Health IT

When hospitalists work in academic centers, medical and surgical services are furnished, in part, by a resident within the scope of the hospitalists’ training program. A resident is “an individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting.”¹ Resident services are covered by Centers for Medicare & Medicaid Services (CMS) and paid by the Fiscal Intermediary through direct GME and Indirect Medical Education (IME) payments. These services are not billed or paid using the Medicare Physician Fee Schedule. The teaching physician is responsible for supervising the resident’s health-care delivery but is not paid for the resident’s work. The teaching physician is paid for their personal and medically necessary service in providing patient care. The teaching physician has the option to perform the entire service, or perform the self-determined critical or key portion(s) of the service.

Comprehensive Service

Teaching physicians independently see the patient and perform all required elements to support the visit level (e.g. 99233: subsequent hospital care, per day, which requires at least two of the following three key components: a detailed interval history, a detailed examination, or high-complexity medical decision-making).² The teaching physician writes a note independent of a resident encounter with the patient or documentation. The teaching physician note “stands alone” and does not rely on the resident’s documentation. If the resident saw the patient and documented the encounter, the teaching physician might choose to “link to” the resident note in lieu of personally documenting the entire service. The linking statement must demonstrate teaching physician involvement in the patient encounter and participation in patient management. Use of CMS-approved statements is best to meet these requirements. Statement examples include:³

• “I performed a history and physical examination of the patient and discussed his management with the resident. I reviewed the resident’s note and agree with the documented findings and plan of care.”
• “I saw and evaluated the patient. I agree with the findings and the plan of care as documented in the resident’s note.”
• “I saw and examined the patient. I agree with the resident’s note, except the heart murmur is louder, so I will obtain an echo to evaluate.”

Each of these statements meets the minimum requirements for billing. However, teaching physicians should offer more information in support of other clinical, quality, and regulatory initiatives and mandates, better exemplified in the last example. The reported visit level will be supported by the combined documentation (teaching physician and resident).

The teaching physician submits a claim in their name and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99223-GC). This alerts the Medicare contractor that services were provided under teaching physician rules. Requests for documentation should include a response with medical record entries from the teaching physician and resident.

Critical/Key Portion

“Supervised” service: The resident and teaching physician can round together; they can see the patient at the same time. The teaching physician observes the resident’s performance during the patient encounter, or personally performs self-determined elements of patient care. The resident documents their patient care. The attending must still note their presence in the medical record, performance of the critical or key portions of the service, and involvement in patient management. CMS-accepted statements include:³

• “I was present with the resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note.”
• “I saw the patient with the resident and agree with the resident’s findings and plan.”

Although these statements demonstrate acceptable billing language, they lack patient-specific details that support the teaching physician’s personal contribution to patient care and the quality of their expertise. The teaching physician selects the visit level that represents the combined documentation and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99232-GC).

“Shared” service: The resident sees the patient unaccompanied and documents the corresponding care provided. The teaching physician sees the patient at a different time but performs only the critical or key portions of the service. The case is subsequently discussed with the resident. The teaching physician must document their presence and performance of the critical or key portions of the service, along with any patient management. Using CMS-quoted statements ensures regulatory compliance:³

• “I saw and evaluated the patient. I reviewed the resident’s note and agree, except that the picture is more consistent with pericarditis than myocardial ischemia. Will begin NSAIDs.”
• “I saw and evaluated the patient. Discussed with resident and agree with resident’s findings and plan as documented in the resident’s note.”
• “See resident’s note for details. I saw and evaluated the patient and agree with the resident’s finding and plans as written.”
• “I saw and evaluated the patient. Agree with resident’s note, but lower extremities are weaker, now 3/5; MRI of L/S spine today.”

Once again, the teaching physician selects the visit level that represents the combined documentation and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99233-GC).

EHR Considerations

When seeing patients independent of one another, the timing of the teaching physician and resident encounters does not impact billing. However, the time that the resident encounter is documented in the medical record can significantly impact the payment when reviewed by external auditors. When the resident note is dated and timed later than the teaching physician’s entry, the teaching physician cannot consider the resident’s note for visit-level selection. The teaching physician should not “link to” a resident note that is viewed as “not having been written” prior to the teaching physician note. This would not fulfill the requirements represented in the CMS-approved language “I reviewed the resident’s note and agree.”

Electronic health record (EHR) systems sometimes hinder compliance. If the resident completes the note but does not “finalize” or “close” the encounter until after the teaching physician documents their own note, it can falsely appear that the resident note did not exist at the time the teaching physician created their entry. Because an auditor can only view the finalized entries, the timing of each entry might be erroneously represented. Proper training and closing of encounters can diminish these issues.

Additionally, scribing the attestation is not permitted. Residents cannot document the teaching physician attestation on behalf of the physician under any circumstance. CMS rules require the teaching physician to document their presence, participation, and management of the patient. In an EHR, the teaching physician must document this entry under his/her own log-in and password, which is not to be shared with anyone.

Students

CMS defines student as “an individual who participates in an accredited educational program [e.g. a medical school] that is not an approved GME program.”1 A student is not regarded as a “physician in training,” and the service is not eligible for reimbursement consideration under the teaching physician rules.

Per CMS guidelines, students can document services in the medical record, but the teaching physician may only refer to the student’s systems review and past/family/social history entries. The teaching physician must verify and redocument the history of present illness. A student’s physical exam findings or medical decision-making are not suitable for tethering, and the teaching physician must personally perform and redocument the physical exam and medical decision-making. The visit level reflects only the teaching physician’s personally performed and documented service.

Carol Pohlig is a billing and coding expert with the University of Pennsylvania Medical Center, Philadelphia. She is also on the faculty of SHM’s inpatient coding course.

References

1. Centers for Medicare and Medicaid Services. Guidelines for Teaching Physicians, Interns, Residents. CMS website. Available at: http://www.cms.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf. Accessed Jan. 8, 2013.
2. Abraham M, Ahlman J, Anderson C, Boudreau A, Connelly J. Current Procedural Terminology 2012 Professional Edition. Chicago: American Medical Association Press; 2011.
3. Centers for Medicare and Medicaid Services. Medicare Claims Processing Manual: Chapter 12, Section 100. CMS website. Available at: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. Accessed Jan. 8, 2013.
4. Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual: Chapter 15, Section 30.2. CMS website. Available at: http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf. Accessed Jan. 8, 2013.

When hospitalists work in academic centers, medical and surgical services are furnished, in part, by a resident within the scope of the hospitalists’ training program. A resident is “an individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting.”¹ Resident services are covered by Centers for Medicare & Medicaid Services (CMS) and paid by the Fiscal Intermediary through direct GME and Indirect Medical Education (IME) payments. These services are not billed or paid using the Medicare Physician Fee Schedule. The teaching physician is responsible for supervising the resident’s health-care delivery but is not paid for the resident’s work. The teaching physician is paid for their personal and medically necessary service in providing patient care. The teaching physician has the option to perform the entire service, or perform the self-determined critical or key portion(s) of the service.

