NATIONAL HARBOR, Md.—One might think that in today's ever-churning healthcare environment that is directing much of its ire to hospitals, Bob Wachter, MD, MHM, might be nervous about the future of the specialty he helped name. But Dr. Wachter, chief of the Division of Hospital Medicine at the University of California at San Francisco, really isn't worried.

He believes HM's reputation as "generalists able to solve all kinds of problems" means the specialty is poised to adapt and thrive, he told a crowded ballroom at HM13's final keynote address yesterday at the Gaylord National Resort & Convention Center.

The annual plenary session was the effective wrap-up of SHM's four-day annual meeting, which drew some 2,700 attendees.

"We will morph into what is needed," he said. "That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists…we will fill new niches."

Watch a 2-minute video excerpt from Dr. Wachter's HM13 keynote address

What Dr. Wachter does not want to see is that the field grows "fat and happy" as it is now firmly entrenched in the U.S. healthcare delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs, and, ultimately, improve the patient experience.

"You can't survive and thrive in a world with the kinds of pressures that we have to improve performance, if you do business the same old way," he added. "It's no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care."

NATIONAL HARBOR, Md.—One might think that in today's ever-churning healthcare environment that is directing much of its ire to hospitals, Bob Wachter, MD, MHM, might be nervous about the future of the specialty he helped name. But Dr. Wachter, chief of the Division of Hospital Medicine at the University of California at San Francisco, really isn't worried.

He believes HM's reputation as "generalists able to solve all kinds of problems" means the specialty is poised to adapt and thrive, he told a crowded ballroom at HM13's final keynote address yesterday at the Gaylord National Resort & Convention Center.

The annual plenary session was the effective wrap-up of SHM's four-day annual meeting, which drew some 2,700 attendees.

"We will morph into what is needed," he said. "That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists…we will fill new niches."

Watch a 2-minute video excerpt from Dr. Wachter's HM13 keynote address

What Dr. Wachter does not want to see is that the field grows "fat and happy" as it is now firmly entrenched in the U.S. healthcare delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs, and, ultimately, improve the patient experience.

"You can't survive and thrive in a world with the kinds of pressures that we have to improve performance, if you do business the same old way," he added. "It's no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care."

NATIONAL HARBOR, Md.—One might think that in today's ever-churning healthcare environment that is directing much of its ire to hospitals, Bob Wachter, MD, MHM, might be nervous about the future of the specialty he helped name. But Dr. Wachter, chief of the Division of Hospital Medicine at the University of California at San Francisco, really isn't worried.

He believes HM's reputation as "generalists able to solve all kinds of problems" means the specialty is poised to adapt and thrive, he told a crowded ballroom at HM13's final keynote address yesterday at the Gaylord National Resort & Convention Center.

The annual plenary session was the effective wrap-up of SHM's four-day annual meeting, which drew some 2,700 attendees.

"We will morph into what is needed," he said. "That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists…we will fill new niches."

Watch a 2-minute video excerpt from Dr. Wachter's HM13 keynote address

What Dr. Wachter does not want to see is that the field grows "fat and happy" as it is now firmly entrenched in the U.S. healthcare delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs, and, ultimately, improve the patient experience.

"You can't survive and thrive in a world with the kinds of pressures that we have to improve performance, if you do business the same old way," he added. "It's no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care."

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

ORLANDO – Vitamin D may protect patients with inflammatory bowel disease from more serious disease flare-ups, investigators reported at the annual Digestive Disease Week.

Among 3,217 patients followed for a median of 8 years, those with Crohn’s disease who had the lowest levels of plasma 25-hydroxyvitamin D had a nearly twofold risk for surgery and double the risk for hospitalization related to IBD, compared with patients who had higher vitamin D levels.

A similar relationship was seen between vitamin D levels and risk of surgery and hospitalization among patients with ulcerative colitis (UC), reported Dr. Ashwin Ananthakrishnan of Massachusetts General Hospital in Boston.

Tellingly, patients with Crohn’s disease (CD) who had initially low vitamin D levels that normalized during the study had significant reductions in their risk of surgery and hospitalization compared with patients whose vitamin D levels did not improve over time. In addition, patients with both CD and UC who normalized their vitamin D status during the study had significantly lower levels of the inflammatory marker C-reactive protein, the investigators found.

