ORLANDO – A slowed, rate-controlled infusion of rituximab during a desensitization protocol significantly reduced the number of hypersensitivity reactions compared with faster, standard-rate desensitization infusions.

"The safety of rituximab desensitization was improved using rate-controlled protocols," said Dr. Caroline L. Sokol, who discussed a review of 16 patients who underwent 103 desensitizations at a single U.S. center. The findings prompted her division to switch to rate-controlled infusions for all rituximab desensitization protocols, said Dr. Sokol of the division of allergy and immunology at Massachusetts General Hospital, Boston (J. Allergy Clin. Immunol. 2012;129[suppl.]:AB371).

Hypersensitivity reactions to rituximab primarily occur among patients who receive the drug to treat cancer. Patients who receive rituximab for other indications, such as rheumatoid diseases, rarely have hypersensitivity reactions. The explanation for this difference isn’t clear, Dr. Sokol said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the series she reviewed, 15 patients received rituximab for cancer and one patient received it to treat multiple sclerosis.

She and her associates also plan to assess the safety of rate-controlled infusions for desensitization to other drugs, including other types of monoclonal antibodies and platinum-containing cancer chemotherapy drugs.

They compared the safety of standard and rate-controlled infusions with rituximab because some cancer patients who receive the drug experience hypersensitivity reactions that are not controllable with antihistamine or steroid pretreatment. These patients must therefore undergo desensitization, a step that usually needs to be repeated every time they start a new course of the drug.

To compare the two infusion protocols, the researchers reviewed the Massachusetts General experience using the rate-control method during 2006-2008 as well as in 2011-2012. Those results were compared against the outcomes using a standard-infusion protocol during 2008-2011.

Among the 103 total rituximab desensitization procedures done on 16 patients during 2006-2012, 75 protocols used the rate-controlled method with a fixed infusion rate that delivered no more than 200 mg/hr of rituximab and 28 used a standard protocol that delivered a fixed fluid volume with varying rituximab concentrations that finished at 320 mg/hr. Most patients underwent desensitization with each of the two methods at some point during the 6 years included in the review. The average age of the 16 patients was 51 years, and they were equally split between men and women.

The 75 rate-controlled desensitizations resulted in 13 hypersensitivity reactions (17%), including 6 mild reactions, 5 moderate, and 2 severe. The 28 standard desensitizations produced eight reactions (29%), a statistically significant difference compared with the rate-control incidence, and included two mild, five moderate, and one severe reaction, Dr. Sokol reported.

The reaction rate was highest in three patients who converted from rituximab skin-test negative to skin-test positive during the course of their 28 desensitization protocols. Hypersensitivity reactions occurred in nine of these 28 protocols (32%). In contrast, the reaction rate was 19% in patients who remained skin-test negative throughout their desensitizations. Among those who remained consistently skin-test positive, the reaction rate was 16%, she said.

Dr. Sokol said that she had no disclosures.

ORLANDO – A slowed, rate-controlled infusion of rituximab during a desensitization protocol significantly reduced the number of hypersensitivity reactions compared with faster, standard-rate desensitization infusions.

"The safety of rituximab desensitization was improved using rate-controlled protocols," said Dr. Caroline L. Sokol, who discussed a review of 16 patients who underwent 103 desensitizations at a single U.S. center. The findings prompted her division to switch to rate-controlled infusions for all rituximab desensitization protocols, said Dr. Sokol of the division of allergy and immunology at Massachusetts General Hospital, Boston (J. Allergy Clin. Immunol. 2012;129[suppl.]:AB371).

Hypersensitivity reactions to rituximab primarily occur among patients who receive the drug to treat cancer. Patients who receive rituximab for other indications, such as rheumatoid diseases, rarely have hypersensitivity reactions. The explanation for this difference isn’t clear, Dr. Sokol said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the series she reviewed, 15 patients received rituximab for cancer and one patient received it to treat multiple sclerosis.

She and her associates also plan to assess the safety of rate-controlled infusions for desensitization to other drugs, including other types of monoclonal antibodies and platinum-containing cancer chemotherapy drugs.