Comprehensive Service

Teaching physicians independently see the patient and perform all required elements to support the visit level (e.g. 99233: subsequent hospital care, per day, which requires at least two of the following three key components: a detailed interval history, a detailed examination, or high-complexity medical decision-making).² The teaching physician writes a note independent of a resident encounter with the patient or documentation. The teaching physician note “stands alone” and does not rely on the resident’s documentation. If the resident saw the patient and documented the encounter, the teaching physician might choose to “link to” the resident note in lieu of personally documenting the entire service. The linking statement must demonstrate teaching physician involvement in the patient encounter and participation in patient management. Use of CMS-approved statements is best to meet these requirements. Statement examples include:³

• “I performed a history and physical examination of the patient and discussed his management with the resident. I reviewed the resident’s note and agree with the documented findings and plan of care.”
• “I saw and evaluated the patient. I agree with the findings and the plan of care as documented in the resident’s note.”
• “I saw and examined the patient. I agree with the resident’s note, except the heart murmur is louder, so I will obtain an echo to evaluate.”

Each of these statements meets the minimum requirements for billing. However, teaching physicians should offer more information in support of other clinical, quality, and regulatory initiatives and mandates, better exemplified in the last example. The reported visit level will be supported by the combined documentation (teaching physician and resident).

The teaching physician submits a claim in their name and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99223-GC). This alerts the Medicare contractor that services were provided under teaching physician rules. Requests for documentation should include a response with medical record entries from the teaching physician and resident.

Critical/Key Portion

“Supervised” service: The resident and teaching physician can round together; they can see the patient at the same time. The teaching physician observes the resident’s performance during the patient encounter, or personally performs self-determined elements of patient care. The resident documents their patient care. The attending must still note their presence in the medical record, performance of the critical or key portions of the service, and involvement in patient management. CMS-accepted statements include:³

• “I was present with the resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note.”
• “I saw the patient with the resident and agree with the resident’s findings and plan.”

Although these statements demonstrate acceptable billing language, they lack patient-specific details that support the teaching physician’s personal contribution to patient care and the quality of their expertise. The teaching physician selects the visit level that represents the combined documentation and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99232-GC).

“Shared” service: The resident sees the patient unaccompanied and documents the corresponding care provided. The teaching physician sees the patient at a different time but performs only the critical or key portions of the service. The case is subsequently discussed with the resident. The teaching physician must document their presence and performance of the critical or key portions of the service, along with any patient management. Using CMS-quoted statements ensures regulatory compliance:³

• “I saw and evaluated the patient. I reviewed the resident’s note and agree, except that the picture is more consistent with pericarditis than myocardial ischemia. Will begin NSAIDs.”
• “I saw and evaluated the patient. Discussed with resident and agree with resident’s findings and plan as documented in the resident’s note.”
• “See resident’s note for details. I saw and evaluated the patient and agree with the resident’s finding and plans as written.”
• “I saw and evaluated the patient. Agree with resident’s note, but lower extremities are weaker, now 3/5; MRI of L/S spine today.”

Once again, the teaching physician selects the visit level that represents the combined documentation and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99233-GC).

EHR Considerations

When seeing patients independent of one another, the timing of the teaching physician and resident encounters does not impact billing. However, the time that the resident encounter is documented in the medical record can significantly impact the payment when reviewed by external auditors. When the resident note is dated and timed later than the teaching physician’s entry, the teaching physician cannot consider the resident’s note for visit-level selection. The teaching physician should not “link to” a resident note that is viewed as “not having been written” prior to the teaching physician note. This would not fulfill the requirements represented in the CMS-approved language “I reviewed the resident’s note and agree.”

Electronic health record (EHR) systems sometimes hinder compliance. If the resident completes the note but does not “finalize” or “close” the encounter until after the teaching physician documents their own note, it can falsely appear that the resident note did not exist at the time the teaching physician created their entry. Because an auditor can only view the finalized entries, the timing of each entry might be erroneously represented. Proper training and closing of encounters can diminish these issues.

Additionally, scribing the attestation is not permitted. Residents cannot document the teaching physician attestation on behalf of the physician under any circumstance. CMS rules require the teaching physician to document their presence, participation, and management of the patient. In an EHR, the teaching physician must document this entry under his/her own log-in and password, which is not to be shared with anyone.

Students

CMS defines student as “an individual who participates in an accredited educational program [e.g. a medical school] that is not an approved GME program.”1 A student is not regarded as a “physician in training,” and the service is not eligible for reimbursement consideration under the teaching physician rules.

Per CMS guidelines, students can document services in the medical record, but the teaching physician may only refer to the student’s systems review and past/family/social history entries. The teaching physician must verify and redocument the history of present illness. A student’s physical exam findings or medical decision-making are not suitable for tethering, and the teaching physician must personally perform and redocument the physical exam and medical decision-making. The visit level reflects only the teaching physician’s personally performed and documented service.

Carol Pohlig is a billing and coding expert with the University of Pennsylvania Medical Center, Philadelphia. She is also on the faculty of SHM’s inpatient coding course.

References

1. Centers for Medicare and Medicaid Services. Guidelines for Teaching Physicians, Interns, Residents. CMS website. Available at: http://www.cms.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf. Accessed Jan. 8, 2013.
2. Abraham M, Ahlman J, Anderson C, Boudreau A, Connelly J. Current Procedural Terminology 2012 Professional Edition. Chicago: American Medical Association Press; 2011.
3. Centers for Medicare and Medicaid Services. Medicare Claims Processing Manual: Chapter 12, Section 100. CMS website. Available at: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. Accessed Jan. 8, 2013.
4. Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual: Chapter 15, Section 30.2. CMS website. Available at: http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf. Accessed Jan. 8, 2013.

When hospitalists work in academic centers, medical and surgical services are furnished, in part, by a resident within the scope of the hospitalists’ training program. A resident is “an individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting.”¹ Resident services are covered by Centers for Medicare & Medicaid Services (CMS) and paid by the Fiscal Intermediary through direct GME and Indirect Medical Education (IME) payments. These services are not billed or paid using the Medicare Physician Fee Schedule. The teaching physician is responsible for supervising the resident’s health-care delivery but is not paid for the resident’s work. The teaching physician is paid for their personal and medically necessary service in providing patient care. The teaching physician has the option to perform the entire service, or perform the self-determined critical or key portion(s) of the service.

Comprehensive Service

Teaching physicians independently see the patient and perform all required elements to support the visit level (e.g. 99233: subsequent hospital care, per day, which requires at least two of the following three key components: a detailed interval history, a detailed examination, or high-complexity medical decision-making).² The teaching physician writes a note independent of a resident encounter with the patient or documentation. The teaching physician note “stands alone” and does not rely on the resident’s documentation. If the resident saw the patient and documented the encounter, the teaching physician might choose to “link to” the resident note in lieu of personally documenting the entire service. The linking statement must demonstrate teaching physician involvement in the patient encounter and participation in patient management. Use of CMS-approved statements is best to meet these requirements. Statement examples include:³

• “I performed a history and physical examination of the patient and discussed his management with the resident. I reviewed the resident’s note and agree with the documented findings and plan of care.”
• “I saw and evaluated the patient. I agree with the findings and the plan of care as documented in the resident’s note.”
• “I saw and examined the patient. I agree with the resident’s note, except the heart murmur is louder, so I will obtain an echo to evaluate.”

Each of these statements meets the minimum requirements for billing. However, teaching physicians should offer more information in support of other clinical, quality, and regulatory initiatives and mandates, better exemplified in the last example. The reported visit level will be supported by the combined documentation (teaching physician and resident).

The teaching physician submits a claim in their name and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99223-GC). This alerts the Medicare contractor that services were provided under teaching physician rules. Requests for documentation should include a response with medical record entries from the teaching physician and resident.

