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Tom Collins is a freelance writer in South Florida who has written about medical topics from nasty infections to ethical dilemmas, runaway tumors to tornado-chasing doctors. He travels the globe gathering conference health news and lives in West Palm Beach.
Hospitalists offer tips on QI projects
Anjala Tess, MD, a hospitalist at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, Boston, asked the audience how many of them had done a quality improvement project that had failed. It was not a time to be bashful: Almost half the hospitalists in the room admitted that it had happened to them.
Dr. Tess and Darlene Tad-y, MD, chair of the Physicians-in-Training Committee and an assistant professor of medicine at the University of Colorado, were there to offer help in their session, “Adding to Your QI Toolbox.”
They highlighted three tools that they say are crucial to a project’s success: Creating a process map for clearly outlining how the project will work, interacting with stakeholders productively, and displaying data in a meaningful way.
Process mapping is a way of visualizing work or a process as distinct, ordered, and related steps, Dr. Tess said. Arranged on Post-It notes or written on a white board, the process should be one that can easily be updated. Seen objectively as a set of steps, it helps remove bias in how a process is viewed, she said.
“I would encourage you to do this on every QI project that you do where you are trying to accomplish something, because it makes a huge difference in understanding the work,” she said.
Stakeholder analysis – understanding the key people whose support could determine the success of the project – is also critical, she said. This can help get buy-in for the change, and it make a project stronger – and without it, you could doom your project, Dr. Tess said.
Doing this well involves understanding their financial and emotional interests, all the way down to whether they prefer face-to-face communication or e-mail, she said.
Then there’s the data. For it to matter, it must be presented well, and that requires context, Dr. Tad-y said.
“Data are just raw facts and figures,” she said. “Data are not the same as information.”
She suggested using run charts, in which data are plotted in some kind of order, usually chronological order. This kind of chart will typically include a median line, showing practice patterns before the QI project began, as well as a “goal line” to aim for, and notations on the timeline when changes were made, she said.
Others will be looking to the project manager for the meaning behind the data, she said.
“The story is going to come from you,” she said. “Otherwise, it’s just numbers.”
Anjala Tess, MD, a hospitalist at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, Boston, asked the audience how many of them had done a quality improvement project that had failed. It was not a time to be bashful: Almost half the hospitalists in the room admitted that it had happened to them.
Dr. Tess and Darlene Tad-y, MD, chair of the Physicians-in-Training Committee and an assistant professor of medicine at the University of Colorado, were there to offer help in their session, “Adding to Your QI Toolbox.”
They highlighted three tools that they say are crucial to a project’s success: Creating a process map for clearly outlining how the project will work, interacting with stakeholders productively, and displaying data in a meaningful way.
Process mapping is a way of visualizing work or a process as distinct, ordered, and related steps, Dr. Tess said. Arranged on Post-It notes or written on a white board, the process should be one that can easily be updated. Seen objectively as a set of steps, it helps remove bias in how a process is viewed, she said.
“I would encourage you to do this on every QI project that you do where you are trying to accomplish something, because it makes a huge difference in understanding the work,” she said.
Stakeholder analysis – understanding the key people whose support could determine the success of the project – is also critical, she said. This can help get buy-in for the change, and it make a project stronger – and without it, you could doom your project, Dr. Tess said.
Doing this well involves understanding their financial and emotional interests, all the way down to whether they prefer face-to-face communication or e-mail, she said.
Then there’s the data. For it to matter, it must be presented well, and that requires context, Dr. Tad-y said.
“Data are just raw facts and figures,” she said. “Data are not the same as information.”
She suggested using run charts, in which data are plotted in some kind of order, usually chronological order. This kind of chart will typically include a median line, showing practice patterns before the QI project began, as well as a “goal line” to aim for, and notations on the timeline when changes were made, she said.
Others will be looking to the project manager for the meaning behind the data, she said.
“The story is going to come from you,” she said. “Otherwise, it’s just numbers.”
Anjala Tess, MD, a hospitalist at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, Boston, asked the audience how many of them had done a quality improvement project that had failed. It was not a time to be bashful: Almost half the hospitalists in the room admitted that it had happened to them.
Dr. Tess and Darlene Tad-y, MD, chair of the Physicians-in-Training Committee and an assistant professor of medicine at the University of Colorado, were there to offer help in their session, “Adding to Your QI Toolbox.”
They highlighted three tools that they say are crucial to a project’s success: Creating a process map for clearly outlining how the project will work, interacting with stakeholders productively, and displaying data in a meaningful way.
Process mapping is a way of visualizing work or a process as distinct, ordered, and related steps, Dr. Tess said. Arranged on Post-It notes or written on a white board, the process should be one that can easily be updated. Seen objectively as a set of steps, it helps remove bias in how a process is viewed, she said.
“I would encourage you to do this on every QI project that you do where you are trying to accomplish something, because it makes a huge difference in understanding the work,” she said.
Stakeholder analysis – understanding the key people whose support could determine the success of the project – is also critical, she said. This can help get buy-in for the change, and it make a project stronger – and without it, you could doom your project, Dr. Tess said.
Doing this well involves understanding their financial and emotional interests, all the way down to whether they prefer face-to-face communication or e-mail, she said.
Then there’s the data. For it to matter, it must be presented well, and that requires context, Dr. Tad-y said.
“Data are just raw facts and figures,” she said. “Data are not the same as information.”
She suggested using run charts, in which data are plotted in some kind of order, usually chronological order. This kind of chart will typically include a median line, showing practice patterns before the QI project began, as well as a “goal line” to aim for, and notations on the timeline when changes were made, she said.
Others will be looking to the project manager for the meaning behind the data, she said.
“The story is going to come from you,” she said. “Otherwise, it’s just numbers.”
Workshop to help hospitalists with patient flow
The “flow” of patients through the hospital can sometimes resemble a 10-lane expressway at gridlock, said Christopher Kim, MD, MBA, SFHM, associate professor of internal medicine and associate medical director of quality and safety at the University of Washington Medical Center in Seattle. That is, there’s no flow at all.
Thursday at HM17, Dr. Kim and a panel of experts will lead small workshops of audience members on how to put the “go” back in the flow. The session, “Hospitalists as Leaders in Patient Flow and Hospital Throughput,” will begin at 10 a.m.
“As hospitalists, we are at the sharp end of this problem and are often asked to be key members of project teams assembled to tackle this challenge of patient flow and capacity management,” said Dr. Kim. “We look forward to an interactive session with our audience members.”
The session will address expedited discharge, the idea of the “hospitalist quarterback,” a kind of in-house controller of patient flow; facilitators of transferring to and from outside hospitals; focused efforts on reducing length of stay; establishing short-stay units to enhance patient flow; and participating in continuous process improvement teams, Dr. Kim said.
