HM19

Stress testing for patients with low-risk chest pain and use of venous thromboembolism chemoprophylaxis in low-risk patients are the latest practices to come under scrutiny and were discussed during a special session at HM19.

Anthony Breu, MD, a hospitalist and director of resident education in the Veterans Affairs Boston Healthcare System, presented “common practices that have low or no value.” He provided arguments against these practices based in both evidence and pathophysiology.

“Things We Do For No Reason: The 2019 Clinical Update for Hospitalists,” presented Tuesday morning, was the latest in a series of such sessions held during SHM’s Annual Conference. Leonard S. Feldman, MD, SFHM, from Johns Hopkins Medicine in Baltimore, presented the first “Things We Do For No Reason” session at the 2012 conference in San Diego, analyzing the 30% target hematocrit for cardiac patients, naso-gastric lavage in gastrointestinal bleeds, fractional excretion of sodium and urea in evaluating acute kidney injuries, and the use of daily chest x-rays in ICUs.

“For patients with low-risk chest pain, stress tests do not add value,” said Dr. Breu. There are a number of ways a hospitalist can determine whether a patient has low-risk chest pain, and the rates of acute MI and mortality at 30 days are “well below 1%” for these patients, he noted.

“Stress tests may lower this rate a bit, but they are unfortunately unable to identify all patients who will experience subsequent events,” he said. “Also, given that pretest probability of coronary artery disease is low in these patients, the false-positive rate approaches 50%.”

Dr. Breu attributed the continued use of stress tests in patients with low-risk chest pain to recent American College of Cardiology and American Heart Association statements on appropriate use of stress testing, which should occur during initial hospitalization or within 72 hours of discharge. In addition, many hospitalists believe a negative stress test result can help them rule out a diagnosis like coronary artery disease.

In a second example of suspect practices, the need for venous thromboembolism (VTE) chemoprophylaxis, such as with subcutaneous enoxaparin, in high-risk patients is based on evidence that shows a reduction in asymptomatic deep vein thrombosis (DVT). However, “the evidence is not as clear” on whether VTE chemoprophylaxis reduces symptomatic DVT or pulmonary embolism (PE), Dr. Breu said.

“When this is coupled with the fact that bleeding is increased with chemoprophylaxis, its use in low-risk patients should be avoided,” Dr. Breu said. “Unfortunately, there is evidence that many of us administer VTE prophylaxis to low-risk patients just as often as we do for high-risk patients.”

Dr. Breu said he suspects many providers “overestimate the benefits” of VTE chemoprophylaxis. “I suspect that if someone is on the fence about whether to administer VTE [chemoprophylaxis], many err on the side of administering, fearing that they will miss an opportunity to prevent a DVT or PE while not realizing the risk of bleeding is real.”

Dr. Breu presented evidence from the literature as support for his argument against the practice of ordering stress tests and administering VTE chemoprophylaxis in low-risk patients. The oldest study goes back to 1967, while the most recent study was published in February 2019, he said.

“My hope is that attendees will be less inclined to order stress tests in patients with low-risk chest pain,” Dr. Breu said in an interview. “I also hope that they will apply scoring systems to better identify patients who are at high risk for VTE and not administer chemoprophylaxis to all others.”

Dr. Breu reported having no relevant financial disclosures.

Stress testing for patients with low-risk chest pain and use of venous thromboembolism chemoprophylaxis in low-risk patients are the latest practices to come under scrutiny and were discussed during a special session at HM19.

Anthony Breu, MD, a hospitalist and director of resident education in the Veterans Affairs Boston Healthcare System, presented “common practices that have low or no value.” He provided arguments against these practices based in both evidence and pathophysiology.

“Things We Do For No Reason: The 2019 Clinical Update for Hospitalists,” presented Tuesday morning, was the latest in a series of such sessions held during SHM’s Annual Conference. Leonard S. Feldman, MD, SFHM, from Johns Hopkins Medicine in Baltimore, presented the first “Things We Do For No Reason” session at the 2012 conference in San Diego, analyzing the 30% target hematocrit for cardiac patients, naso-gastric lavage in gastrointestinal bleeds, fractional excretion of sodium and urea in evaluating acute kidney injuries, and the use of daily chest x-rays in ICUs.

“For patients with low-risk chest pain, stress tests do not add value,” said Dr. Breu. There are a number of ways a hospitalist can determine whether a patient has low-risk chest pain, and the rates of acute MI and mortality at 30 days are “well below 1%” for these patients, he noted.

“Stress tests may lower this rate a bit, but they are unfortunately unable to identify all patients who will experience subsequent events,” he said. “Also, given that pretest probability of coronary artery disease is low in these patients, the false-positive rate approaches 50%.”

Dr. Breu attributed the continued use of stress tests in patients with low-risk chest pain to recent American College of Cardiology and American Heart Association statements on appropriate use of stress testing, which should occur during initial hospitalization or within 72 hours of discharge. In addition, many hospitalists believe a negative stress test result can help them rule out a diagnosis like coronary artery disease.

In a second example of suspect practices, the need for venous thromboembolism (VTE) chemoprophylaxis, such as with subcutaneous enoxaparin, in high-risk patients is based on evidence that shows a reduction in asymptomatic deep vein thrombosis (DVT). However, “the evidence is not as clear” on whether VTE chemoprophylaxis reduces symptomatic DVT or pulmonary embolism (PE), Dr. Breu said.

“When this is coupled with the fact that bleeding is increased with chemoprophylaxis, its use in low-risk patients should be avoided,” Dr. Breu said. “Unfortunately, there is evidence that many of us administer VTE prophylaxis to low-risk patients just as often as we do for high-risk patients.”

Dr. Breu said he suspects many providers “overestimate the benefits” of VTE chemoprophylaxis. “I suspect that if someone is on the fence about whether to administer VTE [chemoprophylaxis], many err on the side of administering, fearing that they will miss an opportunity to prevent a DVT or PE while not realizing the risk of bleeding is real.”

Dr. Breu presented evidence from the literature as support for his argument against the practice of ordering stress tests and administering VTE chemoprophylaxis in low-risk patients. The oldest study goes back to 1967, while the most recent study was published in February 2019, he said.

“My hope is that attendees will be less inclined to order stress tests in patients with low-risk chest pain,” Dr. Breu said in an interview. “I also hope that they will apply scoring systems to better identify patients who are at high risk for VTE and not administer chemoprophylaxis to all others.”

Dr. Breu reported having no relevant financial disclosures.

Stress testing for patients with low-risk chest pain and use of venous thromboembolism chemoprophylaxis in low-risk patients are the latest practices to come under scrutiny and were discussed during a special session at HM19.

Anthony Breu, MD, a hospitalist and director of resident education in the Veterans Affairs Boston Healthcare System, presented “common practices that have low or no value.” He provided arguments against these practices based in both evidence and pathophysiology.

“Things We Do For No Reason: The 2019 Clinical Update for Hospitalists,” presented Tuesday morning, was the latest in a series of such sessions held during SHM’s Annual Conference. Leonard S. Feldman, MD, SFHM, from Johns Hopkins Medicine in Baltimore, presented the first “Things We Do For No Reason” session at the 2012 conference in San Diego, analyzing the 30% target hematocrit for cardiac patients, naso-gastric lavage in gastrointestinal bleeds, fractional excretion of sodium and urea in evaluating acute kidney injuries, and the use of daily chest x-rays in ICUs.

“For patients with low-risk chest pain, stress tests do not add value,” said Dr. Breu. There are a number of ways a hospitalist can determine whether a patient has low-risk chest pain, and the rates of acute MI and mortality at 30 days are “well below 1%” for these patients, he noted.

“Stress tests may lower this rate a bit, but they are unfortunately unable to identify all patients who will experience subsequent events,” he said. “Also, given that pretest probability of coronary artery disease is low in these patients, the false-positive rate approaches 50%.”

Dr. Breu attributed the continued use of stress tests in patients with low-risk chest pain to recent American College of Cardiology and American Heart Association statements on appropriate use of stress testing, which should occur during initial hospitalization or within 72 hours of discharge. In addition, many hospitalists believe a negative stress test result can help them rule out a diagnosis like coronary artery disease.

In a second example of suspect practices, the need for venous thromboembolism (VTE) chemoprophylaxis, such as with subcutaneous enoxaparin, in high-risk patients is based on evidence that shows a reduction in asymptomatic deep vein thrombosis (DVT). However, “the evidence is not as clear” on whether VTE chemoprophylaxis reduces symptomatic DVT or pulmonary embolism (PE), Dr. Breu said.

“When this is coupled with the fact that bleeding is increased with chemoprophylaxis, its use in low-risk patients should be avoided,” Dr. Breu said. “Unfortunately, there is evidence that many of us administer VTE prophylaxis to low-risk patients just as often as we do for high-risk patients.”

Dr. Breu said he suspects many providers “overestimate the benefits” of VTE chemoprophylaxis. “I suspect that if someone is on the fence about whether to administer VTE [chemoprophylaxis], many err on the side of administering, fearing that they will miss an opportunity to prevent a DVT or PE while not realizing the risk of bleeding is real.”

Dr. Breu presented evidence from the literature as support for his argument against the practice of ordering stress tests and administering VTE chemoprophylaxis in low-risk patients. The oldest study goes back to 1967, while the most recent study was published in February 2019, he said.

“My hope is that attendees will be less inclined to order stress tests in patients with low-risk chest pain,” Dr. Breu said in an interview. “I also hope that they will apply scoring systems to better identify patients who are at high risk for VTE and not administer chemoprophylaxis to all others.”

Dr. Breu reported having no relevant financial disclosures.

The word “hospitalist” is clear and concise. It declares that this type of physician is directly tied to hospitals, as much of a fixture as emergency departments, ICUs, and cafeterias. But what if a hospitalist appears on a screen instead of standing at bedside? Is that still hospital medicine?

Absolutely, according to hospitalists Ameet Doshi, MD, MBA, of HealthPartners in Bloomington, Minn.; and Ryan Brown, MD, FHM, and Brian Schroeder, MHA, FHM, FACHE, of Atrium Health in Charlotte, N.C. In an interview before the session, Dr. Doshi said telemedicine can help hospitalists and health care organizations address patient care challenges, ranging from staffing in rural hospitals to handling cross-cover surges, but telemedicine can help providers in any kind of care environment or location.

Currently, he said in the pre-session interview, “many groups are using real-time video capabilities to deliver hospitalist care where in-person providers are not available. This could be for nocturnist coverage at rural hospitals or even providing cross-cover services at larger hospitals where the in-person providers are at capacity.”

