Suzanne Bopp

Hospitalists see patients at their most fragile – and, as a result, they have a unique opportunity to affect their health going forward.

“These moments can transform the way patients see their health and their behaviors, and any opportunity to position patients as empowered to influence their experience is one that can not be squandered,” said Timothy Huerta, PhD, MS, lead author on a study of patient portals and tablets during inpatient care.¹ “In that context, hospitals have the opportunity to set expectations for engagement that can be influenced by technology. Patient portals, positioned within the inpatient setting, offer a platform to engage, empower, and educate.”

His experience – at the first and largest academic medical center to provide this technology across the entire hospital system – offers the first insight into the demands that such a process shift requires, he said. The researchers ran a 90-day pilot program giving tablets to 179 patients; subsequently, the health system committed to providing tablets for accessing inpatient portals in all seven of its hospitals. “Adopting this technology is not easy, and we continue to explore how we can use it more effectively. Our hope is that our experience can make the journey of others easier.”

Reference

1. Huerta T, McAlearney AS, Rizer MK. “Introducing a Patient Portal and Electronic Tablets to Inpatient Care.” Ann Intern Med. 2017;167(11):816-7.

Hospitalists see patients at their most fragile – and, as a result, they have a unique opportunity to affect their health going forward.

“These moments can transform the way patients see their health and their behaviors, and any opportunity to position patients as empowered to influence their experience is one that can not be squandered,” said Timothy Huerta, PhD, MS, lead author on a study of patient portals and tablets during inpatient care.¹ “In that context, hospitals have the opportunity to set expectations for engagement that can be influenced by technology. Patient portals, positioned within the inpatient setting, offer a platform to engage, empower, and educate.”

His experience – at the first and largest academic medical center to provide this technology across the entire hospital system – offers the first insight into the demands that such a process shift requires, he said. The researchers ran a 90-day pilot program giving tablets to 179 patients; subsequently, the health system committed to providing tablets for accessing inpatient portals in all seven of its hospitals. “Adopting this technology is not easy, and we continue to explore how we can use it more effectively. Our hope is that our experience can make the journey of others easier.”

Reference

1. Huerta T, McAlearney AS, Rizer MK. “Introducing a Patient Portal and Electronic Tablets to Inpatient Care.” Ann Intern Med. 2017;167(11):816-7.

Hospitalists see patients at their most fragile – and, as a result, they have a unique opportunity to affect their health going forward.

“These moments can transform the way patients see their health and their behaviors, and any opportunity to position patients as empowered to influence their experience is one that can not be squandered,” said Timothy Huerta, PhD, MS, lead author on a study of patient portals and tablets during inpatient care.¹ “In that context, hospitals have the opportunity to set expectations for engagement that can be influenced by technology. Patient portals, positioned within the inpatient setting, offer a platform to engage, empower, and educate.”

His experience – at the first and largest academic medical center to provide this technology across the entire hospital system – offers the first insight into the demands that such a process shift requires, he said. The researchers ran a 90-day pilot program giving tablets to 179 patients; subsequently, the health system committed to providing tablets for accessing inpatient portals in all seven of its hospitals. “Adopting this technology is not easy, and we continue to explore how we can use it more effectively. Our hope is that our experience can make the journey of others easier.”

Reference

1. Huerta T, McAlearney AS, Rizer MK. “Introducing a Patient Portal and Electronic Tablets to Inpatient Care.” Ann Intern Med. 2017;167(11):816-7.

Hospital boards play an important role in quality improvement (QI), and now researchers in England have developed a framework they can use to help develop their QI capability by comparing 15 health care organizations.

“We already know that certain board practices are associated with higher quality care,” said lead researcher Lorelei Jones, PhD. “For example, hospital boards that regularly review quality performance have better patient outcomes. But we don’t know a lot about what boards actually do, or what ‘good’ looks like in relation to quality governance. There is a lot of guidance for boards on what they should be doing, but very little research evidence.”

In their study, researchers developed an evidence-based measure of QI “maturity” – how developed boards were in how they led and oversaw quality improvement. They applied this measure to various organizations and then looked at the characteristics of organizations that showed a highly developed approach to QI.

“Organizations with higher levels of QI maturity prioritized QI; balanced attention to short-term (external) priorities with a long-term (internal) investment in QI; used data for quality improvement, not just quality assurance; engaged staff and patients in QI; and had a culture of continuous improvement,” Dr. Jones said. These characteristics often seemed to be facilitated by clinical leaders; the study also highlighted the importance of board-level clinical leaders in hospitals, she said.

Researchers found that organizations with a highly developed approach to QI did the following:

• Brought in-depth knowledge and understanding of quality issues and provided the board with meaningful analyses of data.
• Contributed knowledge of relevant developments in national policy and links to external networks.
• Played an important role as “boundary spanners,” providing a link between “the board and the ward,” making connections between sources of data and aligning external demands with internal priorities.

“Boards can use our framework to help develop their QI capability,” Dr. Jones said. “For example, boards can use it to do a gap analysis to explore areas that might need strengthening and for ideas on how they could do this.”

Reference

Jones L et al. How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England. BMJ Qual Saf. 2017 Dec;26(12):978-86.

Hospital boards play an important role in quality improvement (QI), and now researchers in England have developed a framework they can use to help develop their QI capability by comparing 15 health care organizations.

“We already know that certain board practices are associated with higher quality care,” said lead researcher Lorelei Jones, PhD. “For example, hospital boards that regularly review quality performance have better patient outcomes. But we don’t know a lot about what boards actually do, or what ‘good’ looks like in relation to quality governance. There is a lot of guidance for boards on what they should be doing, but very little research evidence.”

In their study, researchers developed an evidence-based measure of QI “maturity” – how developed boards were in how they led and oversaw quality improvement. They applied this measure to various organizations and then looked at the characteristics of organizations that showed a highly developed approach to QI.

“Organizations with higher levels of QI maturity prioritized QI; balanced attention to short-term (external) priorities with a long-term (internal) investment in QI; used data for quality improvement, not just quality assurance; engaged staff and patients in QI; and had a culture of continuous improvement,” Dr. Jones said. These characteristics often seemed to be facilitated by clinical leaders; the study also highlighted the importance of board-level clinical leaders in hospitals, she said.

