the program, email her at adoshi@rchsd.org.

Larry Beresford is a freelance writer in Alameda, Calif.

For Ami Doshi, MD, FAAP, a hospitalist at Rady Children’s Hospital San Diego, the path to establishing a comprehensive pediatric palliative care program began with her realization during medical training that doctors didn’t always adequately address the suffering of young patients with advanced disease and their families. Then, in a hospice rotation, she saw that the palliative approach could offer a better way.

During a pediatric hospital medicine fellowship at the University of California at San Diego, Dr. Doshi conducted an educational needs assessment and then created a palliative care curriculum for residents. Rady administrators supported her attending the Palliative Care Leadership Center training at UC San Francisco, with a team from Rady and Harvard Medical School’s program in Palliative Care Education and Practice.

After five years of development, the program Dr. Doshi helped to launch at Rady has grown into a division of palliative medicine, with a medical director, an inpatient consultation service, a palliative home care program coordinated by a health navigator, and a variety of models in the outpatient clinics.

“The goal is to be seamless and to treat patients across the continuum of care,” says Dr. Doshi, who is now board certified in hospice and palliative. Although she is based in the division of hospital medicine, she leads sit-down rounds with the full palliative care team and bioethics consultants every other week.

“Finding time for this work is always a challenge,” she says, adding that administrative support for physicians’ protected time is growing and that the program is ramping up its data collection to document outcomes resulting from palliative care.

For more information on the program, email her at adoshi@rchsd.org.

Larry Beresford is a freelance writer in Alameda, Calif.

Consumer Reports included for the first time in its national hospital quality ratings a ranking of how well 3,000 hospitals are controlling common deadly infections such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.

The How Your Hospital Can Make You Sick report is based on information provided to the CDC between October 2013 and September 2014. The CDC found that 105 hospitals distinguished themselves by earning high ratings against both infections. Nine hospitals received top ratings for having no infections from MRSA, C. diff, or other measured infections, although none of the country’s highest-profile hospitals are on that list. Only 6% of hospitals scored well against both infections in the new ratings. The CDC estimates that 648,000 people develop infections during their hospital stay, with 75,000 dying from them; many of the deaths can be traced back to widespread, inappropriate use of antibiotics.

“High rates for MRSA and C. diff can be a red flag that a hospital isn’t following the best practices in preventing infections and prescribing antibiotics,” notes Doris Peter, PhD, director of Consumer Reports’ Health Ratings Center, in a prepared statement. “The data show that it is possible to keep infection rates down and in some cases avoid them altogether.”

Among Consumer Reports’ recommendations for hospitals:

• Consistently follow established protocols for managing superbug infections;
• Accurately track how many infections patients get; and
• Promptly report outbreaks to patients and health authorities.

Reference

1. Consumer Reports. America’s antibiotic crisis: how your hospital can make you sick. July 29, 2015. Accessed September 12, 2015.

Consumer Reports included for the first time in its national hospital quality ratings a ranking of how well 3,000 hospitals are controlling common deadly infections such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.

The How Your Hospital Can Make You Sick report is based on information provided to the CDC between October 2013 and September 2014. The CDC found that 105 hospitals distinguished themselves by earning high ratings against both infections. Nine hospitals received top ratings for having no infections from MRSA, C. diff, or other measured infections, although none of the country’s highest-profile hospitals are on that list. Only 6% of hospitals scored well against both infections in the new ratings. The CDC estimates that 648,000 people develop infections during their hospital stay, with 75,000 dying from them; many of the deaths can be traced back to widespread, inappropriate use of antibiotics.

“High rates for MRSA and C. diff can be a red flag that a hospital isn’t following the best practices in preventing infections and prescribing antibiotics,” notes Doris Peter, PhD, director of Consumer Reports’ Health Ratings Center, in a prepared statement. “The data show that it is possible to keep infection rates down and in some cases avoid them altogether.”

Among Consumer Reports’ recommendations for hospitals:

• Consistently follow established protocols for managing superbug infections;
• Accurately track how many infections patients get; and
• Promptly report outbreaks to patients and health authorities.

Reference

1. Consumer Reports. America’s antibiotic crisis: how your hospital can make you sick. July 29, 2015. Accessed September 12, 2015.