There will be several small group workshops interspersed with presentations of background content by the workshop facilitators, who represent a wide range of geographic and care settings. Dr. Kim said they have “all experienced the challenges of patient flow and throughput at their hospitals and health systems and have taken leadership roles to address these issues at their medical centers.”
“We anticipate a highly engaging session, where audience members will be divided into different teams, and each team will be tasked to identify specific interventions and challenges in managing the patient flow and capacity management initiative,” said Dr. Berger, associate medical director for inpatient capacity at the University of Washington. “Audience members will work within their own teams, guided by the workshop facilitators, and after the teams come up with their ideas on each of the topics covered in this workshop, each team will have the opportunity to present their best ideas for sharing and feedback.”
The session comes at a time when hospitals are tapping into hospitalists’ experience.
“Many hospitals across the country are challenged with high-occupancy states, creating pressures and external challenges to serve patients’ needs,” said Dr. Parekh, associate professor of internal medicine at the University of Michigan. “Hospitalists in their daily work have great familiarity with how hospitals run and where the ‘bottlenecks’ are that [block] patient throughput in their organization. Recognizing this experience and talent for enabling patient flow, many hospitals have turned to hospitalists – and in some cases, resident trainees – to lead or contribute to the hospital’s initiatives to enhance patient throughput.”
The importance of patient flow goes beyond efficiency, Dr. Kim said. Hospital staff who work during high-occupancy days feel the brunt of the burden, and this can lead to patient safety problems.
“We will address the importance of optimal communication between providers and staff, both within hospitals and with outside hospitals to ensure patient safety and staff concerns are appropriately addressed,” he said. “This is a topic that affects everyone at the medical center, and so we believe that this topic is applicable to a broad audience. We hope the participants will be able to facilitate a dialogue with a diverse group of leaders at their hospitals.”
Hospitalists as Leaders in Patient Flow and Hospital Throughput
Thursday, 10:00–11:30 a.m.
The “flow” of patients through the hospital can sometimes resemble a 10-lane expressway at gridlock, said Christopher Kim, MD, MBA, SFHM, associate professor of internal medicine and associate medical director of quality and safety at the University of Washington Medical Center in Seattle. That is, there’s no flow at all.
Thursday at HM17, Dr. Kim and a panel of experts will lead small workshops of audience members on how to put the “go” back in the flow. The session, “Hospitalists as Leaders in Patient Flow and Hospital Throughput,” will begin at 10 a.m.
“As hospitalists, we are at the sharp end of this problem and are often asked to be key members of project teams assembled to tackle this challenge of patient flow and capacity management,” said Dr. Kim. “We look forward to an interactive session with our audience members.”
The session will address expedited discharge, the idea of the “hospitalist quarterback,” a kind of in-house controller of patient flow; facilitators of transferring to and from outside hospitals; focused efforts on reducing length of stay; establishing short-stay units to enhance patient flow; and participating in continuous process improvement teams, Dr. Kim said.
There will be several small group workshops interspersed with presentations of background content by the workshop facilitators, who represent a wide range of geographic and care settings. Dr. Kim said they have “all experienced the challenges of patient flow and throughput at their hospitals and health systems and have taken leadership roles to address these issues at their medical centers.”
“We anticipate a highly engaging session, where audience members will be divided into different teams, and each team will be tasked to identify specific interventions and challenges in managing the patient flow and capacity management initiative,” said Dr. Berger, associate medical director for inpatient capacity at the University of Washington. “Audience members will work within their own teams, guided by the workshop facilitators, and after the teams come up with their ideas on each of the topics covered in this workshop, each team will have the opportunity to present their best ideas for sharing and feedback.”
The session comes at a time when hospitals are tapping into hospitalists’ experience.
“Many hospitals across the country are challenged with high-occupancy states, creating pressures and external challenges to serve patients’ needs,” said Dr. Parekh, associate professor of internal medicine at the University of Michigan. “Hospitalists in their daily work have great familiarity with how hospitals run and where the ‘bottlenecks’ are that [block] patient throughput in their organization. Recognizing this experience and talent for enabling patient flow, many hospitals have turned to hospitalists – and in some cases, resident trainees – to lead or contribute to the hospital’s initiatives to enhance patient throughput.”
The importance of patient flow goes beyond efficiency, Dr. Kim said. Hospital staff who work during high-occupancy days feel the brunt of the burden, and this can lead to patient safety problems.
“We will address the importance of optimal communication between providers and staff, both within hospitals and with outside hospitals to ensure patient safety and staff concerns are appropriately addressed,” he said. “This is a topic that affects everyone at the medical center, and so we believe that this topic is applicable to a broad audience. We hope the participants will be able to facilitate a dialogue with a diverse group of leaders at their hospitals.”
Hospitalists as Leaders in Patient Flow and Hospital Throughput
Thursday, 10:00–11:30 a.m.
The “flow” of patients through the hospital can sometimes resemble a 10-lane expressway at gridlock, said Christopher Kim, MD, MBA, SFHM, associate professor of internal medicine and associate medical director of quality and safety at the University of Washington Medical Center in Seattle. That is, there’s no flow at all.
Thursday at HM17, Dr. Kim and a panel of experts will lead small workshops of audience members on how to put the “go” back in the flow. The session, “Hospitalists as Leaders in Patient Flow and Hospital Throughput,” will begin at 10 a.m.
“As hospitalists, we are at the sharp end of this problem and are often asked to be key members of project teams assembled to tackle this challenge of patient flow and capacity management,” said Dr. Kim. “We look forward to an interactive session with our audience members.”
The session will address expedited discharge, the idea of the “hospitalist quarterback,” a kind of in-house controller of patient flow; facilitators of transferring to and from outside hospitals; focused efforts on reducing length of stay; establishing short-stay units to enhance patient flow; and participating in continuous process improvement teams, Dr. Kim said.
There will be several small group workshops interspersed with presentations of background content by the workshop facilitators, who represent a wide range of geographic and care settings. Dr. Kim said they have “all experienced the challenges of patient flow and throughput at their hospitals and health systems and have taken leadership roles to address these issues at their medical centers.”
“We anticipate a highly engaging session, where audience members will be divided into different teams, and each team will be tasked to identify specific interventions and challenges in managing the patient flow and capacity management initiative,” said Dr. Berger, associate medical director for inpatient capacity at the University of Washington. “Audience members will work within their own teams, guided by the workshop facilitators, and after the teams come up with their ideas on each of the topics covered in this workshop, each team will have the opportunity to present their best ideas for sharing and feedback.”
The session comes at a time when hospitals are tapping into hospitalists’ experience.
