Suzanne Bopp

Since 2010, the Affordable Care Act’s Center for Medicare and Medicaid Innovation has run, financed, or partnered on 61,000 demonstration projects, allowing people and institutions to try new things and scale up what works, according to The New York Times article “A Bipartisan Reason to Save Obamacare.”¹

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Reference

1. Rosenberg T. A Bipartisan Reason to Save Obamacare. The New York Times. January 4, 2017. Available at: http://www.nytimes.com. Accessed January 10, 2017.

Since 2010, the Affordable Care Act’s Center for Medicare and Medicaid Innovation has run, financed, or partnered on 61,000 demonstration projects, allowing people and institutions to try new things and scale up what works, according to The New York Times article “A Bipartisan Reason to Save Obamacare.”¹

Thinkstock

Reference

1. Rosenberg T. A Bipartisan Reason to Save Obamacare. The New York Times. January 4, 2017. Available at: http://www.nytimes.com. Accessed January 10, 2017.

Since 2010, the Affordable Care Act’s Center for Medicare and Medicaid Innovation has run, financed, or partnered on 61,000 demonstration projects, allowing people and institutions to try new things and scale up what works, according to The New York Times article “A Bipartisan Reason to Save Obamacare.”¹

Thinkstock

Reference

1. Rosenberg T. A Bipartisan Reason to Save Obamacare. The New York Times. January 4, 2017. Available at: http://www.nytimes.com. Accessed January 10, 2017.

Hospitalists should not overlook apps as tools for better health: Smartphone ownership is rising among all demographic groups, and more than 165,000 health apps exist in app stores. Many apps are aimed at helping caregivers and patients with complex medical conditions.

“Patient-facing mobile health applications (mHealth apps) – those intended for use by patients to manage their health – have the potential to help high-need, high-cost populations manage their health, but a variety of questions related to their utility and function have not previously been explored,” Karandeep Singh, MD, MMSc, said in “Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain.”¹

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• How well do apps serve the needs of patients with varying levels of engagement with their health?
• Can we infer an app’s clinical utility or usability based on its app store rating?
• Do apps appropriately respond to information entered by the user indicating that he or she might be in danger?
• How well do apps protect the privacy and security of user-entered health data?
• Are app costs a barrier to patients’ purchasing and using them?
• The study team found a variety of apps for patients with chronic conditions.

“While many apps allow users to track health information, most apps did not respond appropriately when a user entered potentially dangerous health information,” Dr. Singh says. “Consumers’ ratings of apps on the iOS and Android app stores were poor indications of the apps’ clinical utility or usability. Finally, we found that many apps enable sharing of information with others but primarily through insecure means. This is especially problematic because just under two-thirds of apps we evaluated had a privacy policy.”

He cautions hospitalists that app ratings may have little bearing on its clinical utility as judged by a physician.

“Additionally, for patients tracking health findings using apps during an inpatient stay, the most secure way of sharing this information is the old-fashioned way, in person or in print,” he explains. “Unlike hospital-based health information systems, health data stored in apps is generally not regulated by HIPAA. Hospitalists should not assume that a ‘secure messaging’ system provided by a patient-facing app is actually secure.”

The American Medical Association, American Heart Association, Healthcare Information and Management Systems Society, and digital health nonprofit DHX Group are the founders of the new guideline-writing organization called Xcertia. Xcertia will provide guidance for developing, evaluating, or recommending mHealth apps.

“I hope that hospitalists keenly interested in apps will take an active role in Xcertia, to ensure that their voices are heard in what looks to be an unprecedented large-scale effort in the United States,” Dr. Singh says. “While a medication list printed on a discharge summary cannot remind patients to take their meds, apps can do this quite well.”
 

Reference

1. Singh, K, Drouin, K, Newmark, L, et al. Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Affairs. 2016;35(12):2310-8.

Hospitalists should not overlook apps as tools for better health: Smartphone ownership is rising among all demographic groups, and more than 165,000 health apps exist in app stores. Many apps are aimed at helping caregivers and patients with complex medical conditions.

“Patient-facing mobile health applications (mHealth apps) – those intended for use by patients to manage their health – have the potential to help high-need, high-cost populations manage their health, but a variety of questions related to their utility and function have not previously been explored,” Karandeep Singh, MD, MMSc, said in “Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain.”¹

Thinkstock

• How well do apps serve the needs of patients with varying levels of engagement with their health?
• Can we infer an app’s clinical utility or usability based on its app store rating?
• Do apps appropriately respond to information entered by the user indicating that he or she might be in danger?
• How well do apps protect the privacy and security of user-entered health data?
• Are app costs a barrier to patients’ purchasing and using them?
• The study team found a variety of apps for patients with chronic conditions.

“While many apps allow users to track health information, most apps did not respond appropriately when a user entered potentially dangerous health information,” Dr. Singh says. “Consumers’ ratings of apps on the iOS and Android app stores were poor indications of the apps’ clinical utility or usability. Finally, we found that many apps enable sharing of information with others but primarily through insecure means. This is especially problematic because just under two-thirds of apps we evaluated had a privacy policy.”

He cautions hospitalists that app ratings may have little bearing on its clinical utility as judged by a physician.

“Additionally, for patients tracking health findings using apps during an inpatient stay, the most secure way of sharing this information is the old-fashioned way, in person or in print,” he explains. “Unlike hospital-based health information systems, health data stored in apps is generally not regulated by HIPAA. Hospitalists should not assume that a ‘secure messaging’ system provided by a patient-facing app is actually secure.”

The American Medical Association, American Heart Association, Healthcare Information and Management Systems Society, and digital health nonprofit DHX Group are the founders of the new guideline-writing organization called Xcertia. Xcertia will provide guidance for developing, evaluating, or recommending mHealth apps.