Critical/Key Portion

“Supervised” service: The resident and teaching physician can round together; they can see the patient at the same time. The teaching physician observes the resident’s performance during the patient encounter, or personally performs self-determined elements of patient care. The resident documents their patient care. The attending must still note their presence in the medical record, performance of the critical or key portions of the service, and involvement in patient management. CMS-accepted statements include:³

• “I was present with the resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note.”
• “I saw the patient with the resident and agree with the resident’s findings and plan.”

Although these statements demonstrate acceptable billing language, they lack patient-specific details that support the teaching physician’s personal contribution to patient care and the quality of their expertise. The teaching physician selects the visit level that represents the combined documentation and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99232-GC).

“Shared” service: The resident sees the patient unaccompanied and documents the corresponding care provided. The teaching physician sees the patient at a different time but performs only the critical or key portions of the service. The case is subsequently discussed with the resident. The teaching physician must document their presence and performance of the critical or key portions of the service, along with any patient management. Using CMS-quoted statements ensures regulatory compliance:³

• “I saw and evaluated the patient. I reviewed the resident’s note and agree, except that the picture is more consistent with pericarditis than myocardial ischemia. Will begin NSAIDs.”
• “I saw and evaluated the patient. Discussed with resident and agree with resident’s findings and plan as documented in the resident’s note.”
• “See resident’s note for details. I saw and evaluated the patient and agree with the resident’s finding and plans as written.”
• “I saw and evaluated the patient. Agree with resident’s note, but lower extremities are weaker, now 3/5; MRI of L/S spine today.”

Once again, the teaching physician selects the visit level that represents the combined documentation and, if it is a Medicare claim, appends modifier GC to the selected visit level (e.g. 99233-GC).

EHR Considerations

When seeing patients independent of one another, the timing of the teaching physician and resident encounters does not impact billing. However, the time that the resident encounter is documented in the medical record can significantly impact the payment when reviewed by external auditors. When the resident note is dated and timed later than the teaching physician’s entry, the teaching physician cannot consider the resident’s note for visit-level selection. The teaching physician should not “link to” a resident note that is viewed as “not having been written” prior to the teaching physician note. This would not fulfill the requirements represented in the CMS-approved language “I reviewed the resident’s note and agree.”

Electronic health record (EHR) systems sometimes hinder compliance. If the resident completes the note but does not “finalize” or “close” the encounter until after the teaching physician documents their own note, it can falsely appear that the resident note did not exist at the time the teaching physician created their entry. Because an auditor can only view the finalized entries, the timing of each entry might be erroneously represented. Proper training and closing of encounters can diminish these issues.

Additionally, scribing the attestation is not permitted. Residents cannot document the teaching physician attestation on behalf of the physician under any circumstance. CMS rules require the teaching physician to document their presence, participation, and management of the patient. In an EHR, the teaching physician must document this entry under his/her own log-in and password, which is not to be shared with anyone.

Students

CMS defines student as “an individual who participates in an accredited educational program [e.g. a medical school] that is not an approved GME program.”1 A student is not regarded as a “physician in training,” and the service is not eligible for reimbursement consideration under the teaching physician rules.

Per CMS guidelines, students can document services in the medical record, but the teaching physician may only refer to the student’s systems review and past/family/social history entries. The teaching physician must verify and redocument the history of present illness. A student’s physical exam findings or medical decision-making are not suitable for tethering, and the teaching physician must personally perform and redocument the physical exam and medical decision-making. The visit level reflects only the teaching physician’s personally performed and documented service.

Carol Pohlig is a billing and coding expert with the University of Pennsylvania Medical Center, Philadelphia. She is also on the faculty of SHM’s inpatient coding course.

References

1. Centers for Medicare and Medicaid Services. Guidelines for Teaching Physicians, Interns, Residents. CMS website. Available at: http://www.cms.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf. Accessed Jan. 8, 2013.
2. Abraham M, Ahlman J, Anderson C, Boudreau A, Connelly J. Current Procedural Terminology 2012 Professional Edition. Chicago: American Medical Association Press; 2011.
3. Centers for Medicare and Medicaid Services. Medicare Claims Processing Manual: Chapter 12, Section 100. CMS website. Available at: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. Accessed Jan. 8, 2013.
4. Centers for Medicare and Medicaid Services. Medicare Benefit Policy Manual: Chapter 15, Section 30.2. CMS website. Available at: http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf. Accessed Jan. 8, 2013.

The VA Ann Arbor Healthcare System in Michigan is mobilizing telehealth technology for a disaster-relief initiative that aims to connect first responders in the field with medical specialists at the Ann Arbor Medical Center. As reported in Healthcare IT News, the Disaster Relief Telehealth System of Orion, Mich.-based JEMS Technology (www.jemstech.com) enables secure, live-streaming video to be sent to specialists, who can review the video and respond with medical advice.⁵

The Office of Emergency Management at the Ann Arbor VA supports emergency operations from four treatment sites serving 21 counties in Michigan and Ohio, as well as regional disaster preparedness.

In other technology news, the U.S. Army in March awarded a $2.5 million contract to brain-monitoring-device company NeuroWave Systems of Cleveland Heights, Ohio (www.neurowavesystems.com), to develop a wearable, miniaturized brain monitor to assess via electroencephalogram data for traumatic brain injury (TBI) in the field, directly at the point of suspected injury, such as on battlefronts. The device, called SeizTBI, is “small, lightweight, and designed for rapid deployment in austere environments,” explains NeuroWave principal investigator Stephan Bibian, MD. TBI accounted for 22% of U.S. troop casualties in the Iraq and Afghanistan conflicts, but fewer than half were identified in the field.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

The VA Ann Arbor Healthcare System in Michigan is mobilizing telehealth technology for a disaster-relief initiative that aims to connect first responders in the field with medical specialists at the Ann Arbor Medical Center. As reported in Healthcare IT News, the Disaster Relief Telehealth System of Orion, Mich.-based JEMS Technology (www.jemstech.com) enables secure, live-streaming video to be sent to specialists, who can review the video and respond with medical advice.⁵

The Office of Emergency Management at the Ann Arbor VA supports emergency operations from four treatment sites serving 21 counties in Michigan and Ohio, as well as regional disaster preparedness.

In other technology news, the U.S. Army in March awarded a $2.5 million contract to brain-monitoring-device company NeuroWave Systems of Cleveland Heights, Ohio (www.neurowavesystems.com), to develop a wearable, miniaturized brain monitor to assess via electroencephalogram data for traumatic brain injury (TBI) in the field, directly at the point of suspected injury, such as on battlefronts. The device, called SeizTBI, is “small, lightweight, and designed for rapid deployment in austere environments,” explains NeuroWave principal investigator Stephan Bibian, MD. TBI accounted for 22% of U.S. troop casualties in the Iraq and Afghanistan conflicts, but fewer than half were identified in the field.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

The VA Ann Arbor Healthcare System in Michigan is mobilizing telehealth technology for a disaster-relief initiative that aims to connect first responders in the field with medical specialists at the Ann Arbor Medical Center. As reported in Healthcare IT News, the Disaster Relief Telehealth System of Orion, Mich.-based JEMS Technology (www.jemstech.com) enables secure, live-streaming video to be sent to specialists, who can review the video and respond with medical advice.⁵

The Office of Emergency Management at the Ann Arbor VA supports emergency operations from four treatment sites serving 21 counties in Michigan and Ohio, as well as regional disaster preparedness.