"There’s considerable evidence that supports a role for vitamin D in inflammatory bowel diseases," Dr. Ananthakrishnan said.

He noted that high vitamin D levels were associated with a reduced risk for CD in a prior study performed by his group (Gastroenterology 2012;142:482-9), and a second study showed that polymorphisms in the vitamin D receptor were associated with a risk of both CD and UC (Gut 2000;47:211-4).

Although vitamin D levels have been weakly associated with IBD exacerbations in retrospective studies, stronger evidence for the potential anti-inflammatory role of vitamin D has been hard to come by, partly because of researchers’ inability to determine vitamin D status before clinical outcomes such as surgery or hospitalization, Dr. Ananthakrishnan said.

He and colleagues prospectively followed all members of an IBD cohort treated at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, who had a least one measured plasma 25(OH)D level before a first IBD-related surgery and/or hospitalization (the primary outcome; median C-reactive protein was a secondary outcome).

The researchers found that 16% of all patients had disease-related surgery, and 40% were hospitalized during the follow-up period.

A third of all patients (32%) were considered to be vitamin D deficient, defined as having a plasma 25(OH)D level below 20 ng/mL, and 28% were deemed to be vitamin D insufficient (20-30 ng/mL). The remaining 40% had sufficient vitamin D levels of 30 ng/mL and higher.

When the investigators controlled for age, sex, race, Charlson score (non-IBD comorbidity), disease-related complications, medication, vitamin D supplementation, and season of 25(OH)D measurement, analysis showed that patients with CD who had plasma vitamin D levels below 20 ng/mL had odds ratios of 1.76 for surgery and 2.07 for IBD-related hospitalization.

Similarly, for patients with UC and low vitamin D levels, the odds ratios for surgery and hospitalization were 1.70 and 2.26, respectively.

Overall, 76% of patients in the study with CD who had initial vitamin D levels below 30 ng/mL had subsequent normalization of their D values, as did 80% of those with ulcerative colitis.

In adjusted analysis, patients with CD had a nearly 50% reduction in the risk of surgery (odds ratio, 0.56) and a nearly 25% reduction in the risk of hospitalization (OR, 0.78), compared with patients whose vitamin D levels never corrected to the normal range. Patients with UC also had reductions in risk for both surgery and hospitalization, but these reductions were not significant.

In addition, patients with CD and UC who had vitamin D that normalized over the course of the study had significantly lower C-reactive protein levels than did those who remained vitamin D deficient (–5. 2 mg/L, P = .002).

The study was supported by grants and awards from the American Gastroenterological Association, the IBD Working Group, the Broad Foundation, and the National Institutes of Health. Dr. Ananthakrishnan reported having no financial disclosures.

ORLANDO – Vitamin D may protect patients with inflammatory bowel disease from more serious disease flare-ups, investigators reported at the annual Digestive Disease Week.

Among 3,217 patients followed for a median of 8 years, those with Crohn’s disease who had the lowest levels of plasma 25-hydroxyvitamin D had a nearly twofold risk for surgery and double the risk for hospitalization related to IBD, compared with patients who had higher vitamin D levels.

A similar relationship was seen between vitamin D levels and risk of surgery and hospitalization among patients with ulcerative colitis (UC), reported Dr. Ashwin Ananthakrishnan of Massachusetts General Hospital in Boston.

Tellingly, patients with Crohn’s disease (CD) who had initially low vitamin D levels that normalized during the study had significant reductions in their risk of surgery and hospitalization compared with patients whose vitamin D levels did not improve over time. In addition, patients with both CD and UC who normalized their vitamin D status during the study had significantly lower levels of the inflammatory marker C-reactive protein, the investigators found.

"There’s considerable evidence that supports a role for vitamin D in inflammatory bowel diseases," Dr. Ananthakrishnan said.

He noted that high vitamin D levels were associated with a reduced risk for CD in a prior study performed by his group (Gastroenterology 2012;142:482-9), and a second study showed that polymorphisms in the vitamin D receptor were associated with a risk of both CD and UC (Gut 2000;47:211-4).

Although vitamin D levels have been weakly associated with IBD exacerbations in retrospective studies, stronger evidence for the potential anti-inflammatory role of vitamin D has been hard to come by, partly because of researchers’ inability to determine vitamin D status before clinical outcomes such as surgery or hospitalization, Dr. Ananthakrishnan said.

