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Hospitalists
Kinds of Hospitalists Selected AbstractsHospital Economics of the HospitalistHEALTH SERVICES RESEARCH, Issue 3 2003Douglas Gregory Objective To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. Data Sources The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. Study Design The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. Principal Findings The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to $1,775 from $2,332 (p<.001); costs per day increased to $811 from $679 (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was,$1.44 per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of $1.3 million. Conclusion Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program. [source] The role of the hospitalist in quality improvement: Systems for improving the care of patients with acute coronary syndrome,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010Chad T. Whelan MD Abstract Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies. Journal of Hospital Medicine 2010;5:S1,S7. © 2010 Society of Hospital Medicine. [source] Transitioning the patient with acute coronary syndrome from inpatient to primary care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010FACPE, Tomás Villanueva DO Abstract Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. Journal of Hospital Medicine 2010;5:S8,S14. © 2010 Society of Hospital Medicine. [source] Integrating pediatric hospitalists in the academic health science center: Practice and perceptions in a canadian center,,JOURNAL OF HOSPITAL MEDICINE, Issue 4 2010FRCPC, Sanjay Mahant MD Abstract BACKGROUND: The integration of hospitalists in academic settings has been identified as a challenge to the hospitalist movement. The Division of Pediatric Medicine, Hospital for Sick Children, Toronto, was established in 1981, providing a rich resource to examine this field in the academic context and inform academic program development. OBJECTIVES: To explore the characteristics, practice, perceptions, and contributions of pediatric hospital medicine in an academic health science center (AHSC). METHODS: A cross-sectional survey of physicians attending on the pediatric medicine inpatient unit (PMIU) (n = 20). RESULTS: Clinical activity included attending on the PMIU, consultation and comanagement outside the PMIU, and outpatient care of "hospital intense" patients. There was a high level of engagement in research, education, and quality improvement activities. Perceived advantages to a career as a hospitalist included: working in a team; generalist approach to care; stability relative to community practice; intellectually stimulating and rewarding work; and growing area for scholarship. Perceived disadvantages to a career as a hospitalist included: burnout; recognition and respect; and lack of long-term relationships with patients. Themes regarding barriers to establishing a career as a hospitalist in an AHSC were as follows: burnout; time and skills to develop an academic niche; balance between clinical and academic priorities; and system for career advancement. CONCLUSIONS: The contributions of pediatric hospitalists to the academic mission were diverse. Fellowship training, faculty development, and balance between time allocated to direct patient care and academic pursuits should be defined. This will help ensure career development, viability, and realization of excellence in the academic context. Journal of Hospital Medicine 2010;5:228,233. © 2010 Society of Hospital Medicine. [source] Effect of hospitalist attending physicians on trainee educational experiences: A systematic review,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Pradeep Natarajan MD Abstract BACKGROUND: Trainees receive much of their inpatient education from hospitalists. PURPOSE: To characterize the effects of hospitalists on trainee education. DATA SOURCES: MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term "hospitalist", and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION: Original English language research studies meeting all of the following: involvement of hospitalists; comparison to nonhospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION: Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS: Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing hospitalists to nonhospitalists, trainees were more satisfied with hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonhospitalist general internists from specialists showed that trainees preferred hospitalists, but the other did not demonstrate a hospitalist advantage over general internists. CONCLUSIONS: Trainees are more satisfied with inpatient education from hospitalists. Whether the increased satisfaction translates to improved learning is unclear. Journal of Hospital Medicine 2009;4:490,498. © 2009 Society of Hospital Medicine. [source] Home alone: Assessing mobility independence before discharge,,§¶JOURNAL OF HOSPITAL MEDICINE, Issue 4 2009Dennis M. Manning MD, FACC Abstract Hospitalists are often confronted with discharge planning responsibility and decisions for elderly