They compared the safety of standard and rate-controlled infusions with rituximab because some cancer patients who receive the drug experience hypersensitivity reactions that are not controllable with antihistamine or steroid pretreatment. These patients must therefore undergo desensitization, a step that usually needs to be repeated every time they start a new course of the drug.

To compare the two infusion protocols, the researchers reviewed the Massachusetts General experience using the rate-control method during 2006-2008 as well as in 2011-2012. Those results were compared against the outcomes using a standard-infusion protocol during 2008-2011.

Among the 103 total rituximab desensitization procedures done on 16 patients during 2006-2012, 75 protocols used the rate-controlled method with a fixed infusion rate that delivered no more than 200 mg/hr of rituximab and 28 used a standard protocol that delivered a fixed fluid volume with varying rituximab concentrations that finished at 320 mg/hr. Most patients underwent desensitization with each of the two methods at some point during the 6 years included in the review. The average age of the 16 patients was 51 years, and they were equally split between men and women.

The 75 rate-controlled desensitizations resulted in 13 hypersensitivity reactions (17%), including 6 mild reactions, 5 moderate, and 2 severe. The 28 standard desensitizations produced eight reactions (29%), a statistically significant difference compared with the rate-control incidence, and included two mild, five moderate, and one severe reaction, Dr. Sokol reported.

The reaction rate was highest in three patients who converted from rituximab skin-test negative to skin-test positive during the course of their 28 desensitization protocols. Hypersensitivity reactions occurred in nine of these 28 protocols (32%). In contrast, the reaction rate was 19% in patients who remained skin-test negative throughout their desensitizations. Among those who remained consistently skin-test positive, the reaction rate was 16%, she said.

Dr. Sokol said that she had no disclosures.

ORLANDO – A slowed, rate-controlled infusion of rituximab during a desensitization protocol significantly reduced the number of hypersensitivity reactions compared with faster, standard-rate desensitization infusions.

"The safety of rituximab desensitization was improved using rate-controlled protocols," said Dr. Caroline L. Sokol, who discussed a review of 16 patients who underwent 103 desensitizations at a single U.S. center. The findings prompted her division to switch to rate-controlled infusions for all rituximab desensitization protocols, said Dr. Sokol of the division of allergy and immunology at Massachusetts General Hospital, Boston (J. Allergy Clin. Immunol. 2012;129[suppl.]:AB371).

Hypersensitivity reactions to rituximab primarily occur among patients who receive the drug to treat cancer. Patients who receive rituximab for other indications, such as rheumatoid diseases, rarely have hypersensitivity reactions. The explanation for this difference isn’t clear, Dr. Sokol said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the series she reviewed, 15 patients received rituximab for cancer and one patient received it to treat multiple sclerosis.

She and her associates also plan to assess the safety of rate-controlled infusions for desensitization to other drugs, including other types of monoclonal antibodies and platinum-containing cancer chemotherapy drugs.

They compared the safety of standard and rate-controlled infusions with rituximab because some cancer patients who receive the drug experience hypersensitivity reactions that are not controllable with antihistamine or steroid pretreatment. These patients must therefore undergo desensitization, a step that usually needs to be repeated every time they start a new course of the drug.

To compare the two infusion protocols, the researchers reviewed the Massachusetts General experience using the rate-control method during 2006-2008 as well as in 2011-2012. Those results were compared against the outcomes using a standard-infusion protocol during 2008-2011.

Among the 103 total rituximab desensitization procedures done on 16 patients during 2006-2012, 75 protocols used the rate-controlled method with a fixed infusion rate that delivered no more than 200 mg/hr of rituximab and 28 used a standard protocol that delivered a fixed fluid volume with varying rituximab concentrations that finished at 320 mg/hr. Most patients underwent desensitization with each of the two methods at some point during the 6 years included in the review. The average age of the 16 patients was 51 years, and they were equally split between men and women.

The 75 rate-controlled desensitizations resulted in 13 hypersensitivity reactions (17%), including 6 mild reactions, 5 moderate, and 2 severe. The 28 standard desensitizations produced eight reactions (29%), a statistically significant difference compared with the rate-control incidence, and included two mild, five moderate, and one severe reaction, Dr. Sokol reported.