During the session, the presenters gave several use cases for telemedicine in rural health, critical care, and acute care environments. Dr. Doshi is a telehospitalist with HealthPartners, which provides inpatient telemedicine services to five hospitals across Minnesota and Wisconsin.

Dr. Brown, whose group provides telemedicine services at 12 facilities, said they allow hospitalists to interact virtually with patients, conduct physical exams, and perform many more duties.

As he explained, “we do nighttime cross-cover, perform admissions and consults, supervise NP/PAs in low-risk units, handle census surge situations, provide care in rural and critical-access hospitals that find recruiting difficult, use subspecialty support to keep patients at hospitals closer to their homes, triage transfers into our health care system, and see postdischarge patients for follow-ups in their homes from our transition clinic. Done correctly, telemedicine can be effectively used in many different care scenarios.”

Patients love telemedicine, he said. “The increased access to care where and when they want it is very attractive.” While objective data is not yet available, he noted in a survey of 124 patients in his institution, 37.1% of patients rated their overall care through telemedicine as a 10 out of 10, while 26.6% of patients and 20.2% of patients rated care at a 9 and an 8 out of 10, respectively.

During the HM19 session, Dr. Doshi and colleagues discussed several of the drivers behind the advent of telemedicine, including specific health care situations in which it can be applicable as well as the structural and financial requirements that will help an organization create a viable telemedicine service.

In the big picture, he said, “the biggest take-home we can give to our audience is the idea that telemedicine is not an esoteric, flight-of-fancy program that is only a niche issue. There are a plethora of situations where patient care can be optimally delivered with telemedicine, and we want to outline these situations as well as give the framework for how telemedicine can be organically grown within any organization.”


Randy Dotinga contributed to this report.

The word “hospitalist” is clear and concise. It declares that this type of physician is directly tied to hospitals, as much of a fixture as emergency departments, ICUs, and cafeterias. But what if a hospitalist appears on a screen instead of standing at bedside? Is that still hospital medicine?

Absolutely, according to hospitalists Ameet Doshi, MD, MBA, of HealthPartners in Bloomington, Minn.; and Ryan Brown, MD, FHM, and Brian Schroeder, MHA, FHM, FACHE, of Atrium Health in Charlotte, N.C. In an interview before the session, Dr. Doshi said telemedicine can help hospitalists and health care organizations address patient care challenges, ranging from staffing in rural hospitals to handling cross-cover surges, but telemedicine can help providers in any kind of care environment or location.

Currently, he said in the pre-session interview, “many groups are using real-time video capabilities to deliver hospitalist care where in-person providers are not available. This could be for nocturnist coverage at rural hospitals or even providing cross-cover services at larger hospitals where the in-person providers are at capacity.”

During the session, the presenters gave several use cases for telemedicine in rural health, critical care, and acute care environments. Dr. Doshi is a telehospitalist with HealthPartners, which provides inpatient telemedicine services to five hospitals across Minnesota and Wisconsin.

Dr. Brown, whose group provides telemedicine services at 12 facilities, said they allow hospitalists to interact virtually with patients, conduct physical exams, and perform many more duties.

As he explained, “we do nighttime cross-cover, perform admissions and consults, supervise NP/PAs in low-risk units, handle census surge situations, provide care in rural and critical-access hospitals that find recruiting difficult, use subspecialty support to keep patients at hospitals closer to their homes, triage transfers into our health care system, and see postdischarge patients for follow-ups in their homes from our transition clinic. Done correctly, telemedicine can be effectively used in many different care scenarios.”

Patients love telemedicine, he said. “The increased access to care where and when they want it is very attractive.” While objective data is not yet available, he noted in a survey of 124 patients in his institution, 37.1% of patients rated their overall care through telemedicine as a 10 out of 10, while 26.6% of patients and 20.2% of patients rated care at a 9 and an 8 out of 10, respectively.

During the HM19 session, Dr. Doshi and colleagues discussed several of the drivers behind the advent of telemedicine, including specific health care situations in which it can be applicable as well as the structural and financial requirements that will help an organization create a viable telemedicine service.

In the big picture, he said, “the biggest take-home we can give to our audience is the idea that telemedicine is not an esoteric, flight-of-fancy program that is only a niche issue. There are a plethora of situations where patient care can be optimally delivered with telemedicine, and we want to outline these situations as well as give the framework for how telemedicine can be organically grown within any organization.”


Randy Dotinga contributed to this report.

The word “hospitalist” is clear and concise. It declares that this type of physician is directly tied to hospitals, as much of a fixture as emergency departments, ICUs, and cafeterias. But what if a hospitalist appears on a screen instead of standing at bedside? Is that still hospital medicine?

Absolutely, according to hospitalists Ameet Doshi, MD, MBA, of HealthPartners in Bloomington, Minn.; and Ryan Brown, MD, FHM, and Brian Schroeder, MHA, FHM, FACHE, of Atrium Health in Charlotte, N.C. In an interview before the session, Dr. Doshi said telemedicine can help hospitalists and health care organizations address patient care challenges, ranging from staffing in rural hospitals to handling cross-cover surges, but telemedicine can help providers in any kind of care environment or location.

Currently, he said in the pre-session interview, “many groups are using real-time video capabilities to deliver hospitalist care where in-person providers are not available. This could be for nocturnist coverage at rural hospitals or even providing cross-cover services at larger hospitals where the in-person providers are at capacity.”

During the session, the presenters gave several use cases for telemedicine in rural health, critical care, and acute care environments. Dr. Doshi is a telehospitalist with HealthPartners, which provides inpatient telemedicine services to five hospitals across Minnesota and Wisconsin.

Dr. Brown, whose group provides telemedicine services at 12 facilities, said they allow hospitalists to interact virtually with patients, conduct physical exams, and perform many more duties.

As he explained, “we do nighttime cross-cover, perform admissions and consults, supervise NP/PAs in low-risk units, handle census surge situations, provide care in rural and critical-access hospitals that find recruiting difficult, use subspecialty support to keep patients at hospitals closer to their homes, triage transfers into our health care system, and see postdischarge patients for follow-ups in their homes from our transition clinic. Done correctly, telemedicine can be effectively used in many different care scenarios.”

Patients love telemedicine, he said. “The increased access to care where and when they want it is very attractive.” While objective data is not yet available, he noted in a survey of 124 patients in his institution, 37.1% of patients rated their overall care through telemedicine as a 10 out of 10, while 26.6% of patients and 20.2% of patients rated care at a 9 and an 8 out of 10, respectively.

During the HM19 session, Dr. Doshi and colleagues discussed several of the drivers behind the advent of telemedicine, including specific health care situations in which it can be applicable as well as the structural and financial requirements that will help an organization create a viable telemedicine service.

In the big picture, he said, “the biggest take-home we can give to our audience is the idea that telemedicine is not an esoteric, flight-of-fancy program that is only a niche issue. There are a plethora of situations where patient care can be optimally delivered with telemedicine, and we want to outline these situations as well as give the framework for how telemedicine can be organically grown within any organization.”


Randy Dotinga contributed to this report.

Two experts drew on both personal experience and extant literature in the debate “Steroids for Pneumonia and Sepsis ... Do You Believe?” on Tuesday.

Daniel Dressler, MD, MSC, SFHM, of Emory University, Atlanta, and Daniel J. Brotman, MD, SFHM, director of the hospitalist program at Johns Hopkins Hospital, Baltimore, used a series of case studies to illustrate the conundrum. Despite their “pro” and “con” stances, though, both agreed in the end: First, do no harm.

There are no blanket recommendations for the use of steroids for pneumonia, because historically, studies have come to varied conclusions. However, Dr. Dressler, who advocated for the medications, said in an interview that recent publications paint a more complete picture.

“I think the newer studies in 2015 have made us more comfortable, because they look like there is more benefit” for steroids, especially among more severely ill patients, he noted. These international studies added more than 800 cases to the literature. A Spanish trial randomized 120 patients with high C-reactive protein to placebo or 0.5 mg/kg methylpred-nisolone every 12 hours for 5 days. There were fewer treatment failures in the prednisone group (13% vs. 31%), and fewer adverse clinical outcomes of intubation, shock, or death (3% vs. 14%). The number needed to treat to prevent one event was just six. (JAMA. 2015;313[7]:677-86).

In addition, a Cochrane meta-analysis analyzed 13 randomized trials, comprising more than 2,000 hospitalized patients. It found consistently lower rates of mortality, acute respiratory distress syndrome, early treatment failure, and hyperglycemia (Cochrane Database Syst Rev. 2017 Dec 13;12:CD007720).

Two experts drew on both personal experience and extant literature in the debate “Steroids for Pneumonia and Sepsis ... Do You Believe?” on Tuesday.

Daniel Dressler, MD, MSC, SFHM, of Emory University, Atlanta, and Daniel J. Brotman, MD, SFHM, director of the hospitalist program at Johns Hopkins Hospital, Baltimore, used a series of case studies to illustrate the conundrum. Despite their “pro” and “con” stances, though, both agreed in the end: First, do no harm.

There are no blanket recommendations for the use of steroids for pneumonia, because historically, studies have come to varied conclusions. However, Dr. Dressler, who advocated for the medications, said in an interview that recent publications paint a more complete picture.

“I think the newer studies in 2015 have made us more comfortable, because they look like there is more benefit” for steroids, especially among more severely ill patients, he noted. These international studies added more than 800 cases to the literature. A Spanish trial randomized 120 patients with high C-reactive protein to placebo or 0.5 mg/kg methylpred-nisolone every 12 hours for 5 days. There were fewer treatment failures in the prednisone group (13% vs. 31%), and fewer adverse clinical outcomes of intubation, shock, or death (3% vs. 14%). The number needed to treat to prevent one event was just six. (JAMA. 2015;313[7]:677-86).

In addition, a Cochrane meta-analysis analyzed 13 randomized trials, comprising more than 2,000 hospitalized patients. It found consistently lower rates of mortality, acute respiratory distress syndrome, early treatment failure, and hyperglycemia (Cochrane Database Syst Rev. 2017 Dec 13;12:CD007720).

Two experts drew on both personal experience and extant literature in the debate “Steroids for Pneumonia and Sepsis ... Do You Believe?” on Tuesday.

Daniel Dressler, MD, MSC, SFHM, of Emory University, Atlanta, and Daniel J. Brotman, MD, SFHM, director of the hospitalist program at Johns Hopkins Hospital, Baltimore, used a series of case studies to illustrate the conundrum. Despite their “pro” and “con” stances, though, both agreed in the end: First, do no harm.

There are no blanket recommendations for the use of steroids for pneumonia, because historically, studies have come to varied conclusions. However, Dr. Dressler, who advocated for the medications, said in an interview that recent publications paint a more complete picture.