Researchers found that organizations with a highly developed approach to QI did the following:

• Brought in-depth knowledge and understanding of quality issues and provided the board with meaningful analyses of data.
• Contributed knowledge of relevant developments in national policy and links to external networks.
• Played an important role as “boundary spanners,” providing a link between “the board and the ward,” making connections between sources of data and aligning external demands with internal priorities.

“Boards can use our framework to help develop their QI capability,” Dr. Jones said. “For example, boards can use it to do a gap analysis to explore areas that might need strengthening and for ideas on how they could do this.”

Reference

Jones L et al. How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England. BMJ Qual Saf. 2017 Dec;26(12):978-86.

Hospital boards play an important role in quality improvement (QI), and now researchers in England have developed a framework they can use to help develop their QI capability by comparing 15 health care organizations.

“We already know that certain board practices are associated with higher quality care,” said lead researcher Lorelei Jones, PhD. “For example, hospital boards that regularly review quality performance have better patient outcomes. But we don’t know a lot about what boards actually do, or what ‘good’ looks like in relation to quality governance. There is a lot of guidance for boards on what they should be doing, but very little research evidence.”

In their study, researchers developed an evidence-based measure of QI “maturity” – how developed boards were in how they led and oversaw quality improvement. They applied this measure to various organizations and then looked at the characteristics of organizations that showed a highly developed approach to QI.

“Organizations with higher levels of QI maturity prioritized QI; balanced attention to short-term (external) priorities with a long-term (internal) investment in QI; used data for quality improvement, not just quality assurance; engaged staff and patients in QI; and had a culture of continuous improvement,” Dr. Jones said. These characteristics often seemed to be facilitated by clinical leaders; the study also highlighted the importance of board-level clinical leaders in hospitals, she said.

Researchers found that organizations with a highly developed approach to QI did the following:

• Brought in-depth knowledge and understanding of quality issues and provided the board with meaningful analyses of data.
• Contributed knowledge of relevant developments in national policy and links to external networks.
• Played an important role as “boundary spanners,” providing a link between “the board and the ward,” making connections between sources of data and aligning external demands with internal priorities.

“Boards can use our framework to help develop their QI capability,” Dr. Jones said. “For example, boards can use it to do a gap analysis to explore areas that might need strengthening and for ideas on how they could do this.”

Reference

Jones L et al. How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England. BMJ Qual Saf. 2017 Dec;26(12):978-86.

Every day, hospitalists devote time and energy to the best practices that can limit the spread of infection and the development of antibiotic resistance. Infection Prevention (IP) and Antimicrobial Stewardship (ASP) are two hospital programs that address that same goal.

But there may be a more effective approach possible, according to Jerome A. Leis, MD, MSc, FRCPC, of the Centre for Quality Improvement and Patient Safety at the University of Toronto.

“Despite the high-quality evidence supporting these IP/ASP interventions, our approach to adding these to our current practice sometimes feels like adding scaffolding to a rickety building,” he said. “It supports the underlying structure, but remove the scaffolding without fixing the building, and it may just come tumbling down.” Sometimes the work seems like an uphill battle, he added, as the same problems continue to recur.

That’s because there’s a systemic element to the problems. “Hospitalists know first hand about how the system that we work in makes it difficult to ensure that all the best IP/ASP practices are adhered to all the time,” Dr. Leis said. “Simply reminding staff to remove a urinary catheter in a timely fashion or clean their hands every single time they touch a patient or the environment can only get us so far.” That’s where improvement science comes in.

The relatively new field of improvement science provides a framework for research focused on health care improvement; its goal is to determine which improvement strategies are most effective. Dr. Leis argued that, “when our approach to IP and ASP incorporate principles of improvement science, we are more likely to be successful in achieving sustainable changes in practice.”

Rather than constantly adding extra steps and reminders for hospitalists about patient safety, he said, we need to recognize that there are systemic factors that lead to specific practices. “Our focus should be to use improvement-science methodology to understand these barriers and redesign the processes of care in a way that makes it easier for hospitalists to adhere to the best IP/ASP practices for our patients.”

These structural changes should come from collaboration among content experts in IP/ASP and those with training in improvement science, he said – many IP and ASP programs are already putting this in practice, using improvement science to create safer systems of care.

Reference

Leis J. Advancing infection prevention and antimicrobial stewardship through improvement science. BMJ Qual Saf. 2017 Jun 14. doi: 10.1136/bmjqs-2017-006793.

Every day, hospitalists devote time and energy to the best practices that can limit the spread of infection and the development of antibiotic resistance. Infection Prevention (IP) and Antimicrobial Stewardship (ASP) are two hospital programs that address that same goal.

But there may be a more effective approach possible, according to Jerome A. Leis, MD, MSc, FRCPC, of the Centre for Quality Improvement and Patient Safety at the University of Toronto.

“Despite the high-quality evidence supporting these IP/ASP interventions, our approach to adding these to our current practice sometimes feels like adding scaffolding to a rickety building,” he said. “It supports the underlying structure, but remove the scaffolding without fixing the building, and it may just come tumbling down.” Sometimes the work seems like an uphill battle, he added, as the same problems continue to recur.

That’s because there’s a systemic element to the problems. “Hospitalists know first hand about how the system that we work in makes it difficult to ensure that all the best IP/ASP practices are adhered to all the time,” Dr. Leis said. “Simply reminding staff to remove a urinary catheter in a timely fashion or clean their hands every single time they touch a patient or the environment can only get us so far.” That’s where improvement science comes in.

The relatively new field of improvement science provides a framework for research focused on health care improvement; its goal is to determine which improvement strategies are most effective. Dr. Leis argued that, “when our approach to IP and ASP incorporate principles of improvement science, we are more likely to be successful in achieving sustainable changes in practice.”

Rather than constantly adding extra steps and reminders for hospitalists about patient safety, he said, we need to recognize that there are systemic factors that lead to specific practices. “Our focus should be to use improvement-science methodology to understand these barriers and redesign the processes of care in a way that makes it easier for hospitalists to adhere to the best IP/ASP practices for our patients.”

These structural changes should come from collaboration among content experts in IP/ASP and those with training in improvement science, he said – many IP and ASP programs are already putting this in practice, using improvement science to create safer systems of care.

Reference

Leis J. Advancing infection prevention and antimicrobial stewardship through improvement science. BMJ Qual Saf. 2017 Jun 14. doi: 10.1136/bmjqs-2017-006793.

