Thomas R. Collins

Course Director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School, talks about the SHM annual meeting's new emphasis on work-life balance and on how her past experience at the annual meeting influenced how she helped shape this year's meeting.

Course Director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School, talks about the SHM annual meeting's new emphasis on work-life balance and on how her past experience at the annual meeting influenced how she helped shape this year's meeting.

Course Director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School, talks about the SHM annual meeting's new emphasis on work-life balance and on how her past experience at the annual meeting influenced how she helped shape this year's meeting.

As Karen Smith, MD, SFHM, chief of hospital medicine at Children’s National Health System in Washington, D.C., sees it, communication problems often arise at the first possible opportunity, when she’s trying to find out whom to call when she needs to inform a primary care physician or specialist about a hospitalized patient. Sometimes, that information isn’t readily available.

“Which specialist is on and available to talk?” she says.

Then there’s timing.

“By the time we can set up a time to actually talk to people, it’s after normal business hours,” Dr. Smith says. “People aren’t answering their office phones after five. …Your other choice is going through the answering service, but then you get a variety of people and not the person who knows this patient.”

Dr. Smith spearheaded an effort to reach out in a more reliable fashion to community physicians, with a goal of speaking to—or, more commonly, leaving messages with—at least 90% of hospitalized patients’ physicians. They reached the goal, but it was an eye-opening effort.

“The feedback I got from the hospitalists was it’s ‘just so difficult,’” Dr. Smith says. “I’m sitting on the phone waiting to get ahold of someone. Even trying to use administrative people and have them call and contact us, which is kind of complicated to do.”

Yul Ejnes, MD, MACP, a past chair of the board of regents of the American College of Physicians and an internist at Coastal Medical in R.I., says that if he were grading hospitalist communication with primary care providers on a poor-fair-good-excellent scale, he would give it a “fair.”

“It runs the spectrum from getting nothing—which is rare, I have to say—to getting at least a notification that your patient is in the hospital: ‘Here’s a contact number,’ sometimes with diagnosis,” he says. “And, much less commonly, getting a phone call. That usually occurs when there are questions.”

Dr. Ejnes says consistent communication is not as “robust as I would like it to be.”

“Some institutions do much better than others, in terms of the hospitalist always letting us know patients have come in,” he says. “With others, it doesn’t seem to be part of the institutional culture.”

There has to be a better way.

And, in fact, Dr. Smith and many other hospitalists are developing ways to better use technology to communicate more effectively with primary care, specialists, nurses, and patients. The goal is to make communication more routine, more effective, and more convenient for both parties, all the while—hopefully—improving patient care and strengthening working relationships.

Most of the approaches are not ultra-high tech. Too high tech might, in itself, be a potential barrier to communication for those who might be uncomfortable with new technology. Instead, the initiatives are mostly common sense tweaks to—or new, logical uses of—existing technology.

EHR-Embedded Communication

At Children’s National, Dr. Smith and colleagues use a standardized letter as part of a patient’s electronic health record (EHR). In addition to facts about the patient’s condition, the EHR includes information that makes it easier for physicians to communicate.

“What’s lovely with that is that [the letter] tells the provider the team that they’re on,” she said, adding that teams are divided by letter and color. “It has information on how you can reach the doctor. All of our doctors carry a phone around with them, and so it’s got that number.”

The EHR also includes a note suggesting that physicians avoid calling during rounds and gives them information on how to access the portal, so they can follow along with the patient’s care, should they choose to do so.

 

The amount of actual contact from primary care physicians? Scarce. Maybe one of 20 pediatricians will actually place a call to the hospitalist, but the response she has received has been positive, Dr. Smith says.

The EHR note also includes a sentence further characterizing the patient’s care, such as: Bobby C. was admitted with bronchiolitis. He’s doing fine; I anticipate he will go home tomorrow.

“Pediatricians have loved that,” she says. “They say, ‘I know exactly what my patient’s there for. I had the ability to call if I want.’”

Smarter Pages

At Vanderbilt University Medical Center in Nashville, Tenn., hospitalists noticed a frequent occurrence with pages: Many times, the hospitalist would only receive a phone number.

“With that, you don’t know which patient it’s about, who called you, how urgent it is, or what they need,” says researcher Sunil Kripalani, MD, MSc, SFHM, associate professor and chief of the section of hospital medicine at Vanderbilt.

It’s a tough spot for a busy hospitalist, who might be on the phone or at a bedside with another patient when three, four, or even five pages come through. The page might just be an FYI requiring no callback. It might be urgent. It might be the same page sent multiple times from different numbers (e.g. nursing moving to various phones). Many times, Dr. Kripalani and his hospitalists have had no way to know.

Now, Vanderbilt has established an online template for text pages, with the following basic information:

• Patient;
• Room number;
• Urgency level;
• Name of the sender;
• Callback number;
• Message; and
• Whether or not a callback is needed.

“That structure is very helpful for allowing physicians to triage which pages to call back and how quickly,” Dr. Kripalani says.

He acknowledges it isn’t “fancy bells and whistles.”

“Sometimes it’s doing the basic things well that makes the difference,” he adds.

The “structured pages” have allowed the nature of pages to be analyzed. Dr. Kripalani and colleagues have found that approximately 5% of pages were about a patient’s dietary status. If the patient was ordered not to receive anything by mouth, pages asked, when did that order expire and what diet should the patient resume?

Now, a prompt for that information is included in the hospital’s order entry system, which has cut the number of pages sent.

Vanderbilt is now looking at other, similar ways to streamline communication.

Patients and iPads

At the University of Colorado Hospital in Denver, researchers had an idea to facilitate communication and patient education: Patients are always inquiring about their discharge status and other facets of their hospitalization; what if they got their own tablet to follow along with everything in real time?1

The only real requirements for the study were that patients had to have Internet access at home and an understanding of how to work a web browser, says Jonathan Pell, MD, SFHM, assistant professor of internal medicine at the University of Colorado in Aurora and a hospitalist at University of Colorado Hospital. Patients were shown how to access their schedule for the day, their medication list and dosing schedule, and test results. Much of the information was delivered in real time, so patients who were told that if a lab result came back at a certain level they could be discharged could perhaps start preparing for that possibility earlier than they might have otherwise.