“I think the newer studies in 2015 have made us more comfortable, because they look like there is more benefit” for steroids, especially among more severely ill patients, he noted. These international studies added more than 800 cases to the literature. A Spanish trial randomized 120 patients with high C-reactive protein to placebo or 0.5 mg/kg methylpred-nisolone every 12 hours for 5 days. There were fewer treatment failures in the prednisone group (13% vs. 31%), and fewer adverse clinical outcomes of intubation, shock, or death (3% vs. 14%). The number needed to treat to prevent one event was just six. (JAMA. 2015;313[7]:677-86).

In addition, a Cochrane meta-analysis analyzed 13 randomized trials, comprising more than 2,000 hospitalized patients. It found consistently lower rates of mortality, acute respiratory distress syndrome, early treatment failure, and hyperglycemia (Cochrane Database Syst Rev. 2017 Dec 13;12:CD007720).

A project to improve how hospitalists address inpatient delirium, which has led to reductions in length of stay and cost, took center stage on Tuesday morning at HM19 in the Best of RIV plenary session.

The project, conducted at the University of California, San Francisco (UCSF), was presented alongside projects on alcohol detox at the Cleveland Veterans Affairs Medical Center and on medication reconciliation at Brigham and Women’s Hospital in Boston.

“The plenary is the top three of the 1,000 that are out there – so, impressive work,” said Benji Mathews, MD, SFHM, the chair of the Research, Innovations and Vignettes competition.

At UCSF, the project was meant to tackle the huge problem of delirium in the hospital, said Catherine Lau, MD, SFHM, associate professor of medicine there. Each year delirium affects more than 7 million people who are hospitalized, and hospital-acquired delirium is linked with prolonged stays and more emergency department visits and hospital readmissions. But research has found that as many as a third of these hospital-acquired cases can be prevented, Dr. Lau said.

New admissions and transfers – a total of more than 2,800 patients – were assessed for delirium risk, and those deemed high risk were entered into a delirium care plan, aimed at prevention with nonpharmacologic steps such as maximizing their mobility and helping them sleep at night.

All patients also were screened on every nursing shift for delirium, and those diagnosed with the disorder were placed in the delirium care plan, with notification of the patient’s team for treatment.

The average length of stay decreased by 0.8 days (P less than .001), with a decrease of 1.9 days in patients with delirium, compared with outcomes for nearly 2,600 patients before the intervention was implemented, Dr. Lau said. Researchers also found a decrease in $850 spent per patient (P less than .001), with a direct savings to the hospital of a total of $997,000, she said. The 30-day readmission rate also fell significantly, from 18.9% to 15.9% (P = .03).

The screening itself seemed to be the most important factor in the project, Dr. Lau said.

“Just the recognition that their patient was at risk for delirium or actually had delirium really raised awareness,” she said.

The project on alcohol detox used careful risk assessments at emergency department discharge, e-consults, protocols to limit benzodiazepine prescribing, and telephone follow-up to reduce hospital admissions and 30-day readmissions, as well as length of stay.

Researchers used scores on CIWA – a 10-question measurement of the severity of someone’s alcohol withdrawal – and history of complicated alcohol-use withdrawal to determine whether ED patients should be admitted to the floor or sent home with or without prescriptions for gabapentin and lorazepam, said Robert Patrick, MD, a hospitalist at the Cleveland VA.

Perhaps the most innovative feature of the program was using systolic blood pressure and heart rate in addition to CIWA to determine whether someone should receive a benzodiazepine, he said. Someone with a CIWA of 9-12, for instance, would be prescribed one of these drugs only if their vitals were elevated, Dr. Patrick said.

He encouraged other hospitalists to try a similar program at their centers.

“You don’t have to be at a VA to do this,” he said. “And most importantly, you don’t have to have a cooperative ED to do this. You can do this just within your hospitalist group.”

In another presentation, Jeffrey Schnipper, MD, MPH, FHM, associate professor of medicine at Harvard Medical School, Boston, described the results from a project in which SHM’s MARQUIS program – an evidence-based “toolkit” on medication reconciliation – was implemented at 18 hospitals. The kit offers a plan to get the best possible medication history, give medication counseling on discharge, and identify patients at risk for medication discrepancies. The 18 sites were coached, with areas of improvement identified.

By months 13-18 of the study period, the number of medication discrepancies had fallen to 0.93 per patient for those who’d received at least one form of intervention, compared with 2.69 per patient among those who’d received none.

“The MARQUIS interventions, including the toolkit and mentored implementation,” Dr. Schnipper said, “are associated with a marked reduction in medication discrepancies.”

A project to improve how hospitalists address inpatient delirium, which has led to reductions in length of stay and cost, took center stage on Tuesday morning at HM19 in the Best of RIV plenary session.

The project, conducted at the University of California, San Francisco (UCSF), was presented alongside projects on alcohol detox at the Cleveland Veterans Affairs Medical Center and on medication reconciliation at Brigham and Women’s Hospital in Boston.

“The plenary is the top three of the 1,000 that are out there – so, impressive work,” said Benji Mathews, MD, SFHM, the chair of the Research, Innovations and Vignettes competition.

At UCSF, the project was meant to tackle the huge problem of delirium in the hospital, said Catherine Lau, MD, SFHM, associate professor of medicine there. Each year delirium affects more than 7 million people who are hospitalized, and hospital-acquired delirium is linked with prolonged stays and more emergency department visits and hospital readmissions. But research has found that as many as a third of these hospital-acquired cases can be prevented, Dr. Lau said.

New admissions and transfers – a total of more than 2,800 patients – were assessed for delirium risk, and those deemed high risk were entered into a delirium care plan, aimed at prevention with nonpharmacologic steps such as maximizing their mobility and helping them sleep at night.

All patients also were screened on every nursing shift for delirium, and those diagnosed with the disorder were placed in the delirium care plan, with notification of the patient’s team for treatment.

The average length of stay decreased by 0.8 days (P less than .001), with a decrease of 1.9 days in patients with delirium, compared with outcomes for nearly 2,600 patients before the intervention was implemented, Dr. Lau said. Researchers also found a decrease in $850 spent per patient (P less than .001), with a direct savings to the hospital of a total of $997,000, she said. The 30-day readmission rate also fell significantly, from 18.9% to 15.9% (P = .03).

The screening itself seemed to be the most important factor in the project, Dr. Lau said.

“Just the recognition that their patient was at risk for delirium or actually had delirium really raised awareness,” she said.

The project on alcohol detox used careful risk assessments at emergency department discharge, e-consults, protocols to limit benzodiazepine prescribing, and telephone follow-up to reduce hospital admissions and 30-day readmissions, as well as length of stay.

Researchers used scores on CIWA – a 10-question measurement of the severity of someone’s alcohol withdrawal – and history of complicated alcohol-use withdrawal to determine whether ED patients should be admitted to the floor or sent home with or without prescriptions for gabapentin and lorazepam, said Robert Patrick, MD, a hospitalist at the Cleveland VA.

Perhaps the most innovative feature of the program was using systolic blood pressure and heart rate in addition to CIWA to determine whether someone should receive a benzodiazepine, he said. Someone with a CIWA of 9-12, for instance, would be prescribed one of these drugs only if their vitals were elevated, Dr. Patrick said.

He encouraged other hospitalists to try a similar program at their centers.

“You don’t have to be at a VA to do this,” he said. “And most importantly, you don’t have to have a cooperative ED to do this. You can do this just within your hospitalist group.”

In another presentation, Jeffrey Schnipper, MD, MPH, FHM, associate professor of medicine at Harvard Medical School, Boston, described the results from a project in which SHM’s MARQUIS program – an evidence-based “toolkit” on medication reconciliation – was implemented at 18 hospitals. The kit offers a plan to get the best possible medication history, give medication counseling on discharge, and identify patients at risk for medication discrepancies. The 18 sites were coached, with areas of improvement identified.

By months 13-18 of the study period, the number of medication discrepancies had fallen to 0.93 per patient for those who’d received at least one form of intervention, compared with 2.69 per patient among those who’d received none.

“The MARQUIS interventions, including the toolkit and mentored implementation,” Dr. Schnipper said, “are associated with a marked reduction in medication discrepancies.”

A project to improve how hospitalists address inpatient delirium, which has led to reductions in length of stay and cost, took center stage on Tuesday morning at HM19 in the Best of RIV plenary session.

The project, conducted at the University of California, San Francisco (UCSF), was presented alongside projects on alcohol detox at the Cleveland Veterans Affairs Medical Center and on medication reconciliation at Brigham and Women’s Hospital in Boston.

“The plenary is the top three of the 1,000 that are out there – so, impressive work,” said Benji Mathews, MD, SFHM, the chair of the Research, Innovations and Vignettes competition.

At UCSF, the project was meant to tackle the huge problem of delirium in the hospital, said Catherine Lau, MD, SFHM, associate professor of medicine there. Each year delirium affects more than 7 million people who are hospitalized, and hospital-acquired delirium is linked with prolonged stays and more emergency department visits and hospital readmissions. But research has found that as many as a third of these hospital-acquired cases can be prevented, Dr. Lau said.

New admissions and transfers – a total of more than 2,800 patients – were assessed for delirium risk, and those deemed high risk were entered into a delirium care plan, aimed at prevention with nonpharmacologic steps such as maximizing their mobility and helping them sleep at night.

All patients also were screened on every nursing shift for delirium, and those diagnosed with the disorder were placed in the delirium care plan, with notification of the patient’s team for treatment.

The average length of stay decreased by 0.8 days (P less than .001), with a decrease of 1.9 days in patients with delirium, compared with outcomes for nearly 2,600 patients before the intervention was implemented, Dr. Lau said. Researchers also found a decrease in $850 spent per patient (P less than .001), with a direct savings to the hospital of a total of $997,000, she said. The 30-day readmission rate also fell significantly, from 18.9% to 15.9% (P = .03).

The screening itself seemed to be the most important factor in the project, Dr. Lau said.

“Just the recognition that their patient was at risk for delirium or actually had delirium really raised awareness,” she said.

The project on alcohol detox used careful risk assessments at emergency department discharge, e-consults, protocols to limit benzodiazepine prescribing, and telephone follow-up to reduce hospital admissions and 30-day readmissions, as well as length of stay.

Researchers used scores on CIWA – a 10-question measurement of the severity of someone’s alcohol withdrawal – and history of complicated alcohol-use withdrawal to determine whether ED patients should be admitted to the floor or sent home with or without prescriptions for gabapentin and lorazepam, said Robert Patrick, MD, a hospitalist at the Cleveland VA.