patients who live alone. The absence of an in-home helper (spouse, partner, or care-giver) reduces the margin of safety and resilience to any new debility. Research has documented that during hospital stays elderly patients tend to become deconditioned, even if there is no new specific neurologic or motor deficit. In the patient whose pre-hospital mobility independence is not robust, and perhaps marginally compensated, inpatient stays for any diagnosis may result in critical decrements in mobility independence. The present study is an effort to design a bedside tool for the hospitalist by which to discern, or screen, for such debility. The tool is a hierarchical performance test we named I-MOVE (Independent Mobility Validation Examination). It is a quick series of bedside mobility requests to demonstrate capability of fundamental movements critical to independent living. We describe manner in which I-MOVE can be performed. Moreover, we describe the face validity and the high interrater reliability (> 0.90 intra-class correlation coefficient) of two RNs who independently administered and scored I-MOVE for 41 patients on a General Medical Care Unit. Although not yet studied in correlation with outcomes, nor with validated mobility assessment tools, we believe I-MOVE can serve as a useful extension of the nurse's assessment, or the Hospitalist's physical examination. Discerning the continued capability of mobility independence is a desirable, on-going insight for discharge planning of the elderly patient who resides alone. Journal of Hospital Medicine 2009;4:252,254. © 2009 Society of Hospital Medicine. [source] Factors associated with discussion of care plans and code status at the time of hospital admission: Results from the Multicenter Hospitalist Study,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2008Andrew D. Auerbach MD Abstract BACKGROUND: Hospital admission is a time when patients are sickest and also often encountering an entirely new set of caregivers. As a result, understanding and documenting a patient's care preferences at hospital admission is critically important. OBJECTIVE: To understand factors associated with documentation of care planning discussions in patients admitted to general medical services at 6 academic medical centers. DESIGN: Observational cohort study using data collected during the Multicenter Hospitalist Study, conducted between July 1, 2002 and June 30, 2004. SETTING: Prospective trial enrolling patients admitted to general medicine services at 6 university-based teaching hospitals. PATIENTS: Patients were eligible for this study if they were 18 years of age or older, admitted to a hospitalist or nonhospitalist physician, and able to give informed consent. MEASUREMENTS: Presence of chart documentation that the admitting team had discussed care plans with the patient within the first 24 hours of hospitalization. Notations such as "full code" were not counted as a discussion, whereas notations such as "discussed care wishes and plan with patient" were counted. RESULTS: A total of 17,097 patients over the age of 18 gave informed consent and completed an interview and chart abstraction; of these, 1776 (10.3%) had a code status discussion (CD) documented in the first 24 hours of their admission. Patients with a CD were older (69 years vs. 56 years, P < 0.0001), more often white (52.8% vs. 43.3%, P < 0.0001), and more likely to have cancer (19.8% vs. 11.4%, P < 0.0001), or depression (35.1% vs. 30.9%, P < 0.0001). There was marked variability in CD documentation across sites of enrollment (2.8%-24.9%, P < 0.0001). Despite strong associations seen in unadjusted comparisons, in multivariable models many socioeconomic factors, functional status, comorbid illness, and documentation of a surrogate decision maker were only moderately associated with a CD (adjusted odds ratios all less than 2.0). However, patients' site of enrollment (odds ratios 1.74-5.14) and informal notations describing prehospital care wishes (eg, orders for "do not resuscitate"/"do not intubate;" odds ratios 3.22-11.32 compared with no preexisting documentation) were powerfully associated with CD documentation. Site remained a powerful influence even in patients with no documented prehospital wishes. LIMITATIONS: Our results are derived from a relatively small number of academic sites, and we cannot connect documentation differences to differences in patient outcomes. CONCLUSIONS: Documentation of a CD at admission was more strongly associated with informal documentation of prehospital care wishes and where the patient was hospitalized than legal care planning documents (such as durable power of attorney), or comorbid illnesses. Efforts to improve communication between hospitalists and their patients might target local documentation practices and culture. Journal of Hospital Medicine 2008;3(6):437,445. © 2008 Society of Hospital Medicine. [source] The expanding or shrinking universe of the hospitalistJOURNAL OF HOSPITAL MEDICINE, Issue 4 2008David M. Mitchell MD [source] Non,housestaff medicine services in academic centers: Models and challengesJOURNAL