Every day, hospitalists devote time and energy to the best practices that can limit the spread of infection and the development of antibiotic resistance. Infection Prevention (IP) and Antimicrobial Stewardship (ASP) are two hospital programs that address that same goal.

But there may be a more effective approach possible, according to Jerome A. Leis, MD, MSc, FRCPC, of the Centre for Quality Improvement and Patient Safety at the University of Toronto.

“Despite the high-quality evidence supporting these IP/ASP interventions, our approach to adding these to our current practice sometimes feels like adding scaffolding to a rickety building,” he said. “It supports the underlying structure, but remove the scaffolding without fixing the building, and it may just come tumbling down.” Sometimes the work seems like an uphill battle, he added, as the same problems continue to recur.

That’s because there’s a systemic element to the problems. “Hospitalists know first hand about how the system that we work in makes it difficult to ensure that all the best IP/ASP practices are adhered to all the time,” Dr. Leis said. “Simply reminding staff to remove a urinary catheter in a timely fashion or clean their hands every single time they touch a patient or the environment can only get us so far.” That’s where improvement science comes in.

The relatively new field of improvement science provides a framework for research focused on health care improvement; its goal is to determine which improvement strategies are most effective. Dr. Leis argued that, “when our approach to IP and ASP incorporate principles of improvement science, we are more likely to be successful in achieving sustainable changes in practice.”

Rather than constantly adding extra steps and reminders for hospitalists about patient safety, he said, we need to recognize that there are systemic factors that lead to specific practices. “Our focus should be to use improvement-science methodology to understand these barriers and redesign the processes of care in a way that makes it easier for hospitalists to adhere to the best IP/ASP practices for our patients.”

These structural changes should come from collaboration among content experts in IP/ASP and those with training in improvement science, he said – many IP and ASP programs are already putting this in practice, using improvement science to create safer systems of care.

Reference

Leis J. Advancing infection prevention and antimicrobial stewardship through improvement science. BMJ Qual Saf. 2017 Jun 14. doi: 10.1136/bmjqs-2017-006793.

Transitions of care can be rife with communications issues – and subsequent adverse events. They are also a place where hospitalists can take the lead in making improvements.

“They are the team leaders, typically,” said Ana Pujols McKee, MD, the executive vice president and chief medical officer for The Joint Commission. “The hospitalist really owns this process of the transfer of this accurate information.”

To help, The Joint Commission has issued a new Sentinel Event Alert, which provides seven recommendations to improve the communication failures that can occur when patients are transitioned from one caregiver to another, as well as a Targeted Solutions Tool to put the recommendations into action.

“Every organization is challenged in communicating accurate and timely information regarding patients,” Dr. McKee said. “One of the riskiest transitions that patients go through is when they change levels of care from ICU to med-surg, or from the ER to ICU, OR to ICU, med-surg to home, and home to home care. All of those transitions inherently carry a certain amount of risk and are deeply reliant on the transfer of the right information at the right time to the right person.”

Transitions of care can be rife with communications issues – and subsequent adverse events. They are also a place where hospitalists can take the lead in making improvements.

“They are the team leaders, typically,” said Ana Pujols McKee, MD, the executive vice president and chief medical officer for The Joint Commission. “The hospitalist really owns this process of the transfer of this accurate information.”

To help, The Joint Commission has issued a new Sentinel Event Alert, which provides seven recommendations to improve the communication failures that can occur when patients are transitioned from one caregiver to another, as well as a Targeted Solutions Tool to put the recommendations into action.

“Every organization is challenged in communicating accurate and timely information regarding patients,” Dr. McKee said. “One of the riskiest transitions that patients go through is when they change levels of care from ICU to med-surg, or from the ER to ICU, OR to ICU, med-surg to home, and home to home care. All of those transitions inherently carry a certain amount of risk and are deeply reliant on the transfer of the right information at the right time to the right person.”

Transitions of care can be rife with communications issues – and subsequent adverse events. They are also a place where hospitalists can take the lead in making improvements.

“They are the team leaders, typically,” said Ana Pujols McKee, MD, the executive vice president and chief medical officer for The Joint Commission. “The hospitalist really owns this process of the transfer of this accurate information.”

To help, The Joint Commission has issued a new Sentinel Event Alert, which provides seven recommendations to improve the communication failures that can occur when patients are transitioned from one caregiver to another, as well as a Targeted Solutions Tool to put the recommendations into action.

“Every organization is challenged in communicating accurate and timely information regarding patients,” Dr. McKee said. “One of the riskiest transitions that patients go through is when they change levels of care from ICU to med-surg, or from the ER to ICU, OR to ICU, med-surg to home, and home to home care. All of those transitions inherently carry a certain amount of risk and are deeply reliant on the transfer of the right information at the right time to the right person.”

“The United States health care system has many problems, but it also promotes more innovation than its counterparts in other nations. … It has more clinical trials than any other country. It has the most Nobel laureates in physiology or medicine. It has won more patents. At least one publication ranks it No. 1 in overall scientific innovation. … The nation’s innovation advantage arises from a first-class research university system, along with robust intellectual property laws and significant public and private investment in research and development. Perhaps most important, this country offers a large market in which patients, organizations, and government spend a lot on health and companies are able to profit greatly from health care innovation.”

Reference

1. Carroll AE et al. “Can the U.S. repair its health care while keeping its innovation edge?” The New York Times. Oct 9, 2017.

• https://www.nytimes.com/2017/10/09/upshot/can-the-us-repair-its-health-care-while-keeping-its-innovation-edge.html

. Accessed Oct 10, 2017.

“The United States health care system has many problems, but it also promotes more innovation than its counterparts in other nations. … It has more clinical trials than any other country. It has the most Nobel laureates in physiology or medicine. It has won more patents. At least one publication ranks it No. 1 in overall scientific innovation. … The nation’s innovation advantage arises from a first-class research university system, along with robust intellectual property laws and significant public and private investment in research and development. Perhaps most important, this country offers a large market in which patients, organizations, and government spend a lot on health and companies are able to profit greatly from health care innovation.”

Reference

1. Carroll AE et al. “Can the U.S. repair its health care while keeping its innovation edge?” The New York Times. Oct 9, 2017.

• https://www.nytimes.com/2017/10/09/upshot/can-the-us-repair-its-health-care-while-keeping-its-innovation-edge.html

. Accessed Oct 10, 2017.