“I hope that hospitalists keenly interested in apps will take an active role in Xcertia, to ensure that their voices are heard in what looks to be an unprecedented large-scale effort in the United States,” Dr. Singh says. “While a medication list printed on a discharge summary cannot remind patients to take their meds, apps can do this quite well.”
 

Reference

1. Singh, K, Drouin, K, Newmark, L, et al. Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Affairs. 2016;35(12):2310-8.

Hospitalists should not overlook apps as tools for better health: Smartphone ownership is rising among all demographic groups, and more than 165,000 health apps exist in app stores. Many apps are aimed at helping caregivers and patients with complex medical conditions.

“Patient-facing mobile health applications (mHealth apps) – those intended for use by patients to manage their health – have the potential to help high-need, high-cost populations manage their health, but a variety of questions related to their utility and function have not previously been explored,” Karandeep Singh, MD, MMSc, said in “Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain.”¹

Thinkstock

• How well do apps serve the needs of patients with varying levels of engagement with their health?
• Can we infer an app’s clinical utility or usability based on its app store rating?
• Do apps appropriately respond to information entered by the user indicating that he or she might be in danger?
• How well do apps protect the privacy and security of user-entered health data?
• Are app costs a barrier to patients’ purchasing and using them?
• The study team found a variety of apps for patients with chronic conditions.

“While many apps allow users to track health information, most apps did not respond appropriately when a user entered potentially dangerous health information,” Dr. Singh says. “Consumers’ ratings of apps on the iOS and Android app stores were poor indications of the apps’ clinical utility or usability. Finally, we found that many apps enable sharing of information with others but primarily through insecure means. This is especially problematic because just under two-thirds of apps we evaluated had a privacy policy.”

He cautions hospitalists that app ratings may have little bearing on its clinical utility as judged by a physician.

“Additionally, for patients tracking health findings using apps during an inpatient stay, the most secure way of sharing this information is the old-fashioned way, in person or in print,” he explains. “Unlike hospital-based health information systems, health data stored in apps is generally not regulated by HIPAA. Hospitalists should not assume that a ‘secure messaging’ system provided by a patient-facing app is actually secure.”

The American Medical Association, American Heart Association, Healthcare Information and Management Systems Society, and digital health nonprofit DHX Group are the founders of the new guideline-writing organization called Xcertia. Xcertia will provide guidance for developing, evaluating, or recommending mHealth apps.

“I hope that hospitalists keenly interested in apps will take an active role in Xcertia, to ensure that their voices are heard in what looks to be an unprecedented large-scale effort in the United States,” Dr. Singh says. “While a medication list printed on a discharge summary cannot remind patients to take their meds, apps can do this quite well.”
 

Reference

1. Singh, K, Drouin, K, Newmark, L, et al. Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Affairs. 2016;35(12):2310-8.

Moving patients safely and efficiently through the admission process is always a priority for hospitalists. Is there a way to optimize and standardize the process?

“In hopes of improving admission efficiency, while simultaneously increasing quality of care, we decided to use Lean/Six Sigma methodology to streamline our admission process,” says Escher Howard-Williams, MD, lead author of an abstract called “Standardizing the Admission Process Using Lean/Six Sigma One Piece Flow.”¹

A basic tenet of the methodology is called “one piece flow” (OPF), the idea that standardized processes are more efficient and less prone to error when completed from start to finish without interruption. In the study, hospitalists committed to performing all patient admissions in OPF, focusing on one patient from initiation of chart review through exam, order entry and documentation, without interruption. Researchers then analyzed times, including time to call back to ED, time at initiation of chart review, time of evaluation of patient, time orders were placed, and time of sign-out note completed, before and after implementation of OPF. They found a substantial reduction in time of the admission process across all time points with OPF.

“When you are trying to improve quality of care in your institution, dissecting the overall work flow will allow you to discover areas that hinder the overall process,” Dr. Howard-Williams says. “Reframing your process to focus on providing excellent quality care will allow you to find workable solutions to improve the quality of care and efficiency in your practice. As part of this process, developing a team with an appropriate variety of members lays the foundation for success.”

Dr. Howard-Williams hopes that the study will inspire others to reflect on their own practices.

“If, during that reflection, they can identify areas that they would like to improve quality, we would encourage them to join us,” she says. “They will have the opportunity to build their personal work flow maps, find choke points and devise a plan for moving forward with new solutions.”
 

Reference

1. Howard-Williams E, Liles A, Stephens J, lanza-Kaduce K. Standardizing the admission process using Lean/Six Sigma One Piece Flow [abstract]. J Hosp Med. 2016;11(suppl 1). Available at: http://www.shmabstracts.com/abstract/standardizing-the-admission-process-using-lean-six-sigma-one-piece-flow/. Accessed March 7, 2017.

Moving patients safely and efficiently through the admission process is always a priority for hospitalists. Is there a way to optimize and standardize the process?

“In hopes of improving admission efficiency, while simultaneously increasing quality of care, we decided to use Lean/Six Sigma methodology to streamline our admission process,” says Escher Howard-Williams, MD, lead author of an abstract called “Standardizing the Admission Process Using Lean/Six Sigma One Piece Flow.”¹

A basic tenet of the methodology is called “one piece flow” (OPF), the idea that standardized processes are more efficient and less prone to error when completed from start to finish without interruption. In the study, hospitalists committed to performing all patient admissions in OPF, focusing on one patient from initiation of chart review through exam, order entry and documentation, without interruption. Researchers then analyzed times, including time to call back to ED, time at initiation of chart review, time of evaluation of patient, time orders were placed, and time of sign-out note completed, before and after implementation of OPF. They found a substantial reduction in time of the admission process across all time points with OPF.