He and colleagues prospectively followed all members of an IBD cohort treated at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, who had a least one measured plasma 25(OH)D level before a first IBD-related surgery and/or hospitalization (the primary outcome; median C-reactive protein was a secondary outcome).

The researchers found that 16% of all patients had disease-related surgery, and 40% were hospitalized during the follow-up period.

A third of all patients (32%) were considered to be vitamin D deficient, defined as having a plasma 25(OH)D level below 20 ng/mL, and 28% were deemed to be vitamin D insufficient (20-30 ng/mL). The remaining 40% had sufficient vitamin D levels of 30 ng/mL and higher.

When the investigators controlled for age, sex, race, Charlson score (non-IBD comorbidity), disease-related complications, medication, vitamin D supplementation, and season of 25(OH)D measurement, analysis showed that patients with CD who had plasma vitamin D levels below 20 ng/mL had odds ratios of 1.76 for surgery and 2.07 for IBD-related hospitalization.

Similarly, for patients with UC and low vitamin D levels, the odds ratios for surgery and hospitalization were 1.70 and 2.26, respectively.

Overall, 76% of patients in the study with CD who had initial vitamin D levels below 30 ng/mL had subsequent normalization of their D values, as did 80% of those with ulcerative colitis.

In adjusted analysis, patients with CD had a nearly 50% reduction in the risk of surgery (odds ratio, 0.56) and a nearly 25% reduction in the risk of hospitalization (OR, 0.78), compared with patients whose vitamin D levels never corrected to the normal range. Patients with UC also had reductions in risk for both surgery and hospitalization, but these reductions were not significant.

In addition, patients with CD and UC who had vitamin D that normalized over the course of the study had significantly lower C-reactive protein levels than did those who remained vitamin D deficient (–5. 2 mg/L, P = .002).

The study was supported by grants and awards from the American Gastroenterological Association, the IBD Working Group, the Broad Foundation, and the National Institutes of Health. Dr. Ananthakrishnan reported having no financial disclosures.

ORLANDO – Vitamin D may protect patients with inflammatory bowel disease from more serious disease flare-ups, investigators reported at the annual Digestive Disease Week.

Among 3,217 patients followed for a median of 8 years, those with Crohn’s disease who had the lowest levels of plasma 25-hydroxyvitamin D had a nearly twofold risk for surgery and double the risk for hospitalization related to IBD, compared with patients who had higher vitamin D levels.

A similar relationship was seen between vitamin D levels and risk of surgery and hospitalization among patients with ulcerative colitis (UC), reported Dr. Ashwin Ananthakrishnan of Massachusetts General Hospital in Boston.

Tellingly, patients with Crohn’s disease (CD) who had initially low vitamin D levels that normalized during the study had significant reductions in their risk of surgery and hospitalization compared with patients whose vitamin D levels did not improve over time. In addition, patients with both CD and UC who normalized their vitamin D status during the study had significantly lower levels of the inflammatory marker C-reactive protein, the investigators found.

"There’s considerable evidence that supports a role for vitamin D in inflammatory bowel diseases," Dr. Ananthakrishnan said.

He noted that high vitamin D levels were associated with a reduced risk for CD in a prior study performed by his group (Gastroenterology 2012;142:482-9), and a second study showed that polymorphisms in the vitamin D receptor were associated with a risk of both CD and UC (Gut 2000;47:211-4).

Although vitamin D levels have been weakly associated with IBD exacerbations in retrospective studies, stronger evidence for the potential anti-inflammatory role of vitamin D has been hard to come by, partly because of researchers’ inability to determine vitamin D status before clinical outcomes such as surgery or hospitalization, Dr. Ananthakrishnan said.

He and colleagues prospectively followed all members of an IBD cohort treated at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, who had a least one measured plasma 25(OH)D level before a first IBD-related surgery and/or hospitalization (the primary outcome; median C-reactive protein was a secondary outcome).

The researchers found that 16% of all patients had disease-related surgery, and 40% were hospitalized during the follow-up period.

A third of all patients (32%) were considered to be vitamin D deficient, defined as having a plasma 25(OH)D level below 20 ng/mL, and 28% were deemed to be vitamin D insufficient (20-30 ng/mL). The remaining 40% had sufficient vitamin D levels of 30 ng/mL and higher.