The reaction rate was highest in three patients who converted from rituximab skin-test negative to skin-test positive during the course of their 28 desensitization protocols. Hypersensitivity reactions occurred in nine of these 28 protocols (32%). In contrast, the reaction rate was 19% in patients who remained skin-test negative throughout their desensitizations. Among those who remained consistently skin-test positive, the reaction rate was 16%, she said.

Dr. Sokol said that she had no disclosures.

All hospitalists have seen the phenomenon of "surgical signature," when different surgeons appear to have different rates of surgical intervention. Residents know different physicians often treat a single condition in varying ways. The losers in practice variation are the patients, learners, and the overall healthcare system.

Mark Shen, MD, the pediatric editor for The Hospitalist and presenter of this Tuesday afternoon session at HM12, said he has gone through the five stages of grief in the past when dealing with different care plans in a hospital setting, finally settling on acceptance. Now, he said it is important to move past acceptance and recognize variations in physician practice. Further, it's critical to understand the unintended consequences of unwarranted variation.

There are many factors in variation, said Dr. Shen. Examples include preference-sensitive care, in which a physician has a particular model that she or he follows that is specific to that physician, and supply-sensitive care, the trend where certain procedures are more frequently utilized when they are more readily available. A specific example of variation is the rate of tonsillectomy between surgeons.

Variation arises easily in medicine because of inherent uncertainty in medicine. Uncertainty arises because of the challenges of defining disease, making a diagnosis, selecting a procedure, observing outcomes, and assessing preferences.

Variation can be mitigated by formal protocols individualized to each patient. An example of successful protocols is modern pediatric oncology, which has dramatically improved patient outcomes.

Takeaways

• Hospitalists must recognize variation in care.
• Addressing variation improves patient care and offers improved utilization of limited healthcare resources.
• There are several approaches to mitigate variation, including practice guidelines.
• Shared decision making with the patient and family will also improve individual patient care.

All hospitalists have seen the phenomenon of "surgical signature," when different surgeons appear to have different rates of surgical intervention. Residents know different physicians often treat a single condition in varying ways. The losers in practice variation are the patients, learners, and the overall healthcare system.

Mark Shen, MD, the pediatric editor for The Hospitalist and presenter of this Tuesday afternoon session at HM12, said he has gone through the five stages of grief in the past when dealing with different care plans in a hospital setting, finally settling on acceptance. Now, he said it is important to move past acceptance and recognize variations in physician practice. Further, it's critical to understand the unintended consequences of unwarranted variation.

There are many factors in variation, said Dr. Shen. Examples include preference-sensitive care, in which a physician has a particular model that she or he follows that is specific to that physician, and supply-sensitive care, the trend where certain procedures are more frequently utilized when they are more readily available. A specific example of variation is the rate of tonsillectomy between surgeons.

Variation arises easily in medicine because of inherent uncertainty in medicine. Uncertainty arises because of the challenges of defining disease, making a diagnosis, selecting a procedure, observing outcomes, and assessing preferences.

Variation can be mitigated by formal protocols individualized to each patient. An example of successful protocols is modern pediatric oncology, which has dramatically improved patient outcomes.

Takeaways

• Hospitalists must recognize variation in care.
• Addressing variation improves patient care and offers improved utilization of limited healthcare resources.
• There are several approaches to mitigate variation, including practice guidelines.
• Shared decision making with the patient and family will also improve individual patient care.

All hospitalists have seen the phenomenon of "surgical signature," when different surgeons appear to have different rates of surgical intervention. Residents know different physicians often treat a single condition in varying ways. The losers in practice variation are the patients, learners, and the overall healthcare system.

Mark Shen, MD, the pediatric editor for The Hospitalist and presenter of this Tuesday afternoon session at HM12, said he has gone through the five stages of grief in the past when dealing with different care plans in a hospital setting, finally settling on acceptance. Now, he said it is important to move past acceptance and recognize variations in physician practice. Further, it's critical to understand the unintended consequences of unwarranted variation.

There are many factors in variation, said Dr. Shen. Examples include preference-sensitive care, in which a physician has a particular model that she or he follows that is specific to that physician, and supply-sensitive care, the trend where certain procedures are more frequently utilized when they are more readily available. A specific example of variation is the rate of tonsillectomy between surgeons.