Consumer Reports included for the first time in its national hospital quality ratings a ranking of how well 3,000 hospitals are controlling common deadly infections such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.

The How Your Hospital Can Make You Sick report is based on information provided to the CDC between October 2013 and September 2014. The CDC found that 105 hospitals distinguished themselves by earning high ratings against both infections. Nine hospitals received top ratings for having no infections from MRSA, C. diff, or other measured infections, although none of the country’s highest-profile hospitals are on that list. Only 6% of hospitals scored well against both infections in the new ratings. The CDC estimates that 648,000 people develop infections during their hospital stay, with 75,000 dying from them; many of the deaths can be traced back to widespread, inappropriate use of antibiotics.

“High rates for MRSA and C. diff can be a red flag that a hospital isn’t following the best practices in preventing infections and prescribing antibiotics,” notes Doris Peter, PhD, director of Consumer Reports’ Health Ratings Center, in a prepared statement. “The data show that it is possible to keep infection rates down and in some cases avoid them altogether.”

Among Consumer Reports’ recommendations for hospitals:

• Consistently follow established protocols for managing superbug infections;
• Accurately track how many infections patients get; and
• Promptly report outbreaks to patients and health authorities.

Reference

1. Consumer Reports. America’s antibiotic crisis: how your hospital can make you sick. July 29, 2015. Accessed September 12, 2015.

The Joint Commission’s Center for Transforming Healthcare has released its Targeted Solutions Tool for preventing hospital inpatient falls and falls with injuries. This step-by-step, online resource helps hospitals measure their fall rates and identify barriers to fall prevention and the specific contributing factors that lead to falls. A systematic approach enables the organization to assess each patient’s risk for falling and then implement specific targeted solutions to address the contributing factors, which will vary from one organization to the next.

Hospital falls total between 700,000 and one million per year, according to the Agency for Healthcare Research and Quality; since 2008, the Centers for Medicare and Medicaid Services has not paid hospitals for the costs of extra care related to falls.

The Joint Commission calculates, based on average baseline and improvement figures from its Preventing Falls with Injury Project, that a typical 200-bed hospital could reduce its number of patients injured by falls annually from 117 to 45. Key elements of a program achieving that kind of success include consistent messaging focused on operational and cultural change, staff engagement, and an “all hands on deck” approach that involves hospitalists and other physicians in helping to prevent falls by hospitalized patients.

The Joint Commission’s Center for Transforming Healthcare has released its Targeted Solutions Tool for preventing hospital inpatient falls and falls with injuries. This step-by-step, online resource helps hospitals measure their fall rates and identify barriers to fall prevention and the specific contributing factors that lead to falls. A systematic approach enables the organization to assess each patient’s risk for falling and then implement specific targeted solutions to address the contributing factors, which will vary from one organization to the next.

Hospital falls total between 700,000 and one million per year, according to the Agency for Healthcare Research and Quality; since 2008, the Centers for Medicare and Medicaid Services has not paid hospitals for the costs of extra care related to falls.

The Joint Commission calculates, based on average baseline and improvement figures from its Preventing Falls with Injury Project, that a typical 200-bed hospital could reduce its number of patients injured by falls annually from 117 to 45. Key elements of a program achieving that kind of success include consistent messaging focused on operational and cultural change, staff engagement, and an “all hands on deck” approach that involves hospitalists and other physicians in helping to prevent falls by hospitalized patients.

The Joint Commission’s Center for Transforming Healthcare has released its Targeted Solutions Tool for preventing hospital inpatient falls and falls with injuries. This step-by-step, online resource helps hospitals measure their fall rates and identify barriers to fall prevention and the specific contributing factors that lead to falls. A systematic approach enables the organization to assess each patient’s risk for falling and then implement specific targeted solutions to address the contributing factors, which will vary from one organization to the next.

Hospital falls total between 700,000 and one million per year, according to the Agency for Healthcare Research and Quality; since 2008, the Centers for Medicare and Medicaid Services has not paid hospitals for the costs of extra care related to falls.

The Joint Commission calculates, based on average baseline and improvement figures from its Preventing Falls with Injury Project, that a typical 200-bed hospital could reduce its number of patients injured by falls annually from 117 to 45. Key elements of a program achieving that kind of success include consistent messaging focused on operational and cultural change, staff engagement, and an “all hands on deck” approach that involves hospitalists and other physicians in helping to prevent falls by hospitalized patients.