“The United States health care system has many problems, but it also promotes more innovation than its counterparts in other nations. … It has more clinical trials than any other country. It has the most Nobel laureates in physiology or medicine. It has won more patents. At least one publication ranks it No. 1 in overall scientific innovation. … The nation’s innovation advantage arises from a first-class research university system, along with robust intellectual property laws and significant public and private investment in research and development. Perhaps most important, this country offers a large market in which patients, organizations, and government spend a lot on health and companies are able to profit greatly from health care innovation.”

Reference

1. Carroll AE et al. “Can the U.S. repair its health care while keeping its innovation edge?” The New York Times. Oct 9, 2017.

• https://www.nytimes.com/2017/10/09/upshot/can-the-us-repair-its-health-care-while-keeping-its-innovation-edge.html

. Accessed Oct 10, 2017.

Because health care in the United States is extremely expensive, it’s driving an increased focus on high-value care (HVC), said Carolyn D. Sy, MD. And, she added, while hospitalists and other physicians are the ones responsible for translating HVC from formalized settings (lectures, modules, etc.) to the bedside, there are few instruments designed to measure the success of HVC practices.

So Dr. Sy, director of the University of Washington Medical Center Hospital Medicine Service in Seattle and her colleagues developed an HVC Rounding Tool, which allows users to empirically assess the discussion of HVC topics at the bedside. They divided 10 HVC topics into three domains (quality, cost, patient values) to create an observational tool and tested its validity.

“It addresses an important educational gap in translating HVC from theoretical knowledge to bedside practice,” she said.

The tool is designed to capture multidisciplinary participation: involvement from faculty, fellows or trainees, nurses, pharmacists, families, and other members of the health care team.

It has multidisciplinary benefits too. “The HVC Rounding Tool provides an opportunity for faculty development through peer observation and feedback on the integration and role modeling of HVC at the bedside,” Dr. Sy said. “It also is an instrument to help assess the educational efficacy of formal HVC curriculum and translation into bedside practice. Lastly, it is a tool that could be used to measure the relationship between HVC behaviors and actual patient outcomes, such as length of stay, readmissions, and cost of hospitalization – a feature with increasing importance given our move towards value-based health care.”
 

Reference

1. Sy CD et al. The development and validation of a high-value care rounding tool using the Delphi method. J Hosp Med. 2017;12(suppl 2). Accessed Oct 10, 2017.

Because health care in the United States is extremely expensive, it’s driving an increased focus on high-value care (HVC), said Carolyn D. Sy, MD. And, she added, while hospitalists and other physicians are the ones responsible for translating HVC from formalized settings (lectures, modules, etc.) to the bedside, there are few instruments designed to measure the success of HVC practices.

So Dr. Sy, director of the University of Washington Medical Center Hospital Medicine Service in Seattle and her colleagues developed an HVC Rounding Tool, which allows users to empirically assess the discussion of HVC topics at the bedside. They divided 10 HVC topics into three domains (quality, cost, patient values) to create an observational tool and tested its validity.

“It addresses an important educational gap in translating HVC from theoretical knowledge to bedside practice,” she said.

The tool is designed to capture multidisciplinary participation: involvement from faculty, fellows or trainees, nurses, pharmacists, families, and other members of the health care team.

It has multidisciplinary benefits too. “The HVC Rounding Tool provides an opportunity for faculty development through peer observation and feedback on the integration and role modeling of HVC at the bedside,” Dr. Sy said. “It also is an instrument to help assess the educational efficacy of formal HVC curriculum and translation into bedside practice. Lastly, it is a tool that could be used to measure the relationship between HVC behaviors and actual patient outcomes, such as length of stay, readmissions, and cost of hospitalization – a feature with increasing importance given our move towards value-based health care.”
 

Reference

1. Sy CD et al. The development and validation of a high-value care rounding tool using the Delphi method. J Hosp Med. 2017;12(suppl 2). Accessed Oct 10, 2017.

Because health care in the United States is extremely expensive, it’s driving an increased focus on high-value care (HVC), said Carolyn D. Sy, MD. And, she added, while hospitalists and other physicians are the ones responsible for translating HVC from formalized settings (lectures, modules, etc.) to the bedside, there are few instruments designed to measure the success of HVC practices.

So Dr. Sy, director of the University of Washington Medical Center Hospital Medicine Service in Seattle and her colleagues developed an HVC Rounding Tool, which allows users to empirically assess the discussion of HVC topics at the bedside. They divided 10 HVC topics into three domains (quality, cost, patient values) to create an observational tool and tested its validity.

“It addresses an important educational gap in translating HVC from theoretical knowledge to bedside practice,” she said.

The tool is designed to capture multidisciplinary participation: involvement from faculty, fellows or trainees, nurses, pharmacists, families, and other members of the health care team.

It has multidisciplinary benefits too. “The HVC Rounding Tool provides an opportunity for faculty development through peer observation and feedback on the integration and role modeling of HVC at the bedside,” Dr. Sy said. “It also is an instrument to help assess the educational efficacy of formal HVC curriculum and translation into bedside practice. Lastly, it is a tool that could be used to measure the relationship between HVC behaviors and actual patient outcomes, such as length of stay, readmissions, and cost of hospitalization – a feature with increasing importance given our move towards value-based health care.”
 

Reference

1. Sy CD et al. The development and validation of a high-value care rounding tool using the Delphi method. J Hosp Med. 2017;12(suppl 2). Accessed Oct 10, 2017.

If prior SHM annual meetings are any guide, a highlight of the upcoming HM18 conference will be the Scientific Abstract and Poster Competition. This event, also known as the Research, Innovations, and Clinical Vignettes (RIV), has become one of the annual meeting’s most popular events. Crowds of attendees cluster around posters to read abstracts summarizing some of the most exciting, cutting-edge research in hospital medicine.

Networking in that crowd is a major factor in the RIV’s popularity, says the HM18 Innovations chair, Benji K. Mathews, MD, FACP, SFHM, CLHM, section head of hospital medicine at Regions Hospital, St. Paul, Minn., which is part of HealthPartners, the largest consumer-governed, non-profit health care organization in the U.S.