Variation arises easily in medicine because of inherent uncertainty in medicine. Uncertainty arises because of the challenges of defining disease, making a diagnosis, selecting a procedure, observing outcomes, and assessing preferences.

Variation can be mitigated by formal protocols individualized to each patient. An example of successful protocols is modern pediatric oncology, which has dramatically improved patient outcomes.

Takeaways

• Hospitalists must recognize variation in care.
• Addressing variation improves patient care and offers improved utilization of limited healthcare resources.
• There are several approaches to mitigate variation, including practice guidelines.
• Shared decision making with the patient and family will also improve individual patient care.

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

Participants in a Tuesday workshop at HM12 in San Diego learned how using "teach back" as a patient-education strategy can solve some of the barriers to communicating post-discharge information to hospitalized patients.

These barriers include failure to assess a patient's health literacy or to identify the key learner in the patient's family, as well as the sheer volume of important information some patients need, and the lack of time in busy hospital units to convey it all.

The teach-back process involves asking patients to repeat in their own words what the health professional has told them.

"Most people are under the misconception that teaching takes too much time," said Paula Robinson, MSN, RN-BC, manager of patient, family, and consumer education for Lehigh Valley Health System in Allentown, Pa. She advised hospitalists to give patients smaller amounts of information, in three- to five-minute chunks over several days. Further, it may be necessary to prioritize what the patient needs to know, rather than present so much information that the patient won't remember much of it.

Lehigh Valley's commitment to teach back grew out of a QI project mapping patient-flow processes, including care transitions, throughout its health system. It was tested in a pilot unit and included prompts and scripts hardwired into the electronic health record for unit nurses to easily access. Readmission rates at the pilot unit dropped to 14.0% from 28.2% in the year after teach back was implemented; hospital-wide rates shrunk to 21.9% from 25.3%.

Teach back is presented to patients in the spirit of evaluating how effectively the professional has explained the information, and not as a way to test the patient, Robinson said.

Participants in a Tuesday workshop at HM12 in San Diego learned how using "teach back" as a patient-education strategy can solve some of the barriers to communicating post-discharge information to hospitalized patients.

These barriers include failure to assess a patient's health literacy or to identify the key learner in the patient's family, as well as the sheer volume of important information some patients need, and the lack of time in busy hospital units to convey it all.

The teach-back process involves asking patients to repeat in their own words what the health professional has told them.

"Most people are under the misconception that teaching takes too much time," said Paula Robinson, MSN, RN-BC, manager of patient, family, and consumer education for Lehigh Valley Health System in Allentown, Pa. She advised hospitalists to give patients smaller amounts of information, in three- to five-minute chunks over several days. Further, it may be necessary to prioritize what the patient needs to know, rather than present so much information that the patient won't remember much of it.

Lehigh Valley's commitment to teach back grew out of a QI project mapping patient-flow processes, including care transitions, throughout its health system. It was tested in a pilot unit and included prompts and scripts hardwired into the electronic health record for unit nurses to easily access. Readmission rates at the pilot unit dropped to 14.0% from 28.2% in the year after teach back was implemented; hospital-wide rates shrunk to 21.9% from 25.3%.

Teach back is presented to patients in the spirit of evaluating how effectively the professional has explained the information, and not as a way to test the patient, Robinson said.

Participants in a Tuesday workshop at HM12 in San Diego learned how using "teach back" as a patient-education strategy can solve some of the barriers to communicating post-discharge information to hospitalized patients.

These barriers include failure to assess a patient's health literacy or to identify the key learner in the patient's family, as well as the sheer volume of important information some patients need, and the lack of time in busy hospital units to convey it all.

The teach-back process involves asking patients to repeat in their own words what the health professional has told them.

"Most people are under the misconception that teaching takes too much time," said Paula Robinson, MSN, RN-BC, manager of patient, family, and consumer education for Lehigh Valley Health System in Allentown, Pa. She advised hospitalists to give patients smaller amounts of information, in three- to five-minute chunks over several days. Further, it may be necessary to prioritize what the patient needs to know, rather than present so much information that the patient won't remember much of it.