When the investigators controlled for age, sex, race, Charlson score (non-IBD comorbidity), disease-related complications, medication, vitamin D supplementation, and season of 25(OH)D measurement, analysis showed that patients with CD who had plasma vitamin D levels below 20 ng/mL had odds ratios of 1.76 for surgery and 2.07 for IBD-related hospitalization.

Similarly, for patients with UC and low vitamin D levels, the odds ratios for surgery and hospitalization were 1.70 and 2.26, respectively.

Overall, 76% of patients in the study with CD who had initial vitamin D levels below 30 ng/mL had subsequent normalization of their D values, as did 80% of those with ulcerative colitis.

In adjusted analysis, patients with CD had a nearly 50% reduction in the risk of surgery (odds ratio, 0.56) and a nearly 25% reduction in the risk of hospitalization (OR, 0.78), compared with patients whose vitamin D levels never corrected to the normal range. Patients with UC also had reductions in risk for both surgery and hospitalization, but these reductions were not significant.

In addition, patients with CD and UC who had vitamin D that normalized over the course of the study had significantly lower C-reactive protein levels than did those who remained vitamin D deficient (–5. 2 mg/L, P = .002).

The study was supported by grants and awards from the American Gastroenterological Association, the IBD Working Group, the Broad Foundation, and the National Institutes of Health. Dr. Ananthakrishnan reported having no financial disclosures.

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

 

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

 

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

 

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

Scott Flanders, MD, SFHM, director of the hospitalist program at the University of Michigan in Ann Arbor set out to answer three key questions in “rapid-fire” format during the “Pneumonia Update” at HM13.

1. Is procalcitonin ready for “prime time” in determining community-acquired pneumonia (CAP) treatment duration?
2. What is the utility of diagnostic testing in CAP patients?
3. How do you decide which pneumonia patients need broad-spectrum antibiotic coverage?

It turns out that lots of other countries follow procalcitonin levels as a marker of inflammation during CAP treatment. A 2012 Archives of Internal Medicine article notes that U.S. compliance with measuring procalcitonin levels is less than 40%, and monitoring these levels can help diagnosis and guide treatment and the duration of treatment. Procalcitonin is released in the blood in response to bacterial infection. It rises within four hours of infection (earlier than other markers such as CRP and ESR.) The degree and rate of rise is associated with severity; the rate of decline is associated with resolution. Numerous studies show that when providers correlate CAP treatment with procalcitonin levels there is a safe reduction in antibiotic days.

Dr. Flanders also examined the utility of diagnostic tests. In general, CAP outcomes are unchanged and management rarely is impacted by sputum collection. Within the ICU setting it is recommended to get sputum cultures, as it may have a role in healthcare-associated pneumonia, especially if a patient has a history of drug-resistant organisms.

With regard to blood culture analysis, only 4% to 7% of blood cultures are positive in CAP, with many of them being false positives. False positive cultures lead to a 50% increase in charges, and increase length of stay by 65%. A 2004 American Journal of Respiratory and Critical Care Medicine article recommends targeted blood culture screen that correctly detect 90% of bacteremia with 40% fewer cultures. It recommends that patients who are at risk for bacteremia (those with prior antibiotics, WBC count greater than 20, systolic BP less than 90, history of liver disease, temperature greater than 40 degrees or less than 35 degrees celsius, elevated BUN greater than 30, sodium less than 130, pulse greater than 125) be given a point for each risk factor. Those with no risk and no prior antibiotics were deemed safe to forgo cultures. Those with one risk factor, with prior antibiotics were recommended to get one set of cultures. Those with more than one risk factor were recommended to receive two sets of cultures.

Pneumococcal urinary antigen was evaluated. It is noted to have great specificity, but lousy sensitivity. Patients with bacteremia might have false negative results. In general, the antigen might be appropriate in non-severe cases if it will help you narrow therapy. But it shouldn’t be ordered if it is not going to change therapy.

Dr. Flanders also noted that urinary legionella antigen is 80% sensitive for legionella.