Perhaps the most innovative feature of the program was using systolic blood pressure and heart rate in addition to CIWA to determine whether someone should receive a benzodiazepine, he said. Someone with a CIWA of 9-12, for instance, would be prescribed one of these drugs only if their vitals were elevated, Dr. Patrick said.

He encouraged other hospitalists to try a similar program at their centers.

“You don’t have to be at a VA to do this,” he said. “And most importantly, you don’t have to have a cooperative ED to do this. You can do this just within your hospitalist group.”

In another presentation, Jeffrey Schnipper, MD, MPH, FHM, associate professor of medicine at Harvard Medical School, Boston, described the results from a project in which SHM’s MARQUIS program – an evidence-based “toolkit” on medication reconciliation – was implemented at 18 hospitals. The kit offers a plan to get the best possible medication history, give medication counseling on discharge, and identify patients at risk for medication discrepancies. The 18 sites were coached, with areas of improvement identified.

By months 13-18 of the study period, the number of medication discrepancies had fallen to 0.93 per patient for those who’d received at least one form of intervention, compared with 2.69 per patient among those who’d received none.

“The MARQUIS interventions, including the toolkit and mentored implementation,” Dr. Schnipper said, “are associated with a marked reduction in medication discrepancies.”

How to develop and employ strategies to advance gender equality in hospital medicine was the focus of Tuesday’s Quick Talk “Lead In: Advancing Gender Equity in Hospital Medicine.”

Attendees heard the importance of taking action now to improve gender equality in hospital medicine to better the climate for current and future physicians. The session’s aim was to be informative and serve as a call-to-action, said presenter Vineet Arora, MD, MAPP, MPM, a professor of medicine and assistant dean for scholarship and discovery at the University of Chicago.

“Without deliberate focus and attention, it will take 200 years to close the gender equity gap worldwide,” Dr. Arora said in an interview. “This is a call to action for us to not only help current women but also future generations to come. To make a dent, gender inequity needs to be treated like a never event, much like how we have approached patient safety for the past 20 years, for us to change the culture and make actual progress.”

During the presentation, Dr. Arora discussed various strategies that hospital medicine program leaders can utilize to recognize and empower women in the workplace and that center on making women seen, heard, and known among work teams and leadership. For example, prominent women leaders can be displayed through photos in the building to draw recognition. Supporting and expanding on ideas made by women with appropriate attribution also is key, Dr. Arora noted. She discussed a strategy used by women staffers in the Obama administration during meetings. When one woman staffer made a key point, another woman staffer would repeat the point and give credit to its author, which compelled men in the room to acknowledge the idea while preventing them from claiming the idea as their own later.

Dr. Arora stressed the importance of sponsoring women in their career endeavors, supporting women who are successful, and recognizing gender bias in yourself. She noted a recent study that found when female residents struggled, they received discordant feedback on autonomy and assertiveness.

The take-home message for attendees is that today is the right time to make changes and improve gender equality, said Dr. Arora, who is a founding member of TIME’S UP Healthcare, an organization that addresses gender inequalities and sexual harassment.

“I hope attendees will take immediate action to address gender equity, including create sponsorship programs, make sure women are not only seen but also heard, and address any implicit bias that may be hampering advancement of women,” she said.

How to develop and employ strategies to advance gender equality in hospital medicine was the focus of Tuesday’s Quick Talk “Lead In: Advancing Gender Equity in Hospital Medicine.”

Attendees heard the importance of taking action now to improve gender equality in hospital medicine to better the climate for current and future physicians. The session’s aim was to be informative and serve as a call-to-action, said presenter Vineet Arora, MD, MAPP, MPM, a professor of medicine and assistant dean for scholarship and discovery at the University of Chicago.

“Without deliberate focus and attention, it will take 200 years to close the gender equity gap worldwide,” Dr. Arora said in an interview. “This is a call to action for us to not only help current women but also future generations to come. To make a dent, gender inequity needs to be treated like a never event, much like how we have approached patient safety for the past 20 years, for us to change the culture and make actual progress.”

During the presentation, Dr. Arora discussed various strategies that hospital medicine program leaders can utilize to recognize and empower women in the workplace and that center on making women seen, heard, and known among work teams and leadership. For example, prominent women leaders can be displayed through photos in the building to draw recognition. Supporting and expanding on ideas made by women with appropriate attribution also is key, Dr. Arora noted. She discussed a strategy used by women staffers in the Obama administration during meetings. When one woman staffer made a key point, another woman staffer would repeat the point and give credit to its author, which compelled men in the room to acknowledge the idea while preventing them from claiming the idea as their own later.

Dr. Arora stressed the importance of sponsoring women in their career endeavors, supporting women who are successful, and recognizing gender bias in yourself. She noted a recent study that found when female residents struggled, they received discordant feedback on autonomy and assertiveness.

The take-home message for attendees is that today is the right time to make changes and improve gender equality, said Dr. Arora, who is a founding member of TIME’S UP Healthcare, an organization that addresses gender inequalities and sexual harassment.

“I hope attendees will take immediate action to address gender equity, including create sponsorship programs, make sure women are not only seen but also heard, and address any implicit bias that may be hampering advancement of women,” she said.

How to develop and employ strategies to advance gender equality in hospital medicine was the focus of Tuesday’s Quick Talk “Lead In: Advancing Gender Equity in Hospital Medicine.”

Attendees heard the importance of taking action now to improve gender equality in hospital medicine to better the climate for current and future physicians. The session’s aim was to be informative and serve as a call-to-action, said presenter Vineet Arora, MD, MAPP, MPM, a professor of medicine and assistant dean for scholarship and discovery at the University of Chicago.

“Without deliberate focus and attention, it will take 200 years to close the gender equity gap worldwide,” Dr. Arora said in an interview. “This is a call to action for us to not only help current women but also future generations to come. To make a dent, gender inequity needs to be treated like a never event, much like how we have approached patient safety for the past 20 years, for us to change the culture and make actual progress.”

During the presentation, Dr. Arora discussed various strategies that hospital medicine program leaders can utilize to recognize and empower women in the workplace and that center on making women seen, heard, and known among work teams and leadership. For example, prominent women leaders can be displayed through photos in the building to draw recognition. Supporting and expanding on ideas made by women with appropriate attribution also is key, Dr. Arora noted. She discussed a strategy used by women staffers in the Obama administration during meetings. When one woman staffer made a key point, another woman staffer would repeat the point and give credit to its author, which compelled men in the room to acknowledge the idea while preventing them from claiming the idea as their own later.

Dr. Arora stressed the importance of sponsoring women in their career endeavors, supporting women who are successful, and recognizing gender bias in yourself. She noted a recent study that found when female residents struggled, they received discordant feedback on autonomy and assertiveness.

The take-home message for attendees is that today is the right time to make changes and improve gender equality, said Dr. Arora, who is a founding member of TIME’S UP Healthcare, an organization that addresses gender inequalities and sexual harassment.

“I hope attendees will take immediate action to address gender equity, including create sponsorship programs, make sure women are not only seen but also heard, and address any implicit bias that may be hampering advancement of women,” she said.

As the legalization of medical cannabis becomes more widespread, more and more patients admitted to the hospital are taking it. But once a patient crosses the hospital threshold, how do you incorporate into your care a product that is still illegal at the federal level?

Charles Reznikoff, MD, a physician and addiction specialist who treats medically complex hospitalized patients, walked the audience through the complexities of use of medical cannabis in these patients in a session Tuesday here at HM19. Dr. Reznikoff, from the Hennepin County (Minn.) Medical Center (HCMC), in the Minneapolis area, also discussed medical cannabis indications and contraindications in hospitalized patients.

In 2014, Minnesota passed a law allowing the use of state-based medical cannabis program products in the hospital setting. Two hospitals in the state – HCMC and the Mayo Clinic, which began allowing its use at those centers 3 years ago – illustrate the divergent ways in which different centers manage and oversee the products’ use, as they are forced to navigate nuances particular to their settings.

At Mayo, the medical cannabis is centrally stored, maintained, and administered by hospital nurses, physicians, and pharmacists. At HCMC, the situation is very different.

“Our nursing union told us, ‘Don’t make us handle schedule I substances,’ ” Dr. Reznikoff said. In addition, the hospital’s security officers – who are often off-duty police officers – said that their only interaction with medical cannabis would be to destroy it because of its illegal federal status.

So, at HCMC, the hospital documents which patients have medical cannabis, and the patients let nurses know when they take it and administer it themselves, with that administration documented. Only edibles and tinctures are allowed for use in the hospital – vaping is prohibited.

Despite the departure from the normal use of the hospital’s own formulary and pharmacy, the procedures have worked out, he said.

“For HCMC, it has been pretty straightforward – patients are happy and it has been a piece of cake,” he said, adding that in a few instances patients have been unaware that they could use their medical cannabis, or staff has been confused about the protocol.

Physicians in these situations should be on the lookout for contraindications and potential side effects, Dr. Reznikoff said.

“Medical cannabis has not a ton, but some, important side effects worth knowing about,” he said. “It can cause falls, it can cause dizziness. It can cause a little bit of tachycardia ... If they stop it, people can have mild withdrawal.”

Contraindications include altered mental status such as delirium, having had falls or having a risk of falling, hypotension or hypovolemia, and psychosis.

“For our patients, it is mostly HIV/AIDS and cancer patients who have contraindications, and that comes in the form of infectious diseases and their complications,” he said in an interview.

In the realm of palliative care, cancer, AIDS, and end-of-life care, the use of medical cannabis is a potential tool and should hinge on what patients report back as helpful or not helpful, he said.

But some claims being made about cannabidiol oil, whether as immunotherapy for autoimmune diseases, as an antipsychotic for schizophrenia, or as a cure for heroin addiction, for example, stretch credibility, Dr. Reznikoff said. But the evidence in favor of its use for seizure-reduction, for example, is persuasive, he added.

Overall, medical cannabis for hospitalized patients is no simple matter, but it is worth the fuss for some patients, he said.

“There are a few niches for it – and I think they are niches, but they’re there,” he said. “I don’t love medical cannabis. I think there are a lot of issues with it. I think a lot of physicians are very frustrated with it. But I think also, when we’re talking about palliative care–type issues and seizure disorders not otherwise treated by conventional means ... it’s very reasonable to bring cannabis into the hospital.”

As the legalization of medical cannabis becomes more widespread, more and more patients admitted to the hospital are taking it. But once a patient crosses the hospital threshold, how do you incorporate into your care a product that is still illegal at the federal level?