Lehigh Valley's commitment to teach back grew out of a QI project mapping patient-flow processes, including care transitions, throughout its health system. It was tested in a pilot unit and included prompts and scripts hardwired into the electronic health record for unit nurses to easily access. Readmission rates at the pilot unit dropped to 14.0% from 28.2% in the year after teach back was implemented; hospital-wide rates shrunk to 21.9% from 25.3%.

Teach back is presented to patients in the spirit of evaluating how effectively the professional has explained the information, and not as a way to test the patient, Robinson said.

The key word in the title is change. The most frightening number that proves change has to happen is that in 50 years healthcare expenditures will consume 50% of our nation's GDP. No way that can be sustained.

The three legs of the stool to manage HM economics include 1) cost of healthcare, 2) quality of healthcare, and 3) access to healthcare.

Dr. Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows the cost of healthcare is rapidly rising and thus unsustainable, measures to improve quality and improve patient safety form one of the legs of the healthcare economics stool.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg which is extremely shaky. In the near future, demand will exceed the number of professionals to provide care, as more patients become insured. Some hospitals will go bankrupt; estimates are 15% by 2020.

The last leg is cost, an area in which hospitalists will have a major role in the future, as they become more a part of the financial health of medical institutions. Dr. Bessler called hospitalists the "pit crew leaders," and said our turf is the "accountable," acute-care episode.

Key Takeaways:

• Cost of healthcare is unsustainable.
• Quality will provide key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute care episodes is HM's turf.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The key word in the title is change. The most frightening number that proves change has to happen is that in 50 years healthcare expenditures will consume 50% of our nation's GDP. No way that can be sustained.

The three legs of the stool to manage HM economics include 1) cost of healthcare, 2) quality of healthcare, and 3) access to healthcare.

Dr. Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows the cost of healthcare is rapidly rising and thus unsustainable, measures to improve quality and improve patient safety form one of the legs of the healthcare economics stool.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg which is extremely shaky. In the near future, demand will exceed the number of professionals to provide care, as more patients become insured. Some hospitals will go bankrupt; estimates are 15% by 2020.

The last leg is cost, an area in which hospitalists will have a major role in the future, as they become more a part of the financial health of medical institutions. Dr. Bessler called hospitalists the "pit crew leaders," and said our turf is the "accountable," acute-care episode.

Key Takeaways:

• Cost of healthcare is unsustainable.
• Quality will provide key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute care episodes is HM's turf.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The key word in the title is change. The most frightening number that proves change has to happen is that in 50 years healthcare expenditures will consume 50% of our nation's GDP. No way that can be sustained.

The three legs of the stool to manage HM economics include 1) cost of healthcare, 2) quality of healthcare, and 3) access to healthcare.

Dr. Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows the cost of healthcare is rapidly rising and thus unsustainable, measures to improve quality and improve patient safety form one of the legs of the healthcare economics stool.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg which is extremely shaky. In the near future, demand will exceed the number of professionals to provide care, as more patients become insured. Some hospitals will go bankrupt; estimates are 15% by 2020.

The last leg is cost, an area in which hospitalists will have a major role in the future, as they become more a part of the financial health of medical institutions. Dr. Bessler called hospitalists the "pit crew leaders," and said our turf is the "accountable," acute-care episode.

Key Takeaways:

• Cost of healthcare is unsustainable.
• Quality will provide key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute care episodes is HM's turf.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

Outgoing SHM President Joe Li, MD, SFHM, summarized the Ernest Hemingway history of the “six-word story.” as a metaphor for the future of HM. Hemingway was famous for his short stories; his six-word stories are etched in literary folk lore.

Similarly, the future of hospital medicine will depend on how we are perceived by our six-word stories, Dr. Li said at HM12 in San Diego. Here are a few worrisome outcomes: 

1. “Less continuity, more readmissions, billions lost;” or

2. “Hospitalization, inadequate communications, ready for readmission.”

What we need to work toward are six-word stories that will serve our profession and our patients well, such as “high quality, low cost, high value,” or “hospitalists, high-value, patient-focused care.”