In other technology news, the U.S. Army in March awarded a $2.5 million contract to brain-monitoring-device company NeuroWave Systems of Cleveland Heights, Ohio (www.neurowavesystems.com), to develop a wearable, miniaturized brain monitor to assess via electroencephalogram data for traumatic brain injury (TBI) in the field, directly at the point of suspected injury, such as on battlefronts. The device, called SeizTBI, is “small, lightweight, and designed for rapid deployment in austere environments,” explains NeuroWave principal investigator Stephan Bibian, MD. TBI accounted for 22% of U.S. troop casualties in the Iraq and Afghanistan conflicts, but fewer than half were identified in the field.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

The American Medical Association recently released a report developed by a 21-member expert panel proposing a nine-step plan for primary-care-physician (PCP) practices to play an integral role in improving care transitions and preventing avoidable rehospitalizations.² The report recommends focusing on more than just the hospital-admitting diagnosis, conducting a thorough patient health assessment, clarifying the patient’s short- and long-term goals, and coordinating care with other care settings.

With simultaneous research in JAMA concluding that the vast majority of readmissions are for reasons unrelated to the previous hospital stay, coordination between the inpatient and outpatient teams is crucial to successful transitions of care.³ Moreover, a recent survey showed that nearly 30% of PCPs say they miss alerts about patients’ test results from an electronic health record (EHR) notification system.⁴ According to the survey by Hardeep Singh, MD, MPH, and colleagues from the Michael E. DeBakey VA Medical Center in Houston, the doctors received on average 63 such alerts per day. Seventy percent reported that they cannot effectively manage the alerts, and more than half said that the current EHR notification system makes it possible to miss test results.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

The American Medical Association recently released a report developed by a 21-member expert panel proposing a nine-step plan for primary-care-physician (PCP) practices to play an integral role in improving care transitions and preventing avoidable rehospitalizations.² The report recommends focusing on more than just the hospital-admitting diagnosis, conducting a thorough patient health assessment, clarifying the patient’s short- and long-term goals, and coordinating care with other care settings.

With simultaneous research in JAMA concluding that the vast majority of readmissions are for reasons unrelated to the previous hospital stay, coordination between the inpatient and outpatient teams is crucial to successful transitions of care.³ Moreover, a recent survey showed that nearly 30% of PCPs say they miss alerts about patients’ test results from an electronic health record (EHR) notification system.⁴ According to the survey by Hardeep Singh, MD, MPH, and colleagues from the Michael E. DeBakey VA Medical Center in Houston, the doctors received on average 63 such alerts per day. Seventy percent reported that they cannot effectively manage the alerts, and more than half said that the current EHR notification system makes it possible to miss test results.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

The American Medical Association recently released a report developed by a 21-member expert panel proposing a nine-step plan for primary-care-physician (PCP) practices to play an integral role in improving care transitions and preventing avoidable rehospitalizations.² The report recommends focusing on more than just the hospital-admitting diagnosis, conducting a thorough patient health assessment, clarifying the patient’s short- and long-term goals, and coordinating care with other care settings.

With simultaneous research in JAMA concluding that the vast majority of readmissions are for reasons unrelated to the previous hospital stay, coordination between the inpatient and outpatient teams is crucial to successful transitions of care.³ Moreover, a recent survey showed that nearly 30% of PCPs say they miss alerts about patients’ test results from an electronic health record (EHR) notification system.⁴ According to the survey by Hardeep Singh, MD, MPH, and colleagues from the Michael E. DeBakey VA Medical Center in Houston, the doctors received on average 63 such alerts per day. Seventy percent reported that they cannot effectively manage the alerts, and more than half said that the current EHR notification system makes it possible to miss test results.

Larry Beresford is a freelance writer in Oakland, Calif.

References

1. Quinn K, Neeman N, Mourad M, Sliwka D. Communication coaching: A multifaceted intervention to improve physician-patient communication [abstract]. J Hosp Med. 2012;7 Suppl 2:S108.
2. Sokol PE, Wynia MK. There and Home Again, Safely: Five Responsibilities of Ambulatory Practices in High Quality Care Transitions. American Medical Association website. http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf. Accessed February 12, 2013.
3. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363.
4. JAMA Internal Medicine. Nearly one-third of physicians report missing electronic notification of test results. JAMA Internal Medicine website. Available at: http://media.jamanetwork.com/news-item/nearly-one-third-of-physicians-report-missing-electronic-notification-of-test-results/.Accessed April 8, 2013.
5. Miliard M. VA enlists telehealth for disasters. Healthcare IT News website. http://www.healthcareitnews.com/news/va-enlists-telehealth-disasters. Published February 27, 2013. Accessed April 1, 2013.

Are you a hospitalist who, on daily rounds, often thinks, “There’s got to be a better way to do this”? You might be just the type of person who can carve a niche for yourself in hospital quality and patient safety—and advance your career in the process.

Successful navigation of the quality-improvement (QI) and patient-safety domains, according to three veteran hospitalists, requires an initial passion and an incremental approach. Now is an especially good time, they agree, for young hospitalists to engage in these types of initiatives.

Why Do It?

In her capacity as president of the Mid-Atlantic Business Unit for Brentwood, Tenn.-based CogentHMG, Julia Wright, MD, SFHM, FACP, often encourages young recruits to consider participation in QI and patient-safety initiatives. She admits that the transition from residency to a busy HM practice, with its higher patient volumes and a faster pace, can be daunting at first. Still, she tries to cultivate interest in initiatives and establish a realistic timeframe for involvement.

There are many reasons to consider this as a career step. Dr. Wright says that quality and patient safety dovetail with hospitalists’ initial reasons for choosing medicine: to improve patients’ lives.

Janet Nagamine, RN, MD, SFHM, former patient safety officer and assistant chief of quality at Kaiser Permanente in Santa Clara, Calif., describes the fit this way: “I might be a good doctor, but as a hospitalist, I rely on many others within the system to deliver, so my patients can’t get good care until the entire system is running well,” she says. “There are all kinds of opportunities to fix our [hospital] system, and I really believe that hospitalists cannot separate themselves from that engagement.”

Elizabeth Gundersen, MD, FHM, of Fort Lauderdale, Fla., agrees that it’s a natural step to think about the ways to make a difference on a larger level. At her former institution, the University of Massachusetts (UMass) Medical School in Worcester, she parlayed her interest in QI to work her way up from ground-level hospitalist to associate chief of her division and quality officer for the hospital. “Physicians get a lot of satisfaction from helping individual patients,” she says. “One thing I really liked about getting involved with quality improvement was being able to make a difference for patients on a systems level.”

An Incremental Path

The path to her current position began with a very specific issue for Dr. Nagamine, an SHM board member who also serves as a Project BOOST co-investigator. “Although I have been doing patient safety since before they had a name for it, I didn’t start out saying that I wanted a career in quality and safety,” she says. “I was trying to take better care of my patients with diabetes, but controlling their glucose was extremely challenging because all the related variables—timing and amount of their insulin dosage, when and how much they had eaten—were charted in different places. This made it hard to adjust their insulin appropriately.”

It quickly became clear to Dr. Nagamine that the solution had to be systemic. She realized that something as basic as taking care of her patients with diabetes required multiple departments (i.e. dietary, nursing, and pharmacy) to furnish information in an integrated manner. So she joined the diabetes committee and went to work on the issue. She helped devise a flow chart that could be used by all relevant departments. A further evolution on the path emanated from one of her patients receiving the wrong medication. She joined the medication safety committee, became chair, “and the next thing you know, I’m in charge of patient safety, and an assistant chief of quality.”