Answering the question about the need for broad-spectrum antibiotics, it was thought that any patient receiving home care or home wound care, goes to a dialysis center, lives in a NH or LTC facility would need broad-spectrum antibiotics for HCAP. But Dr. Flanders states it may be a case of doing too much too fast. He recommends patients that reside in nursing homes or who receive home care be treated as a CAP, as the risk of drug-resistant organisms isn’t actually that high in that group. But if a patient had previous admission to the hospital, he recommends treatment for HCAP.

Strong risk factors for resistant organisms include prior hospitalization in past 90 days, LTAC/SNF patients if they have had prior antibiotics and have poor functional status, critically-ill patients, or those with prior MRSA/pseudomonal infections. The data for nursing home patients, home health or home wound care or dialysis patients is less clear. TH

 

Tracy Cardin is a nurse practitioner in the section of hospital medicine at University of Chicago.

Scott Flanders, MD, SFHM, director of the hospitalist program at the University of Michigan in Ann Arbor set out to answer three key questions in “rapid-fire” format during the “Pneumonia Update” at HM13.

1. Is procalcitonin ready for “prime time” in determining community-acquired pneumonia (CAP) treatment duration?
2. What is the utility of diagnostic testing in CAP patients?
3. How do you decide which pneumonia patients need broad-spectrum antibiotic coverage?

It turns out that lots of other countries follow procalcitonin levels as a marker of inflammation during CAP treatment. A 2012 Archives of Internal Medicine article notes that U.S. compliance with measuring procalcitonin levels is less than 40%, and monitoring these levels can help diagnosis and guide treatment and the duration of treatment. Procalcitonin is released in the blood in response to bacterial infection. It rises within four hours of infection (earlier than other markers such as CRP and ESR.) The degree and rate of rise is associated with severity; the rate of decline is associated with resolution. Numerous studies show that when providers correlate CAP treatment with procalcitonin levels there is a safe reduction in antibiotic days.

Dr. Flanders also examined the utility of diagnostic tests. In general, CAP outcomes are unchanged and management rarely is impacted by sputum collection. Within the ICU setting it is recommended to get sputum cultures, as it may have a role in healthcare-associated pneumonia, especially if a patient has a history of drug-resistant organisms.

With regard to blood culture analysis, only 4% to 7% of blood cultures are positive in CAP, with many of them being false positives. False positive cultures lead to a 50% increase in charges, and increase length of stay by 65%. A 2004 American Journal of Respiratory and Critical Care Medicine article recommends targeted blood culture screen that correctly detect 90% of bacteremia with 40% fewer cultures. It recommends that patients who are at risk for bacteremia (those with prior antibiotics, WBC count greater than 20, systolic BP less than 90, history of liver disease, temperature greater than 40 degrees or less than 35 degrees celsius, elevated BUN greater than 30, sodium less than 130, pulse greater than 125) be given a point for each risk factor. Those with no risk and no prior antibiotics were deemed safe to forgo cultures. Those with one risk factor, with prior antibiotics were recommended to get one set of cultures. Those with more than one risk factor were recommended to receive two sets of cultures.

Pneumococcal urinary antigen was evaluated. It is noted to have great specificity, but lousy sensitivity. Patients with bacteremia might have false negative results. In general, the antigen might be appropriate in non-severe cases if it will help you narrow therapy. But it shouldn’t be ordered if it is not going to change therapy.

Dr. Flanders also noted that urinary legionella antigen is 80% sensitive for legionella.

Answering the question about the need for broad-spectrum antibiotics, it was thought that any patient receiving home care or home wound care, goes to a dialysis center, lives in a NH or LTC facility would need broad-spectrum antibiotics for HCAP. But Dr. Flanders states it may be a case of doing too much too fast. He recommends patients that reside in nursing homes or who receive home care be treated as a CAP, as the risk of drug-resistant organisms isn’t actually that high in that group. But if a patient had previous admission to the hospital, he recommends treatment for HCAP.

Strong risk factors for resistant organisms include prior hospitalization in past 90 days, LTAC/SNF patients if they have had prior antibiotics and have poor functional status, critically-ill patients, or those with prior MRSA/pseudomonal infections. The data for nursing home patients, home health or home wound care or dialysis patients is less clear. TH

 

Tracy Cardin is a nurse practitioner in the section of hospital medicine at University of Chicago.