“Many hospitals across the country are challenged with high-occupancy states, creating pressures and external challenges to serve patients’ needs,” said Dr. Parekh, associate professor of internal medicine at the University of Michigan. “Hospitalists in their daily work have great familiarity with how hospitals run and where the ‘bottlenecks’ are that [block] patient throughput in their organization. Recognizing this experience and talent for enabling patient flow, many hospitals have turned to hospitalists – and in some cases, resident trainees – to lead or contribute to the hospital’s initiatives to enhance patient throughput.”
The importance of patient flow goes beyond efficiency, Dr. Kim said. Hospital staff who work during high-occupancy days feel the brunt of the burden, and this can lead to patient safety problems.
“We will address the importance of optimal communication between providers and staff, both within hospitals and with outside hospitals to ensure patient safety and staff concerns are appropriately addressed,” he said. “This is a topic that affects everyone at the medical center, and so we believe that this topic is applicable to a broad audience. We hope the participants will be able to facilitate a dialogue with a diverse group of leaders at their hospitals.”
Hospitalists as Leaders in Patient Flow and Hospital Throughput
Thursday, 10:00–11:30 a.m.
Diabetes specialist to offer disease management tips
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Culture change necessary to weed out health care overuse
Chris Moriates, MD, assistant dean for healthcare value and associate professor of medicine at the University of Texas at Austin Dell Medical School, drew insight from writer David Foster Wallace on Tuesday afternoon as he discussed overuse in hospital care.
He cited a story by Wallace: Two young fish are swimming along when they pass an old, wise fish who says, “Mornin’, boys. How’s the water?” One of the young fish asks the other, “What the hell is water?”
For hospitalists, the culture is their water: Even though they’re swimming in it every day, it can be an abstraction that gets little attention. But the culture is what needs to be tended to in order to turn the tide of unnecessary expenses, Dr. Moriates said in his talk, “Overcoming a Culture Overrun with Overuse.”
“How we’re addressing this problem is by making guidelines, algorithms, evidence-based medicine, Choosing Wisely lists,” he said during the well-attended session in the High-Value Care track. “It’s important that we codify our practices in these ways. But it is insufficient, because we must recognize that we are all swimming in that same water.
“If we don’t change this culture, this water, we will not make any progress.”
A 2013 survey by the Society of Academic Emergency Medicine found that 97% of physicians thought that at least some of the imaging they have personally ordered is medically unnecessary. And a 2011 Annals of Internal Medicine study found that organizational culture was a key factor in distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction.
He pointed to lessons from his previous institution, the University of California San Francisco, where they launched Caring Wisely, a program meant to support front-line clinicians who want to eradicate unnecessary costs. Part of the program involves funding clinicians up to $50,000 for their projects. One such project found that feedback to surgeons about expenses, and a small financial incentive to the department to keep costs down, was associated with reduced operating room costs.
This kind of change can be done anywhere, he said. After all, culture change, he said, can start with something as small as encouraging patient interaction by asking, “What questions do you have?” rather than “Do you have any questions?”
“I don’t want you to leave and think, ‘Well, unless I work somewhere like UCSF, where they’re going to give me $50,000 to do this, or I have an amazing boss like [Dr.] Bob Wachter [the former SHM president from UCSF who coined the term “hospitalist”], there is nothing I can do about this,” Dr. Moriates said. “It turns out that, yes, that is important for changing culture, but each of us has a personal responsibility.”
Chris Moriates, MD, assistant dean for healthcare value and associate professor of medicine at the University of Texas at Austin Dell Medical School, drew insight from writer David Foster Wallace on Tuesday afternoon as he discussed overuse in hospital care.
He cited a story by Wallace: Two young fish are swimming along when they pass an old, wise fish who says, “Mornin’, boys. How’s the water?” One of the young fish asks the other, “What the hell is water?”
For hospitalists, the culture is their water: Even though they’re swimming in it every day, it can be an abstraction that gets little attention. But the culture is what needs to be tended to in order to turn the tide of unnecessary expenses, Dr. Moriates said in his talk, “Overcoming a Culture Overrun with Overuse.”
“How we’re addressing this problem is by making guidelines, algorithms, evidence-based medicine, Choosing Wisely lists,” he said during the well-attended session in the High-Value Care track. “It’s important that we codify our practices in these ways. But it is insufficient, because we must recognize that we are all swimming in that same water.
“If we don’t change this culture, this water, we will not make any progress.”
A 2013 survey by the Society of Academic Emergency Medicine found that 97% of physicians thought that at least some of the imaging they have personally ordered is medically unnecessary. And a 2011 Annals of Internal Medicine study found that organizational culture was a key factor in distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction.
He pointed to lessons from his previous institution, the University of California San Francisco, where they launched Caring Wisely, a program meant to support front-line clinicians who want to eradicate unnecessary costs. Part of the program involves funding clinicians up to $50,000 for their projects. One such project found that feedback to surgeons about expenses, and a small financial incentive to the department to keep costs down, was associated with reduced operating room costs.
This kind of change can be done anywhere, he said. After all, culture change, he said, can start with something as small as encouraging patient interaction by asking, “What questions do you have?” rather than “Do you have any questions?”
“I don’t want you to leave and think, ‘Well, unless I work somewhere like UCSF, where they’re going to give me $50,000 to do this, or I have an amazing boss like [Dr.] Bob Wachter [the former SHM president from UCSF who coined the term “hospitalist”], there is nothing I can do about this,” Dr. Moriates said. “It turns out that, yes, that is important for changing culture, but each of us has a personal responsibility.”
Chris Moriates, MD, assistant dean for healthcare value and associate professor of medicine at the University of Texas at Austin Dell Medical School, drew insight from writer David Foster Wallace on Tuesday afternoon as he discussed overuse in hospital care.
He cited a story by Wallace: Two young fish are swimming along when they pass an old, wise fish who says, “Mornin’, boys. How’s the water?” One of the young fish asks the other, “What the hell is water?”
For hospitalists, the culture is their water: Even though they’re swimming in it every day, it can be an abstraction that gets little attention. But the culture is what needs to be tended to in order to turn the tide of unnecessary expenses, Dr. Moriates said in his talk, “Overcoming a Culture Overrun with Overuse.”
“How we’re addressing this problem is by making guidelines, algorithms, evidence-based medicine, Choosing Wisely lists,” he said during the well-attended session in the High-Value Care track. “It’s important that we codify our practices in these ways. But it is insufficient, because we must recognize that we are all swimming in that same water.
“If we don’t change this culture, this water, we will not make any progress.”
A 2013 survey by the Society of Academic Emergency Medicine found that 97% of physicians thought that at least some of the imaging they have personally ordered is medically unnecessary. And a 2011 Annals of Internal Medicine study found that organizational culture was a key factor in distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction.