Training Is Necessary

QI and patient-safety methodologies have become sophisticated disciplines in the past two decades, Dr. Wright says. Access to training in QI basics now is readily available to early-career hospitalists. For example, CogentHMG offers program support for QI so that anyone interested “doesn’t have to start from scratch anymore; we can help show them the way and support them in doing it.”

This month, HM13 (www.hospital medicine2013.org)—just outside Washington, D.C.—will offer multiple sessions on quality, as well as the “Initiating Quality Improvement Projects with Built-In Sustainment” workshop, led by Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) core investigator Peter Kaboli, MD, MS, who will address sustainability.

Beyond methodological tools, success in quality and patient safety requires the ability to motivate people, often across multiple disciplines, Dr. Nagamine says. “If you want things to work better, you must invite the right people to the table. For example, we often forget to include key nonclinical stakeholders,” she adds.

When working with hospitals across the country to implement rapid-response tTeams, Dr. Nagamine often reminds them to invite the operators, or “key people,” in the process.

“If you put patient safety at the core of your initiative and create the context for that, most people will agree that it’s the right thing to do and will get on board, even if it’s an extra step for them,” she says. “Know your audience, listen to their perspective, and learn what matters to them. And to most people, it matters that they give good patient care.”

Gretchen Henkel is a freelance writer in California.

Branch Out: QI and Patient-Safety Initiatives

Pick a passion. It’s best to choose an issue that’s important to you. “It has to be a

passion because much of the time it’s an uphill battle,” says Dr. Gundersen. She started with the issue of reducing readmissions, and with two colleagues pitched the idea of involving the UMass HM group in SHM’s Project BOOST. After that, she set out to become an expert on reducing readmissions, applying what she had learned to other successful initiatives.

Learn the lingo. Dr. Wright advises learning some of the most basic principles, such as Shewhart’s PDCA (Plan-Do-Check-Act) or Deming’s adaptation PDSA (Plan-Do-Study-Act) cycles; the quality tripod; and accessing resources made available from SHM. A member of SHM’s Hospital Quality and Patient Safety Committee, Dr. Wright says a subcommittee for leadership engagement has been created and furnishes tools and training for advancing quality initiatives. The Institute for Healthcare Improvement (www.ihi.org) also offers a wealth of measures, speaker series, and white papers on improvement in health care.

It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss.

Start small. You can test your ability to work with interdisciplinary departments, often a prerequisite of many quality initiatives, by first joining a committee, Dr. Nagamine advises. “See how effective or persuasive you are in pitching an idea and seeing it through with other departments,” she says.

Brace for a marathon. “Most people,” Dr. Gundersen says, “do not hand you 100% of their cooperation and a budget you can work with.” It takes time to get buy-in, especially if you’re doing interdisciplinary initiatives. If possible, break your projects into achievable units. “Start with some quick wins. Small payoffs here and there can re-energize your team and eventually yield a larger payoff,” she says.

Limit sweat equity. It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss. “Being a good citizen and volunteering for committees is one thing,” Dr. Nagamine cautions, “but taking on leadership roles in too many projects, without dedicated time, is not sustainable and can jeopardize the success of your projects.”

—Gretchen Henkel

Are you a hospitalist who, on daily rounds, often thinks, “There’s got to be a better way to do this”? You might be just the type of person who can carve a niche for yourself in hospital quality and patient safety—and advance your career in the process.

Successful navigation of the quality-improvement (QI) and patient-safety domains, according to three veteran hospitalists, requires an initial passion and an incremental approach. Now is an especially good time, they agree, for young hospitalists to engage in these types of initiatives.

Why Do It?

In her capacity as president of the Mid-Atlantic Business Unit for Brentwood, Tenn.-based CogentHMG, Julia Wright, MD, SFHM, FACP, often encourages young recruits to consider participation in QI and patient-safety initiatives. She admits that the transition from residency to a busy HM practice, with its higher patient volumes and a faster pace, can be daunting at first. Still, she tries to cultivate interest in initiatives and establish a realistic timeframe for involvement.

There are many reasons to consider this as a career step. Dr. Wright says that quality and patient safety dovetail with hospitalists’ initial reasons for choosing medicine: to improve patients’ lives.

Janet Nagamine, RN, MD, SFHM, former patient safety officer and assistant chief of quality at Kaiser Permanente in Santa Clara, Calif., describes the fit this way: “I might be a good doctor, but as a hospitalist, I rely on many others within the system to deliver, so my patients can’t get good care until the entire system is running well,” she says. “There are all kinds of opportunities to fix our [hospital] system, and I really believe that hospitalists cannot separate themselves from that engagement.”

Elizabeth Gundersen, MD, FHM, of Fort Lauderdale, Fla., agrees that it’s a natural step to think about the ways to make a difference on a larger level. At her former institution, the University of Massachusetts (UMass) Medical School in Worcester, she parlayed her interest in QI to work her way up from ground-level hospitalist to associate chief of her division and quality officer for the hospital. “Physicians get a lot of satisfaction from helping individual patients,” she says. “One thing I really liked about getting involved with quality improvement was being able to make a difference for patients on a systems level.”

An Incremental Path

The path to her current position began with a very specific issue for Dr. Nagamine, an SHM board member who also serves as a Project BOOST co-investigator. “Although I have been doing patient safety since before they had a name for it, I didn’t start out saying that I wanted a career in quality and safety,” she says. “I was trying to take better care of my patients with diabetes, but controlling their glucose was extremely challenging because all the related variables—timing and amount of their insulin dosage, when and how much they had eaten—were charted in different places. This made it hard to adjust their insulin appropriately.”

It quickly became clear to Dr. Nagamine that the solution had to be systemic. She realized that something as basic as taking care of her patients with diabetes required multiple departments (i.e. dietary, nursing, and pharmacy) to furnish information in an integrated manner. So she joined the diabetes committee and went to work on the issue. She helped devise a flow chart that could be used by all relevant departments. A further evolution on the path emanated from one of her patients receiving the wrong medication. She joined the medication safety committee, became chair, “and the next thing you know, I’m in charge of patient safety, and an assistant chief of quality.”

Training Is Necessary

QI and patient-safety methodologies have become sophisticated disciplines in the past two decades, Dr. Wright says. Access to training in QI basics now is readily available to early-career hospitalists. For example, CogentHMG offers program support for QI so that anyone interested “doesn’t have to start from scratch anymore; we can help show them the way and support them in doing it.”

This month, HM13 (www.hospital medicine2013.org)—just outside Washington, D.C.—will offer multiple sessions on quality, as well as the “Initiating Quality Improvement Projects with Built-In Sustainment” workshop, led by Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) core investigator Peter Kaboli, MD, MS, who will address sustainability.

Beyond methodological tools, success in quality and patient safety requires the ability to motivate people, often across multiple disciplines, Dr. Nagamine says. “If you want things to work better, you must invite the right people to the table. For example, we often forget to include key nonclinical stakeholders,” she adds.

When working with hospitals across the country to implement rapid-response tTeams, Dr. Nagamine often reminds them to invite the operators, or “key people,” in the process.

“If you put patient safety at the core of your initiative and create the context for that, most people will agree that it’s the right thing to do and will get on board, even if it’s an extra step for them,” she says. “Know your audience, listen to their perspective, and learn what matters to them. And to most people, it matters that they give good patient care.”

Gretchen Henkel is a freelance writer in California.