“From my standpoint, the power of this Innovations RIV competition is the opportunity to network,” said Dr. Mathews, who is also assistant professor of medicine at the University of Minnesota, Minneapolis. “In addition to primary authors, often these posters have several different people involved, and then there’s the foot traffic: We’re expecting thousands of people to walk through. The hope is to create the opportunity to network, to collaborate intergenerationally and also cross-institutionally.”

The RIV competition features some 1,000 posters this year, Dr. Mathews said. Plenary and oral sessions are chosen from the pool of abstracts prior to the meeting, and their authors are invited to present on-site at HM18.

But in spirit, the RIV is not really a competition, said RIV chair Ethan Cumbler, MD, FACP, FHM, professor of medicine at the University of Colorado.

What’s new in 2018

The more than 1,000 posters and oral presentations at HM18 is a new record, and it demonstrates the growth of hospital medicine as a scientific field, Dr. Cumbler said.

“We received a huge number of submissions,” he revealed. “We see that trend rise, year over year, and the quality has been going up as well.”

New this year is a Trainee Award category for resident and student authors. Another difference in 2018: The top 15 advances in Research and Innovations have been given a special track on day 2 of the conference, with oral presentations by the authors sharing their work.

The Vignettes are being featured in a new way as well. “We have so many incredible cases that we’re going to have a clinical vignette luncheon on two different days of the conference,” Dr. Cumbler said. “These are cases that we want to highlight, so that the experience of a hospitalist in one part of the country could help a hospitalist provide the right diagnosis for a patient on the other side of the country. There are lessons to be learned in clinical medicine, and our clinical vignettes is a fantastic way of sharing them.”

In making their selections in the different categories, the judges aimed to highlight some negative studies this year, Dr. Mathews said, which is a slight departure from previous years. “Sometimes you try something and it didn’t work, and it’s important to share that so we don’t just try the same thing over and over.”

This year, Research and Innovations abstracts will be grouped by theme, making it easier for attendees to navigate the posters. “If you’ve got a particular interest in a topic like transitions or communication, you’ll be able to find that portion of the poster session and talk to some of the people who are doing groundbreaking work in that topic,” Dr. Cumbler said. 

He also noted that he expects to see a strong expression of RIV content on social media from HM18, as judges encounter some of the best and most interesting work at RIV. Dr. Mathews is similarly enthusiastic about that amplification of the work.

“I love that the conversation continues into social media platforms such as Twitter,” he said. “People are engaging back and forth, saying, ‘Hey, take a look at this poster.’ Being in a room with countless people interested in research innovations for a field that’s still relatively young – I love that there’s movement toward that.”
 

Exciting research

By definition, the research on display at the RIV is the best of the best. “It’s difficult to get your work accepted at a national meeting, and it’s a high honor to be selected as a finalist. The poster abstracts or oral presentations that win are always remarkable pieces of work,” Dr. Cumbler said.

Some of this year’s most exciting projects examine prediction models and scoring systems for patients with infections such as sepsis or influenza, he said. “One of the most fascinating abstracts looked at deep learning, or machine learning, to create algorithms to predict sepsis and decompensation in ways that simplistic models might not. Many of our current prediction rules are designed around simple acronyms, because they’re easy to remember: the ABCD score, the CURB-65 score. But if you looked at the source code of the Google search algorithm – not that they’d let you – you’d discover that it doesn’t translate to a simple four-variable prediction model. It’s incredibly complex; it looks at interactions between variables.”

This research attempts to move medical prediction models in that direction, Dr. Cumbler said. “Examining deep learning models, or neural networks, to help clinicians make more accurate predictions and take better care of patients – we are getting a taste of the future of clinical medicine at HM18.”

Several research projects highlighted at RIV this year examine ways to make better use of the data in the electronic health record.

“One of the pieces of research I’m particularly excited to hear more about looks at how the vast data that exists within electronic health records is actually used,” Dr. Cumbler said. “With electronic health records, we have all of the information in a patient’s record at our fingertips, yet this creates incredible new challenges for the hospitalist needing to make decisions in real time, with the limitations of our organic neural networks.” Dr. Cumbler revealed that one of the research teams sharing their work at HM18 explored how hospitalists interact with the volume of information that exists within the health record at the time of admission. “The results are pretty amazing,” he said.

Another project Dr. Cumbler found fascinating examines the impact of delivery of real-time performance data to hospitalists on their phones, and how it affected practice across a number of different performance metrics.

“We will see a project using game theory to teach quality improvement and another sharing important quality improvement work occurring at the intersection of evidence-based medicine and patient experience – like looking at how to keep patients NPO for less unnecessary time,” he said. “It makes perfect sense that we don’t want to keep people hungry in the hospital longer than we need to. It’s really interesting seeing how one team worked to make that happen and what they found.”
 

The importance of the RIV

The influence of the RIV program extends far beyond the conference itself; there are implications for the field of hospital medicine today and into the future.

“The RIV competition allows the field in hospital medicine to mature and evolve, so we remain cutting edge,” Dr. Mathews said. “That’s the beauty of the innovation field: Research is built off of it.”

Dr. Cumbler said that the growth and evolution of the RIV is reflective of the maturation of hospital medicine as a specialty. “It’s transitioning from a different way to organize patient care to learning more, in a scientific way, about how care can and should be delivered.”

At its heart, the RIV is really about community, he added. “The community of hospitalists is sharing knowledge, graciously and unselfishly, so that we can all improve the quality of care that we’re providing and give patients safer care, a better experience, and improved outcomes.”

Finally, RIV offers a way for hospitalists to be engaged in lifelong learning. “The presenters are teaching from their experience, and the hospitalists who come to the RIV get to leave better clinicians, researchers, and leaders as a result,” Dr. Cumbler said. “These things, to me, are about our evolution as a profession.”

If prior SHM annual meetings are any guide, a highlight of the upcoming HM18 conference will be the Scientific Abstract and Poster Competition. This event, also known as the Research, Innovations, and Clinical Vignettes (RIV), has become one of the annual meeting’s most popular events. Crowds of attendees cluster around posters to read abstracts summarizing some of the most exciting, cutting-edge research in hospital medicine.

Networking in that crowd is a major factor in the RIV’s popularity, says the HM18 Innovations chair, Benji K. Mathews, MD, FACP, SFHM, CLHM, section head of hospital medicine at Regions Hospital, St. Paul, Minn., which is part of HealthPartners, the largest consumer-governed, non-profit health care organization in the U.S.