“When you are trying to improve quality of care in your institution, dissecting the overall work flow will allow you to discover areas that hinder the overall process,” Dr. Howard-Williams says. “Reframing your process to focus on providing excellent quality care will allow you to find workable solutions to improve the quality of care and efficiency in your practice. As part of this process, developing a team with an appropriate variety of members lays the foundation for success.”

Dr. Howard-Williams hopes that the study will inspire others to reflect on their own practices.

“If, during that reflection, they can identify areas that they would like to improve quality, we would encourage them to join us,” she says. “They will have the opportunity to build their personal work flow maps, find choke points and devise a plan for moving forward with new solutions.”
 

Reference

1. Howard-Williams E, Liles A, Stephens J, lanza-Kaduce K. Standardizing the admission process using Lean/Six Sigma One Piece Flow [abstract]. J Hosp Med. 2016;11(suppl 1). Available at: http://www.shmabstracts.com/abstract/standardizing-the-admission-process-using-lean-six-sigma-one-piece-flow/. Accessed March 7, 2017.

Moving patients safely and efficiently through the admission process is always a priority for hospitalists. Is there a way to optimize and standardize the process?

“In hopes of improving admission efficiency, while simultaneously increasing quality of care, we decided to use Lean/Six Sigma methodology to streamline our admission process,” says Escher Howard-Williams, MD, lead author of an abstract called “Standardizing the Admission Process Using Lean/Six Sigma One Piece Flow.”¹

A basic tenet of the methodology is called “one piece flow” (OPF), the idea that standardized processes are more efficient and less prone to error when completed from start to finish without interruption. In the study, hospitalists committed to performing all patient admissions in OPF, focusing on one patient from initiation of chart review through exam, order entry and documentation, without interruption. Researchers then analyzed times, including time to call back to ED, time at initiation of chart review, time of evaluation of patient, time orders were placed, and time of sign-out note completed, before and after implementation of OPF. They found a substantial reduction in time of the admission process across all time points with OPF.

“When you are trying to improve quality of care in your institution, dissecting the overall work flow will allow you to discover areas that hinder the overall process,” Dr. Howard-Williams says. “Reframing your process to focus on providing excellent quality care will allow you to find workable solutions to improve the quality of care and efficiency in your practice. As part of this process, developing a team with an appropriate variety of members lays the foundation for success.”

Dr. Howard-Williams hopes that the study will inspire others to reflect on their own practices.

“If, during that reflection, they can identify areas that they would like to improve quality, we would encourage them to join us,” she says. “They will have the opportunity to build their personal work flow maps, find choke points and devise a plan for moving forward with new solutions.”
 

Reference

1. Howard-Williams E, Liles A, Stephens J, lanza-Kaduce K. Standardizing the admission process using Lean/Six Sigma One Piece Flow [abstract]. J Hosp Med. 2016;11(suppl 1). Available at: http://www.shmabstracts.com/abstract/standardizing-the-admission-process-using-lean-six-sigma-one-piece-flow/. Accessed March 7, 2017.

As a hospitalist, you typically have little, if any, contact with patients outside the hospital and, at most, you’ll only spend a couple of hours a year in front of any particular patient. The vast majority of the determinants of your patients’ health occur when you’re not there.

In a commentary in the New England Journal of Medicine entitled “Engineering Social Incentives for Health,” lead author David A. Asch, MD, MBA, addresses that issue.¹
 

“The motivation for the piece is that the people who are in a position to influence a patient’s health are their friends and family, and yet so much of how we have structured health care is between a clinician and a patient,” he says. “We often fail to engage the people in patients’ everyday lives, who can be quite willing partners in improving health care. There are all sorts of things they can do to help patients with hard-to-control diabetes or ... heart failure, or anything that might have put them in the hospital in the first place.”

The column describes a ladder of social engineering strategies, from very simple to complex. One example on the simple end might be to help a patient remember a daily medication by having him place the medication bottle where his partner can see him taking – or not taking – it. (The alternative is that medications are taken in a private place, such in the bathroom, where no one might be watching over the routine to keep the patient on track.)

Moving up the ladder, a hospitalist might help set up a network of other patients with heart failure, so that they can help each other in a kind of peer mentorship.

“These peer-to-peer connections might require Web-based platforms or social support groups, so that kind of activity is a lot more complicated, but the general theme is: Can hospitalists think about ways to constructively engage the social networks that already surround patients, so they don’t need to invoke the health system to do it?”

It’s long been known that people with more social support do better: People who are married do better; people who have more friends do better. “Up until now, it’s just been an observation,” Dr. Asch says. “I think we’re at a point where we could begin to prescribe social support in the way we might prescribe a diuretic. I’d like to try it out at least. I think that’s the call to action.”

Reference

1. Asch D, Rosin R. Engineering social incentives for health. NEJM. 2016;375:2511-2513.

As a hospitalist, you typically have little, if any, contact with patients outside the hospital and, at most, you’ll only spend a couple of hours a year in front of any particular patient. The vast majority of the determinants of your patients’ health occur when you’re not there.

In a commentary in the New England Journal of Medicine entitled “Engineering Social Incentives for Health,” lead author David A. Asch, MD, MBA, addresses that issue.¹
 

“The motivation for the piece is that the people who are in a position to influence a patient’s health are their friends and family, and yet so much of how we have structured health care is between a clinician and a patient,” he says. “We often fail to engage the people in patients’ everyday lives, who can be quite willing partners in improving health care. There are all sorts of things they can do to help patients with hard-to-control diabetes or ... heart failure, or anything that might have put them in the hospital in the first place.”