Charles Reznikoff, MD, a physician and addiction specialist who treats medically complex hospitalized patients, walked the audience through the complexities of use of medical cannabis in these patients in a session Tuesday here at HM19. Dr. Reznikoff, from the Hennepin County (Minn.) Medical Center (HCMC), in the Minneapolis area, also discussed medical cannabis indications and contraindications in hospitalized patients.

In 2014, Minnesota passed a law allowing the use of state-based medical cannabis program products in the hospital setting. Two hospitals in the state – HCMC and the Mayo Clinic, which began allowing its use at those centers 3 years ago – illustrate the divergent ways in which different centers manage and oversee the products’ use, as they are forced to navigate nuances particular to their settings.

At Mayo, the medical cannabis is centrally stored, maintained, and administered by hospital nurses, physicians, and pharmacists. At HCMC, the situation is very different.

“Our nursing union told us, ‘Don’t make us handle schedule I substances,’ ” Dr. Reznikoff said. In addition, the hospital’s security officers – who are often off-duty police officers – said that their only interaction with medical cannabis would be to destroy it because of its illegal federal status.

So, at HCMC, the hospital documents which patients have medical cannabis, and the patients let nurses know when they take it and administer it themselves, with that administration documented. Only edibles and tinctures are allowed for use in the hospital – vaping is prohibited.

Despite the departure from the normal use of the hospital’s own formulary and pharmacy, the procedures have worked out, he said.

“For HCMC, it has been pretty straightforward – patients are happy and it has been a piece of cake,” he said, adding that in a few instances patients have been unaware that they could use their medical cannabis, or staff has been confused about the protocol.

Physicians in these situations should be on the lookout for contraindications and potential side effects, Dr. Reznikoff said.

“Medical cannabis has not a ton, but some, important side effects worth knowing about,” he said. “It can cause falls, it can cause dizziness. It can cause a little bit of tachycardia ... If they stop it, people can have mild withdrawal.”

Contraindications include altered mental status such as delirium, having had falls or having a risk of falling, hypotension or hypovolemia, and psychosis.

“For our patients, it is mostly HIV/AIDS and cancer patients who have contraindications, and that comes in the form of infectious diseases and their complications,” he said in an interview.

In the realm of palliative care, cancer, AIDS, and end-of-life care, the use of medical cannabis is a potential tool and should hinge on what patients report back as helpful or not helpful, he said.

But some claims being made about cannabidiol oil, whether as immunotherapy for autoimmune diseases, as an antipsychotic for schizophrenia, or as a cure for heroin addiction, for example, stretch credibility, Dr. Reznikoff said. But the evidence in favor of its use for seizure-reduction, for example, is persuasive, he added.

Overall, medical cannabis for hospitalized patients is no simple matter, but it is worth the fuss for some patients, he said.

“There are a few niches for it – and I think they are niches, but they’re there,” he said. “I don’t love medical cannabis. I think there are a lot of issues with it. I think a lot of physicians are very frustrated with it. But I think also, when we’re talking about palliative care–type issues and seizure disorders not otherwise treated by conventional means ... it’s very reasonable to bring cannabis into the hospital.”

As the legalization of medical cannabis becomes more widespread, more and more patients admitted to the hospital are taking it. But once a patient crosses the hospital threshold, how do you incorporate into your care a product that is still illegal at the federal level?

Charles Reznikoff, MD, a physician and addiction specialist who treats medically complex hospitalized patients, walked the audience through the complexities of use of medical cannabis in these patients in a session Tuesday here at HM19. Dr. Reznikoff, from the Hennepin County (Minn.) Medical Center (HCMC), in the Minneapolis area, also discussed medical cannabis indications and contraindications in hospitalized patients.

In 2014, Minnesota passed a law allowing the use of state-based medical cannabis program products in the hospital setting. Two hospitals in the state – HCMC and the Mayo Clinic, which began allowing its use at those centers 3 years ago – illustrate the divergent ways in which different centers manage and oversee the products’ use, as they are forced to navigate nuances particular to their settings.

At Mayo, the medical cannabis is centrally stored, maintained, and administered by hospital nurses, physicians, and pharmacists. At HCMC, the situation is very different.

“Our nursing union told us, ‘Don’t make us handle schedule I substances,’ ” Dr. Reznikoff said. In addition, the hospital’s security officers – who are often off-duty police officers – said that their only interaction with medical cannabis would be to destroy it because of its illegal federal status.

So, at HCMC, the hospital documents which patients have medical cannabis, and the patients let nurses know when they take it and administer it themselves, with that administration documented. Only edibles and tinctures are allowed for use in the hospital – vaping is prohibited.

Despite the departure from the normal use of the hospital’s own formulary and pharmacy, the procedures have worked out, he said.

“For HCMC, it has been pretty straightforward – patients are happy and it has been a piece of cake,” he said, adding that in a few instances patients have been unaware that they could use their medical cannabis, or staff has been confused about the protocol.

Physicians in these situations should be on the lookout for contraindications and potential side effects, Dr. Reznikoff said.

“Medical cannabis has not a ton, but some, important side effects worth knowing about,” he said. “It can cause falls, it can cause dizziness. It can cause a little bit of tachycardia ... If they stop it, people can have mild withdrawal.”

Contraindications include altered mental status such as delirium, having had falls or having a risk of falling, hypotension or hypovolemia, and psychosis.

“For our patients, it is mostly HIV/AIDS and cancer patients who have contraindications, and that comes in the form of infectious diseases and their complications,” he said in an interview.

In the realm of palliative care, cancer, AIDS, and end-of-life care, the use of medical cannabis is a potential tool and should hinge on what patients report back as helpful or not helpful, he said.

But some claims being made about cannabidiol oil, whether as immunotherapy for autoimmune diseases, as an antipsychotic for schizophrenia, or as a cure for heroin addiction, for example, stretch credibility, Dr. Reznikoff said. But the evidence in favor of its use for seizure-reduction, for example, is persuasive, he added.

Overall, medical cannabis for hospitalized patients is no simple matter, but it is worth the fuss for some patients, he said.

“There are a few niches for it – and I think they are niches, but they’re there,” he said. “I don’t love medical cannabis. I think there are a lot of issues with it. I think a lot of physicians are very frustrated with it. But I think also, when we’re talking about palliative care–type issues and seizure disorders not otherwise treated by conventional means ... it’s very reasonable to bring cannabis into the hospital.”

Every year SHM’s Annual Conference Committee examines prior attendee surveys, reviews the content presented the preceding year, and asks itself what new areas of learning are needed by hospitalists, said Dustin Smith, MD, SFHM, associate professor of medicine at Emory University in Atlanta, and HM19 course director.

“The conference’s schedule-at-a-glance of content can be overwhelming, so we have tried to use distinct educational tracks to provide focus and clarity for conference attendees,” he said. “Every year there are a few areas where questions often come up about complex clinical situations in which established medical guidelines aren’t much help.”

As a result, for HM19 an educational mini-track called “Between the Guidelines” was developed to gather up several of these areas of clinical complexity where what’s available in established clinical practice guidelines doesn’t offer clear answers, Dr. Smith said. These include controversies around antithrombotic therapy in patients with major bleeds, and a debate on controversial aspects of guidelines to direct inpatient care.

A Wednesday session, “The History of Hospitals via Arts and Stories,” fits nicely into this mini-track.

“It’s a history lesson you can’t glean from medical guidelines, which maybe point us toward what to incorporate and what not to repeat from across the history of hospitals,” he said. “That could help us better appreciate the work hospitalists are doing today and into the future.”

Jordan Messler, MD, SFHM, a hospitalist with the Morton Plant Hospitalist group in Clearwater, Fla., will lead the session and thinks that modern physicians can learn a great deal from both the history of medicine and the evolution of hospitals, starting with the ancient Greek physician, Galen (129-200 AD), who directed the celebrated Asclepeion or hospital in Pergamon (present-day Bergama, Turkey). Dr. Messler said this ancient hospital’s treatment of disease also addressed the senses, the emotions, and the spirit – an early prototype for whole-person care – with an em-phasis on self-therapy through rest, relaxation, exercise, and the promotion of healthy lifestyles.
 

A different perspective on hospitals

“People used to travel to Pergamon for healing at the Asclepeion, next to the amphitheater, where plays and music were presented, and to be outdoors in the natural elements. Now we’re seeing hospitals being built with healing gardens, and a new emphasis on how artwork and music and environmental design can assist in healing,” Dr. Messler said.

Dr. Messler explained that his “History of Hospitals” presentation also will survey the advent of more recent hospitals in France in the 18th century, pioneering work done at Johns Hopkins Hospital in Baltimore and Bellevue Hospital in New York, and the influence of nursing pioneer Florence Nightingale (1820-1910) on the modern hospital. Dr. Messler said Ms. Nightingale helped improve hospitals in her day, which still influences their modern design, and fundamentally changed the role of nursing in hospitals, introducing professional training standards for nurses.

Part of the goal for “Between the Guidelines” is to take a break from more clinically focused presentations and to think about the hospital from a different perspective, Dr. Messler said. His session will emphasize the power of stories and storytelling to inform and inspire medical practice.

“This is not something that can be applied clinically the next day, but lessons from the past can inform the design of hospitals and how we manage patients,” he said. “We need to ask ourselves, ‘How can we analyze hospital history to inform what we do today?’ ”
 

Origins Not Forgotten: The History of Hospitals via Arts and Stories
Wednesday, 12:30-1:10 p.m.
Woodrow Wilson A

Every year SHM’s Annual Conference Committee examines prior attendee surveys, reviews the content presented the preceding year, and asks itself what new areas of learning are needed by hospitalists, said Dustin Smith, MD, SFHM, associate professor of medicine at Emory University in Atlanta, and HM19 course director.

“The conference’s schedule-at-a-glance of content can be overwhelming, so we have tried to use distinct educational tracks to provide focus and clarity for conference attendees,” he said. “Every year there are a few areas where questions often come up about complex clinical situations in which established medical guidelines aren’t much help.”

As a result, for HM19 an educational mini-track called “Between the Guidelines” was developed to gather up several of these areas of clinical complexity where what’s available in established clinical practice guidelines doesn’t offer clear answers, Dr. Smith said. These include controversies around antithrombotic therapy in patients with major bleeds, and a debate on controversial aspects of guidelines to direct inpatient care.

A Wednesday session, “The History of Hospitals via Arts and Stories,” fits nicely into this mini-track.

“It’s a history lesson you can’t glean from medical guidelines, which maybe point us toward what to incorporate and what not to repeat from across the history of hospitals,” he said. “That could help us better appreciate the work hospitalists are doing today and into the future.”