He pointed to lessons from his previous institution, the University of California San Francisco, where they launched Caring Wisely, a program meant to support front-line clinicians who want to eradicate unnecessary costs. Part of the program involves funding clinicians up to $50,000 for their projects. One such project found that feedback to surgeons about expenses, and a small financial incentive to the department to keep costs down, was associated with reduced operating room costs.
This kind of change can be done anywhere, he said. After all, culture change, he said, can start with something as small as encouraging patient interaction by asking, “What questions do you have?” rather than “Do you have any questions?”
“I don’t want you to leave and think, ‘Well, unless I work somewhere like UCSF, where they’re going to give me $50,000 to do this, or I have an amazing boss like [Dr.] Bob Wachter [the former SHM president from UCSF who coined the term “hospitalist”], there is nothing I can do about this,” Dr. Moriates said. “It turns out that, yes, that is important for changing culture, but each of us has a personal responsibility.”
Experts to review ‘hot topics’ in pediatric hospital medicine research
Pediatric hospital medicine (PHM) is a fast-moving field, so having the best information is part of being a good doctor. But try going through all the relevant journals every month and pulling out the relevant findings. It’s a tall task.
Never fear! Akshata Hopkins, MD, an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., and Amit Singh, MD, of Stanford (Calif.) Children’s Health, have done the work for you. They reviewed every issue from 18 relevant journals over the last year and chose studies that are “hot topics” and involve important, evolving clinical questions that any physician caring for hospitalized children should know about.
As pediatric hospitalists, “we’re looking at articles from a pediatric hospital medicine standpoint, but the way that we chose the articles was based on topics that are prevalent to not only academic centers but community centers – and so it’s more broad,” Dr. Hopkins said. “The topics themselves are not necessarily new, but there are nuances to management [for which] every year there is new data that’s coming out. So what we’ve done is digest it for them.”
[[{"fid":"195832","view_mode":"medstat_image_flush_right","attributes":{"alt":"Dr. Akshata Hopkins","height":"220","width":"146","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":""}}}]]Their session at 5:30 p.m. today, “Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016,” will touch on both clinical and systems issues, often with a case used as a way to introduce topics, followed by a review of findings from a recent article. Dr. Hopkins said that questions will be answered throughout the session. Topics will include the management of young febrile infants, nasogastric feeding in bronchiolitis, prediction of severe pneumonia outcomes in children, and a review of quality measures that include patient experience and antibiotic stewardship.
“With the rise of more PCR testing and discussions of Choosing Wisely and high-value care, there’s more testing available,” Dr. Hopkins said. “But what is that going to cost versus what are the benefits that it brings? Are these tests valuable and in what way? And that’s kind of a hot topic. It depends on the age of the child and actually the results of [testing] are a little surprising.”
Dr. Singh said he hopes the session appeals to hospitalists in a wide array of care settings. “You want to make sure you are covering the breadth and scope of practice we might find ourselves in, whether it is in an adult hospital as the only hospital-based pediatrician covering ED consults, a NICU, a delivery room, and a small pediatric ward, or whether it is a pediatric hospitalist leading a team of medical students and residents in a large, free-standing, university-affiliated, children’s hospital,” he said.
Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016
Wednesday, 5:30–6:20 p.m.
Pediatric hospital medicine (PHM) is a fast-moving field, so having the best information is part of being a good doctor. But try going through all the relevant journals every month and pulling out the relevant findings. It’s a tall task.
Never fear! Akshata Hopkins, MD, an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., and Amit Singh, MD, of Stanford (Calif.) Children’s Health, have done the work for you. They reviewed every issue from 18 relevant journals over the last year and chose studies that are “hot topics” and involve important, evolving clinical questions that any physician caring for hospitalized children should know about.
As pediatric hospitalists, “we’re looking at articles from a pediatric hospital medicine standpoint, but the way that we chose the articles was based on topics that are prevalent to not only academic centers but community centers – and so it’s more broad,” Dr. Hopkins said. “The topics themselves are not necessarily new, but there are nuances to management [for which] every year there is new data that’s coming out. So what we’ve done is digest it for them.”
[[{"fid":"195832","view_mode":"medstat_image_flush_right","attributes":{"alt":"Dr. Akshata Hopkins","height":"220","width":"146","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":""}}}]]Their session at 5:30 p.m. today, “Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016,” will touch on both clinical and systems issues, often with a case used as a way to introduce topics, followed by a review of findings from a recent article. Dr. Hopkins said that questions will be answered throughout the session. Topics will include the management of young febrile infants, nasogastric feeding in bronchiolitis, prediction of severe pneumonia outcomes in children, and a review of quality measures that include patient experience and antibiotic stewardship.
“With the rise of more PCR testing and discussions of Choosing Wisely and high-value care, there’s more testing available,” Dr. Hopkins said. “But what is that going to cost versus what are the benefits that it brings? Are these tests valuable and in what way? And that’s kind of a hot topic. It depends on the age of the child and actually the results of [testing] are a little surprising.”
Dr. Singh said he hopes the session appeals to hospitalists in a wide array of care settings. “You want to make sure you are covering the breadth and scope of practice we might find ourselves in, whether it is in an adult hospital as the only hospital-based pediatrician covering ED consults, a NICU, a delivery room, and a small pediatric ward, or whether it is a pediatric hospitalist leading a team of medical students and residents in a large, free-standing, university-affiliated, children’s hospital,” he said.
Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016
Wednesday, 5:30–6:20 p.m.
Pediatric hospital medicine (PHM) is a fast-moving field, so having the best information is part of being a good doctor. But try going through all the relevant journals every month and pulling out the relevant findings. It’s a tall task.
Never fear! Akshata Hopkins, MD, an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., and Amit Singh, MD, of Stanford (Calif.) Children’s Health, have done the work for you. They reviewed every issue from 18 relevant journals over the last year and chose studies that are “hot topics” and involve important, evolving clinical questions that any physician caring for hospitalized children should know about.
As pediatric hospitalists, “we’re looking at articles from a pediatric hospital medicine standpoint, but the way that we chose the articles was based on topics that are prevalent to not only academic centers but community centers – and so it’s more broad,” Dr. Hopkins said. “The topics themselves are not necessarily new, but there are nuances to management [for which] every year there is new data that’s coming out. So what we’ve done is digest it for them.”
[[{"fid":"195832","view_mode":"medstat_image_flush_right","attributes":{"alt":"Dr. Akshata Hopkins","height":"220","width":"146","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Akshata Hopkins","field_file_image_credit[und][0][value]":""}}}]]Their session at 5:30 p.m. today, “Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016,” will touch on both clinical and systems issues, often with a case used as a way to introduce topics, followed by a review of findings from a recent article. Dr. Hopkins said that questions will be answered throughout the session. Topics will include the management of young febrile infants, nasogastric feeding in bronchiolitis, prediction of severe pneumonia outcomes in children, and a review of quality measures that include patient experience and antibiotic stewardship.