OF HOSPITAL MEDICINE, Issue 3 2008Niraj L. Sehgal MD Abstract Non,housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapid growth. However, limited evidence is available on designing these services, including the similarities and differences of existing ones. We describe non,housestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the "academic hospitalist"), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow long careers in hospital medicine, academic leadership must carefully plan for and evaluate the methods of providing these clinical services while expanding on our academic mission. Journal of Hospital Medicine 2008;3:247,255. © 2008 Society of Hospital Medicine. [source] Introduction: Role of the hospitalist in secondary stroke prevention care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2008David J. Likosky MD Abstract Stroke is a prevalent and often devastating condition that is likely to affect a growing proportion of the United States population in the coming decades. Individuals who have experienced a stroke or transient ischemic attack are at elevated risk for recurrent events, which are frequently more severe. Therefore, secondary prevention has become the focus of much clinical research and widespread initiatives to deliver evidence-based care. Hospitalists are in a unique position to contribute substantially to these efforts. The 4 articles in this supplement are a call to action for hospital-based physicians. They are based on the conclusions of a panel of hospitalists, neurohospitalists, vascular neurologists, and neurointensivists who met for a roundtable discussion in March 2007. This, the first of the 4 articles, discusses the opportunity for hospitalists to take a leadership role in creating stroke systems of care that integrate secondary stroke prevention with inpatient treatment of acute stroke. The articles that follow will summarize the consensus of roundtable participants on stroke care best practices and their implementation. Journal of Hospital Medicine 2008;3(4 Suppl):S1,S5. © 2008 Society of Hospital Medicine. [source] Peripheral arterial disease and the hospitalist: The rationale for early detection and optimal therapyJOURNAL OF HOSPITAL MEDICINE, Issue S2 2008Steven B. Deitelzweig MD [source] Aggressive management of ischemic stroke: The case for the hospitalistJOURNAL OF HOSPITAL MEDICINE, Issue S2 2008Geoffrey S. F. Ling MD [source] ASHP,SHM joint statement on hospitalist,pharmacist collaboration,,§JOURNAL OF HOSPITAL MEDICINE, Issue S3 2008DABAT, Daniel J. Cobaugh PharmD, FAACT [source] Management of blood pressure after acute ischemic stroke: An evidence-based guide for the hospitalistJOURNAL OF HOSPITAL MEDICINE, Issue 4 2007Ethan Cumbler MD Abstract Hospitalists are frequently called upon to manage blood pressure after acute ischemic stroke. A review of both post infarction cerebral perfusion physiology and the data from randomized trials of antihypertensive therapy is necessary to explain why consensus guidelines for blood pressure management after stroke differ from those of other hypertensive emergencies. The peri-infarct penumbra is the central concept in understanding post ischemic cerebral perfusion. This area of impaired cerebral blood flow is dependent on mean arterial blood pressure and acute reduction of blood pressure may expand the area of infarction. Review of clinical trials fails to show benefit from reduction of blood pressure after ischemic stroke and current guidelines suggest antihypertensive therapy be employed if the systemic blood pressure is greater than 180/105 mmHg after tPA is employed, or 220/120 mmHg when tPA is not used. Induced hypertension remains a promising but unproven therapy in the acute setting, but the evidence for long term control of blood pressure to less than 140/80 mmHG for secondary prevention of stroke is strong. Adherence to guidelines is poor but it is recognized that current evidence is limited by a lack of trials in which blood pressure is titrated to a pre-specified goal, as is common in clinical practice. Journal of Hospital Medicine 2007;2:261,267. © 2007 Society of Hospital Medicine. [source] A new home awaits the hospitalistJOURNAL OF HOSPITAL MEDICINE, Issue 1 2007FACP, Jeff Wiese MD [source] Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-outJOURNAL OF HOSPITAL MEDICINE, Issue 4 2006Arpana R. Vidyarthi MD Abstract BACKGROUND Restrictions in the hours residents can be on duty have resulted in increased sign-outs, that is, transfer of patient care information and responsibility from one physician to a cross-coverage physician, leading to discontinuity in patient care. This sign-out process, which occurs primarily in the inpatient setting, traditionally has been informal, unstructured, and idiosyncratic. Although studies show that discontinuity may be harmful to patients, this is little data to assist residency programs in redesigning systems to improve sign-out and manage the discontinuity. PURPOSE This article reviews the relevant medical literature, current practices in non,health professions in managing discontinuity, and