Key Takeaways:

• Our six-word stories are vital to the perception and reality of hospital medicine;
• We are all responsible for the future of the six word stories of hospital medicine.

Dr. Scheurer is physician editor of The Hospitalist.

Outgoing SHM President Joe Li, MD, SFHM, summarized the Ernest Hemingway history of the “six-word story.” as a metaphor for the future of HM. Hemingway was famous for his short stories; his six-word stories are etched in literary folk lore.

Similarly, the future of hospital medicine will depend on how we are perceived by our six-word stories, Dr. Li said at HM12 in San Diego. Here are a few worrisome outcomes: 

1. “Less continuity, more readmissions, billions lost;” or

2. “Hospitalization, inadequate communications, ready for readmission.”

What we need to work toward are six-word stories that will serve our profession and our patients well, such as “high quality, low cost, high value,” or “hospitalists, high-value, patient-focused care.”

Key Takeaways:

• Our six-word stories are vital to the perception and reality of hospital medicine;
• We are all responsible for the future of the six word stories of hospital medicine.

Dr. Scheurer is physician editor of The Hospitalist.

Outgoing SHM President Joe Li, MD, SFHM, summarized the Ernest Hemingway history of the “six-word story.” as a metaphor for the future of HM. Hemingway was famous for his short stories; his six-word stories are etched in literary folk lore.

Similarly, the future of hospital medicine will depend on how we are perceived by our six-word stories, Dr. Li said at HM12 in San Diego. Here are a few worrisome outcomes: 

1. “Less continuity, more readmissions, billions lost;” or

2. “Hospitalization, inadequate communications, ready for readmission.”

What we need to work toward are six-word stories that will serve our profession and our patients well, such as “high quality, low cost, high value,” or “hospitalists, high-value, patient-focused care.”

Key Takeaways:

• Our six-word stories are vital to the perception and reality of hospital medicine;
• We are all responsible for the future of the six word stories of hospital medicine.

Dr. Scheurer is physician editor of The Hospitalist.

We have staked our reputation on our ability to improve healthcare quality, and we need to deliver, according to incoming SHM President Shaun Frost, MD, SFHM, who addressed hospitalists this morning at HM12 in San Diego. Such care delivery will require personal accountability to embrace the work necessary to realize the potential of HM.

As Lou Holtz, the former Notre Dame head football coach, once said, “when all is said and done, a lot more is said than done.” Although always couched within a system, many current limitations with quality improvement and patient safety are rooted at the level of individual accountability. Dr. Frost pointed to hand hygiene and sign-out performance as tangible examples.

Key Takeaways:

• We are at a point in our profession where we need to define and enforce individual accountability for processes considered vital to good patient care.
• We need to all hold ourselves accountability for our ability to deliver genuine results.

Dr. Scheurer is physician editor of The Hospitalist

We have staked our reputation on our ability to improve healthcare quality, and we need to deliver, according to incoming SHM President Shaun Frost, MD, SFHM, who addressed hospitalists this morning at HM12 in San Diego. Such care delivery will require personal accountability to embrace the work necessary to realize the potential of HM.

As Lou Holtz, the former Notre Dame head football coach, once said, “when all is said and done, a lot more is said than done.” Although always couched within a system, many current limitations with quality improvement and patient safety are rooted at the level of individual accountability. Dr. Frost pointed to hand hygiene and sign-out performance as tangible examples.

Key Takeaways:

• We are at a point in our profession where we need to define and enforce individual accountability for processes considered vital to good patient care.
• We need to all hold ourselves accountability for our ability to deliver genuine results.

Dr. Scheurer is physician editor of The Hospitalist

We have staked our reputation on our ability to improve healthcare quality, and we need to deliver, according to incoming SHM President Shaun Frost, MD, SFHM, who addressed hospitalists this morning at HM12 in San Diego. Such care delivery will require personal accountability to embrace the work necessary to realize the potential of HM.

As Lou Holtz, the former Notre Dame head football coach, once said, “when all is said and done, a lot more is said than done.” Although always couched within a system, many current limitations with quality improvement and patient safety are rooted at the level of individual accountability. Dr. Frost pointed to hand hygiene and sign-out performance as tangible examples.