“With the rise of more PCR testing and discussions of Choosing Wisely and high-value care, there’s more testing available,” Dr. Hopkins said. “But what is that going to cost versus what are the benefits that it brings? Are these tests valuable and in what way? And that’s kind of a hot topic. It depends on the age of the child and actually the results of [testing] are a little surprising.”
Dr. Singh said he hopes the session appeals to hospitalists in a wide array of care settings. “You want to make sure you are covering the breadth and scope of practice we might find ourselves in, whether it is in an adult hospital as the only hospital-based pediatrician covering ED consults, a NICU, a delivery room, and a small pediatric ward, or whether it is a pediatric hospitalist leading a team of medical students and residents in a large, free-standing, university-affiliated, children’s hospital,” he said.
Pediatric Update: Top Articles in Pediatric Hospital Medicine 2016
Wednesday, 5:30–6:20 p.m.
Hospitalists can do better at end-of-life care, expert says
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
On the big stage, SHM leaders discuss pressing issues
When Society of Hospital Medicine president Brian Harte, MD, SFHM, made remarks last year as president-elect, he outlined four areas that call for attention and action.
On Tuesday, as the outgoing president making remarks at the opening plenary session, he traced the progress in those areas, while also airing some concerns as the society moves forward.
On the “absolute necessity” for SHM to reach out and connect with all practicing hospitalists, he reported that the society continued to expand its footprint, making contact with 50,000 hospitalists.
“SHM continues to be a strong professional organization,” Dr. Harte said, noting how the society cleared the 15,000 mark in membership last year. He also emphasized the “big tent” concept – making SHM the home for practitioners in many disciplines – and the importance of leadership.
“Sometimes it feels like everyone thinks of themselves as someone that we have to report to and therefore leadership development continues to be an important driver for our activities,” said Dr. Harte, president of Cleveland Clinic’s Akron General Hospital.
On the need to continue to focus on patient and family-centered care, he said, the curriculum at this meeting and past meetings shows a recognition of how important communication and empathy are.
“By doing so, we support a culture and environment wherein patients and families can actively participate in their care,” he said.
On being involved in shaping the changing healthcare landscape, the SHM board last fall held a retreat with hospitalist leaders to outline a framework for SHM to take advantage of members’ experience and expertise in this effort. The society is also working with the American College of Surgeons on designing an alternative payment model that could be more favorable for hospitals and hospitalists.
On the push for recognition of the hospitalist specialty, the new C6 Medicare billing code for hospitalists was a big step forward.
There are also some “things that keep me up at night,” he said.
“Having to prove our value continuously is absolutely essential, and it worries me that we may not always have this at the fore of our minds,” he said. Things that help him “get back to sleep,” he said, are the youthfulness and forward-thinking nature of hospitalists and the strength of the society.
“While respecting our past,” Dr. Harte said, “we can only be successful in moving forward if we refuse to be too beholden to it.”
President-elect Ron Greeno, MD, MHM, senior adviser for medical affairs at Team Health, in brief remarks, reminded the audience about how hospital medicine itself was a reform intended to deliver better care at lower prices, and that it therefore makes perfect sense for hospitalists to be involved in this latest wave of reform.
He made an enthusiastic call for more hospitalists to be involved.
“We need more – this is a big challenge,” he said. “At the end of the day, it’s going to take more than us knowing how to take care of patients at the bedside. We have to get involved in designing the new delivery system if we’re going to make sure that we actually have a say in the kind of care that our patients get.”
When Society of Hospital Medicine president Brian Harte, MD, SFHM, made remarks last year as president-elect, he outlined four areas that call for attention and action.
On Tuesday, as the outgoing president making remarks at the opening plenary session, he traced the progress in those areas, while also airing some concerns as the society moves forward.
On the “absolute necessity” for SHM to reach out and connect with all practicing hospitalists, he reported that the society continued to expand its footprint, making contact with 50,000 hospitalists.
“SHM continues to be a strong professional organization,” Dr. Harte said, noting how the society cleared the 15,000 mark in membership last year. He also emphasized the “big tent” concept – making SHM the home for practitioners in many disciplines – and the importance of leadership.
“Sometimes it feels like everyone thinks of themselves as someone that we have to report to and therefore leadership development continues to be an important driver for our activities,” said Dr. Harte, president of Cleveland Clinic’s Akron General Hospital.
On the need to continue to focus on patient and family-centered care, he said, the curriculum at this meeting and past meetings shows a recognition of how important communication and empathy are.
“By doing so, we support a culture and environment wherein patients and families can actively participate in their care,” he said.
On being involved in shaping the changing healthcare landscape, the SHM board last fall held a retreat with hospitalist leaders to outline a framework for SHM to take advantage of members’ experience and expertise in this effort. The society is also working with the American College of Surgeons on designing an alternative payment model that could be more favorable for hospitals and hospitalists.
On the push for recognition of the hospitalist specialty, the new C6 Medicare billing code for hospitalists was a big step forward.
There are also some “things that keep me up at night,” he said.
“Having to prove our value continuously is absolutely essential, and it worries me that we may not always have this at the fore of our minds,” he said. Things that help him “get back to sleep,” he said, are the youthfulness and forward-thinking nature of hospitalists and the strength of the society.
“While respecting our past,” Dr. Harte said, “we can only be successful in moving forward if we refuse to be too beholden to it.”
President-elect Ron Greeno, MD, MHM, senior adviser for medical affairs at Team Health, in brief remarks, reminded the audience about how hospital medicine itself was a reform intended to deliver better care at lower prices, and that it therefore makes perfect sense for hospitalists to be involved in this latest wave of reform.
He made an enthusiastic call for more hospitalists to be involved.
“We need more – this is a big challenge,” he said. “At the end of the day, it’s going to take more than us knowing how to take care of patients at the bedside. We have to get involved in designing the new delivery system if we’re going to make sure that we actually have a say in the kind of care that our patients get.”
When Society of Hospital Medicine president Brian Harte, MD, SFHM, made remarks last year as president-elect, he outlined four areas that call for attention and action.
On Tuesday, as the outgoing president making remarks at the opening plenary session, he traced the progress in those areas, while also airing some concerns as the society moves forward.
On the “absolute necessity” for SHM to reach out and connect with all practicing hospitalists, he reported that the society continued to expand its footprint, making contact with 50,000 hospitalists.
“SHM continues to be a strong professional organization,” Dr. Harte said, noting how the society cleared the 15,000 mark in membership last year. He also emphasized the “big tent” concept – making SHM the home for practitioners in many disciplines – and the importance of leadership.
“Sometimes it feels like everyone thinks of themselves as someone that we have to report to and therefore leadership development continues to be an important driver for our activities,” said Dr. Harte, president of Cleveland Clinic’s Akron General Hospital.