“From my standpoint, the power of this Innovations RIV competition is the opportunity to network,” said Dr. Mathews, who is also assistant professor of medicine at the University of Minnesota, Minneapolis. “In addition to primary authors, often these posters have several different people involved, and then there’s the foot traffic: We’re expecting thousands of people to walk through. The hope is to create the opportunity to network, to collaborate intergenerationally and also cross-institutionally.”

The RIV competition features some 1,000 posters this year, Dr. Mathews said. Plenary and oral sessions are chosen from the pool of abstracts prior to the meeting, and their authors are invited to present on-site at HM18.

But in spirit, the RIV is not really a competition, said RIV chair Ethan Cumbler, MD, FACP, FHM, professor of medicine at the University of Colorado.

What’s new in 2018

The more than 1,000 posters and oral presentations at HM18 is a new record, and it demonstrates the growth of hospital medicine as a scientific field, Dr. Cumbler said.

“We received a huge number of submissions,” he revealed. “We see that trend rise, year over year, and the quality has been going up as well.”

New this year is a Trainee Award category for resident and student authors. Another difference in 2018: The top 15 advances in Research and Innovations have been given a special track on day 2 of the conference, with oral presentations by the authors sharing their work.

The Vignettes are being featured in a new way as well. “We have so many incredible cases that we’re going to have a clinical vignette luncheon on two different days of the conference,” Dr. Cumbler said. “These are cases that we want to highlight, so that the experience of a hospitalist in one part of the country could help a hospitalist provide the right diagnosis for a patient on the other side of the country. There are lessons to be learned in clinical medicine, and our clinical vignettes is a fantastic way of sharing them.”

In making their selections in the different categories, the judges aimed to highlight some negative studies this year, Dr. Mathews said, which is a slight departure from previous years. “Sometimes you try something and it didn’t work, and it’s important to share that so we don’t just try the same thing over and over.”

This year, Research and Innovations abstracts will be grouped by theme, making it easier for attendees to navigate the posters. “If you’ve got a particular interest in a topic like transitions or communication, you’ll be able to find that portion of the poster session and talk to some of the people who are doing groundbreaking work in that topic,” Dr. Cumbler said. 

He also noted that he expects to see a strong expression of RIV content on social media from HM18, as judges encounter some of the best and most interesting work at RIV. Dr. Mathews is similarly enthusiastic about that amplification of the work.

“I love that the conversation continues into social media platforms such as Twitter,” he said. “People are engaging back and forth, saying, ‘Hey, take a look at this poster.’ Being in a room with countless people interested in research innovations for a field that’s still relatively young – I love that there’s movement toward that.”
 

Exciting research

By definition, the research on display at the RIV is the best of the best. “It’s difficult to get your work accepted at a national meeting, and it’s a high honor to be selected as a finalist. The poster abstracts or oral presentations that win are always remarkable pieces of work,” Dr. Cumbler said.

Some of this year’s most exciting projects examine prediction models and scoring systems for patients with infections such as sepsis or influenza, he said. “One of the most fascinating abstracts looked at deep learning, or machine learning, to create algorithms to predict sepsis and decompensation in ways that simplistic models might not. Many of our current prediction rules are designed around simple acronyms, because they’re easy to remember: the ABCD score, the CURB-65 score. But if you looked at the source code of the Google search algorithm – not that they’d let you – you’d discover that it doesn’t translate to a simple four-variable prediction model. It’s incredibly complex; it looks at interactions between variables.”

This research attempts to move medical prediction models in that direction, Dr. Cumbler said. “Examining deep learning models, or neural networks, to help clinicians make more accurate predictions and take better care of patients – we are getting a taste of the future of clinical medicine at HM18.”

Several research projects highlighted at RIV this year examine ways to make better use of the data in the electronic health record.

“One of the pieces of research I’m particularly excited to hear more about looks at how the vast data that exists within electronic health records is actually used,” Dr. Cumbler said. “With electronic health records, we have all of the information in a patient’s record at our fingertips, yet this creates incredible new challenges for the hospitalist needing to make decisions in real time, with the limitations of our organic neural networks.” Dr. Cumbler revealed that one of the research teams sharing their work at HM18 explored how hospitalists interact with the volume of information that exists within the health record at the time of admission. “The results are pretty amazing,” he said.

Another project Dr. Cumbler found fascinating examines the impact of delivery of real-time performance data to hospitalists on their phones, and how it affected practice across a number of different performance metrics.

“We will see a project using game theory to teach quality improvement and another sharing important quality improvement work occurring at the intersection of evidence-based medicine and patient experience – like looking at how to keep patients NPO for less unnecessary time,” he said. “It makes perfect sense that we don’t want to keep people hungry in the hospital longer than we need to. It’s really interesting seeing how one team worked to make that happen and what they found.”
 

The importance of the RIV

The influence of the RIV program extends far beyond the conference itself; there are implications for the field of hospital medicine today and into the future.

“The RIV competition allows the field in hospital medicine to mature and evolve, so we remain cutting edge,” Dr. Mathews said. “That’s the beauty of the innovation field: Research is built off of it.”

Dr. Cumbler said that the growth and evolution of the RIV is reflective of the maturation of hospital medicine as a specialty. “It’s transitioning from a different way to organize patient care to learning more, in a scientific way, about how care can and should be delivered.”

At its heart, the RIV is really about community, he added. “The community of hospitalists is sharing knowledge, graciously and unselfishly, so that we can all improve the quality of care that we’re providing and give patients safer care, a better experience, and improved outcomes.”

Finally, RIV offers a way for hospitalists to be engaged in lifelong learning. “The presenters are teaching from their experience, and the hospitalists who come to the RIV get to leave better clinicians, researchers, and leaders as a result,” Dr. Cumbler said. “These things, to me, are about our evolution as a profession.”

If prior SHM annual meetings are any guide, a highlight of the upcoming HM18 conference will be the Scientific Abstract and Poster Competition. This event, also known as the Research, Innovations, and Clinical Vignettes (RIV), has become one of the annual meeting’s most popular events. Crowds of attendees cluster around posters to read abstracts summarizing some of the most exciting, cutting-edge research in hospital medicine.

Networking in that crowd is a major factor in the RIV’s popularity, says the HM18 Innovations chair, Benji K. Mathews, MD, FACP, SFHM, CLHM, section head of hospital medicine at Regions Hospital, St. Paul, Minn., which is part of HealthPartners, the largest consumer-governed, non-profit health care organization in the U.S.