Researchers found that their patients worried less and reported less confusion. They also found that providing the tablets didn’t cause any increase in workload for doctors or nurses.

 

Providers and nurses expected that patients would notice medication errors, but that endpoint was not significant. Surprisingly, patients’ understanding of discharge times did not live up to expectations. But the results overall were encouraging enough that the effort will continue.

“We have these mixed results,” Dr. Pell says. “I think it’s good to get something out there in the literature and see what else people may be interested in doing. Our next step is to potentially open up notes to patients and let them see their doctor’s and nurse’s notes during their hospitalization.”

He says that, in some cases, communication with patients is the most crucial channel for hospitalists.

“For the very engaged patient [who has] a busy primary care doctor who’s hard to get in touch with,” he explains, “using the patient, informing them well, and getting them all the information they need is actually the best way to make sure that transition of care is smooth.”

Discharge, Facebook-Style

New England Inpatient Specialists (NEIS), a hospitalist group in North Andover, Mass., has an interesting approach to discharge. Instead of a nurse picking up the phone to make a follow-up appointment for a patient leaving the hospital, a secretary posts a message on “Chatter,” a secure tool similar to Facebook. The technology was developed by Salesforce.com, which offers platforms mainly designed to assist businesses with communication.

The idea behind Chatter is that the primary care office personnel can respond to a post at a time that’s convenient to them.

“All of this is so time-consuming. Why would you want somebody like an RN spending 15 to 20 minutes on the phone setting up an appointment when she could be on the floor?” says Sawad Thotathil, MD, vice president of performance and physician recruitment at NEIS. “Our program secretary will just post a discharge, and then somebody at the practice will look at it when they can and find out what associated information is needed and answer at their own convenience.”

Dr. Thotathil’s group also has been using the Imprivata Cortext secure text messaging system for more than a year, with what he deems “overall positive” results. About 60% of the practices with which NEIS staff need to communicate have signed on to the system.

“That kind of helps in management,” he says. “Sometimes, a patient is in the hospital and you can text the cardiologist, asking if the patient can be taken on for a procedure. That kind of communication, which would have taken longer or would not have happened, is happening now.

“Have we been able to directly link it to better outcomes?” he adds. “No, we haven’t looked at it that way. But what we have seen is that there’s always going to be a variation in how many people in a network actually will use it. ... There are going to be those high users, and there are going to be those providers who are going to be minimally using it.”

Videoconferencing

Pediatric hospitalists at the main hospital at Children’s National have been helping to provide care to children who are seen at five community sites. Dr. Smith says the communication at these sites, mostly from the ED, in which the pediatric hospitalists are helping make medical decisions, has been dramatically enhanced.

“The visual aspect of it changes the whole conversation,” she says. “You could tell them the exact same thing verbally and they are like, ‘OK, that’s fine,’ and there doesn’t seem to be a true understanding of what I’m trying to impart to you. Once people look at the child, all of a sudden there is a true shared mental model of, ‘OK, I understand what you’re doing. What’s going on?’”

 

Hospitalists also have been spearheading videoconferencing at diabetes clinics, to provide better care at community sites.

“We know what the need is. We know the gap in care,” Dr. Smith says. “We’ve been able to advocate and get those specialists brought out to the community via telemedicine, if it’s too difficult to get out on a regular basis.”

There are no hard data on the effects of the programs, but Dr. Smith says the improvement is noticeable.

“Anecdotally, we’ve seen a decrease in kids coming in with DKA (diabetic ketoacidosis) to the emergency room, so we’ve been able to change some of the trajectory. Many of those kids just didn’t have access to care. [For some], it would be a day’s trip for them to get to one of the academic centers to get follow up. They just wouldn’t go.”

EHR-Facilitated Calls

At Cincinnati Children’s, phone contact with community pediatricians at discharge is established with remarkable consistency: 98% to 99% of the time. The reason? A communication system, “Priority Link,” is connected to the EHR.

When the hospitalist signs a discharge order, the patient’s name is put in a queue. An operator sends out a page to inform the resident that the call is about to be made to the outpatient physician, making sure they’re ready for the call to be made.

“The key innovation was that we were trying to make sure that the inpatient side of it was really ready for the call, so we weren’t placing calls out to doctors and then we weren’t ready,” says Jeffrey Simmons, MD, MSc, associate director of clinical operations and quality in Cincinnati Children’s hospital medicine division.

He says there has been some pushback from pediatricians who feel the calls don’t provide any more value than the discharge summary itself. But the opportunity for questions and for a dialogue makes the calls worthwhile, Dr. Simmons notes. The system could be improved by tailoring communications to the community physicians’ preference—via fax or email, perhaps—and by having the call placed by physicians who are more knowledgeable about the details of the case.

Priority Link also is used to help community physicians with direct admissions for patients who don’t need to go to the ED. The operator coordinates a three-way call among the community physician, the hospitalist, and a nurse familiar with the bed situation.

“That three-way call is really great because we’re big and busy enough that sometimes we need that nurse manager on the phone, too, to No. 1, let us know if there really is a bed and, No. 2, coordinate with the nursing unit,” he says. TH

---

Tom Collins is a freelance writer in South Florida.

Reference

Pell JM, Mancuso M, Limon S, Oman K, Lin CT. Patient access to electronic health records during hospitalization. JAMA Intern Med. 2015;175(5):856-858. doi: 10.1001/jamainternmed.2015.121.

 

As Karen Smith, MD, SFHM, chief of hospital medicine at Children’s National Health System in Washington, D.C., sees it, communication problems often arise at the first possible opportunity, when she’s trying to find out whom to call when she needs to inform a primary care physician or specialist about a hospitalized patient. Sometimes, that information isn’t readily available.

“Which specialist is on and available to talk?” she says.