The column describes a ladder of social engineering strategies, from very simple to complex. One example on the simple end might be to help a patient remember a daily medication by having him place the medication bottle where his partner can see him taking – or not taking – it. (The alternative is that medications are taken in a private place, such in the bathroom, where no one might be watching over the routine to keep the patient on track.)

Moving up the ladder, a hospitalist might help set up a network of other patients with heart failure, so that they can help each other in a kind of peer mentorship.

“These peer-to-peer connections might require Web-based platforms or social support groups, so that kind of activity is a lot more complicated, but the general theme is: Can hospitalists think about ways to constructively engage the social networks that already surround patients, so they don’t need to invoke the health system to do it?”

It’s long been known that people with more social support do better: People who are married do better; people who have more friends do better. “Up until now, it’s just been an observation,” Dr. Asch says. “I think we’re at a point where we could begin to prescribe social support in the way we might prescribe a diuretic. I’d like to try it out at least. I think that’s the call to action.”

Reference

1. Asch D, Rosin R. Engineering social incentives for health. NEJM. 2016;375:2511-2513.

As a hospitalist, you typically have little, if any, contact with patients outside the hospital and, at most, you’ll only spend a couple of hours a year in front of any particular patient. The vast majority of the determinants of your patients’ health occur when you’re not there.

In a commentary in the New England Journal of Medicine entitled “Engineering Social Incentives for Health,” lead author David A. Asch, MD, MBA, addresses that issue.¹
 

“The motivation for the piece is that the people who are in a position to influence a patient’s health are their friends and family, and yet so much of how we have structured health care is between a clinician and a patient,” he says. “We often fail to engage the people in patients’ everyday lives, who can be quite willing partners in improving health care. There are all sorts of things they can do to help patients with hard-to-control diabetes or ... heart failure, or anything that might have put them in the hospital in the first place.”

The column describes a ladder of social engineering strategies, from very simple to complex. One example on the simple end might be to help a patient remember a daily medication by having him place the medication bottle where his partner can see him taking – or not taking – it. (The alternative is that medications are taken in a private place, such in the bathroom, where no one might be watching over the routine to keep the patient on track.)

Moving up the ladder, a hospitalist might help set up a network of other patients with heart failure, so that they can help each other in a kind of peer mentorship.

“These peer-to-peer connections might require Web-based platforms or social support groups, so that kind of activity is a lot more complicated, but the general theme is: Can hospitalists think about ways to constructively engage the social networks that already surround patients, so they don’t need to invoke the health system to do it?”

It’s long been known that people with more social support do better: People who are married do better; people who have more friends do better. “Up until now, it’s just been an observation,” Dr. Asch says. “I think we’re at a point where we could begin to prescribe social support in the way we might prescribe a diuretic. I’d like to try it out at least. I think that’s the call to action.”

Reference

1. Asch D, Rosin R. Engineering social incentives for health. NEJM. 2016;375:2511-2513.

Hospitalists can help enlist patients in the movement toward improved patient safety, and they can begin simply by sharing their notes.

OpenNotes offers a new platform to do that, according to a BMJ Quality & Safety article, “A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.”¹

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• Share their notes with patients and families (by printing the discharge summaries if they are not available on the portal and/or sharing notes from post-discharge follow-up visits).
• Emphasize for patients and families the important role they play as safety partners.
• Ask patients who receive care in other healthcare centers if they have OpenNotes, which can help hospitalists obtain medical records quickly and efficiently.
• Encourage patients to sign up for the patient portal and ask for their notes, for ambulatory visits to begin with and for in-patient notes when they become available.

Suzanne Bopp is a freelance medical writer in New York City.

Reference

1. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships [published online ahead of print, Dec. 13, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-006020.

Hospitalists can help enlist patients in the movement toward improved patient safety, and they can begin simply by sharing their notes.

OpenNotes offers a new platform to do that, according to a BMJ Quality & Safety article, “A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.”¹

Thinkstock

• Share their notes with patients and families (by printing the discharge summaries if they are not available on the portal and/or sharing notes from post-discharge follow-up visits).
• Emphasize for patients and families the important role they play as safety partners.
• Ask patients who receive care in other healthcare centers if they have OpenNotes, which can help hospitalists obtain medical records quickly and efficiently.
• Encourage patients to sign up for the patient portal and ask for their notes, for ambulatory visits to begin with and for in-patient notes when they become available.

Suzanne Bopp is a freelance medical writer in New York City.

Reference

1. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships [published online ahead of print, Dec. 13, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-006020.

Hospitalists can help enlist patients in the movement toward improved patient safety, and they can begin simply by sharing their notes.

OpenNotes offers a new platform to do that, according to a BMJ Quality & Safety article, “A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.”¹

Thinkstock

• Share their notes with patients and families (by printing the discharge summaries if they are not available on the portal and/or sharing notes from post-discharge follow-up visits).
• Emphasize for patients and families the important role they play as safety partners.
• Ask patients who receive care in other healthcare centers if they have OpenNotes, which can help hospitalists obtain medical records quickly and efficiently.
• Encourage patients to sign up for the patient portal and ask for their notes, for ambulatory visits to begin with and for in-patient notes when they become available.

Suzanne Bopp is a freelance medical writer in New York City.

Reference

1. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships [published online ahead of print, Dec. 13, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-006020.

Hospitalists have been paying close attention to 30-day readmission figures since public reporting and payment programs embraced that number as an indicator of the quality of hospital care. But there is limited evidence to demonstrate 30-day readmission is really a meaningful interval of time, according to a recent study, “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators of Quality of Care.”

“I began to dig through the literature to find some sort of evidence to support this figure – I couldn’t find anything. In talking with quality experts, they all, more or less, believe that things that happen outside of 7 or 10 days are really out of the control of the clinician,” says lead author David L. Chin, PhD, of the Center for Healthcare Policy and Research at the University of California, Davis.