Branch Out: QI and Patient-Safety Initiatives

Pick a passion. It’s best to choose an issue that’s important to you. “It has to be a

passion because much of the time it’s an uphill battle,” says Dr. Gundersen. She started with the issue of reducing readmissions, and with two colleagues pitched the idea of involving the UMass HM group in SHM’s Project BOOST. After that, she set out to become an expert on reducing readmissions, applying what she had learned to other successful initiatives.

Learn the lingo. Dr. Wright advises learning some of the most basic principles, such as Shewhart’s PDCA (Plan-Do-Check-Act) or Deming’s adaptation PDSA (Plan-Do-Study-Act) cycles; the quality tripod; and accessing resources made available from SHM. A member of SHM’s Hospital Quality and Patient Safety Committee, Dr. Wright says a subcommittee for leadership engagement has been created and furnishes tools and training for advancing quality initiatives. The Institute for Healthcare Improvement (www.ihi.org) also offers a wealth of measures, speaker series, and white papers on improvement in health care.

It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss.

Start small. You can test your ability to work with interdisciplinary departments, often a prerequisite of many quality initiatives, by first joining a committee, Dr. Nagamine advises. “See how effective or persuasive you are in pitching an idea and seeing it through with other departments,” she says.

Brace for a marathon. “Most people,” Dr. Gundersen says, “do not hand you 100% of their cooperation and a budget you can work with.” It takes time to get buy-in, especially if you’re doing interdisciplinary initiatives. If possible, break your projects into achievable units. “Start with some quick wins. Small payoffs here and there can re-energize your team and eventually yield a larger payoff,” she says.

Limit sweat equity. It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss. “Being a good citizen and volunteering for committees is one thing,” Dr. Nagamine cautions, “but taking on leadership roles in too many projects, without dedicated time, is not sustainable and can jeopardize the success of your projects.”

—Gretchen Henkel

Are you a hospitalist who, on daily rounds, often thinks, “There’s got to be a better way to do this”? You might be just the type of person who can carve a niche for yourself in hospital quality and patient safety—and advance your career in the process.

Successful navigation of the quality-improvement (QI) and patient-safety domains, according to three veteran hospitalists, requires an initial passion and an incremental approach. Now is an especially good time, they agree, for young hospitalists to engage in these types of initiatives.

Why Do It?

In her capacity as president of the Mid-Atlantic Business Unit for Brentwood, Tenn.-based CogentHMG, Julia Wright, MD, SFHM, FACP, often encourages young recruits to consider participation in QI and patient-safety initiatives. She admits that the transition from residency to a busy HM practice, with its higher patient volumes and a faster pace, can be daunting at first. Still, she tries to cultivate interest in initiatives and establish a realistic timeframe for involvement.

There are many reasons to consider this as a career step. Dr. Wright says that quality and patient safety dovetail with hospitalists’ initial reasons for choosing medicine: to improve patients’ lives.

Janet Nagamine, RN, MD, SFHM, former patient safety officer and assistant chief of quality at Kaiser Permanente in Santa Clara, Calif., describes the fit this way: “I might be a good doctor, but as a hospitalist, I rely on many others within the system to deliver, so my patients can’t get good care until the entire system is running well,” she says. “There are all kinds of opportunities to fix our [hospital] system, and I really believe that hospitalists cannot separate themselves from that engagement.”

Elizabeth Gundersen, MD, FHM, of Fort Lauderdale, Fla., agrees that it’s a natural step to think about the ways to make a difference on a larger level. At her former institution, the University of Massachusetts (UMass) Medical School in Worcester, she parlayed her interest in QI to work her way up from ground-level hospitalist to associate chief of her division and quality officer for the hospital. “Physicians get a lot of satisfaction from helping individual patients,” she says. “One thing I really liked about getting involved with quality improvement was being able to make a difference for patients on a systems level.”

An Incremental Path

The path to her current position began with a very specific issue for Dr. Nagamine, an SHM board member who also serves as a Project BOOST co-investigator. “Although I have been doing patient safety since before they had a name for it, I didn’t start out saying that I wanted a career in quality and safety,” she says. “I was trying to take better care of my patients with diabetes, but controlling their glucose was extremely challenging because all the related variables—timing and amount of their insulin dosage, when and how much they had eaten—were charted in different places. This made it hard to adjust their insulin appropriately.”

It quickly became clear to Dr. Nagamine that the solution had to be systemic. She realized that something as basic as taking care of her patients with diabetes required multiple departments (i.e. dietary, nursing, and pharmacy) to furnish information in an integrated manner. So she joined the diabetes committee and went to work on the issue. She helped devise a flow chart that could be used by all relevant departments. A further evolution on the path emanated from one of her patients receiving the wrong medication. She joined the medication safety committee, became chair, “and the next thing you know, I’m in charge of patient safety, and an assistant chief of quality.”

Training Is Necessary

QI and patient-safety methodologies have become sophisticated disciplines in the past two decades, Dr. Wright says. Access to training in QI basics now is readily available to early-career hospitalists. For example, CogentHMG offers program support for QI so that anyone interested “doesn’t have to start from scratch anymore; we can help show them the way and support them in doing it.”

This month, HM13 (www.hospital medicine2013.org)—just outside Washington, D.C.—will offer multiple sessions on quality, as well as the “Initiating Quality Improvement Projects with Built-In Sustainment” workshop, led by Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) core investigator Peter Kaboli, MD, MS, who will address sustainability.

Beyond methodological tools, success in quality and patient safety requires the ability to motivate people, often across multiple disciplines, Dr. Nagamine says. “If you want things to work better, you must invite the right people to the table. For example, we often forget to include key nonclinical stakeholders,” she adds.

When working with hospitals across the country to implement rapid-response tTeams, Dr. Nagamine often reminds them to invite the operators, or “key people,” in the process.

“If you put patient safety at the core of your initiative and create the context for that, most people will agree that it’s the right thing to do and will get on board, even if it’s an extra step for them,” she says. “Know your audience, listen to their perspective, and learn what matters to them. And to most people, it matters that they give good patient care.”

Gretchen Henkel is a freelance writer in California.

Branch Out: QI and Patient-Safety Initiatives

Pick a passion. It’s best to choose an issue that’s important to you. “It has to be a

passion because much of the time it’s an uphill battle,” says Dr. Gundersen. She started with the issue of reducing readmissions, and with two colleagues pitched the idea of involving the UMass HM group in SHM’s Project BOOST. After that, she set out to become an expert on reducing readmissions, applying what she had learned to other successful initiatives.

Learn the lingo. Dr. Wright advises learning some of the most basic principles, such as Shewhart’s PDCA (Plan-Do-Check-Act) or Deming’s adaptation PDSA (Plan-Do-Study-Act) cycles; the quality tripod; and accessing resources made available from SHM. A member of SHM’s Hospital Quality and Patient Safety Committee, Dr. Wright says a subcommittee for leadership engagement has been created and furnishes tools and training for advancing quality initiatives. The Institute for Healthcare Improvement (www.ihi.org) also offers a wealth of measures, speaker series, and white papers on improvement in health care.

It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss.

Start small. You can test your ability to work with interdisciplinary departments, often a prerequisite of many quality initiatives, by first joining a committee, Dr. Nagamine advises. “See how effective or persuasive you are in pitching an idea and seeing it through with other departments,” she says.

Brace for a marathon. “Most people,” Dr. Gundersen says, “do not hand you 100% of their cooperation and a budget you can work with.” It takes time to get buy-in, especially if you’re doing interdisciplinary initiatives. If possible, break your projects into achievable units. “Start with some quick wins. Small payoffs here and there can re-energize your team and eventually yield a larger payoff,” she says.