Then there’s timing.

“By the time we can set up a time to actually talk to people, it’s after normal business hours,” Dr. Smith says. “People aren’t answering their office phones after five. …Your other choice is going through the answering service, but then you get a variety of people and not the person who knows this patient.”

Dr. Smith spearheaded an effort to reach out in a more reliable fashion to community physicians, with a goal of speaking to—or, more commonly, leaving messages with—at least 90% of hospitalized patients’ physicians. They reached the goal, but it was an eye-opening effort.

“The feedback I got from the hospitalists was it’s ‘just so difficult,’” Dr. Smith says. “I’m sitting on the phone waiting to get ahold of someone. Even trying to use administrative people and have them call and contact us, which is kind of complicated to do.”

Yul Ejnes, MD, MACP, a past chair of the board of regents of the American College of Physicians and an internist at Coastal Medical in R.I., says that if he were grading hospitalist communication with primary care providers on a poor-fair-good-excellent scale, he would give it a “fair.”

“It runs the spectrum from getting nothing—which is rare, I have to say—to getting at least a notification that your patient is in the hospital: ‘Here’s a contact number,’ sometimes with diagnosis,” he says. “And, much less commonly, getting a phone call. That usually occurs when there are questions.”

Dr. Ejnes says consistent communication is not as “robust as I would like it to be.”

“Some institutions do much better than others, in terms of the hospitalist always letting us know patients have come in,” he says. “With others, it doesn’t seem to be part of the institutional culture.”

There has to be a better way.

And, in fact, Dr. Smith and many other hospitalists are developing ways to better use technology to communicate more effectively with primary care, specialists, nurses, and patients. The goal is to make communication more routine, more effective, and more convenient for both parties, all the while—hopefully—improving patient care and strengthening working relationships.

Most of the approaches are not ultra-high tech. Too high tech might, in itself, be a potential barrier to communication for those who might be uncomfortable with new technology. Instead, the initiatives are mostly common sense tweaks to—or new, logical uses of—existing technology.

EHR-Embedded Communication

At Children’s National, Dr. Smith and colleagues use a standardized letter as part of a patient’s electronic health record (EHR). In addition to facts about the patient’s condition, the EHR includes information that makes it easier for physicians to communicate.

“What’s lovely with that is that [the letter] tells the provider the team that they’re on,” she said, adding that teams are divided by letter and color. “It has information on how you can reach the doctor. All of our doctors carry a phone around with them, and so it’s got that number.”

The EHR also includes a note suggesting that physicians avoid calling during rounds and gives them information on how to access the portal, so they can follow along with the patient’s care, should they choose to do so.

 

The amount of actual contact from primary care physicians? Scarce. Maybe one of 20 pediatricians will actually place a call to the hospitalist, but the response she has received has been positive, Dr. Smith says.

The EHR note also includes a sentence further characterizing the patient’s care, such as: Bobby C. was admitted with bronchiolitis. He’s doing fine; I anticipate he will go home tomorrow.

“Pediatricians have loved that,” she says. “They say, ‘I know exactly what my patient’s there for. I had the ability to call if I want.’”

Smarter Pages

At Vanderbilt University Medical Center in Nashville, Tenn., hospitalists noticed a frequent occurrence with pages: Many times, the hospitalist would only receive a phone number.

“With that, you don’t know which patient it’s about, who called you, how urgent it is, or what they need,” says researcher Sunil Kripalani, MD, MSc, SFHM, associate professor and chief of the section of hospital medicine at Vanderbilt.

It’s a tough spot for a busy hospitalist, who might be on the phone or at a bedside with another patient when three, four, or even five pages come through. The page might just be an FYI requiring no callback. It might be urgent. It might be the same page sent multiple times from different numbers (e.g. nursing moving to various phones). Many times, Dr. Kripalani and his hospitalists have had no way to know.

Now, Vanderbilt has established an online template for text pages, with the following basic information:

• Patient;
• Room number;
• Urgency level;
• Name of the sender;
• Callback number;
• Message; and
• Whether or not a callback is needed.

“That structure is very helpful for allowing physicians to triage which pages to call back and how quickly,” Dr. Kripalani says.

He acknowledges it isn’t “fancy bells and whistles.”

“Sometimes it’s doing the basic things well that makes the difference,” he adds.

The “structured pages” have allowed the nature of pages to be analyzed. Dr. Kripalani and colleagues have found that approximately 5% of pages were about a patient’s dietary status. If the patient was ordered not to receive anything by mouth, pages asked, when did that order expire and what diet should the patient resume?

Now, a prompt for that information is included in the hospital’s order entry system, which has cut the number of pages sent.

Vanderbilt is now looking at other, similar ways to streamline communication.

Patients and iPads

At the University of Colorado Hospital in Denver, researchers had an idea to facilitate communication and patient education: Patients are always inquiring about their discharge status and other facets of their hospitalization; what if they got their own tablet to follow along with everything in real time?1

The only real requirements for the study were that patients had to have Internet access at home and an understanding of how to work a web browser, says Jonathan Pell, MD, SFHM, assistant professor of internal medicine at the University of Colorado in Aurora and a hospitalist at University of Colorado Hospital. Patients were shown how to access their schedule for the day, their medication list and dosing schedule, and test results. Much of the information was delivered in real time, so patients who were told that if a lab result came back at a certain level they could be discharged could perhaps start preparing for that possibility earlier than they might have otherwise.

Researchers found that their patients worried less and reported less confusion. They also found that providing the tablets didn’t cause any increase in workload for doctors or nurses.

 

Providers and nurses expected that patients would notice medication errors, but that endpoint was not significant. Surprisingly, patients’ understanding of discharge times did not live up to expectations. But the results overall were encouraging enough that the effort will continue.

“We have these mixed results,” Dr. Pell says. “I think it’s good to get something out there in the literature and see what else people may be interested in doing. Our next step is to potentially open up notes to patients and let them see their doctor’s and nurse’s notes during their hospitalization.”