“From my standpoint, the power of this Innovations RIV competition is the opportunity to network,” said Dr. Mathews, who is also assistant professor of medicine at the University of Minnesota, Minneapolis. “In addition to primary authors, often these posters have several different people involved, and then there’s the foot traffic: We’re expecting thousands of people to walk through. The hope is to create the opportunity to network, to collaborate intergenerationally and also cross-institutionally.”

The RIV competition features some 1,000 posters this year, Dr. Mathews said. Plenary and oral sessions are chosen from the pool of abstracts prior to the meeting, and their authors are invited to present on-site at HM18.

But in spirit, the RIV is not really a competition, said RIV chair Ethan Cumbler, MD, FACP, FHM, professor of medicine at the University of Colorado.

What’s new in 2018

The more than 1,000 posters and oral presentations at HM18 is a new record, and it demonstrates the growth of hospital medicine as a scientific field, Dr. Cumbler said.

“We received a huge number of submissions,” he revealed. “We see that trend rise, year over year, and the quality has been going up as well.”

New this year is a Trainee Award category for resident and student authors. Another difference in 2018: The top 15 advances in Research and Innovations have been given a special track on day 2 of the conference, with oral presentations by the authors sharing their work.

The Vignettes are being featured in a new way as well. “We have so many incredible cases that we’re going to have a clinical vignette luncheon on two different days of the conference,” Dr. Cumbler said. “These are cases that we want to highlight, so that the experience of a hospitalist in one part of the country could help a hospitalist provide the right diagnosis for a patient on the other side of the country. There are lessons to be learned in clinical medicine, and our clinical vignettes is a fantastic way of sharing them.”

In making their selections in the different categories, the judges aimed to highlight some negative studies this year, Dr. Mathews said, which is a slight departure from previous years. “Sometimes you try something and it didn’t work, and it’s important to share that so we don’t just try the same thing over and over.”

This year, Research and Innovations abstracts will be grouped by theme, making it easier for attendees to navigate the posters. “If you’ve got a particular interest in a topic like transitions or communication, you’ll be able to find that portion of the poster session and talk to some of the people who are doing groundbreaking work in that topic,” Dr. Cumbler said. 

He also noted that he expects to see a strong expression of RIV content on social media from HM18, as judges encounter some of the best and most interesting work at RIV. Dr. Mathews is similarly enthusiastic about that amplification of the work.

“I love that the conversation continues into social media platforms such as Twitter,” he said. “People are engaging back and forth, saying, ‘Hey, take a look at this poster.’ Being in a room with countless people interested in research innovations for a field that’s still relatively young – I love that there’s movement toward that.”
 

Exciting research

By definition, the research on display at the RIV is the best of the best. “It’s difficult to get your work accepted at a national meeting, and it’s a high honor to be selected as a finalist. The poster abstracts or oral presentations that win are always remarkable pieces of work,” Dr. Cumbler said.

Some of this year’s most exciting projects examine prediction models and scoring systems for patients with infections such as sepsis or influenza, he said. “One of the most fascinating abstracts looked at deep learning, or machine learning, to create algorithms to predict sepsis and decompensation in ways that simplistic models might not. Many of our current prediction rules are designed around simple acronyms, because they’re easy to remember: the ABCD score, the CURB-65 score. But if you looked at the source code of the Google search algorithm – not that they’d let you – you’d discover that it doesn’t translate to a simple four-variable prediction model. It’s incredibly complex; it looks at interactions between variables.”

This research attempts to move medical prediction models in that direction, Dr. Cumbler said. “Examining deep learning models, or neural networks, to help clinicians make more accurate predictions and take better care of patients – we are getting a taste of the future of clinical medicine at HM18.”

Several research projects highlighted at RIV this year examine ways to make better use of the data in the electronic health record.

“One of the pieces of research I’m particularly excited to hear more about looks at how the vast data that exists within electronic health records is actually used,” Dr. Cumbler said. “With electronic health records, we have all of the information in a patient’s record at our fingertips, yet this creates incredible new challenges for the hospitalist needing to make decisions in real time, with the limitations of our organic neural networks.” Dr. Cumbler revealed that one of the research teams sharing their work at HM18 explored how hospitalists interact with the volume of information that exists within the health record at the time of admission. “The results are pretty amazing,” he said.

Another project Dr. Cumbler found fascinating examines the impact of delivery of real-time performance data to hospitalists on their phones, and how it affected practice across a number of different performance metrics.

“We will see a project using game theory to teach quality improvement and another sharing important quality improvement work occurring at the intersection of evidence-based medicine and patient experience – like looking at how to keep patients NPO for less unnecessary time,” he said. “It makes perfect sense that we don’t want to keep people hungry in the hospital longer than we need to. It’s really interesting seeing how one team worked to make that happen and what they found.”
 

The importance of the RIV

The influence of the RIV program extends far beyond the conference itself; there are implications for the field of hospital medicine today and into the future.

“The RIV competition allows the field in hospital medicine to mature and evolve, so we remain cutting edge,” Dr. Mathews said. “That’s the beauty of the innovation field: Research is built off of it.”

Dr. Cumbler said that the growth and evolution of the RIV is reflective of the maturation of hospital medicine as a specialty. “It’s transitioning from a different way to organize patient care to learning more, in a scientific way, about how care can and should be delivered.”

At its heart, the RIV is really about community, he added. “The community of hospitalists is sharing knowledge, graciously and unselfishly, so that we can all improve the quality of care that we’re providing and give patients safer care, a better experience, and improved outcomes.”

Finally, RIV offers a way for hospitalists to be engaged in lifelong learning. “The presenters are teaching from their experience, and the hospitalists who come to the RIV get to leave better clinicians, researchers, and leaders as a result,” Dr. Cumbler said. “These things, to me, are about our evolution as a profession.”

For many patients, paying for medication presents a serious challenge. Studies show that up to 45% of Americans do not fill prescriptions secondary to cost, and medication nonadherence leads to morbidity and mortality, with costs from $100 billion to $300 billion annually.

One way to address the problem is by empowering clinicians to reduce patient outpatient medication costs – the goal described in a recent abstract.