Limit sweat equity. It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss. “Being a good citizen and volunteering for committees is one thing,” Dr. Nagamine cautions, “but taking on leadership roles in too many projects, without dedicated time, is not sustainable and can jeopardize the success of your projects.”

—Gretchen Henkel

Dr. Wachter

Most hospitalists have heard the adage “If you’ve seen one hospitalist group, you’ve seen one hospitalist group.” Another HM truism is “If you’ve seen one SHM annual meeting, then you’ve seen Bob Wachter, MD, MHM.”

Dr. Wachter, professor, chief of the division of hospital medicine, and chief of the medical service at the University of California at San Francisco Medical Center, is to HM conventions as warfarin is to anticoagulation. His keynote address is the finale to the yearly confab, and HM13’s version is scheduled for noon May 19 at the Gaylord National Harbor Resort & Convention Center in National Harbor, Md.

This year’s address is titled “Quality, Safety, and IT: A Decade of Successes, Failures, Surprises, and Epiphanies.” Dr. Wachter spoke recently with The Hospitalist about his annual tradition.

Question: With your interest in the intersection between healthcare and politics, to be back in D.C. has to be something enjoyable for you to write and talk about.

Answer: It’s a very interesting time in the life of healthcare, in that now that everybody knows that the [Affordable Care Act] is real and not going away, and we’re actually beginning to implement parts of it, you can kind of see what the future is going to look like, and everybody’s responding. And there are parts of that that are very exciting, because they’re forcing us to think about value in new ways. [And] there are parts of it that are somewhat frustrating.

Q: Does that give the hospitalist community the chance to ride herd on more global issues?

A: I think that’s the most optimistic interpretation—that we stick to our knitting, that we continue to be the leaders in improvement, and eventually all of the deals will be done, lawyers will be dismissed, and people will turn back to focusing on performance and say to us, “Thank goodness you’ve been doing this work, because now we realize that it’s not just about contracts; it’s about how we deliver care, and you’re the ones that have been leading the way.”

Q: What’s the most realistic interpretation?

A: This work gets less attention and less support than it needs. … I think we’re going to go through three to five years where we’re continuing to do the work. It’s really important—in many ways, it’s as important as growing—but as its importance is growing, the importance of other things that require more tending-to by the senior leadership is growing even faster. The risk is that there will be a disconnect.

Q: When you see the literature that suggests just how difficult the nuts and bolts implementation of reform is, what message do you want to get across to the people who are going to be listening, in terms of actually implementing all of this?

A: The message I don’t want to get across is “frustration, burnout, and it’s not worth it.” The endgame is worth it. The endgame is not even elective. We have to get to a place where we’re delivering higher-quality, safer, more satisfying care to patients at a lower cost. We’re in a unique position to deliver on that promise. … This is really tough stuff, and it takes time and it takes learning.

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Richard Quinn is a freelance writer in New Jersey.

Dr. Wachter

Most hospitalists have heard the adage “If you’ve seen one hospitalist group, you’ve seen one hospitalist group.” Another HM truism is “If you’ve seen one SHM annual meeting, then you’ve seen Bob Wachter, MD, MHM.”

Dr. Wachter, professor, chief of the division of hospital medicine, and chief of the medical service at the University of California at San Francisco Medical Center, is to HM conventions as warfarin is to anticoagulation. His keynote address is the finale to the yearly confab, and HM13’s version is scheduled for noon May 19 at the Gaylord National Harbor Resort & Convention Center in National Harbor, Md.

This year’s address is titled “Quality, Safety, and IT: A Decade of Successes, Failures, Surprises, and Epiphanies.” Dr. Wachter spoke recently with The Hospitalist about his annual tradition.

Question: With your interest in the intersection between healthcare and politics, to be back in D.C. has to be something enjoyable for you to write and talk about.

Answer: It’s a very interesting time in the life of healthcare, in that now that everybody knows that the [Affordable Care Act] is real and not going away, and we’re actually beginning to implement parts of it, you can kind of see what the future is going to look like, and everybody’s responding. And there are parts of that that are very exciting, because they’re forcing us to think about value in new ways. [And] there are parts of it that are somewhat frustrating.

Q: Does that give the hospitalist community the chance to ride herd on more global issues?

A: I think that’s the most optimistic interpretation—that we stick to our knitting, that we continue to be the leaders in improvement, and eventually all of the deals will be done, lawyers will be dismissed, and people will turn back to focusing on performance and say to us, “Thank goodness you’ve been doing this work, because now we realize that it’s not just about contracts; it’s about how we deliver care, and you’re the ones that have been leading the way.”

Q: What’s the most realistic interpretation?

A: This work gets less attention and less support than it needs. … I think we’re going to go through three to five years where we’re continuing to do the work. It’s really important—in many ways, it’s as important as growing—but as its importance is growing, the importance of other things that require more tending-to by the senior leadership is growing even faster. The risk is that there will be a disconnect.

Q: When you see the literature that suggests just how difficult the nuts and bolts implementation of reform is, what message do you want to get across to the people who are going to be listening, in terms of actually implementing all of this?

A: The message I don’t want to get across is “frustration, burnout, and it’s not worth it.” The endgame is worth it. The endgame is not even elective. We have to get to a place where we’re delivering higher-quality, safer, more satisfying care to patients at a lower cost. We’re in a unique position to deliver on that promise. … This is really tough stuff, and it takes time and it takes learning.

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Richard Quinn is a freelance writer in New Jersey.

Dr. Wachter

Most hospitalists have heard the adage “If you’ve seen one hospitalist group, you’ve seen one hospitalist group.” Another HM truism is “If you’ve seen one SHM annual meeting, then you’ve seen Bob Wachter, MD, MHM.”

Dr. Wachter, professor, chief of the division of hospital medicine, and chief of the medical service at the University of California at San Francisco Medical Center, is to HM conventions as warfarin is to anticoagulation. His keynote address is the finale to the yearly confab, and HM13’s version is scheduled for noon May 19 at the Gaylord National Harbor Resort & Convention Center in National Harbor, Md.

This year’s address is titled “Quality, Safety, and IT: A Decade of Successes, Failures, Surprises, and Epiphanies.” Dr. Wachter spoke recently with The Hospitalist about his annual tradition.

Question: With your interest in the intersection between healthcare and politics, to be back in D.C. has to be something enjoyable for you to write and talk about.

Answer: It’s a very interesting time in the life of healthcare, in that now that everybody knows that the [Affordable Care Act] is real and not going away, and we’re actually beginning to implement parts of it, you can kind of see what the future is going to look like, and everybody’s responding. And there are parts of that that are very exciting, because they’re forcing us to think about value in new ways. [And] there are parts of it that are somewhat frustrating.

Q: Does that give the hospitalist community the chance to ride herd on more global issues?

A: I think that’s the most optimistic interpretation—that we stick to our knitting, that we continue to be the leaders in improvement, and eventually all of the deals will be done, lawyers will be dismissed, and people will turn back to focusing on performance and say to us, “Thank goodness you’ve been doing this work, because now we realize that it’s not just about contracts; it’s about how we deliver care, and you’re the ones that have been leading the way.”

Q: What’s the most realistic interpretation?