He says that, in some cases, communication with patients is the most crucial channel for hospitalists.

“For the very engaged patient [who has] a busy primary care doctor who’s hard to get in touch with,” he explains, “using the patient, informing them well, and getting them all the information they need is actually the best way to make sure that transition of care is smooth.”

Discharge, Facebook-Style

New England Inpatient Specialists (NEIS), a hospitalist group in North Andover, Mass., has an interesting approach to discharge. Instead of a nurse picking up the phone to make a follow-up appointment for a patient leaving the hospital, a secretary posts a message on “Chatter,” a secure tool similar to Facebook. The technology was developed by Salesforce.com, which offers platforms mainly designed to assist businesses with communication.

The idea behind Chatter is that the primary care office personnel can respond to a post at a time that’s convenient to them.

“All of this is so time-consuming. Why would you want somebody like an RN spending 15 to 20 minutes on the phone setting up an appointment when she could be on the floor?” says Sawad Thotathil, MD, vice president of performance and physician recruitment at NEIS. “Our program secretary will just post a discharge, and then somebody at the practice will look at it when they can and find out what associated information is needed and answer at their own convenience.”

Dr. Thotathil’s group also has been using the Imprivata Cortext secure text messaging system for more than a year, with what he deems “overall positive” results. About 60% of the practices with which NEIS staff need to communicate have signed on to the system.

“That kind of helps in management,” he says. “Sometimes, a patient is in the hospital and you can text the cardiologist, asking if the patient can be taken on for a procedure. That kind of communication, which would have taken longer or would not have happened, is happening now.

“Have we been able to directly link it to better outcomes?” he adds. “No, we haven’t looked at it that way. But what we have seen is that there’s always going to be a variation in how many people in a network actually will use it. ... There are going to be those high users, and there are going to be those providers who are going to be minimally using it.”

Videoconferencing

Pediatric hospitalists at the main hospital at Children’s National have been helping to provide care to children who are seen at five community sites. Dr. Smith says the communication at these sites, mostly from the ED, in which the pediatric hospitalists are helping make medical decisions, has been dramatically enhanced.

“The visual aspect of it changes the whole conversation,” she says. “You could tell them the exact same thing verbally and they are like, ‘OK, that’s fine,’ and there doesn’t seem to be a true understanding of what I’m trying to impart to you. Once people look at the child, all of a sudden there is a true shared mental model of, ‘OK, I understand what you’re doing. What’s going on?’”

 

Hospitalists also have been spearheading videoconferencing at diabetes clinics, to provide better care at community sites.

“We know what the need is. We know the gap in care,” Dr. Smith says. “We’ve been able to advocate and get those specialists brought out to the community via telemedicine, if it’s too difficult to get out on a regular basis.”

There are no hard data on the effects of the programs, but Dr. Smith says the improvement is noticeable.

“Anecdotally, we’ve seen a decrease in kids coming in with DKA (diabetic ketoacidosis) to the emergency room, so we’ve been able to change some of the trajectory. Many of those kids just didn’t have access to care. [For some], it would be a day’s trip for them to get to one of the academic centers to get follow up. They just wouldn’t go.”

EHR-Facilitated Calls

At Cincinnati Children’s, phone contact with community pediatricians at discharge is established with remarkable consistency: 98% to 99% of the time. The reason? A communication system, “Priority Link,” is connected to the EHR.

When the hospitalist signs a discharge order, the patient’s name is put in a queue. An operator sends out a page to inform the resident that the call is about to be made to the outpatient physician, making sure they’re ready for the call to be made.

“The key innovation was that we were trying to make sure that the inpatient side of it was really ready for the call, so we weren’t placing calls out to doctors and then we weren’t ready,” says Jeffrey Simmons, MD, MSc, associate director of clinical operations and quality in Cincinnati Children’s hospital medicine division.

He says there has been some pushback from pediatricians who feel the calls don’t provide any more value than the discharge summary itself. But the opportunity for questions and for a dialogue makes the calls worthwhile, Dr. Simmons notes. The system could be improved by tailoring communications to the community physicians’ preference—via fax or email, perhaps—and by having the call placed by physicians who are more knowledgeable about the details of the case.

Priority Link also is used to help community physicians with direct admissions for patients who don’t need to go to the ED. The operator coordinates a three-way call among the community physician, the hospitalist, and a nurse familiar with the bed situation.

“That three-way call is really great because we’re big and busy enough that sometimes we need that nurse manager on the phone, too, to No. 1, let us know if there really is a bed and, No. 2, coordinate with the nursing unit,” he says. TH

---

Tom Collins is a freelance writer in South Florida.

Reference

Pell JM, Mancuso M, Limon S, Oman K, Lin CT. Patient access to electronic health records during hospitalization. JAMA Intern Med. 2015;175(5):856-858. doi: 10.1001/jamainternmed.2015.121.

 

As Karen Smith, MD, SFHM, chief of hospital medicine at Children’s National Health System in Washington, D.C., sees it, communication problems often arise at the first possible opportunity, when she’s trying to find out whom to call when she needs to inform a primary care physician or specialist about a hospitalized patient. Sometimes, that information isn’t readily available.

“Which specialist is on and available to talk?” she says.

Then there’s timing.

“By the time we can set up a time to actually talk to people, it’s after normal business hours,” Dr. Smith says. “People aren’t answering their office phones after five. …Your other choice is going through the answering service, but then you get a variety of people and not the person who knows this patient.”

Dr. Smith spearheaded an effort to reach out in a more reliable fashion to community physicians, with a goal of speaking to—or, more commonly, leaving messages with—at least 90% of hospitalized patients’ physicians. They reached the goal, but it was an eye-opening effort.

“The feedback I got from the hospitalists was it’s ‘just so difficult,’” Dr. Smith says. “I’m sitting on the phone waiting to get ahold of someone. Even trying to use administrative people and have them call and contact us, which is kind of complicated to do.”