Jordan Messler, MD, SFHM, a hospitalist with the Morton Plant Hospitalist group in Clearwater, Fla., will lead the session and thinks that modern physicians can learn a great deal from both the history of medicine and the evolution of hospitals, starting with the ancient Greek physician, Galen (129-200 AD), who directed the celebrated Asclepeion or hospital in Pergamon (present-day Bergama, Turkey). Dr. Messler said this ancient hospital’s treatment of disease also addressed the senses, the emotions, and the spirit – an early prototype for whole-person care – with an em-phasis on self-therapy through rest, relaxation, exercise, and the promotion of healthy lifestyles.
 

A different perspective on hospitals

“People used to travel to Pergamon for healing at the Asclepeion, next to the amphitheater, where plays and music were presented, and to be outdoors in the natural elements. Now we’re seeing hospitals being built with healing gardens, and a new emphasis on how artwork and music and environmental design can assist in healing,” Dr. Messler said.

Dr. Messler explained that his “History of Hospitals” presentation also will survey the advent of more recent hospitals in France in the 18th century, pioneering work done at Johns Hopkins Hospital in Baltimore and Bellevue Hospital in New York, and the influence of nursing pioneer Florence Nightingale (1820-1910) on the modern hospital. Dr. Messler said Ms. Nightingale helped improve hospitals in her day, which still influences their modern design, and fundamentally changed the role of nursing in hospitals, introducing professional training standards for nurses.

Part of the goal for “Between the Guidelines” is to take a break from more clinically focused presentations and to think about the hospital from a different perspective, Dr. Messler said. His session will emphasize the power of stories and storytelling to inform and inspire medical practice.

“This is not something that can be applied clinically the next day, but lessons from the past can inform the design of hospitals and how we manage patients,” he said. “We need to ask ourselves, ‘How can we analyze hospital history to inform what we do today?’ ”
 

Origins Not Forgotten: The History of Hospitals via Arts and Stories
Wednesday, 12:30-1:10 p.m.
Woodrow Wilson A

Every year SHM’s Annual Conference Committee examines prior attendee surveys, reviews the content presented the preceding year, and asks itself what new areas of learning are needed by hospitalists, said Dustin Smith, MD, SFHM, associate professor of medicine at Emory University in Atlanta, and HM19 course director.

“The conference’s schedule-at-a-glance of content can be overwhelming, so we have tried to use distinct educational tracks to provide focus and clarity for conference attendees,” he said. “Every year there are a few areas where questions often come up about complex clinical situations in which established medical guidelines aren’t much help.”

As a result, for HM19 an educational mini-track called “Between the Guidelines” was developed to gather up several of these areas of clinical complexity where what’s available in established clinical practice guidelines doesn’t offer clear answers, Dr. Smith said. These include controversies around antithrombotic therapy in patients with major bleeds, and a debate on controversial aspects of guidelines to direct inpatient care.

A Wednesday session, “The History of Hospitals via Arts and Stories,” fits nicely into this mini-track.

“It’s a history lesson you can’t glean from medical guidelines, which maybe point us toward what to incorporate and what not to repeat from across the history of hospitals,” he said. “That could help us better appreciate the work hospitalists are doing today and into the future.”

Jordan Messler, MD, SFHM, a hospitalist with the Morton Plant Hospitalist group in Clearwater, Fla., will lead the session and thinks that modern physicians can learn a great deal from both the history of medicine and the evolution of hospitals, starting with the ancient Greek physician, Galen (129-200 AD), who directed the celebrated Asclepeion or hospital in Pergamon (present-day Bergama, Turkey). Dr. Messler said this ancient hospital’s treatment of disease also addressed the senses, the emotions, and the spirit – an early prototype for whole-person care – with an em-phasis on self-therapy through rest, relaxation, exercise, and the promotion of healthy lifestyles.
 

A different perspective on hospitals

“People used to travel to Pergamon for healing at the Asclepeion, next to the amphitheater, where plays and music were presented, and to be outdoors in the natural elements. Now we’re seeing hospitals being built with healing gardens, and a new emphasis on how artwork and music and environmental design can assist in healing,” Dr. Messler said.

Dr. Messler explained that his “History of Hospitals” presentation also will survey the advent of more recent hospitals in France in the 18th century, pioneering work done at Johns Hopkins Hospital in Baltimore and Bellevue Hospital in New York, and the influence of nursing pioneer Florence Nightingale (1820-1910) on the modern hospital. Dr. Messler said Ms. Nightingale helped improve hospitals in her day, which still influences their modern design, and fundamentally changed the role of nursing in hospitals, introducing professional training standards for nurses.

Part of the goal for “Between the Guidelines” is to take a break from more clinically focused presentations and to think about the hospital from a different perspective, Dr. Messler said. His session will emphasize the power of stories and storytelling to inform and inspire medical practice.

“This is not something that can be applied clinically the next day, but lessons from the past can inform the design of hospitals and how we manage patients,” he said. “We need to ask ourselves, ‘How can we analyze hospital history to inform what we do today?’ ”
 

Origins Not Forgotten: The History of Hospitals via Arts and Stories
Wednesday, 12:30-1:10 p.m.
Woodrow Wilson A

A program using “telehospitalists” to hasten and improve patient care won the top prize in the Innovations category of the RIV competition on Monday night at HM19. In the Research category, a study on workload to improve overnight cross-coverage care took the top prize.

Lou Ferraro, Park South Photography

Jeetinder Kaur Gujral, MD, a family medicine and palliative care physician at Northwell Health in Bay Shore, N.Y., said that the telehospitalist program at her institution uses a telehealth hub that is on call to consult with patients when the on-site hospitalist is unable to evaluate a patient in the emergency department within 30 minutes.

Dr. Gujral’s winning study – presented on Monday night and evaluated based on its novelty and the quality of the presentation and the poster – examined results at one of Northwell’s tertiary centers from January to October of 2018, where a telehospitalist works from 12 p.m. to 10 p.m.

Researchers found there was no significant difference in the severity of illness between the patients seen by the on-site hospitalist and the telehospitalist – if anything, the patients consulted by the telehospitalist were a bit sicker, Dr. Gujral said. But there was significantly less variation in the time it took for a telehospitalist to consult with a patient than the on-site physician.

“We are more predictable, because it’s a press of a button, and we are there,” Dr. Gujral said. “And the orders go in faster. I don’t have to leave to go down to the ED to see the patient. I’m seeing the patient right there.”

Kelly Sponsler, MD, assistant professor at Vanderbilt University Medical Center in Nashville, Tenn., who led the Innovations judging, said the project seems to be a brand-new idea: taking a concept built to cover long distances at rural centers and using it within a center’s own program to improve care.

“We really felt like this was something we had not seen before,” Dr. Sponsler said. “There was a clear problem that the team had identified, and it’s a common problem that I think can be scalable, or that other groups probably encounter.”

In the cross-coverage study that won in the Research category, an index developed by NASA to quantify perceived workload was used to assess the factors that boost workload during night shifts, said Ruth Bates, MD, an assistant professor at Mayo Clinic in Rochester, Minn.

The key finding was that it wasn’t the number of patients that boosts workload during these hours, but the number of pages, action items, and rapid-response team and ICU activations. The number of unnecessary pages that overnight hospitalists receive is the prime target as a way to reduce the workload.

The idea is to reduce “low-value communication,” Dr. Bates said. An example is a page about a lab value that is a “tiny bit off.”

“That’s just one example of really low-value communication that has interrupted somebody’s work flow and is not really increasing the quality of patient care.”

Trainee winners were Cameron Locke, MD, a resident physician at the University of California, San Francisco, for a study on a multidisciplinary approach to reduce endoscopy delays, which won in the Innovations category. That study was presented by Molly Kantor, MD, assistant clinical professor at UCSF.

The Research category trainee winner was Monisha Bhatia, MD, JD, MPH, of Jackson Memorial Hospital in Miami for her work on using phenotypic data from electronic health records to predict discharge destination.

On Tuesday afternoon, Erin Frost, MD, a resident in internal medicine and pediatrics at Duke University, Durham, N.C., won the top prize in the Clinical Vignettes category, for her presentation of a case of a woman with acute digital ischemia after an injection of sublingual buprenorphine and naloxone.

The trainee winner in Clinical Vignettes was a case of C. difficile infection of a total hip arthroplasty, presented by Benjamin Claxton, MPH, a medical student at Penn State University, Hershey. The category’s pediatrics winner was Erin Finn, MD, a resident at the University of North Carolina, Chapel Hill, for her presentation of a case of myocarditis in a 14-year-old.

The oral presentation winner for the Innovations category was Nainesh Shah, MD, of UT Southwestern Medical Center, Dallas, for his abstract presentation "Alert: Structured Radiology Reports are Here." For the Research category, the oral presentation winner was David Meltzer, MD, PhD, section chief of hospital medicine at University of Chicago Medicine, for his abstract presentation "Effects of Comprehensive Care Physicians on Patient Experience, Outcomes and Hospitalization."

A program using “telehospitalists” to hasten and improve patient care won the top prize in the Innovations category of the RIV competition on Monday night at HM19. In the Research category, a study on workload to improve overnight cross-coverage care took the top prize.

Lou Ferraro, Park South Photography

Jeetinder Kaur Gujral, MD, a family medicine and palliative care physician at Northwell Health in Bay Shore, N.Y., said that the telehospitalist program at her institution uses a telehealth hub that is on call to consult with patients when the on-site hospitalist is unable to evaluate a patient in the emergency department within 30 minutes.

Dr. Gujral’s winning study – presented on Monday night and evaluated based on its novelty and the quality of the presentation and the poster – examined results at one of Northwell’s tertiary centers from January to October of 2018, where a telehospitalist works from 12 p.m. to 10 p.m.

Researchers found there was no significant difference in the severity of illness between the patients seen by the on-site hospitalist and the telehospitalist – if anything, the patients consulted by the telehospitalist were a bit sicker, Dr. Gujral said. But there was significantly less variation in the time it took for a telehospitalist to consult with a patient than the on-site physician.

“We are more predictable, because it’s a press of a button, and we are there,” Dr. Gujral said. “And the orders go in faster. I don’t have to leave to go down to the ED to see the patient. I’m seeing the patient right there.”

Kelly Sponsler, MD, assistant professor at Vanderbilt University Medical Center in Nashville, Tenn., who led the Innovations judging, said the project seems to be a brand-new idea: taking a concept built to cover long distances at rural centers and using it within a center’s own program to improve care.

“We really felt like this was something we had not seen before,” Dr. Sponsler said. “There was a clear problem that the team had identified, and it’s a common problem that I think can be scalable, or that other groups probably encounter.”

In the cross-coverage study that won in the Research category, an index developed by NASA to quantify perceived workload was used to assess the factors that boost workload during night shifts, said Ruth Bates, MD, an assistant professor at Mayo Clinic in Rochester, Minn.