Scott Flanders, MD, SFHM, director of the hospitalist program at the University of Michigan in Ann Arbor set out to answer three key questions in “rapid-fire” format during the “Pneumonia Update” at HM13.

1. Is procalcitonin ready for “prime time” in determining community-acquired pneumonia (CAP) treatment duration?
2. What is the utility of diagnostic testing in CAP patients?
3. How do you decide which pneumonia patients need broad-spectrum antibiotic coverage?

It turns out that lots of other countries follow procalcitonin levels as a marker of inflammation during CAP treatment. A 2012 Archives of Internal Medicine article notes that U.S. compliance with measuring procalcitonin levels is less than 40%, and monitoring these levels can help diagnosis and guide treatment and the duration of treatment. Procalcitonin is released in the blood in response to bacterial infection. It rises within four hours of infection (earlier than other markers such as CRP and ESR.) The degree and rate of rise is associated with severity; the rate of decline is associated with resolution. Numerous studies show that when providers correlate CAP treatment with procalcitonin levels there is a safe reduction in antibiotic days.

Dr. Flanders also examined the utility of diagnostic tests. In general, CAP outcomes are unchanged and management rarely is impacted by sputum collection. Within the ICU setting it is recommended to get sputum cultures, as it may have a role in healthcare-associated pneumonia, especially if a patient has a history of drug-resistant organisms.

With regard to blood culture analysis, only 4% to 7% of blood cultures are positive in CAP, with many of them being false positives. False positive cultures lead to a 50% increase in charges, and increase length of stay by 65%. A 2004 American Journal of Respiratory and Critical Care Medicine article recommends targeted blood culture screen that correctly detect 90% of bacteremia with 40% fewer cultures. It recommends that patients who are at risk for bacteremia (those with prior antibiotics, WBC count greater than 20, systolic BP less than 90, history of liver disease, temperature greater than 40 degrees or less than 35 degrees celsius, elevated BUN greater than 30, sodium less than 130, pulse greater than 125) be given a point for each risk factor. Those with no risk and no prior antibiotics were deemed safe to forgo cultures. Those with one risk factor, with prior antibiotics were recommended to get one set of cultures. Those with more than one risk factor were recommended to receive two sets of cultures.

Pneumococcal urinary antigen was evaluated. It is noted to have great specificity, but lousy sensitivity. Patients with bacteremia might have false negative results. In general, the antigen might be appropriate in non-severe cases if it will help you narrow therapy. But it shouldn’t be ordered if it is not going to change therapy.

Dr. Flanders also noted that urinary legionella antigen is 80% sensitive for legionella.

Answering the question about the need for broad-spectrum antibiotics, it was thought that any patient receiving home care or home wound care, goes to a dialysis center, lives in a NH or LTC facility would need broad-spectrum antibiotics for HCAP. But Dr. Flanders states it may be a case of doing too much too fast. He recommends patients that reside in nursing homes or who receive home care be treated as a CAP, as the risk of drug-resistant organisms isn’t actually that high in that group. But if a patient had previous admission to the hospital, he recommends treatment for HCAP.

Strong risk factors for resistant organisms include prior hospitalization in past 90 days, LTAC/SNF patients if they have had prior antibiotics and have poor functional status, critically-ill patients, or those with prior MRSA/pseudomonal infections. The data for nursing home patients, home health or home wound care or dialysis patients is less clear. TH

 

Tracy Cardin is a nurse practitioner in the section of hospital medicine at University of Chicago.

The practice management session titled, “Improving Patient Satisfaction—Two Success Stories,” was presented by Steven Deiteizweig, MD, system chairman, Department of Hospital Medicine and medical director, regional business development from Ochsner Health System in New Orleans, Peter Short, MD, CMO for Addison Gilbert and Beverly Hospitals in Massachusetts, and Richard Slataper, MD, medical director for the HM service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Optimizing the patient experience and overall satisfaction continues to be a focus of all hospitals and hospitalists. Presenters examined realistic expectations and tactics to improve patient satisfaction scores, as well as leverage the hospitalists’ role with hospital administration. Additionally, key considerations in reporting and benchmarking patient satisfaction were discussed.

One of the key messages was not to attempt to implement all of the suggestions but to pick three tactics, perfect them, and move on to another three tactics.