Yul Ejnes, MD, MACP, a past chair of the board of regents of the American College of Physicians and an internist at Coastal Medical in R.I., says that if he were grading hospitalist communication with primary care providers on a poor-fair-good-excellent scale, he would give it a “fair.”

“It runs the spectrum from getting nothing—which is rare, I have to say—to getting at least a notification that your patient is in the hospital: ‘Here’s a contact number,’ sometimes with diagnosis,” he says. “And, much less commonly, getting a phone call. That usually occurs when there are questions.”

Dr. Ejnes says consistent communication is not as “robust as I would like it to be.”

“Some institutions do much better than others, in terms of the hospitalist always letting us know patients have come in,” he says. “With others, it doesn’t seem to be part of the institutional culture.”

There has to be a better way.

And, in fact, Dr. Smith and many other hospitalists are developing ways to better use technology to communicate more effectively with primary care, specialists, nurses, and patients. The goal is to make communication more routine, more effective, and more convenient for both parties, all the while—hopefully—improving patient care and strengthening working relationships.

Most of the approaches are not ultra-high tech. Too high tech might, in itself, be a potential barrier to communication for those who might be uncomfortable with new technology. Instead, the initiatives are mostly common sense tweaks to—or new, logical uses of—existing technology.

EHR-Embedded Communication

At Children’s National, Dr. Smith and colleagues use a standardized letter as part of a patient’s electronic health record (EHR). In addition to facts about the patient’s condition, the EHR includes information that makes it easier for physicians to communicate.

“What’s lovely with that is that [the letter] tells the provider the team that they’re on,” she said, adding that teams are divided by letter and color. “It has information on how you can reach the doctor. All of our doctors carry a phone around with them, and so it’s got that number.”

The EHR also includes a note suggesting that physicians avoid calling during rounds and gives them information on how to access the portal, so they can follow along with the patient’s care, should they choose to do so.

 

The amount of actual contact from primary care physicians? Scarce. Maybe one of 20 pediatricians will actually place a call to the hospitalist, but the response she has received has been positive, Dr. Smith says.

The EHR note also includes a sentence further characterizing the patient’s care, such as: Bobby C. was admitted with bronchiolitis. He’s doing fine; I anticipate he will go home tomorrow.

“Pediatricians have loved that,” she says. “They say, ‘I know exactly what my patient’s there for. I had the ability to call if I want.’”

Smarter Pages

At Vanderbilt University Medical Center in Nashville, Tenn., hospitalists noticed a frequent occurrence with pages: Many times, the hospitalist would only receive a phone number.

“With that, you don’t know which patient it’s about, who called you, how urgent it is, or what they need,” says researcher Sunil Kripalani, MD, MSc, SFHM, associate professor and chief of the section of hospital medicine at Vanderbilt.

It’s a tough spot for a busy hospitalist, who might be on the phone or at a bedside with another patient when three, four, or even five pages come through. The page might just be an FYI requiring no callback. It might be urgent. It might be the same page sent multiple times from different numbers (e.g. nursing moving to various phones). Many times, Dr. Kripalani and his hospitalists have had no way to know.

Now, Vanderbilt has established an online template for text pages, with the following basic information:

• Patient;
• Room number;
• Urgency level;
• Name of the sender;
• Callback number;
• Message; and
• Whether or not a callback is needed.

“That structure is very helpful for allowing physicians to triage which pages to call back and how quickly,” Dr. Kripalani says.

He acknowledges it isn’t “fancy bells and whistles.”

“Sometimes it’s doing the basic things well that makes the difference,” he adds.

The “structured pages” have allowed the nature of pages to be analyzed. Dr. Kripalani and colleagues have found that approximately 5% of pages were about a patient’s dietary status. If the patient was ordered not to receive anything by mouth, pages asked, when did that order expire and what diet should the patient resume?

Now, a prompt for that information is included in the hospital’s order entry system, which has cut the number of pages sent.

Vanderbilt is now looking at other, similar ways to streamline communication.

Patients and iPads

At the University of Colorado Hospital in Denver, researchers had an idea to facilitate communication and patient education: Patients are always inquiring about their discharge status and other facets of their hospitalization; what if they got their own tablet to follow along with everything in real time?1

The only real requirements for the study were that patients had to have Internet access at home and an understanding of how to work a web browser, says Jonathan Pell, MD, SFHM, assistant professor of internal medicine at the University of Colorado in Aurora and a hospitalist at University of Colorado Hospital. Patients were shown how to access their schedule for the day, their medication list and dosing schedule, and test results. Much of the information was delivered in real time, so patients who were told that if a lab result came back at a certain level they could be discharged could perhaps start preparing for that possibility earlier than they might have otherwise.

Researchers found that their patients worried less and reported less confusion. They also found that providing the tablets didn’t cause any increase in workload for doctors or nurses.

 

Providers and nurses expected that patients would notice medication errors, but that endpoint was not significant. Surprisingly, patients’ understanding of discharge times did not live up to expectations. But the results overall were encouraging enough that the effort will continue.

“We have these mixed results,” Dr. Pell says. “I think it’s good to get something out there in the literature and see what else people may be interested in doing. Our next step is to potentially open up notes to patients and let them see their doctor’s and nurse’s notes during their hospitalization.”

He says that, in some cases, communication with patients is the most crucial channel for hospitalists.

“For the very engaged patient [who has] a busy primary care doctor who’s hard to get in touch with,” he explains, “using the patient, informing them well, and getting them all the information they need is actually the best way to make sure that transition of care is smooth.”

Discharge, Facebook-Style

New England Inpatient Specialists (NEIS), a hospitalist group in North Andover, Mass., has an interesting approach to discharge. Instead of a nurse picking up the phone to make a follow-up appointment for a patient leaving the hospital, a secretary posts a message on “Chatter,” a secure tool similar to Facebook. The technology was developed by Salesforce.com, which offers platforms mainly designed to assist businesses with communication.

The idea behind Chatter is that the primary care office personnel can respond to a post at a time that’s convenient to them.