Dr. Chin and his team examined the 30-day risk of unplanned inpatient readmission at the hospital level for Medicare patients aged 65 and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. Across states and diagnoses, the hospital-level quality signal captured in readmission risk was highest on the first day after discharge, and it declined quickly to its lowest level at day 7.

“The rapid decay in the quality signal suggests that most readmissions after the seventh-day postdischarge were explained by community- and household-level factors beyond hospitals’ control,” the authors concluded.

Dr. Chin said the study results show the 30-day measure is “a blunt instrument.”

“It isn’t really measuring anything that we’re supposed to be measuring,” he explains. “Essentially, 97% of the reasons a person comes back to the hospital is due to some other, non-hospital thing.”

He does not advocate for 7 days as the new standard, however.

“This is more intended to be a message that this is really not the right way of approaching [readmissions] to begin with,” he says. “I think we convincingly showed that it shouldn’t be 30 days, but we don’t really have a very good picture of what is driving readmission. Hospitals are getting dinged on these things that have happened that, really, they don’t have direct influence on.”

Reference

1. Chin DL, Bang H, Manickam RN, Romano PS. Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Aff (Millwood). 2016;35(10):1867-75.

Quality Improvement: Overuse as medical error

Hospitalists may recognize a culture of overuse at their hospitals, but how can they address it? That’s the question behind an HM16 abstract, “Occam’s Conference: Overuse as a Medical Error.”

“We wanted to change the culture of overuse here among the hospitalists and the house staff,” said lead author Hyung Cho, MD, director of quality and patient safety at the Icahn School of Medicine at Mount Sinai in New York City. “We wanted to frame it in a way that people can recognize and feel free to talk about and also give it the weight that it deserves. It’s a common thing that we all do: the chest x-ray or the EKG before a surgery, things like that.”

Seeing overuse as a medical error is a place to start.

“A framework in which overuse is considered a medical error would facilitate understanding of the drivers of overuse and systems factors that lead to it,” the authors wrote.

Dr. Cho and colleagues chose a monthly inpatient conference format, with all the relevant players gathered together.

“We also wanted to use the formula that Brandon Combs had with the ‘Do No Harm’ project, which is taking cases of overuse that actually lead to harm or a near miss. I think people respond to that as opposed to just talking about the cost, which people have a hard time actually figuring out,” Dr. Cho said.

The resulting Occam’s Conference provides a process to identify and discuss overuse as a medical error. It uses a fish-bone diagram to help analyze each case.

“That conversation needs to happen,” Dr. Cho said. “You realize that people are all on the same page, and if they’re not, they need to get on the same page and have an open dialogue.”
 

Reference

1. Cho HJ, Lutz C, Truong TTN, et al. Occam’s Conference: overuse as a medical error [abstract]. J Hosp Med. 2016;11(suppl1).

Practice Management: There’s an app for … end-of-life communications

Hospitalists wanting to help patients navigate end-of-life decisions or assist bereaved families in dealing with the death of a loved one have some new tools, according to The New York Times article, “Start-Ups for the End of Life.”

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Reference

1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.

Quality Improvement: How to create a high-value culture

Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.

“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”

Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.

Four factors emerged with strong reliability:

• Leadership and health system messaging.

• Data transparency and access.

• Comfort with cost conversations.

• Blame-free environment.

The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.

Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.

“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
 

Reference

Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.

Quick Byte: Cleaning robotic surgical instruments

Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.

Reference

1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.

Suzanne Bopp is a freelance writer in New Jersey.

Hospitalists have been paying close attention to 30-day readmission figures since public reporting and payment programs embraced that number as an indicator of the quality of hospital care. But there is limited evidence to demonstrate 30-day readmission is really a meaningful interval of time, according to a recent study, “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators of Quality of Care.”

“I began to dig through the literature to find some sort of evidence to support this figure – I couldn’t find anything. In talking with quality experts, they all, more or less, believe that things that happen outside of 7 or 10 days are really out of the control of the clinician,” says lead author David L. Chin, PhD, of the Center for Healthcare Policy and Research at the University of California, Davis.

Dr. Chin and his team examined the 30-day risk of unplanned inpatient readmission at the hospital level for Medicare patients aged 65 and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. Across states and diagnoses, the hospital-level quality signal captured in readmission risk was highest on the first day after discharge, and it declined quickly to its lowest level at day 7.

“The rapid decay in the quality signal suggests that most readmissions after the seventh-day postdischarge were explained by community- and household-level factors beyond hospitals’ control,” the authors concluded.

Dr. Chin said the study results show the 30-day measure is “a blunt instrument.”

“It isn’t really measuring anything that we’re supposed to be measuring,” he explains. “Essentially, 97% of the reasons a person comes back to the hospital is due to some other, non-hospital thing.”

He does not advocate for 7 days as the new standard, however.

“This is more intended to be a message that this is really not the right way of approaching [readmissions] to begin with,” he says. “I think we convincingly showed that it shouldn’t be 30 days, but we don’t really have a very good picture of what is driving readmission. Hospitals are getting dinged on these things that have happened that, really, they don’t have direct influence on.”

Reference

1. Chin DL, Bang H, Manickam RN, Romano PS. Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Aff (Millwood). 2016;35(10):1867-75.

Quality Improvement: Overuse as medical error

Hospitalists may recognize a culture of overuse at their hospitals, but how can they address it? That’s the question behind an HM16 abstract, “Occam’s Conference: Overuse as a Medical Error.”