Dr. Short stressed patience in implementing the approach. He also emphasized that in order to make a difference, all stakeholders need to be committed to enhancing the patient experience and no one person can change the outcome. It has to be the complete patient experience team—physicians, nursing, administration, environmental services, transportation, etc.

Drs. Short and Slataper discussed the Studer group application of the mnemonic AIDET (Acknowledge, Introduce, Duration, Explain, and Thank), as well as the importance of sitting down to discuss a patients’ care and consistent utilization of a white board in every patient room. Dr. Short implemented hourly rounding in his hospitals, which faced initial resistance from nursing but over time experienced a 50% reduction in call lights.

Dr. Short also discussed making sure to take the time to celebrate success when the patient experience improvement has been improved.

Another key message was to insure the right hospitalists are hired to be part of the team. Without engaged and enthusiastic providers, how can anyone expect the patients to be engaged in their care?

Dr. Slataper took some time to talk about his program’s efforts to keep the caseload to 16 patients per day, which coincided with benchmarks presented in another practice management session. Slataper’s program has grown and they have recruited to keep the average encounters per day to around 16, which he says helps prevent provider burnout and is supported by research.

A number of the tactics to improve the patient experience are common sense to how we would want ourselves, or one of your family members, treated. However, it really comes down to communication. For example:

• Mentality of all care-team members who will interact with the patient during their stay;
• Time with the patient and their family to make them perceive as though they are the only patient in the hospital;
• Alignment of goals from the board of trustees/directors to the environmental staff; and
• Communication with the PCP or sub-acute facility during and post-discharge.

Each hospitalist program needs to define what success will look like for their program with all of the stakeholders and then execute on those tactics. Additionally, consistent feedback in the forms of dashboards and feedback assist in moving the needle. TH

Bryan Weiss is managing director of MedSynergies, Inc., in Irving, Texas.

 

The practice management session titled, “Improving Patient Satisfaction—Two Success Stories,” was presented by Steven Deiteizweig, MD, system chairman, Department of Hospital Medicine and medical director, regional business development from Ochsner Health System in New Orleans, Peter Short, MD, CMO for Addison Gilbert and Beverly Hospitals in Massachusetts, and Richard Slataper, MD, medical director for the HM service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Optimizing the patient experience and overall satisfaction continues to be a focus of all hospitals and hospitalists. Presenters examined realistic expectations and tactics to improve patient satisfaction scores, as well as leverage the hospitalists’ role with hospital administration. Additionally, key considerations in reporting and benchmarking patient satisfaction were discussed.

One of the key messages was not to attempt to implement all of the suggestions but to pick three tactics, perfect them, and move on to another three tactics.

Dr. Short stressed patience in implementing the approach. He also emphasized that in order to make a difference, all stakeholders need to be committed to enhancing the patient experience and no one person can change the outcome. It has to be the complete patient experience team—physicians, nursing, administration, environmental services, transportation, etc.

Drs. Short and Slataper discussed the Studer group application of the mnemonic AIDET (Acknowledge, Introduce, Duration, Explain, and Thank), as well as the importance of sitting down to discuss a patients’ care and consistent utilization of a white board in every patient room. Dr. Short implemented hourly rounding in his hospitals, which faced initial resistance from nursing but over time experienced a 50% reduction in call lights.

Dr. Short also discussed making sure to take the time to celebrate success when the patient experience improvement has been improved.

Another key message was to insure the right hospitalists are hired to be part of the team. Without engaged and enthusiastic providers, how can anyone expect the patients to be engaged in their care?

Dr. Slataper took some time to talk about his program’s efforts to keep the caseload to 16 patients per day, which coincided with benchmarks presented in another practice management session. Slataper’s program has grown and they have recruited to keep the average encounters per day to around 16, which he says helps prevent provider burnout and is supported by research.

A number of the tactics to improve the patient experience are common sense to how we would want ourselves, or one of your family members, treated. However, it really comes down to communication. For example:

• Mentality of all care-team members who will interact with the patient during their stay;
• Time with the patient and their family to make them perceive as though they are the only patient in the hospital;
• Alignment of goals from the board of trustees/directors to the environmental staff; and
• Communication with the PCP or sub-acute facility during and post-discharge.