The key finding was that it wasn’t the number of patients that boosts workload during these hours, but the number of pages, action items, and rapid-response team and ICU activations. The number of unnecessary pages that overnight hospitalists receive is the prime target as a way to reduce the workload.

The idea is to reduce “low-value communication,” Dr. Bates said. An example is a page about a lab value that is a “tiny bit off.”

“That’s just one example of really low-value communication that has interrupted somebody’s work flow and is not really increasing the quality of patient care.”

Trainee winners were Cameron Locke, MD, a resident physician at the University of California, San Francisco, for a study on a multidisciplinary approach to reduce endoscopy delays, which won in the Innovations category. That study was presented by Molly Kantor, MD, assistant clinical professor at UCSF.

The Research category trainee winner was Monisha Bhatia, MD, JD, MPH, of Jackson Memorial Hospital in Miami for her work on using phenotypic data from electronic health records to predict discharge destination.

On Tuesday afternoon, Erin Frost, MD, a resident in internal medicine and pediatrics at Duke University, Durham, N.C., won the top prize in the Clinical Vignettes category, for her presentation of a case of a woman with acute digital ischemia after an injection of sublingual buprenorphine and naloxone.

The trainee winner in Clinical Vignettes was a case of C. difficile infection of a total hip arthroplasty, presented by Benjamin Claxton, MPH, a medical student at Penn State University, Hershey. The category’s pediatrics winner was Erin Finn, MD, a resident at the University of North Carolina, Chapel Hill, for her presentation of a case of myocarditis in a 14-year-old.

The oral presentation winner for the Innovations category was Nainesh Shah, MD, of UT Southwestern Medical Center, Dallas, for his abstract presentation "Alert: Structured Radiology Reports are Here." For the Research category, the oral presentation winner was David Meltzer, MD, PhD, section chief of hospital medicine at University of Chicago Medicine, for his abstract presentation "Effects of Comprehensive Care Physicians on Patient Experience, Outcomes and Hospitalization."

A program using “telehospitalists” to hasten and improve patient care won the top prize in the Innovations category of the RIV competition on Monday night at HM19. In the Research category, a study on workload to improve overnight cross-coverage care took the top prize.

Lou Ferraro, Park South Photography

Jeetinder Kaur Gujral, MD, a family medicine and palliative care physician at Northwell Health in Bay Shore, N.Y., said that the telehospitalist program at her institution uses a telehealth hub that is on call to consult with patients when the on-site hospitalist is unable to evaluate a patient in the emergency department within 30 minutes.

Dr. Gujral’s winning study – presented on Monday night and evaluated based on its novelty and the quality of the presentation and the poster – examined results at one of Northwell’s tertiary centers from January to October of 2018, where a telehospitalist works from 12 p.m. to 10 p.m.

Researchers found there was no significant difference in the severity of illness between the patients seen by the on-site hospitalist and the telehospitalist – if anything, the patients consulted by the telehospitalist were a bit sicker, Dr. Gujral said. But there was significantly less variation in the time it took for a telehospitalist to consult with a patient than the on-site physician.

“We are more predictable, because it’s a press of a button, and we are there,” Dr. Gujral said. “And the orders go in faster. I don’t have to leave to go down to the ED to see the patient. I’m seeing the patient right there.”

Kelly Sponsler, MD, assistant professor at Vanderbilt University Medical Center in Nashville, Tenn., who led the Innovations judging, said the project seems to be a brand-new idea: taking a concept built to cover long distances at rural centers and using it within a center’s own program to improve care.

“We really felt like this was something we had not seen before,” Dr. Sponsler said. “There was a clear problem that the team had identified, and it’s a common problem that I think can be scalable, or that other groups probably encounter.”

In the cross-coverage study that won in the Research category, an index developed by NASA to quantify perceived workload was used to assess the factors that boost workload during night shifts, said Ruth Bates, MD, an assistant professor at Mayo Clinic in Rochester, Minn.

The key finding was that it wasn’t the number of patients that boosts workload during these hours, but the number of pages, action items, and rapid-response team and ICU activations. The number of unnecessary pages that overnight hospitalists receive is the prime target as a way to reduce the workload.

The idea is to reduce “low-value communication,” Dr. Bates said. An example is a page about a lab value that is a “tiny bit off.”

“That’s just one example of really low-value communication that has interrupted somebody’s work flow and is not really increasing the quality of patient care.”

Trainee winners were Cameron Locke, MD, a resident physician at the University of California, San Francisco, for a study on a multidisciplinary approach to reduce endoscopy delays, which won in the Innovations category. That study was presented by Molly Kantor, MD, assistant clinical professor at UCSF.

The Research category trainee winner was Monisha Bhatia, MD, JD, MPH, of Jackson Memorial Hospital in Miami for her work on using phenotypic data from electronic health records to predict discharge destination.

On Tuesday afternoon, Erin Frost, MD, a resident in internal medicine and pediatrics at Duke University, Durham, N.C., won the top prize in the Clinical Vignettes category, for her presentation of a case of a woman with acute digital ischemia after an injection of sublingual buprenorphine and naloxone.

The trainee winner in Clinical Vignettes was a case of C. difficile infection of a total hip arthroplasty, presented by Benjamin Claxton, MPH, a medical student at Penn State University, Hershey. The category’s pediatrics winner was Erin Finn, MD, a resident at the University of North Carolina, Chapel Hill, for her presentation of a case of myocarditis in a 14-year-old.

The oral presentation winner for the Innovations category was Nainesh Shah, MD, of UT Southwestern Medical Center, Dallas, for his abstract presentation "Alert: Structured Radiology Reports are Here." For the Research category, the oral presentation winner was David Meltzer, MD, PhD, section chief of hospital medicine at University of Chicago Medicine, for his abstract presentation "Effects of Comprehensive Care Physicians on Patient Experience, Outcomes and Hospitalization."

Social media can be more than a tool to connect with friends and family, said Vineet Chopra, MD, MBBS, FHM, Charlie Wray, DO, and Vineet Arora, MD, MAPP, MHM, at Monday’s “Tweet Your Way to the Top? Social Media as a Career Development Tool in Hospital Medicine” session.

Online outreach can play crucial roles in everything from continuing education and research to networking and career advancement, but most of the conversations in medicine are really focused in the Twittersphere, the three hospitalists said.

“Social media has allowed me to connect with leaders in hospital medicine and many other medical communities,” said Dr. Wray, an assistant professor of medicine at the University of California, San Francisco. “It has allowed me to share my work and success with the hospitalist community in addition to highlighting my trainees’ and colleagues’ successes. My engagement has created opportunities to get involved with projects that I could never have previously imagined. And it has extended my networking circle and made annual gatherings like the SHM Annual Conference even more beneficial and high yield for my career.”

For session copresenter Dr. Chopra, associate professor and chief of the division of hospital medicine at the University of Michigan, Ann Arbor, social media “helps develop your brand and your identity. It is a wonderful way for people to know what you do, who you are, what you stand for, and your views and opinions on various topics.”

On the career front, social media “can connect you to leaders in the community so that they know who you are and what you are accomplishing. So when time comes for you to move on, people within this community will know who you are and what you’re known for at a national level,” said Dr. Wray, who is also deputy digital media editor for the Journal of Hospital Medicine.

Sharing on social media – and Twitter in particular – for the medical profession is focused mainly on dissemination of information, engaging in communities, and networking beyond your institution. The three presenters shared tips of the trade during the session, such as how to boost exposure to a tweet by including hashtags, posting photos, and sharing links. To overcome time commitment barriers, tie your Twitter contributions to something you are doing already, said Dr. Arora, associate chief medical officer-clinical learning environment at the University of Chicago.

A presence on social media isn’t just a tool to boost your own profile, Dr. Wray said. It also helps you stay on top of medical news. “There is so much information and new data coming out nowadays, it can be hard to keep up,” he said. “A properly curated social media feed can help a busy clinician stay on top of what is really important. This is an invaluable skill for the modern hospitalist.”

But be careful how much you disclose on social media about yourself and, especially, other people. “A good rule of thumb is: Don’t put anything online that you wouldn’t want your mother to read,” Dr. Chopra said. “As well, sharing any personal or patient information without understanding your institution’s guidelines or obtaining explicit permission is a general no-no,” he said.

“Also, many employers look at social media profiles before they hire people. We certainly do so when we are looking at various individuals. We often call this a ‘Google biopsy.’ ”

Randy Dotinga contributed to this report.

Social media can be more than a tool to connect with friends and family, said Vineet Chopra, MD, MBBS, FHM, Charlie Wray, DO, and Vineet Arora, MD, MAPP, MHM, at Monday’s “Tweet Your Way to the Top? Social Media as a Career Development Tool in Hospital Medicine” session.

Online outreach can play crucial roles in everything from continuing education and research to networking and career advancement, but most of the conversations in medicine are really focused in the Twittersphere, the three hospitalists said.

“Social media has allowed me to connect with leaders in hospital medicine and many other medical communities,” said Dr. Wray, an assistant professor of medicine at the University of California, San Francisco. “It has allowed me to share my work and success with the hospitalist community in addition to highlighting my trainees’ and colleagues’ successes. My engagement has created opportunities to get involved with projects that I could never have previously imagined. And it has extended my networking circle and made annual gatherings like the SHM Annual Conference even more beneficial and high yield for my career.”

For session copresenter Dr. Chopra, associate professor and chief of the division of hospital medicine at the University of Michigan, Ann Arbor, social media “helps develop your brand and your identity. It is a wonderful way for people to know what you do, who you are, what you stand for, and your views and opinions on various topics.”

On the career front, social media “can connect you to leaders in the community so that they know who you are and what you are accomplishing. So when time comes for you to move on, people within this community will know who you are and what you’re known for at a national level,” said Dr. Wray, who is also deputy digital media editor for the Journal of Hospital Medicine.

Sharing on social media – and Twitter in particular – for the medical profession is focused mainly on dissemination of information, engaging in communities, and networking beyond your institution. The three presenters shared tips of the trade during the session, such as how to boost exposure to a tweet by including hashtags, posting photos, and sharing links. To overcome time commitment barriers, tie your Twitter contributions to something you are doing already, said Dr. Arora, associate chief medical officer-clinical learning environment at the University of Chicago.

A presence on social media isn’t just a tool to boost your own profile, Dr. Wray said. It also helps you stay on top of medical news. “There is so much information and new data coming out nowadays, it can be hard to keep up,” he said. “A properly curated social media feed can help a busy clinician stay on top of what is really important. This is an invaluable skill for the modern hospitalist.”