“We wanted to change the culture of overuse here among the hospitalists and the house staff,” said lead author Hyung Cho, MD, director of quality and patient safety at the Icahn School of Medicine at Mount Sinai in New York City. “We wanted to frame it in a way that people can recognize and feel free to talk about and also give it the weight that it deserves. It’s a common thing that we all do: the chest x-ray or the EKG before a surgery, things like that.”

Seeing overuse as a medical error is a place to start.

“A framework in which overuse is considered a medical error would facilitate understanding of the drivers of overuse and systems factors that lead to it,” the authors wrote.

Dr. Cho and colleagues chose a monthly inpatient conference format, with all the relevant players gathered together.

“We also wanted to use the formula that Brandon Combs had with the ‘Do No Harm’ project, which is taking cases of overuse that actually lead to harm or a near miss. I think people respond to that as opposed to just talking about the cost, which people have a hard time actually figuring out,” Dr. Cho said.

The resulting Occam’s Conference provides a process to identify and discuss overuse as a medical error. It uses a fish-bone diagram to help analyze each case.

“That conversation needs to happen,” Dr. Cho said. “You realize that people are all on the same page, and if they’re not, they need to get on the same page and have an open dialogue.”
 

Reference

1. Cho HJ, Lutz C, Truong TTN, et al. Occam’s Conference: overuse as a medical error [abstract]. J Hosp Med. 2016;11(suppl1).

Practice Management: There’s an app for … end-of-life communications

Hospitalists wanting to help patients navigate end-of-life decisions or assist bereaved families in dealing with the death of a loved one have some new tools, according to The New York Times article, “Start-Ups for the End of Life.”

Thinkstock

Reference

1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.

Quality Improvement: How to create a high-value culture

Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.

“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”

Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.

Four factors emerged with strong reliability:

• Leadership and health system messaging.

• Data transparency and access.

• Comfort with cost conversations.

• Blame-free environment.

The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.

Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.

“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
 

Reference

Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.

Quick Byte: Cleaning robotic surgical instruments

Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.

Reference

1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.

Suzanne Bopp is a freelance writer in New Jersey.

Hospitalists have been paying close attention to 30-day readmission figures since public reporting and payment programs embraced that number as an indicator of the quality of hospital care. But there is limited evidence to demonstrate 30-day readmission is really a meaningful interval of time, according to a recent study, “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators of Quality of Care.”

“I began to dig through the literature to find some sort of evidence to support this figure – I couldn’t find anything. In talking with quality experts, they all, more or less, believe that things that happen outside of 7 or 10 days are really out of the control of the clinician,” says lead author David L. Chin, PhD, of the Center for Healthcare Policy and Research at the University of California, Davis.

Dr. Chin and his team examined the 30-day risk of unplanned inpatient readmission at the hospital level for Medicare patients aged 65 and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. Across states and diagnoses, the hospital-level quality signal captured in readmission risk was highest on the first day after discharge, and it declined quickly to its lowest level at day 7.

“The rapid decay in the quality signal suggests that most readmissions after the seventh-day postdischarge were explained by community- and household-level factors beyond hospitals’ control,” the authors concluded.

Dr. Chin said the study results show the 30-day measure is “a blunt instrument.”

“It isn’t really measuring anything that we’re supposed to be measuring,” he explains. “Essentially, 97% of the reasons a person comes back to the hospital is due to some other, non-hospital thing.”

He does not advocate for 7 days as the new standard, however.

“This is more intended to be a message that this is really not the right way of approaching [readmissions] to begin with,” he says. “I think we convincingly showed that it shouldn’t be 30 days, but we don’t really have a very good picture of what is driving readmission. Hospitals are getting dinged on these things that have happened that, really, they don’t have direct influence on.”

Reference

1. Chin DL, Bang H, Manickam RN, Romano PS. Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Aff (Millwood). 2016;35(10):1867-75.

Quality Improvement: Overuse as medical error

Hospitalists may recognize a culture of overuse at their hospitals, but how can they address it? That’s the question behind an HM16 abstract, “Occam’s Conference: Overuse as a Medical Error.”

“We wanted to change the culture of overuse here among the hospitalists and the house staff,” said lead author Hyung Cho, MD, director of quality and patient safety at the Icahn School of Medicine at Mount Sinai in New York City. “We wanted to frame it in a way that people can recognize and feel free to talk about and also give it the weight that it deserves. It’s a common thing that we all do: the chest x-ray or the EKG before a surgery, things like that.”

Seeing overuse as a medical error is a place to start.

“A framework in which overuse is considered a medical error would facilitate understanding of the drivers of overuse and systems factors that lead to it,” the authors wrote.

Dr. Cho and colleagues chose a monthly inpatient conference format, with all the relevant players gathered together.

“We also wanted to use the formula that Brandon Combs had with the ‘Do No Harm’ project, which is taking cases of overuse that actually lead to harm or a near miss. I think people respond to that as opposed to just talking about the cost, which people have a hard time actually figuring out,” Dr. Cho said.

The resulting Occam’s Conference provides a process to identify and discuss overuse as a medical error. It uses a fish-bone diagram to help analyze each case.

“That conversation needs to happen,” Dr. Cho said. “You realize that people are all on the same page, and if they’re not, they need to get on the same page and have an open dialogue.”
 

Reference

1. Cho HJ, Lutz C, Truong TTN, et al. Occam’s Conference: overuse as a medical error [abstract]. J Hosp Med. 2016;11(suppl1).

Practice Management: There’s an app for … end-of-life communications

Hospitalists wanting to help patients navigate end-of-life decisions or assist bereaved families in dealing with the death of a loved one have some new tools, according to The New York Times article, “Start-Ups for the End of Life.”

Thinkstock

Reference

1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.

Quality Improvement: How to create a high-value culture

Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.

“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”

Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.