summarizes the existing practice and experiences at 3 academic internal medicine hospitalist-based programs. CONCLUSIONS We provide recommendations and strategies for best practices to design safe and effective sign-out systems for residents that may also be useful to hospitalists working in academic and community settings. Journal of Hospital Medicine 2006;1:257,266. © 2006 Society of Hospital Medicine. [source] Pandemic influenza and the hospitalist: Apocalypse when?JOURNAL OF HOSPITAL MEDICINE, Issue 2 2006James C. Pile MD Abstract Beginning with a cluster of human cases in Hong Kong in 1997, avian influenza (H5N1) has spread progressively through, and beyond, Asia in poultry and other birds; and has resulted in sporadic cases of human disease associated with high mortality. The potential for H5N1 influenza to cause a pandemic of human disease continues to be the subject of intense scrutiny by both the media and the scientific community. While the likelihood of such a prospect is uncertain, the inevitability of future pandemics of influenza is clear. Planning for the eventuality of a virulent influenza pandemic at the local, national and global level is critical to limiting the mortality and morbidity of such an occurrence. Hospitalists have a key role to play in institutional efforts to prepare for a influenza pandemic, and should be aware of lessons that my be applied from both the response to Hurricane Katrina, as well as the severe acute respiratory syndrome (SARS) epidemic. Journal of Hospital Medicine 2006;1:118,123. © 2006 Society of Hospital Medicine [source] Curriculum development: The venous thromboembolism quality improvement resource roomJOURNAL OF HOSPITAL MEDICINE, Issue 2 2006Sylvia McKean MD Abstract BACKGROUND The role of the hospitalist has evolved over the last decade, with hospitalists increasingly being asked to lead systems-based initiatives to improve the quality of inpatient care. The educational strategy of the Society of Hospital Medicine (SHM) includes development of practice-based resources to support hospitalist-led improvement in clinically important measures of hospital care quality. OBJECTIVE To develop a resource at the SHM Web site to present quality improvement (QI) principles for systems-based care in the hospital and to help individual hospitalists improve specific patient outcomes. DESIGN The SHM defined the role of the hospitalist in QI, performed an assessment of the educational needs of hospitalists, and executed a Web-based educational strategy to address these needs. The organization identified the most common cause of preventable inpatient deaths, hospital-acquired venous thromboembolism (VTE), and prioritized the need to improve prophylaxis. RESULTS This new resource at the SHM Web site presents principles for conducting QI in the hospital. To enable learning that is practice based, the VTE Quality Improvement Resource Room (QI RR) features Ask the Expert, an interactive discussion community, and an original Improvement Workbook, a downloadable project outline and tutorial that hospitalists can use to guide and document steps in an effort aimed at reducing hospital-acquired VTE. CONCLUSIONS This QI resource serves as a template for the development of subsequent hospital-based resources. User feedback will refine the QI RR and its format so that similar offerings can target other significant inpatient problems. Additional research is needed to evaluate learning and the clinical impact of this quality improvement resource on hospital performance measures and patient outcomes. Journal of Hospital Medicine 2006;1:124,132. © 2006 Society of Hospital Medicine. [source] The role of the hospitalist in quality improvement: Systems for improving the care of patients with acute coronary syndrome,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010Chad T. Whelan MD Abstract Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies. Journal of Hospital Medicine 2010;5:S1,S7. © 2010 Society of Hospital Medicine. [source] Transitioning the patient with acute coronary syndrome from inpatient to primary care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010FACPE, Tomás Villanueva DO Abstract Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. Journal of Hospital Medicine 2010;5:S8,S14. © 2010 Society of Hospital Medicine. [source] Comparing academic and community-based hospitalists,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2010David Malkenson BS Abstract In 2006, hospitalist programs were formally introduced at both an academic and community hospital in the same city providing an opportunity to study the similarities and differences in workflows in these two settings. The data were collected using a time-flow methodology allowing the two workflows to be compared quantitatively. The results showed that the hospitalists in the two settings devoted similar proportions of their workday to the task categories studied. Most of the time was spent providing indirect patient care followed by direct patient care, travel, personal, and other. However, after adjusting for patient volumes, the data revealed that