A: This work gets less attention and less support than it needs. … I think we’re going to go through three to five years where we’re continuing to do the work. It’s really important—in many ways, it’s as important as growing—but as its importance is growing, the importance of other things that require more tending-to by the senior leadership is growing even faster. The risk is that there will be a disconnect.

Q: When you see the literature that suggests just how difficult the nuts and bolts implementation of reform is, what message do you want to get across to the people who are going to be listening, in terms of actually implementing all of this?

A: The message I don’t want to get across is “frustration, burnout, and it’s not worth it.” The endgame is worth it. The endgame is not even elective. We have to get to a place where we’re delivering higher-quality, safer, more satisfying care to patients at a lower cost. We’re in a unique position to deliver on that promise. … This is really tough stuff, and it takes time and it takes learning.

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Richard Quinn is a freelance writer in New Jersey.

SHM Sections offer opportunities for members to connect with communities of their peers who share specialties or interests. At present, SHM Sections include:

• Med-Peds
• International
• Global Health and Human Rights
• Rural Hospitalists
• Practice Administrators

SHM Section of the Month

Seeing as how the focused-practice pathway for hospitalists is a first of its kind for physician credentialing boards, the ABIM is planning a “fairly significant” research effort tracking participants’ experience, Dr. Holmboe says.

Global Health and Human Rights is one of the newest SHM Sections, and represents a growing passion among hospitalists as increasing numbers of internal-medicine physicians express interest in overseas placements in resource-limited settings. SHM also recognizes the need for mentored training in global health.

Over the last decade, interest in global health has grown significantly amongst trainees, faculty, and staff. Current priorities for global health include: health-system strengthening, workforce training, QI and patient safety. These priorities align to core strengths of hospital medicine, which is therefore well suited to meet these global health challenges.

For more information about this and other Sections, visit www.hospitalmedicine.org/membership.

SHM Sections offer opportunities for members to connect with communities of their peers who share specialties or interests. At present, SHM Sections include:

• Med-Peds
• International
• Global Health and Human Rights
• Rural Hospitalists
• Practice Administrators

SHM Section of the Month

Seeing as how the focused-practice pathway for hospitalists is a first of its kind for physician credentialing boards, the ABIM is planning a “fairly significant” research effort tracking participants’ experience, Dr. Holmboe says.

Global Health and Human Rights is one of the newest SHM Sections, and represents a growing passion among hospitalists as increasing numbers of internal-medicine physicians express interest in overseas placements in resource-limited settings. SHM also recognizes the need for mentored training in global health.

Over the last decade, interest in global health has grown significantly amongst trainees, faculty, and staff. Current priorities for global health include: health-system strengthening, workforce training, QI and patient safety. These priorities align to core strengths of hospital medicine, which is therefore well suited to meet these global health challenges.

For more information about this and other Sections, visit www.hospitalmedicine.org/membership.

SHM Sections offer opportunities for members to connect with communities of their peers who share specialties or interests. At present, SHM Sections include:

• Med-Peds
• International
• Global Health and Human Rights
• Rural Hospitalists
• Practice Administrators

SHM Section of the Month

Seeing as how the focused-practice pathway for hospitalists is a first of its kind for physician credentialing boards, the ABIM is planning a “fairly significant” research effort tracking participants’ experience, Dr. Holmboe says.

Global Health and Human Rights is one of the newest SHM Sections, and represents a growing passion among hospitalists as increasing numbers of internal-medicine physicians express interest in overseas placements in resource-limited settings. SHM also recognizes the need for mentored training in global health.

Over the last decade, interest in global health has grown significantly amongst trainees, faculty, and staff. Current priorities for global health include: health-system strengthening, workforce training, QI and patient safety. These priorities align to core strengths of hospital medicine, which is therefore well suited to meet these global health challenges.

For more information about this and other Sections, visit www.hospitalmedicine.org/membership.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

Hospitalists play an increasingly pivotal role in ensuring the highest quality and safety for patients in hospitals. The implementation of healthcare reform has only heightened the importance of hospital quality and patient safety for hospitalists. To enable education and advancement of quality improvement (QI), SHM has developed the Hospital Quality & Patient Safety (HQPS) Online Academy (http://www.hospitalmedicine.org/hqps).

The HQPS Online Academy consists of Internet-based modules that provide training not included in traditional medical education. These modules bridge the gap between the conceptualization and practice of quality in hospitals, helping hospitalists to prepare and lead quality initiatives to improve patient outcomes. The modules allow healthcare providers to explore and evaluate current quality initiatives and practices, as well as reflect on ways to improve core measures within their hospital.

Each module focuses on a core principle of QI and patient safety, and provides three AMA PRA Category 1 credits.

SHM members who are insured with The Doctors Company can earn a 5% risk-management credit by completing the first five HQPS modules (see below). Eligible members also enjoy premium savings through a 5% program discount and a claims-free credit of up to 25%.

HQPS Online Academy modules

• Quality measurement and stakeholder interests
• Teamwork and communication
• Organizational knowledge and leadership skills
• Patient safety principles
• Quality and safety improvement methods and skills (RCA and FMEA)

Hospitalists play an increasingly pivotal role in ensuring the highest quality and safety for patients in hospitals. The implementation of healthcare reform has only heightened the importance of hospital quality and patient safety for hospitalists. To enable education and advancement of quality improvement (QI), SHM has developed the Hospital Quality & Patient Safety (HQPS) Online Academy (http://www.hospitalmedicine.org/hqps).

The HQPS Online Academy consists of Internet-based modules that provide training not included in traditional medical education. These modules bridge the gap between the conceptualization and practice of quality in hospitals, helping hospitalists to prepare and lead quality initiatives to improve patient outcomes. The modules allow healthcare providers to explore and evaluate current quality initiatives and practices, as well as reflect on ways to improve core measures within their hospital.

Each module focuses on a core principle of QI and patient safety, and provides three AMA PRA Category 1 credits.

SHM members who are insured with The Doctors Company can earn a 5% risk-management credit by completing the first five HQPS modules (see below). Eligible members also enjoy premium savings through a 5% program discount and a claims-free credit of up to 25%.

HQPS Online Academy modules

• Quality measurement and stakeholder interests
• Teamwork and communication
• Organizational knowledge and leadership skills
• Patient safety principles
• Quality and safety improvement methods and skills (RCA and FMEA)

Hospitalists play an increasingly pivotal role in ensuring the highest quality and safety for patients in hospitals. The implementation of healthcare reform has only heightened the importance of hospital quality and patient safety for hospitalists. To enable education and advancement of quality improvement (QI), SHM has developed the Hospital Quality & Patient Safety (HQPS) Online Academy (http://www.hospitalmedicine.org/hqps).

The HQPS Online Academy consists of Internet-based modules that provide training not included in traditional medical education. These modules bridge the gap between the conceptualization and practice of quality in hospitals, helping hospitalists to prepare and lead quality initiatives to improve patient outcomes. The modules allow healthcare providers to explore and evaluate current quality initiatives and practices, as well as reflect on ways to improve core measures within their hospital.

Each module focuses on a core principle of QI and patient safety, and provides three AMA PRA Category 1 credits.

SHM members who are insured with The Doctors Company can earn a 5% risk-management credit by completing the first five HQPS modules (see below). Eligible members also enjoy premium savings through a 5% program discount and a claims-free credit of up to 25%.

HQPS Online Academy modules

• Quality measurement and stakeholder interests
• Teamwork and communication
• Organizational knowledge and leadership skills
• Patient safety principles
• Quality and safety improvement methods and skills (RCA and FMEA)

Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.

Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.

Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.