Four factors emerged with strong reliability:

• Leadership and health system messaging.

• Data transparency and access.

• Comfort with cost conversations.

• Blame-free environment.

The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.

Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.

“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
 

Reference

Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.

Quick Byte: Cleaning robotic surgical instruments

Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.

Reference

1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.

Suzanne Bopp is a freelance writer in New Jersey.

Between 700,000 and 1 million people fall each year in U.S. hospitals, and about a third of those result in injuries that add an additional 6.3 days to hospital stays, according to a report from the Joint Commission Center for Transforming Healthcare. Some 11,000 falls are fatal. The Joint Commission Center for Transforming Healthcare has now issued a report on the subject called “Preventing Patient Falls: A Systematic Approach from the Joint Commission Center for Transforming Healthcare Project.”1

“We try to pick those topics that healthcare organizations just haven’t been able to fully tackle even though they’ve put a lot of time and resources into trying to fix them,” says Kelly Barnes, MS, a center project lead in the Center for Transforming Healthcare at The Joint Commission.

The Joint Commission project involved seven hospitals that used Robust Process Improvement, which incorporates tools from Lean Six Sigma and change management methodologies, to reduce falls with injury on inpatient pilot units within their organizations.

During the project, each organization identified the specific factors that led to falls with injury in their environment and developed solutions targeted to those factors. The organizations identified 30 root causes and developed 21 targeted solutions. Because the contributing factors were different at each organization, solution sets were unique to each. Afterward, the organizations saw an aggregate 35% reduction in falls and a 62% reduction in falls with injury.

“One of the takeaways is that you really need support across an organization to have success,” Barnes says. “The more engaged the entire organization is from top down all the way to the bottom, the more successful people are in solving the problems.”

The study resulted in a Targeted Solutions Tool (TST), free to all Joint Commission–accredited customers, to help hospitals.

“You can put your data right into the tool,” Barnes says. “It tells you what your top contributing factors are, and it gives you the solutions that have worked for those contributing factors at other organizations.”

Reference

Health Research & Educational Trust. Preventing patient falls: a systematic approach from the Joint Commission Center for Transforming Healthcare project. Hospitals in Pursuit of Excellence website.

Between 700,000 and 1 million people fall each year in U.S. hospitals, and about a third of those result in injuries that add an additional 6.3 days to hospital stays, according to a report from the Joint Commission Center for Transforming Healthcare. Some 11,000 falls are fatal. The Joint Commission Center for Transforming Healthcare has now issued a report on the subject called “Preventing Patient Falls: A Systematic Approach from the Joint Commission Center for Transforming Healthcare Project.”1

“We try to pick those topics that healthcare organizations just haven’t been able to fully tackle even though they’ve put a lot of time and resources into trying to fix them,” says Kelly Barnes, MS, a center project lead in the Center for Transforming Healthcare at The Joint Commission.

The Joint Commission project involved seven hospitals that used Robust Process Improvement, which incorporates tools from Lean Six Sigma and change management methodologies, to reduce falls with injury on inpatient pilot units within their organizations.

During the project, each organization identified the specific factors that led to falls with injury in their environment and developed solutions targeted to those factors. The organizations identified 30 root causes and developed 21 targeted solutions. Because the contributing factors were different at each organization, solution sets were unique to each. Afterward, the organizations saw an aggregate 35% reduction in falls and a 62% reduction in falls with injury.

“One of the takeaways is that you really need support across an organization to have success,” Barnes says. “The more engaged the entire organization is from top down all the way to the bottom, the more successful people are in solving the problems.”

The study resulted in a Targeted Solutions Tool (TST), free to all Joint Commission–accredited customers, to help hospitals.

“You can put your data right into the tool,” Barnes says. “It tells you what your top contributing factors are, and it gives you the solutions that have worked for those contributing factors at other organizations.”

Reference

Health Research & Educational Trust. Preventing patient falls: a systematic approach from the Joint Commission Center for Transforming Healthcare project. Hospitals in Pursuit of Excellence website.

Between 700,000 and 1 million people fall each year in U.S. hospitals, and about a third of those result in injuries that add an additional 6.3 days to hospital stays, according to a report from the Joint Commission Center for Transforming Healthcare. Some 11,000 falls are fatal. The Joint Commission Center for Transforming Healthcare has now issued a report on the subject called “Preventing Patient Falls: A Systematic Approach from the Joint Commission Center for Transforming Healthcare Project.”1

“We try to pick those topics that healthcare organizations just haven’t been able to fully tackle even though they’ve put a lot of time and resources into trying to fix them,” says Kelly Barnes, MS, a center project lead in the Center for Transforming Healthcare at The Joint Commission.

The Joint Commission project involved seven hospitals that used Robust Process Improvement, which incorporates tools from Lean Six Sigma and change management methodologies, to reduce falls with injury on inpatient pilot units within their organizations.

During the project, each organization identified the specific factors that led to falls with injury in their environment and developed solutions targeted to those factors. The organizations identified 30 root causes and developed 21 targeted solutions. Because the contributing factors were different at each organization, solution sets were unique to each. Afterward, the organizations saw an aggregate 35% reduction in falls and a 62% reduction in falls with injury.

“One of the takeaways is that you really need support across an organization to have success,” Barnes says. “The more engaged the entire organization is from top down all the way to the bottom, the more successful people are in solving the problems.”

The study resulted in a Targeted Solutions Tool (TST), free to all Joint Commission–accredited customers, to help hospitals.

“You can put your data right into the tool,” Barnes says. “It tells you what your top contributing factors are, and it gives you the solutions that have worked for those contributing factors at other organizations.”

Reference

Health Research & Educational Trust. Preventing patient falls: a systematic approach from the Joint Commission Center for Transforming Healthcare project. Hospitals in Pursuit of Excellence website.