academic hospitalists spent significantly more time per patient providing indirect patient care (Academic: 54.7 ± 11.1 min/patient, Community: 41.9 ± 9.8 min/patient, p < 0.001). Additionally, we found that nearly half of the hospitalists' time at both settings was spent multitasking. Although we found subtle workflow differences between the academic and community programs, their similarities were more striking as well as greater than their differences. We attribute these small differences to the higher case mix index at the academic program as well greater complexity and additional communication hand-offs inherent to a tertiary academic medical center. It appears that hospitalists, irrespective of their work environment, spend far more time documenting, communicating and coordinating care than they do at the bedside raising the question, is this is a necessary feature of the hospitalist care model or should hospitalists restructure their workflow to improve outcomes? Journal of Hospital Medicine 2010;5:349,352. © 2010 Society of Hospital Medicine. [source] Integrating pediatric hospitalists in the academic health science center: Practice and perceptions in a canadian center,,JOURNAL OF HOSPITAL MEDICINE, Issue 4 2010FRCPC, Sanjay Mahant MD Abstract BACKGROUND: The integration of hospitalists in academic settings has been identified as a challenge to the hospitalist movement. The Division of Pediatric Medicine, Hospital for Sick Children, Toronto, was established in 1981, providing a rich resource to examine this field in the academic context and inform academic program development. OBJECTIVES: To explore the characteristics, practice, perceptions, and contributions of pediatric hospital medicine in an academic health science center (AHSC). METHODS: A cross-sectional survey of physicians attending on the pediatric medicine inpatient unit (PMIU) (n = 20). RESULTS: Clinical activity included attending on the PMIU, consultation and comanagement outside the PMIU, and outpatient care of "hospital intense" patients. There was a high level of engagement in research, education, and quality improvement activities. Perceived advantages to a career as a hospitalist included: working in a team; generalist approach to care; stability relative to community practice; intellectually stimulating and rewarding work; and growing area for scholarship. Perceived disadvantages to a career as a hospitalist included: burnout; recognition and respect; and lack of long-term relationships with patients. Themes regarding barriers to establishing a career as a hospitalist in an AHSC were as follows: burnout; time and skills to develop an academic niche; balance between clinical and academic priorities; and system for career advancement. CONCLUSIONS: The contributions of pediatric hospitalists to the academic mission were diverse. Fellowship training, faculty development, and balance between time allocated to direct patient care and academic pursuits should be defined. This will help ensure career development, viability, and realization of excellence in the academic context. Journal of Hospital Medicine 2010;5:228,233. © 2010 Society of Hospital Medicine. [source] Pediatric hospital medicine core competencies: Development and methodologyJOURNAL OF HOSPITAL MEDICINE, Issue S2 2010Erin R. Stucky MD Abstract Background: Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed. Methods: In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM. Results: The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care. Conclusion: These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. Journal of Hospital Medicine 2010;5(4)(Suppl 2):82,86. © 2010 Society of Hospital Medicine. [source] Hospitalists and intensivists: Partners in caring for the critically ill,The time has come,JOURNAL OF HOSPITAL MEDICINE, Issue 1 2010Michael Heisler MD Abstract A report by the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS), published in 2000, predicted that beginning in 2007 a gap between the demand and availability of intensivists in the United States would become apparent and steadily increase to 22% by 2020 and to 35% by 2030. Subsequent reports have reiterated those projections including a report to congress in 2006 by the U.S. Department of Health and Human Services/Health Resources and Services Administration. This "gap" has been called a health system "crisis" by multiple authors. Two important documents have published specific recommendations for how to resolve this crisis: the Framing Options for Critical Care in the United States (FOCCUS) Task Force Report in 2004 and the Prioritizing the Organization and Management of Intensive Care Services in the Unites States (PrOMIS) Conference Report in 2007. Since the initial COMPACCS report and since these 2 additional reports were published, a new opportunity to take a major step in resolving this crisis has emerged: the growing number of hospitalists providing critical care services at secondary and tertiary care facilities. According to the 2005/2006 Society of Hospital Medicine (SHM) National Survey, that number has increased to 75%. Since