On the need to continue to focus on patient and family-centered care, he said, the curriculum at this meeting and past meetings shows a recognition of how important communication and empathy are.
“By doing so, we support a culture and environment wherein patients and families can actively participate in their care,” he said.
On being involved in shaping the changing healthcare landscape, the SHM board last fall held a retreat with hospitalist leaders to outline a framework for SHM to take advantage of members’ experience and expertise in this effort. The society is also working with the American College of Surgeons on designing an alternative payment model that could be more favorable for hospitals and hospitalists.
On the push for recognition of the hospitalist specialty, the new C6 Medicare billing code for hospitalists was a big step forward.
There are also some “things that keep me up at night,” he said.
“Having to prove our value continuously is absolutely essential, and it worries me that we may not always have this at the fore of our minds,” he said. Things that help him “get back to sleep,” he said, are the youthfulness and forward-thinking nature of hospitalists and the strength of the society.
“While respecting our past,” Dr. Harte said, “we can only be successful in moving forward if we refuse to be too beholden to it.”
President-elect Ron Greeno, MD, MHM, senior adviser for medical affairs at Team Health, in brief remarks, reminded the audience about how hospital medicine itself was a reform intended to deliver better care at lower prices, and that it therefore makes perfect sense for hospitalists to be involved in this latest wave of reform.
He made an enthusiastic call for more hospitalists to be involved.
“We need more – this is a big challenge,” he said. “At the end of the day, it’s going to take more than us knowing how to take care of patients at the bedside. We have to get involved in designing the new delivery system if we’re going to make sure that we actually have a say in the kind of care that our patients get.”
Attendees drill down on infections at ID boot camp
No hands went up when Glenn Wortmann, MD, chief of infectious diseases at MedStar Washington Hospital Center, asked whether any of the hospitalists in front of him had handled any cases of Candida auris, a kind of yeast that is highly resistant to several potent antifungals and, in some cases, has been found to be resistant to every antifungal thrown at it.
They might not have seen this dreadful bug, first identified in Japan in 2009, yet. But they will soon, Dr. Wortmann said.
James Pile, MD, SFHM, a pre-course director and associate professor of internal medicine at Case Western Reserve University, Cleveland, said he expected that most of those who signed up already knew quite a bit about I.D. issues, but the point of the course was to go deeper.
“Our goal was to find the sweet spot in what they don’t know or need a refresher on,” he said.
In his talk, he focused on infectious disease emergencies – such as infective endocarditis – which hospitalists may not see as often but that “we just have to get right when we do see them because the stakes are very high.”
He covered spinal epidural abscess, bacterial meningitis, and soft tissue necrotizing infections, saying that a crucial element in managing these cases is to seriously consider them a possibility in the first place. He also recommended having a low threshold for obtaining a surgical consultation, a CT scan, or both in patients with what appears to be severe cellulitis.
John Sanders, MD, MPH, head of infectious diseases at Wake Forest Baptist Health, Winston-Salem, N.C., dug into the nitty-gritty of C. difficile infections, touching on the possible role of acid suppressants, especially proton pump inhibitors, in the increasing incidence of these infections. The news wasn’t all bad: He also discussed emerging therapies, such as CRS3123 – a narrow-spectrum antibiotic that inhibits protein synthesis, toxin production, and sporulation – and monoclonal antibodies, which have been shown to lower recurrence rates when used with antibiotics.
The keys to controlling C. diff infections, he said, are hand-washing, remembering that the spores are resistant to ethanol, limiting fluoroquinolone use, and isolating patients with active infections.
Ultraviolet lighting for C. diff control is a gray area, he said.
“The data [are] mixed,” he said. “I think it’s a good idea to do it, and it’s certainly being pushed. But it’s somewhat controversial as to whether it’s cost effective.”
No hands went up when Glenn Wortmann, MD, chief of infectious diseases at MedStar Washington Hospital Center, asked whether any of the hospitalists in front of him had handled any cases of Candida auris, a kind of yeast that is highly resistant to several potent antifungals and, in some cases, has been found to be resistant to every antifungal thrown at it.
They might not have seen this dreadful bug, first identified in Japan in 2009, yet. But they will soon, Dr. Wortmann said.
James Pile, MD, SFHM, a pre-course director and associate professor of internal medicine at Case Western Reserve University, Cleveland, said he expected that most of those who signed up already knew quite a bit about I.D. issues, but the point of the course was to go deeper.
“Our goal was to find the sweet spot in what they don’t know or need a refresher on,” he said.
In his talk, he focused on infectious disease emergencies – such as infective endocarditis – which hospitalists may not see as often but that “we just have to get right when we do see them because the stakes are very high.”
He covered spinal epidural abscess, bacterial meningitis, and soft tissue necrotizing infections, saying that a crucial element in managing these cases is to seriously consider them a possibility in the first place. He also recommended having a low threshold for obtaining a surgical consultation, a CT scan, or both in patients with what appears to be severe cellulitis.
John Sanders, MD, MPH, head of infectious diseases at Wake Forest Baptist Health, Winston-Salem, N.C., dug into the nitty-gritty of C. difficile infections, touching on the possible role of acid suppressants, especially proton pump inhibitors, in the increasing incidence of these infections. The news wasn’t all bad: He also discussed emerging therapies, such as CRS3123 – a narrow-spectrum antibiotic that inhibits protein synthesis, toxin production, and sporulation – and monoclonal antibodies, which have been shown to lower recurrence rates when used with antibiotics.
The keys to controlling C. diff infections, he said, are hand-washing, remembering that the spores are resistant to ethanol, limiting fluoroquinolone use, and isolating patients with active infections.
Ultraviolet lighting for C. diff control is a gray area, he said.
“The data [are] mixed,” he said. “I think it’s a good idea to do it, and it’s certainly being pushed. But it’s somewhat controversial as to whether it’s cost effective.”
No hands went up when Glenn Wortmann, MD, chief of infectious diseases at MedStar Washington Hospital Center, asked whether any of the hospitalists in front of him had handled any cases of Candida auris, a kind of yeast that is highly resistant to several potent antifungals and, in some cases, has been found to be resistant to every antifungal thrown at it.
They might not have seen this dreadful bug, first identified in Japan in 2009, yet. But they will soon, Dr. Wortmann said.
James Pile, MD, SFHM, a pre-course director and associate professor of internal medicine at Case Western Reserve University, Cleveland, said he expected that most of those who signed up already knew quite a bit about I.D. issues, but the point of the course was to go deeper.
“Our goal was to find the sweet spot in what they don’t know or need a refresher on,” he said.
In his talk, he focused on infectious disease emergencies – such as infective endocarditis – which hospitalists may not see as often but that “we just have to get right when we do see them because the stakes are very high.”