An RIV poster presented at HM15 highlights a common problem hospitalists face: morning hyperglycemia in hospitalized patients, including patients not previously diagnosed with diabetes.¹ Lead author Regina Heyl DePietro, BA, now a medical student at Stony Brook (N.Y.) School of Medicine, working with colleagues including David O. Meltzer, MD, PhD, MHM, and Vineet Arora, MD, MAPP, FHM, at the University of Chicago, gathered data to analyze the connections among sleep deprivation, diabetes, and hyperglycemia of hospitalization.

Prior epidemiologic and laboratory research has shown a correlation between hyperglycemia and impaired sleep, DePietro says, but she is not aware of any inpatient cohort study done on this subject. Although diabetic patients have worse morning fasting glucose measures, the correlation between poor quality and quantity of sleep and higher blood glucose levels is also present in patients not previously diagnosed with diabetes.

In her study, participating patients reported their sleep quality prior to hospitalization, while wrist actigraphy measured the duration and efficiency of their sleep in the hospital. Every hour of inpatient sleep loss raised the odds of elevated subsequent morning blood glucose rates by 17%.

“Sleep helps healing,” DePietro says. “Sleep deprivation is a preventable patient quality metric that we have shown affects a health measure.”

Based on additional research, hospitals could take behavioral and/or design measures to help ameliorate this problem.

Reference

1. DePietro RH, Spampinato LM, Knutson KL, Cauter EV, Meltzer DO, Arora VM. Hyperglycemia of hospitalization: side effect of sleep deprivation? [abstract] Society of Hospital Medicine Annual Meeting 2015. Accessed September 12, 2015.

An RIV poster presented at HM15 highlights a common problem hospitalists face: morning hyperglycemia in hospitalized patients, including patients not previously diagnosed with diabetes.¹ Lead author Regina Heyl DePietro, BA, now a medical student at Stony Brook (N.Y.) School of Medicine, working with colleagues including David O. Meltzer, MD, PhD, MHM, and Vineet Arora, MD, MAPP, FHM, at the University of Chicago, gathered data to analyze the connections among sleep deprivation, diabetes, and hyperglycemia of hospitalization.

Prior epidemiologic and laboratory research has shown a correlation between hyperglycemia and impaired sleep, DePietro says, but she is not aware of any inpatient cohort study done on this subject. Although diabetic patients have worse morning fasting glucose measures, the correlation between poor quality and quantity of sleep and higher blood glucose levels is also present in patients not previously diagnosed with diabetes.

In her study, participating patients reported their sleep quality prior to hospitalization, while wrist actigraphy measured the duration and efficiency of their sleep in the hospital. Every hour of inpatient sleep loss raised the odds of elevated subsequent morning blood glucose rates by 17%.

“Sleep helps healing,” DePietro says. “Sleep deprivation is a preventable patient quality metric that we have shown affects a health measure.”

Based on additional research, hospitals could take behavioral and/or design measures to help ameliorate this problem.

Reference

1. DePietro RH, Spampinato LM, Knutson KL, Cauter EV, Meltzer DO, Arora VM. Hyperglycemia of hospitalization: side effect of sleep deprivation? [abstract] Society of Hospital Medicine Annual Meeting 2015. Accessed September 12, 2015.

An RIV poster presented at HM15 highlights a common problem hospitalists face: morning hyperglycemia in hospitalized patients, including patients not previously diagnosed with diabetes.¹ Lead author Regina Heyl DePietro, BA, now a medical student at Stony Brook (N.Y.) School of Medicine, working with colleagues including David O. Meltzer, MD, PhD, MHM, and Vineet Arora, MD, MAPP, FHM, at the University of Chicago, gathered data to analyze the connections among sleep deprivation, diabetes, and hyperglycemia of hospitalization.

Prior epidemiologic and laboratory research has shown a correlation between hyperglycemia and impaired sleep, DePietro says, but she is not aware of any inpatient cohort study done on this subject. Although diabetic patients have worse morning fasting glucose measures, the correlation between poor quality and quantity of sleep and higher blood glucose levels is also present in patients not previously diagnosed with diabetes.