“All of this is so time-consuming. Why would you want somebody like an RN spending 15 to 20 minutes on the phone setting up an appointment when she could be on the floor?” says Sawad Thotathil, MD, vice president of performance and physician recruitment at NEIS. “Our program secretary will just post a discharge, and then somebody at the practice will look at it when they can and find out what associated information is needed and answer at their own convenience.”

Dr. Thotathil’s group also has been using the Imprivata Cortext secure text messaging system for more than a year, with what he deems “overall positive” results. About 60% of the practices with which NEIS staff need to communicate have signed on to the system.

“That kind of helps in management,” he says. “Sometimes, a patient is in the hospital and you can text the cardiologist, asking if the patient can be taken on for a procedure. That kind of communication, which would have taken longer or would not have happened, is happening now.

“Have we been able to directly link it to better outcomes?” he adds. “No, we haven’t looked at it that way. But what we have seen is that there’s always going to be a variation in how many people in a network actually will use it. ... There are going to be those high users, and there are going to be those providers who are going to be minimally using it.”

Videoconferencing

Pediatric hospitalists at the main hospital at Children’s National have been helping to provide care to children who are seen at five community sites. Dr. Smith says the communication at these sites, mostly from the ED, in which the pediatric hospitalists are helping make medical decisions, has been dramatically enhanced.

“The visual aspect of it changes the whole conversation,” she says. “You could tell them the exact same thing verbally and they are like, ‘OK, that’s fine,’ and there doesn’t seem to be a true understanding of what I’m trying to impart to you. Once people look at the child, all of a sudden there is a true shared mental model of, ‘OK, I understand what you’re doing. What’s going on?’”

 

Hospitalists also have been spearheading videoconferencing at diabetes clinics, to provide better care at community sites.

“We know what the need is. We know the gap in care,” Dr. Smith says. “We’ve been able to advocate and get those specialists brought out to the community via telemedicine, if it’s too difficult to get out on a regular basis.”

There are no hard data on the effects of the programs, but Dr. Smith says the improvement is noticeable.

“Anecdotally, we’ve seen a decrease in kids coming in with DKA (diabetic ketoacidosis) to the emergency room, so we’ve been able to change some of the trajectory. Many of those kids just didn’t have access to care. [For some], it would be a day’s trip for them to get to one of the academic centers to get follow up. They just wouldn’t go.”

EHR-Facilitated Calls

At Cincinnati Children’s, phone contact with community pediatricians at discharge is established with remarkable consistency: 98% to 99% of the time. The reason? A communication system, “Priority Link,” is connected to the EHR.

When the hospitalist signs a discharge order, the patient’s name is put in a queue. An operator sends out a page to inform the resident that the call is about to be made to the outpatient physician, making sure they’re ready for the call to be made.

“The key innovation was that we were trying to make sure that the inpatient side of it was really ready for the call, so we weren’t placing calls out to doctors and then we weren’t ready,” says Jeffrey Simmons, MD, MSc, associate director of clinical operations and quality in Cincinnati Children’s hospital medicine division.

He says there has been some pushback from pediatricians who feel the calls don’t provide any more value than the discharge summary itself. But the opportunity for questions and for a dialogue makes the calls worthwhile, Dr. Simmons notes. The system could be improved by tailoring communications to the community physicians’ preference—via fax or email, perhaps—and by having the call placed by physicians who are more knowledgeable about the details of the case.

Priority Link also is used to help community physicians with direct admissions for patients who don’t need to go to the ED. The operator coordinates a three-way call among the community physician, the hospitalist, and a nurse familiar with the bed situation.

“That three-way call is really great because we’re big and busy enough that sometimes we need that nurse manager on the phone, too, to No. 1, let us know if there really is a bed and, No. 2, coordinate with the nursing unit,” he says. TH

---

Tom Collins is a freelance writer in South Florida.

Reference

Pell JM, Mancuso M, Limon S, Oman K, Lin CT. Patient access to electronic health records during hospitalization. JAMA Intern Med. 2015;175(5):856-858. doi: 10.1001/jamainternmed.2015.121.

 

Health information technology (IT) will take center stage early and often at this year’s annual meeting of the Society of Hospital Medicine.

Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health in the U.S. Department of Health & Human Services (HHS) and the national coordinator for health information technology, will deliver the keynote address. She is scheduled to give her talk an hour into the first day of programming.

Another highly anticipated talk will be delivered by Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, the “godfather” of hospital medicine, and the field’s most well-known practitioner. Dr. Wachter will give his 12th straight meeting-closing talk at noon Wednesday.

Dr. DeSalvo, an internist by training, was the chief of general internal medicine at Tulane University for about 10 years. She also started at Charity Hospital in New Orleans, site of one of the earliest hospital medicine programs.

She says her speech will take a broad look at information technology as a tool for advancing good health, with attention to the role that hospitals and hospitalists play. She also plans to touch on the successes in U.S. healthcare in recent years, including expanded coverage, quality and safety improvements, and the rapid rate of adoption of electronic health records (EHRs), especially in the hospital. She says the hospital setting is “most ripe” for health IT advancement because it is the site of “the most rich data about the patient’s care and care experience and health … and there is the best interoperability right now between hospital systems and the best opportunity to make that more seamless.”

The future, she says, will be about “much more than the electronic health record.”

“I want to talk a bit about what’s happening on the pioneering edge in health IT, ranging anywhere from apps to consumer interface with digital health records to some really on-the-edge things like using telehealth and hologram technology for remote patient care,” she explains.

Dr. DeSalvo also plans to underscore health IT’s key role in HHS’s push for delivery system reform: changing the way care is paid for and delivered and the way information is delivered. HHS’s goal is for 50% of payments to be in the form of alternative or value-based payment models by 2018. Without health IT advancements, that won’t be possible, she says.

Health IT policy at HHS, she notes, has centered largely on “freeing the data” so that information is no longer trapped within a particular EHR system. A rule taking effect in 2018 will require that EHRs be built so that apps can be overlaid onto the data, allowing easier access and the ability to tailor data to an individual’s needs.