He covered spinal epidural abscess, bacterial meningitis, and soft tissue necrotizing infections, saying that a crucial element in managing these cases is to seriously consider them a possibility in the first place. He also recommended having a low threshold for obtaining a surgical consultation, a CT scan, or both in patients with what appears to be severe cellulitis.
John Sanders, MD, MPH, head of infectious diseases at Wake Forest Baptist Health, Winston-Salem, N.C., dug into the nitty-gritty of C. difficile infections, touching on the possible role of acid suppressants, especially proton pump inhibitors, in the increasing incidence of these infections. The news wasn’t all bad: He also discussed emerging therapies, such as CRS3123 – a narrow-spectrum antibiotic that inhibits protein synthesis, toxin production, and sporulation – and monoclonal antibodies, which have been shown to lower recurrence rates when used with antibiotics.
The keys to controlling C. diff infections, he said, are hand-washing, remembering that the spores are resistant to ethanol, limiting fluoroquinolone use, and isolating patients with active infections.
Ultraviolet lighting for C. diff control is a gray area, he said.
“The data [are] mixed,” he said. “I think it’s a good idea to do it, and it’s certainly being pushed. But it’s somewhat controversial as to whether it’s cost effective.”
Student-Resident Luncheon offers relaxed networking
The ritual of networking at medical conferences often involves waiting to chat with a speaker after a session or finessing an introduction in a busy hallway. That’s why, at the Student-Resident Luncheon, organized by SHM’s Physicians-in-Training Committee, Tuesday, May 2, at noon, trainees will have a chance to interact with experts in the field in a much more relaxed setting.
The free luncheon will include several tables, each dedicated to a specific topic, such as pediatric hospital medicine, with an experienced hospitalist at each one. The residents and students who attend can choose their table and will have a chance to sit at two different tables. There will also be an “open forum” segment at the end, when the trainees can seek out other experts, said Darlene Tad-y, MD, committee chair and assistant professor of medicine at the University of Colorado at Denver, Aurora.
“The purpose behind it was to bring our trainees together so that they can meet each other and to bring some of the SHM leaders to them so that they can learn about what [the leaders] do in hospital medicine and see the breadth of work that hospitalists are doing around the country,” she said.
Pediatric hospital medicine, medical education, and global health are three of the confirmed topics that will be covered at the luncheon, Dr. Tad-y said. There will be a maximum of 10 people at each table, including the expert.
“We wanted it to be very immediate for the students and residents who are going to be there,” she said. “It’s a pretty small group setting.”
The event has been getting more popular each year and is now in its third year. SHM said 500 students and residents participated last year. Residents and students who register for the annual meeting receive an invitation to attend the luncheon. Those who decide on-site that they want to attend will have the ability to do so, Dr. Tad-y said.
Such close interaction with people whose literature they may have read can be very helpful for trainees, she said. They can “sit at a table with them and hear their story and learn how they got to where they were. I think it’s quite impactful.
The ritual of networking at medical conferences often involves waiting to chat with a speaker after a session or finessing an introduction in a busy hallway. That’s why, at the Student-Resident Luncheon, organized by SHM’s Physicians-in-Training Committee, Tuesday, May 2, at noon, trainees will have a chance to interact with experts in the field in a much more relaxed setting.
The free luncheon will include several tables, each dedicated to a specific topic, such as pediatric hospital medicine, with an experienced hospitalist at each one. The residents and students who attend can choose their table and will have a chance to sit at two different tables. There will also be an “open forum” segment at the end, when the trainees can seek out other experts, said Darlene Tad-y, MD, committee chair and assistant professor of medicine at the University of Colorado at Denver, Aurora.
“The purpose behind it was to bring our trainees together so that they can meet each other and to bring some of the SHM leaders to them so that they can learn about what [the leaders] do in hospital medicine and see the breadth of work that hospitalists are doing around the country,” she said.
Pediatric hospital medicine, medical education, and global health are three of the confirmed topics that will be covered at the luncheon, Dr. Tad-y said. There will be a maximum of 10 people at each table, including the expert.
“We wanted it to be very immediate for the students and residents who are going to be there,” she said. “It’s a pretty small group setting.”
The event has been getting more popular each year and is now in its third year. SHM said 500 students and residents participated last year. Residents and students who register for the annual meeting receive an invitation to attend the luncheon. Those who decide on-site that they want to attend will have the ability to do so, Dr. Tad-y said.
Such close interaction with people whose literature they may have read can be very helpful for trainees, she said. They can “sit at a table with them and hear their story and learn how they got to where they were. I think it’s quite impactful.
The ritual of networking at medical conferences often involves waiting to chat with a speaker after a session or finessing an introduction in a busy hallway. That’s why, at the Student-Resident Luncheon, organized by SHM’s Physicians-in-Training Committee, Tuesday, May 2, at noon, trainees will have a chance to interact with experts in the field in a much more relaxed setting.
The free luncheon will include several tables, each dedicated to a specific topic, such as pediatric hospital medicine, with an experienced hospitalist at each one. The residents and students who attend can choose their table and will have a chance to sit at two different tables. There will also be an “open forum” segment at the end, when the trainees can seek out other experts, said Darlene Tad-y, MD, committee chair and assistant professor of medicine at the University of Colorado at Denver, Aurora.
“The purpose behind it was to bring our trainees together so that they can meet each other and to bring some of the SHM leaders to them so that they can learn about what [the leaders] do in hospital medicine and see the breadth of work that hospitalists are doing around the country,” she said.
Pediatric hospital medicine, medical education, and global health are three of the confirmed topics that will be covered at the luncheon, Dr. Tad-y said. There will be a maximum of 10 people at each table, including the expert.
“We wanted it to be very immediate for the students and residents who are going to be there,” she said. “It’s a pretty small group setting.”
The event has been getting more popular each year and is now in its third year. SHM said 500 students and residents participated last year. Residents and students who register for the annual meeting receive an invitation to attend the luncheon. Those who decide on-site that they want to attend will have the ability to do so, Dr. Tad-y said.
Such close interaction with people whose literature they may have read can be very helpful for trainees, she said. They can “sit at a table with them and hear their story and learn how they got to where they were. I think it’s quite impactful.
High-value care abstracts in spotlight
If the annual meeting of the Society of Hospital Medicine could be boiled down to a single goal, it might be to give hospitalists the information they need to be the best doctors they can be.
It shouldn’t come as a surprise, then, that research performed by hospitalists on high-value care (HVC) will be featured in an abstract session at this year’s conference.
The “Best of HVC Abstract Submissions” session, scheduled for Tuesday, May 2, 3:05–3:45 p.m., will be part of a day-long track devoted entirely to HVC, a new feature at this year’s annual meeting.