But be careful how much you disclose on social media about yourself and, especially, other people. “A good rule of thumb is: Don’t put anything online that you wouldn’t want your mother to read,” Dr. Chopra said. “As well, sharing any personal or patient information without understanding your institution’s guidelines or obtaining explicit permission is a general no-no,” he said.

“Also, many employers look at social media profiles before they hire people. We certainly do so when we are looking at various individuals. We often call this a ‘Google biopsy.’ ”

Randy Dotinga contributed to this report.

Social media can be more than a tool to connect with friends and family, said Vineet Chopra, MD, MBBS, FHM, Charlie Wray, DO, and Vineet Arora, MD, MAPP, MHM, at Monday’s “Tweet Your Way to the Top? Social Media as a Career Development Tool in Hospital Medicine” session.

Online outreach can play crucial roles in everything from continuing education and research to networking and career advancement, but most of the conversations in medicine are really focused in the Twittersphere, the three hospitalists said.

“Social media has allowed me to connect with leaders in hospital medicine and many other medical communities,” said Dr. Wray, an assistant professor of medicine at the University of California, San Francisco. “It has allowed me to share my work and success with the hospitalist community in addition to highlighting my trainees’ and colleagues’ successes. My engagement has created opportunities to get involved with projects that I could never have previously imagined. And it has extended my networking circle and made annual gatherings like the SHM Annual Conference even more beneficial and high yield for my career.”

For session copresenter Dr. Chopra, associate professor and chief of the division of hospital medicine at the University of Michigan, Ann Arbor, social media “helps develop your brand and your identity. It is a wonderful way for people to know what you do, who you are, what you stand for, and your views and opinions on various topics.”

On the career front, social media “can connect you to leaders in the community so that they know who you are and what you are accomplishing. So when time comes for you to move on, people within this community will know who you are and what you’re known for at a national level,” said Dr. Wray, who is also deputy digital media editor for the Journal of Hospital Medicine.

Sharing on social media – and Twitter in particular – for the medical profession is focused mainly on dissemination of information, engaging in communities, and networking beyond your institution. The three presenters shared tips of the trade during the session, such as how to boost exposure to a tweet by including hashtags, posting photos, and sharing links. To overcome time commitment barriers, tie your Twitter contributions to something you are doing already, said Dr. Arora, associate chief medical officer-clinical learning environment at the University of Chicago.

A presence on social media isn’t just a tool to boost your own profile, Dr. Wray said. It also helps you stay on top of medical news. “There is so much information and new data coming out nowadays, it can be hard to keep up,” he said. “A properly curated social media feed can help a busy clinician stay on top of what is really important. This is an invaluable skill for the modern hospitalist.”

But be careful how much you disclose on social media about yourself and, especially, other people. “A good rule of thumb is: Don’t put anything online that you wouldn’t want your mother to read,” Dr. Chopra said. “As well, sharing any personal or patient information without understanding your institution’s guidelines or obtaining explicit permission is a general no-no,” he said.

“Also, many employers look at social media profiles before they hire people. We certainly do so when we are looking at various individuals. We often call this a ‘Google biopsy.’ ”

Randy Dotinga contributed to this report.

Physicians have had diverse patients as long as there have been physicians (and patients). But diversity among health professionals remains elusive.

Can we do better? Absolutely, says a team of experts who will offer perspective to colleagues in a Wednesday morning session titled, “Best Practices and Tips for Developing Diversity in a Hospitalist Group.”

“The goals of our session are to review best practices for recruiting and retaining a diverse health care workforce, discuss strategies for dealing with implicit and explicit bias, and identify ways in which we can achieve common goals when working across cultures,” said hospitalist Amira del Pino-Jones, MD, assistant professor of medicine at the University of Colorado at Denver, Aurora, and director of the CU Hospitalist Scholars Program.

“Those who are interested in achieving excellence in hospital medicine through prioritizing diversity and equity efforts within their divisions, departments, and groups should attend,” said Dr. del Pino-Jones, who will be one of the speakers at the session.

Why is diversity important in hospital medicine? “Studies have shown that diversity enhances learning and work environments, promotes innovation, broadens research agendas, and improves the quality of care we provide for patients,” Dr. del Pino-Jones said. “In short, it is central to achieving excellence in hospital medicine.”

The session will focus on diverse groups, which have been historically underrepresented or discriminated against in medicine, including racial and ethnic minorities, women, LGBTQ+ individuals, and those with disabilities.

All speakers at the session are physicians, and each has seen or experienced challenges in diversifying their groups and divisions. “We hope to share our experiences, what we have learned, and ways to approach each of these issues. We also are hoping to hear from others and come up with new ways to approach these issues as a collective,” Dr. del Pino-Jones said.

Women and members of minority groups often have small numbers in their hospital medicine workplaces, especially in higher-level positions, and have trouble developing the critical mass to make progress on the diversity front, she said. Even when leaders recognize the importance of a diverse workforce, she said, “there is often a disconnect between motivation for increasing diversity and the ability to develop tangible, evidence-based methods that can be used to increase diversity.”

The session will tackle more than diversity at the workplace. Speakers also will discuss the relationship between medical professionals and patients.

“We will focus on the importance of inclusion and belonging, both of which are essential for creating a positive climate for all individuals,” Dr. del Pino-Jones said. “We will also discuss ways in which to cultivate cultural intelligence and enhance cross-cultural interactions between patients and providers. And we’ll look at ways to reduce and/or mitigate implicit and explicit bias in medicine.”

Dr. del Pino-Jones has no relevant disclosures.
 

Best Practices and Tips
for Developing Diversity in a Hospitalist Group
Wednesday, 10 - 11:30 a.m.
Potomac 4-6

Physicians have had diverse patients as long as there have been physicians (and patients). But diversity among health professionals remains elusive.

Can we do better? Absolutely, says a team of experts who will offer perspective to colleagues in a Wednesday morning session titled, “Best Practices and Tips for Developing Diversity in a Hospitalist Group.”

“The goals of our session are to review best practices for recruiting and retaining a diverse health care workforce, discuss strategies for dealing with implicit and explicit bias, and identify ways in which we can achieve common goals when working across cultures,” said hospitalist Amira del Pino-Jones, MD, assistant professor of medicine at the University of Colorado at Denver, Aurora, and director of the CU Hospitalist Scholars Program.

“Those who are interested in achieving excellence in hospital medicine through prioritizing diversity and equity efforts within their divisions, departments, and groups should attend,” said Dr. del Pino-Jones, who will be one of the speakers at the session.

Why is diversity important in hospital medicine? “Studies have shown that diversity enhances learning and work environments, promotes innovation, broadens research agendas, and improves the quality of care we provide for patients,” Dr. del Pino-Jones said. “In short, it is central to achieving excellence in hospital medicine.”

The session will focus on diverse groups, which have been historically underrepresented or discriminated against in medicine, including racial and ethnic minorities, women, LGBTQ+ individuals, and those with disabilities.

All speakers at the session are physicians, and each has seen or experienced challenges in diversifying their groups and divisions. “We hope to share our experiences, what we have learned, and ways to approach each of these issues. We also are hoping to hear from others and come up with new ways to approach these issues as a collective,” Dr. del Pino-Jones said.

Women and members of minority groups often have small numbers in their hospital medicine workplaces, especially in higher-level positions, and have trouble developing the critical mass to make progress on the diversity front, she said. Even when leaders recognize the importance of a diverse workforce, she said, “there is often a disconnect between motivation for increasing diversity and the ability to develop tangible, evidence-based methods that can be used to increase diversity.”

The session will tackle more than diversity at the workplace. Speakers also will discuss the relationship between medical professionals and patients.

“We will focus on the importance of inclusion and belonging, both of which are essential for creating a positive climate for all individuals,” Dr. del Pino-Jones said. “We will also discuss ways in which to cultivate cultural intelligence and enhance cross-cultural interactions between patients and providers. And we’ll look at ways to reduce and/or mitigate implicit and explicit bias in medicine.”

Dr. del Pino-Jones has no relevant disclosures.
 

Best Practices and Tips
for Developing Diversity in a Hospitalist Group
Wednesday, 10 - 11:30 a.m.
Potomac 4-6

Physicians have had diverse patients as long as there have been physicians (and patients). But diversity among health professionals remains elusive.

Can we do better? Absolutely, says a team of experts who will offer perspective to colleagues in a Wednesday morning session titled, “Best Practices and Tips for Developing Diversity in a Hospitalist Group.”

“The goals of our session are to review best practices for recruiting and retaining a diverse health care workforce, discuss strategies for dealing with implicit and explicit bias, and identify ways in which we can achieve common goals when working across cultures,” said hospitalist Amira del Pino-Jones, MD, assistant professor of medicine at the University of Colorado at Denver, Aurora, and director of the CU Hospitalist Scholars Program.

“Those who are interested in achieving excellence in hospital medicine through prioritizing diversity and equity efforts within their divisions, departments, and groups should attend,” said Dr. del Pino-Jones, who will be one of the speakers at the session.

Why is diversity important in hospital medicine? “Studies have shown that diversity enhances learning and work environments, promotes innovation, broadens research agendas, and improves the quality of care we provide for patients,” Dr. del Pino-Jones said. “In short, it is central to achieving excellence in hospital medicine.”

The session will focus on diverse groups, which have been historically underrepresented or discriminated against in medicine, including racial and ethnic minorities, women, LGBTQ+ individuals, and those with disabilities.

All speakers at the session are physicians, and each has seen or experienced challenges in diversifying their groups and divisions. “We hope to share our experiences, what we have learned, and ways to approach each of these issues. We also are hoping to hear from others and come up with new ways to approach these issues as a collective,” Dr. del Pino-Jones said.

Women and members of minority groups often have small numbers in their hospital medicine workplaces, especially in higher-level positions, and have trouble developing the critical mass to make progress on the diversity front, she said. Even when leaders recognize the importance of a diverse workforce, she said, “there is often a disconnect between motivation for increasing diversity and the ability to develop tangible, evidence-based methods that can be used to increase diversity.”

The session will tackle more than diversity at the workplace. Speakers also will discuss the relationship between medical professionals and patients.

“We will focus on the importance of inclusion and belonging, both of which are essential for creating a positive climate for all individuals,” Dr. del Pino-Jones said. “We will also discuss ways in which to cultivate cultural intelligence and enhance cross-cultural interactions between patients and providers. And we’ll look at ways to reduce and/or mitigate implicit and explicit bias in medicine.”

Dr. del Pino-Jones has no relevant disclosures.
 

Best Practices and Tips
for Developing Diversity in a Hospitalist Group
Wednesday, 10 - 11:30 a.m.
Potomac 4-6