Reference

Kubey A et al. Expensive free hospitalizations – A novel approach to reducing outpatient medication cost [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

For many patients, paying for medication presents a serious challenge. Studies show that up to 45% of Americans do not fill prescriptions secondary to cost, and medication nonadherence leads to morbidity and mortality, with costs from $100 billion to $300 billion annually.

One way to address the problem is by empowering clinicians to reduce patient outpatient medication costs – the goal described in a recent abstract.

Reference

Kubey A et al. Expensive free hospitalizations – A novel approach to reducing outpatient medication cost [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

For many patients, paying for medication presents a serious challenge. Studies show that up to 45% of Americans do not fill prescriptions secondary to cost, and medication nonadherence leads to morbidity and mortality, with costs from $100 billion to $300 billion annually.

One way to address the problem is by empowering clinicians to reduce patient outpatient medication costs – the goal described in a recent abstract.

Reference

Kubey A et al. Expensive free hospitalizations – A novel approach to reducing outpatient medication cost [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

A survey of 305 inpatients showed that patients who reported that at least one provider sat down while caring for them were more likely to feel that their provider spent appropriate time with them and that their provider kept them well informed. The authors concluded that sitting down at a patient’s bedside improves some aspects of patients’ and families’ experience of their hospital care, and should be included in hospital efforts to improve the patient experience.

Reference

1. Adebusuyi OA et al. Does sitting enhance patient satisfaction in the hospital? [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

A survey of 305 inpatients showed that patients who reported that at least one provider sat down while caring for them were more likely to feel that their provider spent appropriate time with them and that their provider kept them well informed. The authors concluded that sitting down at a patient’s bedside improves some aspects of patients’ and families’ experience of their hospital care, and should be included in hospital efforts to improve the patient experience.

Reference

1. Adebusuyi OA et al. Does sitting enhance patient satisfaction in the hospital? [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

A survey of 305 inpatients showed that patients who reported that at least one provider sat down while caring for them were more likely to feel that their provider spent appropriate time with them and that their provider kept them well informed. The authors concluded that sitting down at a patient’s bedside improves some aspects of patients’ and families’ experience of their hospital care, and should be included in hospital efforts to improve the patient experience.

Reference

1. Adebusuyi OA et al. Does sitting enhance patient satisfaction in the hospital? [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

Health care workers creating innovations by applying “design thinking” – “a human-centered approach to innovation” that comes from the business world – is a growing trend, according to a recent New York Times article.

“With design thinking, the innovations come from those who actually work there, providing feedback to designers to improve the final product,” wrote author Amitha Kalaichandran, MD, MHS.

“Health providers ... are uniquely positioned to come up with fresh solutions to health care problems,” Dr. Kalaichandran wrote. An example at her own hospital: The leader of the trauma team now wears an orange vest, clearly identifying who’s in charge in a potentially chaotic situation. It was an idea created by a hospital nurse.

“A 2016 report that looked at ways in which a health system can implement design thinking identified three principles behind the approach: empathy for the user, in this case a patient, doctor or other health care provider; the involvement of an interdisciplinary team; and rapid prototyping of the idea,” she wrote. “To develop a truly useful product, a comprehensive understanding of the problem the innovation aims to solve is paramount.”

In design thinking, described as creative, multidisciplinary thinking around a problem, groups naturally coalesce to find such solutions. The article cites examples such as Clinicians for Design, an international group of providers focused on improving hospital layouts, and Health Design by Us, a collaborative group that supports health care innovations such as a mobile system for diabetes management, designed by a patient.
 

Reference

Kalaichandran A. Design thinking for doctors and nurses. The New York Times. Aug. 3, 2017. Accessed Aug. 7, 2017.

Health care workers creating innovations by applying “design thinking” – “a human-centered approach to innovation” that comes from the business world – is a growing trend, according to a recent New York Times article.

“With design thinking, the innovations come from those who actually work there, providing feedback to designers to improve the final product,” wrote author Amitha Kalaichandran, MD, MHS.

“Health providers ... are uniquely positioned to come up with fresh solutions to health care problems,” Dr. Kalaichandran wrote. An example at her own hospital: The leader of the trauma team now wears an orange vest, clearly identifying who’s in charge in a potentially chaotic situation. It was an idea created by a hospital nurse.

“A 2016 report that looked at ways in which a health system can implement design thinking identified three principles behind the approach: empathy for the user, in this case a patient, doctor or other health care provider; the involvement of an interdisciplinary team; and rapid prototyping of the idea,” she wrote. “To develop a truly useful product, a comprehensive understanding of the problem the innovation aims to solve is paramount.”

In design thinking, described as creative, multidisciplinary thinking around a problem, groups naturally coalesce to find such solutions. The article cites examples such as Clinicians for Design, an international group of providers focused on improving hospital layouts, and Health Design by Us, a collaborative group that supports health care innovations such as a mobile system for diabetes management, designed by a patient.
 

Reference

Kalaichandran A. Design thinking for doctors and nurses. The New York Times. Aug. 3, 2017. Accessed Aug. 7, 2017.

Health care workers creating innovations by applying “design thinking” – “a human-centered approach to innovation” that comes from the business world – is a growing trend, according to a recent New York Times article.

“With design thinking, the innovations come from those who actually work there, providing feedback to designers to improve the final product,” wrote author Amitha Kalaichandran, MD, MHS.

“Health providers ... are uniquely positioned to come up with fresh solutions to health care problems,” Dr. Kalaichandran wrote. An example at her own hospital: The leader of the trauma team now wears an orange vest, clearly identifying who’s in charge in a potentially chaotic situation. It was an idea created by a hospital nurse.

“A 2016 report that looked at ways in which a health system can implement design thinking identified three principles behind the approach: empathy for the user, in this case a patient, doctor or other health care provider; the involvement of an interdisciplinary team; and rapid prototyping of the idea,” she wrote. “To develop a truly useful product, a comprehensive understanding of the problem the innovation aims to solve is paramount.”

In design thinking, described as creative, multidisciplinary thinking around a problem, groups naturally coalesce to find such solutions. The article cites examples such as Clinicians for Design, an international group of providers focused on improving hospital layouts, and Health Design by Us, a collaborative group that supports health care innovations such as a mobile system for diabetes management, designed by a patient.
 

Reference

Kalaichandran A. Design thinking for doctors and nurses. The New York Times. Aug. 3, 2017. Accessed Aug. 7, 2017.