Each hospitalist program needs to define what success will look like for their program with all of the stakeholders and then execute on those tactics. Additionally, consistent feedback in the forms of dashboards and feedback assist in moving the needle. TH

Bryan Weiss is managing director of MedSynergies, Inc., in Irving, Texas.

 

The practice management session titled, “Improving Patient Satisfaction—Two Success Stories,” was presented by Steven Deiteizweig, MD, system chairman, Department of Hospital Medicine and medical director, regional business development from Ochsner Health System in New Orleans, Peter Short, MD, CMO for Addison Gilbert and Beverly Hospitals in Massachusetts, and Richard Slataper, MD, medical director for the HM service at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Optimizing the patient experience and overall satisfaction continues to be a focus of all hospitals and hospitalists. Presenters examined realistic expectations and tactics to improve patient satisfaction scores, as well as leverage the hospitalists’ role with hospital administration. Additionally, key considerations in reporting and benchmarking patient satisfaction were discussed.

One of the key messages was not to attempt to implement all of the suggestions but to pick three tactics, perfect them, and move on to another three tactics.

Dr. Short stressed patience in implementing the approach. He also emphasized that in order to make a difference, all stakeholders need to be committed to enhancing the patient experience and no one person can change the outcome. It has to be the complete patient experience team—physicians, nursing, administration, environmental services, transportation, etc.

Drs. Short and Slataper discussed the Studer group application of the mnemonic AIDET (Acknowledge, Introduce, Duration, Explain, and Thank), as well as the importance of sitting down to discuss a patients’ care and consistent utilization of a white board in every patient room. Dr. Short implemented hourly rounding in his hospitals, which faced initial resistance from nursing but over time experienced a 50% reduction in call lights.

Dr. Short also discussed making sure to take the time to celebrate success when the patient experience improvement has been improved.

Another key message was to insure the right hospitalists are hired to be part of the team. Without engaged and enthusiastic providers, how can anyone expect the patients to be engaged in their care?

Dr. Slataper took some time to talk about his program’s efforts to keep the caseload to 16 patients per day, which coincided with benchmarks presented in another practice management session. Slataper’s program has grown and they have recruited to keep the average encounters per day to around 16, which he says helps prevent provider burnout and is supported by research.

A number of the tactics to improve the patient experience are common sense to how we would want ourselves, or one of your family members, treated. However, it really comes down to communication. For example:

• Mentality of all care-team members who will interact with the patient during their stay;
• Time with the patient and their family to make them perceive as though they are the only patient in the hospital;
• Alignment of goals from the board of trustees/directors to the environmental staff; and
• Communication with the PCP or sub-acute facility during and post-discharge.

Each hospitalist program needs to define what success will look like for their program with all of the stakeholders and then execute on those tactics. Additionally, consistent feedback in the forms of dashboards and feedback assist in moving the needle. TH

Bryan Weiss is managing director of MedSynergies, Inc., in Irving, Texas.

 

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA

HM13 is off to a strong start with a clear overarching goal of improving patient care in a global way. David Feinberg, MD, MBA, President of the UCLA Health System, gave a wonderful perspective of leading a large health care system as an “outsider.” His training as a child psychiatrist helped him look at the human perspective of health care. Dr. Feinberg gave the example of his first 100 days as interim CEO, in which he spent up to two hours a day just visiting hospital patients to hear their perspective.

After continuing on as president of the UCLA Health System, Dr. Feinberg continued this philosophy of “healing patients, one patient at a time.” UCLA is a top-rated medical institution, but even they have had low patient satisfaction scores in the past. By focusing institutional resources on individual patients, UCLA’s satisfaction scores rose from the 38th percentile to the 99th percentile.

Dr. Feinberg also discussed the advantages of having a strong professional staff. In addition to assessing core certifications before a potential new employee is hired, the service perspective is extremely important in health care. Dr. Feinberg has employed the “Talent Plus” model used by the Ritz-Carlton luxury hotels and resorts. This is a program designed to assess service skills in new staff and teach service techniques to new hires.

Takeaways:

• “Healing patients one patient at a time” is an incredible hospital approach that leads to better health care, improved patient satisfaction, and even financial success.

• A strong professional staff who is looking out for a patient’s comfort and well-being while providing high quality health care is the touch that will help improve several areas of health care, not just patient satisfaction.

Dan Hale, MD, FAAP, is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center, Boston, MA