the number of intensivists is unlikely to change significantly over the next 25 years, the question is no longer "if" hospitalists should be in the intensive care unit (ICU); rather the question is how to assure quality and improved clinical outcomes through enhanced collaboration between hospital medicine and critical care medicine. Journal of Hospital Medicine 2010;5:1,3. © 2010 Society of Hospital Medicine. [source] JHM's new CME feature,helping hospitalists stay afloat,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Tom Baudendistel MD [source] Effect of hospitalist attending physicians on trainee educational experiences: A systematic review,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Pradeep Natarajan MD Abstract BACKGROUND: Trainees receive much of their inpatient education from hospitalists. PURPOSE: To characterize the effects of hospitalists on trainee education. DATA SOURCES: MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term "hospitalist", and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION: Original English language research studies meeting all of the following: involvement of hospitalists; comparison to nonhospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION: Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS: Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing hospitalists to nonhospitalists, trainees were more satisfied with hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonhospitalist general internists from specialists showed that trainees preferred hospitalists, but the other did not demonstrate a hospitalist advantage over general internists. CONCLUSIONS: Trainees are more satisfied with inpatient education from hospitalists. Whether the increased satisfaction translates to improved learning is unclear. Journal of Hospital Medicine 2009;4:490,498. © 2009 Society of Hospital Medicine. [source] Training future hospitalists with simulators: A needed step toward accessible, expertly performed bedside procedures,JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009Brian P. Lucas MD [source] A SAFE DC: A conceptual framework for care of the homeless inpatient,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2009Jennifer A. Best MD Abstract Homeless patients suffer disproportionately from medical disease and from barriers to healthcare, affecting their likelihood of presentation, severity of disease, long-term outcomes, and mortality. In the hospital, homeless patients are frequently cared for by hospitalists. Homeless patients' unstable social situation may challenge usual systems of inpatient care and discharge. To provide more effective care for this group, it is important to recognize the demographics of the hospitalized homeless patient. We suggest a structured approach to the inpatient care of the unstably housed patient, represented by a simple mnemonic checklist "A SAFE DC," describing evidence-based adaptations of care, where available, and discussing systems-based approaches to discharge. Journal of Hospital Medicine 2009;4:375,381. © 2009 Society of Hospital Medicine. [source] Peripherally inserted central catheter use in the hospitalized patient: Is there a role for the hospitalist?,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2009Adam S. Akers MD Abstract BACKGROUND: Peripherally-inserted central venous catheters (PICCs) are frequently used in hospitals for central intravenous access. These catheters may offer advantages over traditional central catheters with respect to ease of placement and decreased complication rates. However, hospital physicians have not traditionally been trained to place PICCs. METHODS: We trained 3 of 5 hospitalists to place PICCs in our small university-affiliated community hospital as we converted from a house physician model to a hospitalist model for inpatient care. We then looked retrospectively at the rates of all PICC and other central catheter placements as well as the number of femoral and nonfemoral catheter days for the 18-month period prior to and after the inception of the hospitalist program. RESULTS: Comparing the periods prior to and after the inception of the hospitalist program, the total number of central catheter placements doubled and the PICC rate rose from 20% to 80% of all central catheters. The rate of femoral and subclavian catheter placements decreased by approximately 50% and the rate of internal jugular catheter placement was roughly unchanged. There was also a fall in the number of femoral catheter days and a great increase in the number of total nonfemoral catheter days. The rate of catheter-related bacteremia remained low and did not appear to increase. CONCLUSIONS: PICCs may be a safe and easy alternative to centrally placed catheters for the hospital physician attempting to secure central intravenous access and may lead to a decrease in the need for more risky central venous catheter (CVC) insertions. Journal of Hospital Medicine 2009;4:E1,E4. © 2009 Society of Hospital Medicine. [source] A new narrative for hospitalistsJOURNAL OF HOSPITAL MEDICINE, Issue 4 2009Audrey Young MD [source] | ||||||||||