“It’s going to get to be more like the way we do our banking or call for transportation with a smartphone or have an interface for our travel arrangements,” she says. “That’s the way that the health IT world is evolving.”

She says hospitalists are “pioneering, early adopters who are by nature very innovative” and are ideal for helping refine health IT. But she also recognizes that the bumps along the way can cause technology to be seen as a hurdle. That’s why HHS policy has focused on making data more readily available, smoothing out clunkiness, making EHR vendors become more transparent about their products, and aligning documentation requirements with real patient outcomes so that unnecessary requirements can be eliminated.

Good systems have been developed, but improvements are needed, she acknowledges.

 

“We’re working with an intense sense of urgency at HHS because we know that is a source of frustration to doctors on the frontlines,” Dr. DeSalvo says. “We not only hear it all the time when we’re out speaking with folks, but some of us still practice and will shortly be practicing again, so it’s very real to us to know that this has to get better. What we don’t want is for people to be frustrated with the technology. We want it to lift them up and help make their practice better. We also want it to be an enabler for consumers.”

Dr. Wachter has an easy way to remember how many annual meeting lectures he’s given: The 10th was the one where he dressed up as Elton John, sang, and played the piano on stage. That was in Las Vegas, of course.

This year? Don’t expect the piano, or singing for that matter. His HM16 theme will be more sober, one of caution and the importance of perspective.

The early title, he tells The Hospitalist, is “Why Culture Is Key to Improvement … And Why Hospitalists Are the Key to Hospital Culture.” The title might change, and the precise direction and details of his talk are still in flux, he says.

But the thrust will be a concern that, with a blizzard of quality improvement (QI) projects and process analyses being taken on by hospitalists, hospitalists are not immune to the burnout we’re seeing throughout medicine. A bad vibe is creeping in, he fears, and unless there’s more awareness of, and attention to, the culture itself—and not just a grim soldiering on from one initiative to another—the field will suffer.

“There’s a risk that we’ll lose sight of the people and culture within the organization,” Dr. Wachter says. “Even good people are beginning to say, ‘I just can’t do another QI project; I just can’t do another thing.’”

He wants hospitalists to think “more deeply” about the issues of culture, how the workforce is being managed, and “that we’re focusing on the right things in the right way.”

He hopes to call on hospitalists and hospitalist leaders to continue to recognize “the importance of the human spirit in all of this.”

So how worried is he?

“It won’t be a downer,” he says. “I still think we’re in great shape, but I am a bit worried, in part, because of our successes. We grew so fast, and we became so important to our organizations. We have to be sure we’re taking care of ourselves.”

So many hospitalists now have leadership roles. That’s a good thing, he adds, “but it does mean that as people are beginning to be burned out or organizations are struggling with dealing with initiative fatigue, we’re the first ones that are going to feel that because we are disproportionately involved.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

Health information technology (IT) will take center stage early and often at this year’s annual meeting of the Society of Hospital Medicine.

Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health in the U.S. Department of Health & Human Services (HHS) and the national coordinator for health information technology, will deliver the keynote address. She is scheduled to give her talk an hour into the first day of programming.

Another highly anticipated talk will be delivered by Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, the “godfather” of hospital medicine, and the field’s most well-known practitioner. Dr. Wachter will give his 12th straight meeting-closing talk at noon Wednesday.

Dr. DeSalvo, an internist by training, was the chief of general internal medicine at Tulane University for about 10 years. She also started at Charity Hospital in New Orleans, site of one of the earliest hospital medicine programs.

She says her speech will take a broad look at information technology as a tool for advancing good health, with attention to the role that hospitals and hospitalists play. She also plans to touch on the successes in U.S. healthcare in recent years, including expanded coverage, quality and safety improvements, and the rapid rate of adoption of electronic health records (EHRs), especially in the hospital. She says the hospital setting is “most ripe” for health IT advancement because it is the site of “the most rich data about the patient’s care and care experience and health … and there is the best interoperability right now between hospital systems and the best opportunity to make that more seamless.”

The future, she says, will be about “much more than the electronic health record.”

“I want to talk a bit about what’s happening on the pioneering edge in health IT, ranging anywhere from apps to consumer interface with digital health records to some really on-the-edge things like using telehealth and hologram technology for remote patient care,” she explains.

Dr. DeSalvo also plans to underscore health IT’s key role in HHS’s push for delivery system reform: changing the way care is paid for and delivered and the way information is delivered. HHS’s goal is for 50% of payments to be in the form of alternative or value-based payment models by 2018. Without health IT advancements, that won’t be possible, she says.

Health IT policy at HHS, she notes, has centered largely on “freeing the data” so that information is no longer trapped within a particular EHR system. A rule taking effect in 2018 will require that EHRs be built so that apps can be overlaid onto the data, allowing easier access and the ability to tailor data to an individual’s needs.

“It’s going to get to be more like the way we do our banking or call for transportation with a smartphone or have an interface for our travel arrangements,” she says. “That’s the way that the health IT world is evolving.”

She says hospitalists are “pioneering, early adopters who are by nature very innovative” and are ideal for helping refine health IT. But she also recognizes that the bumps along the way can cause technology to be seen as a hurdle. That’s why HHS policy has focused on making data more readily available, smoothing out clunkiness, making EHR vendors become more transparent about their products, and aligning documentation requirements with real patient outcomes so that unnecessary requirements can be eliminated.

Good systems have been developed, but improvements are needed, she acknowledges.

 

“We’re working with an intense sense of urgency at HHS because we know that is a source of frustration to doctors on the frontlines,” Dr. DeSalvo says. “We not only hear it all the time when we’re out speaking with folks, but some of us still practice and will shortly be practicing again, so it’s very real to us to know that this has to get better. What we don’t want is for people to be frustrated with the technology. We want it to lift them up and help make their practice better. We also want it to be an enabler for consumers.”

Dr. Wachter has an easy way to remember how many annual meeting lectures he’s given: The 10th was the one where he dressed up as Elton John, sang, and played the piano on stage. That was in Las Vegas, of course.