“The panel will give them feedback and ask questions and sort of engage in conversation about it,” Dr. Feldman said. He thinks that featuring these abstracts in a high-profile setting is a good way for hospitalists to learn from one another. “There are so many hospitalists interested in this topic right now and people working in this area and coming up with quality improvement projects around high-value care. It’s nice to know what other folks are doing.”
Dr. Feldman hopes that, if hospitalists find out what is happening at other centers, it will spur even more quality projects.
“We don’t often have the opportunity to share the work that we’ve done and to motivate each other,” he said. “When you hear about the great work that other people are doing, it is invigorating; it’s exciting; it gets you jazzed up about doing the work in your own institution. A lot of this isn’t incredibly sophisticated. It is stuff that can be relatively easily disseminated from one institution to another without having a ton of support. To be able to see the type of work that people do is thrilling for the hospitalists who attend.”
“With the growing recognition of the costs and harms from medical overuse, high-value care has become a national imperative,” he said. “Hospitalists are natural leaders for high-value care, much like we have been for patient safety and quality improvement. Hospitalists have already led the way on developing programs that target areas of overuse in hospitals. Our ‘Best of HVC’ session will highlight many of these promising examples. There will be plenty of opportunities to learn from innovators and take back the best ideas to our own hospitals.”
Organizers said that the HVC track “will guide attendees on how to avoid diagnostic and therapeutic overuse and how to move toward the right care for every hospital medicine patient.” Other sessions in the track will cover “things we do for no reason,” how to use imaging wisely, and tips on overcoming cultures fraught with overuse.
Dr. Feldman said the track is intended to meet the demand of meeting attendees.
“There are lots of hospitalists who are engaging in this type of work in their institutions and systems,” he said. “So, it’s just timely. People are engaged in it and they’re excited about it, so it makes sense that adding a track right now would fulfill the needs of many of the hospitalists who are going to be attending.”
Best of HVC Abstract Submissions
Tuesday, May 2, 3:05–3:45 p.m.
If the annual meeting of the Society of Hospital Medicine could be boiled down to a single goal, it might be to give hospitalists the information they need to be the best doctors they can be.
It shouldn’t come as a surprise, then, that research performed by hospitalists on high-value care (HVC) will be featured in an abstract session at this year’s conference.
The “Best of HVC Abstract Submissions” session, scheduled for Tuesday, May 2, 3:05–3:45 p.m., will be part of a day-long track devoted entirely to HVC, a new feature at this year’s annual meeting.
“The panel will give them feedback and ask questions and sort of engage in conversation about it,” Dr. Feldman said. He thinks that featuring these abstracts in a high-profile setting is a good way for hospitalists to learn from one another. “There are so many hospitalists interested in this topic right now and people working in this area and coming up with quality improvement projects around high-value care. It’s nice to know what other folks are doing.”
Dr. Feldman hopes that, if hospitalists find out what is happening at other centers, it will spur even more quality projects.
“We don’t often have the opportunity to share the work that we’ve done and to motivate each other,” he said. “When you hear about the great work that other people are doing, it is invigorating; it’s exciting; it gets you jazzed up about doing the work in your own institution. A lot of this isn’t incredibly sophisticated. It is stuff that can be relatively easily disseminated from one institution to another without having a ton of support. To be able to see the type of work that people do is thrilling for the hospitalists who attend.”
“With the growing recognition of the costs and harms from medical overuse, high-value care has become a national imperative,” he said. “Hospitalists are natural leaders for high-value care, much like we have been for patient safety and quality improvement. Hospitalists have already led the way on developing programs that target areas of overuse in hospitals. Our ‘Best of HVC’ session will highlight many of these promising examples. There will be plenty of opportunities to learn from innovators and take back the best ideas to our own hospitals.”
Organizers said that the HVC track “will guide attendees on how to avoid diagnostic and therapeutic overuse and how to move toward the right care for every hospital medicine patient.” Other sessions in the track will cover “things we do for no reason,” how to use imaging wisely, and tips on overcoming cultures fraught with overuse.
Dr. Feldman said the track is intended to meet the demand of meeting attendees.
“There are lots of hospitalists who are engaging in this type of work in their institutions and systems,” he said. “So, it’s just timely. People are engaged in it and they’re excited about it, so it makes sense that adding a track right now would fulfill the needs of many of the hospitalists who are going to be attending.”
Best of HVC Abstract Submissions
Tuesday, May 2, 3:05–3:45 p.m.
If the annual meeting of the Society of Hospital Medicine could be boiled down to a single goal, it might be to give hospitalists the information they need to be the best doctors they can be.
It shouldn’t come as a surprise, then, that research performed by hospitalists on high-value care (HVC) will be featured in an abstract session at this year’s conference.
The “Best of HVC Abstract Submissions” session, scheduled for Tuesday, May 2, 3:05–3:45 p.m., will be part of a day-long track devoted entirely to HVC, a new feature at this year’s annual meeting.
“The panel will give them feedback and ask questions and sort of engage in conversation about it,” Dr. Feldman said. He thinks that featuring these abstracts in a high-profile setting is a good way for hospitalists to learn from one another. “There are so many hospitalists interested in this topic right now and people working in this area and coming up with quality improvement projects around high-value care. It’s nice to know what other folks are doing.”
Dr. Feldman hopes that, if hospitalists find out what is happening at other centers, it will spur even more quality projects.
“We don’t often have the opportunity to share the work that we’ve done and to motivate each other,” he said. “When you hear about the great work that other people are doing, it is invigorating; it’s exciting; it gets you jazzed up about doing the work in your own institution. A lot of this isn’t incredibly sophisticated. It is stuff that can be relatively easily disseminated from one institution to another without having a ton of support. To be able to see the type of work that people do is thrilling for the hospitalists who attend.”
“With the growing recognition of the costs and harms from medical overuse, high-value care has become a national imperative,” he said. “Hospitalists are natural leaders for high-value care, much like we have been for patient safety and quality improvement. Hospitalists have already led the way on developing programs that target areas of overuse in hospitals. Our ‘Best of HVC’ session will highlight many of these promising examples. There will be plenty of opportunities to learn from innovators and take back the best ideas to our own hospitals.”
Organizers said that the HVC track “will guide attendees on how to avoid diagnostic and therapeutic overuse and how to move toward the right care for every hospital medicine patient.” Other sessions in the track will cover “things we do for no reason,” how to use imaging wisely, and tips on overcoming cultures fraught with overuse.
Dr. Feldman said the track is intended to meet the demand of meeting attendees.
“There are lots of hospitalists who are engaging in this type of work in their institutions and systems,” he said. “So, it’s just timely. People are engaged in it and they’re excited about it, so it makes sense that adding a track right now would fulfill the needs of many of the hospitalists who are going to be attending.”
Best of HVC Abstract Submissions
Tuesday, May 2, 3:05–3:45 p.m.