Key Takeaways:

• We are at a point in our profession where we need to define and enforce individual accountability for processes considered vital to good patient care.
• We need to all hold ourselves accountability for our ability to deliver genuine results.

Dr. Scheurer is physician editor of The Hospitalist

"Palliative care is not about death and dying or just pain management," said Sarah Friebert, MD, at a morning breakout session on Tuesday at HM12. Rather, she said, palliative care is a method of holistic care delivery for individuals with chronic, complex, and/or life-threatening conditions.

"There is a role for [palliative] subspecialty care" beyond just "good care," said Dr. Friebert. It is a model of shared management with other caregivers that is similar to other models of chronic disease. Additionally, palliative care has evolved to embrace an integrated model, such that palliation is longitudinally woven together with care for curing, dying, and bereavement.

Families continue to have many unmet needs, and hospitalists should provide them with clear and honest communication. Involving the palliative care team early on in the course of the illness is important to facilitate effective care.

Takeaways

• Palliative care is not code for "hospice."
• Other care (providers and treatment) does not need to be given up.
• Early integration of the palliative care team is essential.
• Consider using triggers to prompt referral to palliative care.

Dr. Shen is medical director of hospital medicine and assistant professor of pediatrics at UTMB Austin Pediatrics and Dell Children's Medical Center of Central Texas.

"Palliative care is not about death and dying or just pain management," said Sarah Friebert, MD, at a morning breakout session on Tuesday at HM12. Rather, she said, palliative care is a method of holistic care delivery for individuals with chronic, complex, and/or life-threatening conditions.

"There is a role for [palliative] subspecialty care" beyond just "good care," said Dr. Friebert. It is a model of shared management with other caregivers that is similar to other models of chronic disease. Additionally, palliative care has evolved to embrace an integrated model, such that palliation is longitudinally woven together with care for curing, dying, and bereavement.

Families continue to have many unmet needs, and hospitalists should provide them with clear and honest communication. Involving the palliative care team early on in the course of the illness is important to facilitate effective care.

Takeaways

• Palliative care is not code for "hospice."
• Other care (providers and treatment) does not need to be given up.
• Early integration of the palliative care team is essential.
• Consider using triggers to prompt referral to palliative care.

Dr. Shen is medical director of hospital medicine and assistant professor of pediatrics at UTMB Austin Pediatrics and Dell Children's Medical Center of Central Texas.

"Palliative care is not about death and dying or just pain management," said Sarah Friebert, MD, at a morning breakout session on Tuesday at HM12. Rather, she said, palliative care is a method of holistic care delivery for individuals with chronic, complex, and/or life-threatening conditions.

"There is a role for [palliative] subspecialty care" beyond just "good care," said Dr. Friebert. It is a model of shared management with other caregivers that is similar to other models of chronic disease. Additionally, palliative care has evolved to embrace an integrated model, such that palliation is longitudinally woven together with care for curing, dying, and bereavement.

Families continue to have many unmet needs, and hospitalists should provide them with clear and honest communication. Involving the palliative care team early on in the course of the illness is important to facilitate effective care.

Takeaways

• Palliative care is not code for "hospice."
• Other care (providers and treatment) does not need to be given up.
• Early integration of the palliative care team is essential.
• Consider using triggers to prompt referral to palliative care.

Dr. Shen is medical director of hospital medicine and assistant professor of pediatrics at UTMB Austin Pediatrics and Dell Children's Medical Center of Central Texas.

Shalini Chandra, MD, MS, Gregory Harlan, MD, FAAP, MPH, Brian Donovan, MD, MMM, FACP, SFHM, and Judy Shumway, DO, MPH, led a standing-room only morning breakout session on Monday at HM12 that focused on the challenges and opportunities of scheduling and rounding.

Dr. Harlan, a hospitalist at IPC, introduced the topic of innovative scheduling by placing the issue in a framework easily understood by hospitalists: quality improvement. He advocated identifying the salient problems faced by each individual group and then applying changes that make sense to each facility and group.