In her study, participating patients reported their sleep quality prior to hospitalization, while wrist actigraphy measured the duration and efficiency of their sleep in the hospital. Every hour of inpatient sleep loss raised the odds of elevated subsequent morning blood glucose rates by 17%.

“Sleep helps healing,” DePietro says. “Sleep deprivation is a preventable patient quality metric that we have shown affects a health measure.”

Based on additional research, hospitals could take behavioral and/or design measures to help ameliorate this problem.

Reference

1. DePietro RH, Spampinato LM, Knutson KL, Cauter EV, Meltzer DO, Arora VM. Hyperglycemia of hospitalization: side effect of sleep deprivation? [abstract] Society of Hospital Medicine Annual Meeting 2015. Accessed September 12, 2015.

The American Academy of Family Physicians (AAFP) has appealed to some of the nation's largest insurers, asking for coverage of hospital consults conducted by PCPs on behalf of hospitalists for their patients who are in the hospital.

"We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system," says AAFP's commercial insurance strategist Brennan Cantrell. Cantrell's letter to the insurers asks them to review their coverage and payment policies.

Some insurers have downplayed the value of a hospital consultation by the outpatient physician, but advocates have emphasized its value in improving communication and enhancing care transitions.

"Payors' responses to our letter have been positive,” Cantrell tells The Hospitalist. The seven companies indicate that they have policies to permit separate payment for consults done by hospitalists and by PCPs brought in for hospital consults.

Hospitalist Claudia K. Geyer, MD, SFHM, chair of SHM's Family Medicine Committee, says AAFP's consultation initiative could help to formalize the social consult visit for primary care physicians, turning it into a true multidisciplinary approach to managing transitions. However, which patients are most appropriate for this type of consult, how it is initiated, and how many PCPs would be willing and able to provide the service—even if it were billable—require further clarification.

"The key would be for the hospitalist and PCP to work together as a team," Dr. Geyer says.

Visit our website for more information on inpatient visits by PCPs.

The American Academy of Family Physicians (AAFP) has appealed to some of the nation's largest insurers, asking for coverage of hospital consults conducted by PCPs on behalf of hospitalists for their patients who are in the hospital.

"We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system," says AAFP's commercial insurance strategist Brennan Cantrell. Cantrell's letter to the insurers asks them to review their coverage and payment policies.

Some insurers have downplayed the value of a hospital consultation by the outpatient physician, but advocates have emphasized its value in improving communication and enhancing care transitions.

"Payors' responses to our letter have been positive,” Cantrell tells The Hospitalist. The seven companies indicate that they have policies to permit separate payment for consults done by hospitalists and by PCPs brought in for hospital consults.

Hospitalist Claudia K. Geyer, MD, SFHM, chair of SHM's Family Medicine Committee, says AAFP's consultation initiative could help to formalize the social consult visit for primary care physicians, turning it into a true multidisciplinary approach to managing transitions. However, which patients are most appropriate for this type of consult, how it is initiated, and how many PCPs would be willing and able to provide the service—even if it were billable—require further clarification.

"The key would be for the hospitalist and PCP to work together as a team," Dr. Geyer says.

Visit our website for more information on inpatient visits by PCPs.

The American Academy of Family Physicians (AAFP) has appealed to some of the nation's largest insurers, asking for coverage of hospital consults conducted by PCPs on behalf of hospitalists for their patients who are in the hospital.

"We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system," says AAFP's commercial insurance strategist Brennan Cantrell. Cantrell's letter to the insurers asks them to review their coverage and payment policies.

Some insurers have downplayed the value of a hospital consultation by the outpatient physician, but advocates have emphasized its value in improving communication and enhancing care transitions.

"Payors' responses to our letter have been positive,” Cantrell tells The Hospitalist. The seven companies indicate that they have policies to permit separate payment for consults done by hospitalists and by PCPs brought in for hospital consults.

Hospitalist Claudia K. Geyer, MD, SFHM, chair of SHM's Family Medicine Committee, says AAFP's consultation initiative could help to formalize the social consult visit for primary care physicians, turning it into a true multidisciplinary approach to managing transitions. However, which patients are most appropriate for this type of consult, how it is initiated, and how many PCPs would be willing and able to provide the service—even if it were billable—require further clarification.

"The key would be for the hospitalist and PCP to work together as a team," Dr. Geyer says.

Visit our website for more information on inpatient visits by PCPs.