Inpatient hospitalization can be a key time for patients to quit smoking, according to an abstract called “No More Butts: An Automated System for Inpatient Smoking Cessation Team Consults.”1

“Tobacco smoking continues to be one of the most important public health threats that we face,” says lead author Sujatha Sankaran, MD, assistant clinical professor in the division of hospital medicine and medical director of smoking cessation at the University of California, San Francisco. “Hospitalization is an extremely important moment and provides an excellent opportunity to counsel and provide cessation resources for people who are concerned about their health.”

Inpatients who receive smoking cessation counseling, nicotine replacement, and referral to outpatient resources have increased quit rates six weeks after hospital discharge, their research showed.

However, according to the abstract, in 2014:

• 34.5% of tobacco users admitted to one 600-bed academic hospital were documented as having received and accepted tobacco cessation counseling
• 45.7% of tobacco users received nicotine replacement therapy
• 1.35% of tobacco users received after-discharge consultations to outpatient smoking cessation resources

Researchers piloted a system in which a dedicated respiratory therapist–staffed smoking cessation consult service was trained to provide targeted tobacco cessation services to all inpatients who use tobacco. Of 1944 patients identified as using tobacco, 1545 received and accepted cessation counseling from a trained member of the Smoking Cessation Team, 1526 received nicotine replacement therapy, and 464 received an electronic referral to either a telephone or in-person quit line

“Hospitalists know firsthand the serious harm that tobacco use causes to patients but often are overwhelmed by the acute issues of patients and are unable to fully address tobacco use with hospitalized patients,” Dr. Sankaran says. “An automated cessation service can help lessen this burden by providing automatic cessation resources to all tobacco users.”

Reference

1. Sankaran S, Burke R, O’Keefe S. No more butts: an automated system for inpatient smoking cessation team consults [abstract]. J Hosp Med. 2016;11(suppl 1). Accessed November 9, 2016.

Inpatient hospitalization can be a key time for patients to quit smoking, according to an abstract called “No More Butts: An Automated System for Inpatient Smoking Cessation Team Consults.”1

“Tobacco smoking continues to be one of the most important public health threats that we face,” says lead author Sujatha Sankaran, MD, assistant clinical professor in the division of hospital medicine and medical director of smoking cessation at the University of California, San Francisco. “Hospitalization is an extremely important moment and provides an excellent opportunity to counsel and provide cessation resources for people who are concerned about their health.”

Inpatients who receive smoking cessation counseling, nicotine replacement, and referral to outpatient resources have increased quit rates six weeks after hospital discharge, their research showed.

However, according to the abstract, in 2014:

• 34.5% of tobacco users admitted to one 600-bed academic hospital were documented as having received and accepted tobacco cessation counseling
• 45.7% of tobacco users received nicotine replacement therapy
• 1.35% of tobacco users received after-discharge consultations to outpatient smoking cessation resources

Researchers piloted a system in which a dedicated respiratory therapist–staffed smoking cessation consult service was trained to provide targeted tobacco cessation services to all inpatients who use tobacco. Of 1944 patients identified as using tobacco, 1545 received and accepted cessation counseling from a trained member of the Smoking Cessation Team, 1526 received nicotine replacement therapy, and 464 received an electronic referral to either a telephone or in-person quit line

“Hospitalists know firsthand the serious harm that tobacco use causes to patients but often are overwhelmed by the acute issues of patients and are unable to fully address tobacco use with hospitalized patients,” Dr. Sankaran says. “An automated cessation service can help lessen this burden by providing automatic cessation resources to all tobacco users.”

Reference

1. Sankaran S, Burke R, O’Keefe S. No more butts: an automated system for inpatient smoking cessation team consults [abstract]. J Hosp Med. 2016;11(suppl 1). Accessed November 9, 2016.

Inpatient hospitalization can be a key time for patients to quit smoking, according to an abstract called “No More Butts: An Automated System for Inpatient Smoking Cessation Team Consults.”1

“Tobacco smoking continues to be one of the most important public health threats that we face,” says lead author Sujatha Sankaran, MD, assistant clinical professor in the division of hospital medicine and medical director of smoking cessation at the University of California, San Francisco. “Hospitalization is an extremely important moment and provides an excellent opportunity to counsel and provide cessation resources for people who are concerned about their health.”

Inpatients who receive smoking cessation counseling, nicotine replacement, and referral to outpatient resources have increased quit rates six weeks after hospital discharge, their research showed.

However, according to the abstract, in 2014:

• 34.5% of tobacco users admitted to one 600-bed academic hospital were documented as having received and accepted tobacco cessation counseling
• 45.7% of tobacco users received nicotine replacement therapy
• 1.35% of tobacco users received after-discharge consultations to outpatient smoking cessation resources

Researchers piloted a system in which a dedicated respiratory therapist–staffed smoking cessation consult service was trained to provide targeted tobacco cessation services to all inpatients who use tobacco. Of 1944 patients identified as using tobacco, 1545 received and accepted cessation counseling from a trained member of the Smoking Cessation Team, 1526 received nicotine replacement therapy, and 464 received an electronic referral to either a telephone or in-person quit line

“Hospitalists know firsthand the serious harm that tobacco use causes to patients but often are overwhelmed by the acute issues of patients and are unable to fully address tobacco use with hospitalized patients,” Dr. Sankaran says. “An automated cessation service can help lessen this burden by providing automatic cessation resources to all tobacco users.”

Reference

1. Sankaran S, Burke R, O’Keefe S. No more butts: an automated system for inpatient smoking cessation team consults [abstract]. J Hosp Med. 2016;11(suppl 1). Accessed November 9, 2016.