Dr. Chandra, a hospitalist at Johns Hopkins Bayview Medical Center, further elaborated on this by explaining how the PDSA (plan, do, study, act) approach can be used to initiate and assess the changes implemented in scheduling. Metrics such as hospitalist morale, patient satisfaction, length of stay, and time of discharge, can be used to assess the effect of each scheduling change.

Dr. Donovan, medical director of IPC, described a “zone” approach to scheduling. This rounding scheme assigns a hospitalist to a geographic unit, allowing for greater accessibility and higher efficiency. Closer relationships with multidisciplinary personnel can be achieved with this model.

Takeaways

• Test your scheduling changes with PDSA methods of quality improvement.
• Multidisciplinary rounds are critical to success.
• "Zone" rounding allows the development of physician leaders in each zone, and enable more efficiency.
• Engaging stakeholders in the success of physician scheduling is critical; this may enable more support and resources for these changes from administration.

Dr. Chang is a pediatric hospitalist with the University of San Diego Medical Center and  Rady Children's Hospital, San Diego.

Shalini Chandra, MD, MS, Gregory Harlan, MD, FAAP, MPH, Brian Donovan, MD, MMM, FACP, SFHM, and Judy Shumway, DO, MPH, led a standing-room only morning breakout session on Monday at HM12 that focused on the challenges and opportunities of scheduling and rounding.

Dr. Harlan, a hospitalist at IPC, introduced the topic of innovative scheduling by placing the issue in a framework easily understood by hospitalists: quality improvement. He advocated identifying the salient problems faced by each individual group and then applying changes that make sense to each facility and group.

Dr. Chandra, a hospitalist at Johns Hopkins Bayview Medical Center, further elaborated on this by explaining how the PDSA (plan, do, study, act) approach can be used to initiate and assess the changes implemented in scheduling. Metrics such as hospitalist morale, patient satisfaction, length of stay, and time of discharge, can be used to assess the effect of each scheduling change.

Dr. Donovan, medical director of IPC, described a “zone” approach to scheduling. This rounding scheme assigns a hospitalist to a geographic unit, allowing for greater accessibility and higher efficiency. Closer relationships with multidisciplinary personnel can be achieved with this model.

Takeaways

• Test your scheduling changes with PDSA methods of quality improvement.
• Multidisciplinary rounds are critical to success.
• "Zone" rounding allows the development of physician leaders in each zone, and enable more efficiency.
• Engaging stakeholders in the success of physician scheduling is critical; this may enable more support and resources for these changes from administration.

Dr. Chang is a pediatric hospitalist with the University of San Diego Medical Center and  Rady Children's Hospital, San Diego.

Shalini Chandra, MD, MS, Gregory Harlan, MD, FAAP, MPH, Brian Donovan, MD, MMM, FACP, SFHM, and Judy Shumway, DO, MPH, led a standing-room only morning breakout session on Monday at HM12 that focused on the challenges and opportunities of scheduling and rounding.

Dr. Harlan, a hospitalist at IPC, introduced the topic of innovative scheduling by placing the issue in a framework easily understood by hospitalists: quality improvement. He advocated identifying the salient problems faced by each individual group and then applying changes that make sense to each facility and group.

Dr. Chandra, a hospitalist at Johns Hopkins Bayview Medical Center, further elaborated on this by explaining how the PDSA (plan, do, study, act) approach can be used to initiate and assess the changes implemented in scheduling. Metrics such as hospitalist morale, patient satisfaction, length of stay, and time of discharge, can be used to assess the effect of each scheduling change.

Dr. Donovan, medical director of IPC, described a “zone” approach to scheduling. This rounding scheme assigns a hospitalist to a geographic unit, allowing for greater accessibility and higher efficiency. Closer relationships with multidisciplinary personnel can be achieved with this model.

Takeaways

• Test your scheduling changes with PDSA methods of quality improvement.
• Multidisciplinary rounds are critical to success.
• "Zone" rounding allows the development of physician leaders in each zone, and enable more efficiency.
• Engaging stakeholders in the success of physician scheduling is critical; this may enable more support and resources for these changes from administration.

Dr. Chang is a pediatric hospitalist with the University of San Diego Medical Center and  Rady Children's Hospital, San Diego.