This year? Don’t expect the piano, or singing for that matter. His HM16 theme will be more sober, one of caution and the importance of perspective.

The early title, he tells The Hospitalist, is “Why Culture Is Key to Improvement … And Why Hospitalists Are the Key to Hospital Culture.” The title might change, and the precise direction and details of his talk are still in flux, he says.

But the thrust will be a concern that, with a blizzard of quality improvement (QI) projects and process analyses being taken on by hospitalists, hospitalists are not immune to the burnout we’re seeing throughout medicine. A bad vibe is creeping in, he fears, and unless there’s more awareness of, and attention to, the culture itself—and not just a grim soldiering on from one initiative to another—the field will suffer.

“There’s a risk that we’ll lose sight of the people and culture within the organization,” Dr. Wachter says. “Even good people are beginning to say, ‘I just can’t do another QI project; I just can’t do another thing.’”

He wants hospitalists to think “more deeply” about the issues of culture, how the workforce is being managed, and “that we’re focusing on the right things in the right way.”

He hopes to call on hospitalists and hospitalist leaders to continue to recognize “the importance of the human spirit in all of this.”

So how worried is he?

“It won’t be a downer,” he says. “I still think we’re in great shape, but I am a bit worried, in part, because of our successes. We grew so fast, and we became so important to our organizations. We have to be sure we’re taking care of ourselves.”

So many hospitalists now have leadership roles. That’s a good thing, he adds, “but it does mean that as people are beginning to be burned out or organizations are struggling with dealing with initiative fatigue, we’re the first ones that are going to feel that because we are disproportionately involved.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

Health information technology (IT) will take center stage early and often at this year’s annual meeting of the Society of Hospital Medicine.

Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health in the U.S. Department of Health & Human Services (HHS) and the national coordinator for health information technology, will deliver the keynote address. She is scheduled to give her talk an hour into the first day of programming.

Another highly anticipated talk will be delivered by Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, the “godfather” of hospital medicine, and the field’s most well-known practitioner. Dr. Wachter will give his 12th straight meeting-closing talk at noon Wednesday.

Dr. DeSalvo, an internist by training, was the chief of general internal medicine at Tulane University for about 10 years. She also started at Charity Hospital in New Orleans, site of one of the earliest hospital medicine programs.

She says her speech will take a broad look at information technology as a tool for advancing good health, with attention to the role that hospitals and hospitalists play. She also plans to touch on the successes in U.S. healthcare in recent years, including expanded coverage, quality and safety improvements, and the rapid rate of adoption of electronic health records (EHRs), especially in the hospital. She says the hospital setting is “most ripe” for health IT advancement because it is the site of “the most rich data about the patient’s care and care experience and health … and there is the best interoperability right now between hospital systems and the best opportunity to make that more seamless.”

The future, she says, will be about “much more than the electronic health record.”

“I want to talk a bit about what’s happening on the pioneering edge in health IT, ranging anywhere from apps to consumer interface with digital health records to some really on-the-edge things like using telehealth and hologram technology for remote patient care,” she explains.

Dr. DeSalvo also plans to underscore health IT’s key role in HHS’s push for delivery system reform: changing the way care is paid for and delivered and the way information is delivered. HHS’s goal is for 50% of payments to be in the form of alternative or value-based payment models by 2018. Without health IT advancements, that won’t be possible, she says.

Health IT policy at HHS, she notes, has centered largely on “freeing the data” so that information is no longer trapped within a particular EHR system. A rule taking effect in 2018 will require that EHRs be built so that apps can be overlaid onto the data, allowing easier access and the ability to tailor data to an individual’s needs.

“It’s going to get to be more like the way we do our banking or call for transportation with a smartphone or have an interface for our travel arrangements,” she says. “That’s the way that the health IT world is evolving.”

She says hospitalists are “pioneering, early adopters who are by nature very innovative” and are ideal for helping refine health IT. But she also recognizes that the bumps along the way can cause technology to be seen as a hurdle. That’s why HHS policy has focused on making data more readily available, smoothing out clunkiness, making EHR vendors become more transparent about their products, and aligning documentation requirements with real patient outcomes so that unnecessary requirements can be eliminated.

Good systems have been developed, but improvements are needed, she acknowledges.

 

“We’re working with an intense sense of urgency at HHS because we know that is a source of frustration to doctors on the frontlines,” Dr. DeSalvo says. “We not only hear it all the time when we’re out speaking with folks, but some of us still practice and will shortly be practicing again, so it’s very real to us to know that this has to get better. What we don’t want is for people to be frustrated with the technology. We want it to lift them up and help make their practice better. We also want it to be an enabler for consumers.”

Dr. Wachter has an easy way to remember how many annual meeting lectures he’s given: The 10th was the one where he dressed up as Elton John, sang, and played the piano on stage. That was in Las Vegas, of course.

This year? Don’t expect the piano, or singing for that matter. His HM16 theme will be more sober, one of caution and the importance of perspective.

The early title, he tells The Hospitalist, is “Why Culture Is Key to Improvement … And Why Hospitalists Are the Key to Hospital Culture.” The title might change, and the precise direction and details of his talk are still in flux, he says.

But the thrust will be a concern that, with a blizzard of quality improvement (QI) projects and process analyses being taken on by hospitalists, hospitalists are not immune to the burnout we’re seeing throughout medicine. A bad vibe is creeping in, he fears, and unless there’s more awareness of, and attention to, the culture itself—and not just a grim soldiering on from one initiative to another—the field will suffer.

“There’s a risk that we’ll lose sight of the people and culture within the organization,” Dr. Wachter says. “Even good people are beginning to say, ‘I just can’t do another QI project; I just can’t do another thing.’”

He wants hospitalists to think “more deeply” about the issues of culture, how the workforce is being managed, and “that we’re focusing on the right things in the right way.”

He hopes to call on hospitalists and hospitalist leaders to continue to recognize “the importance of the human spirit in all of this.”

So how worried is he?

“It won’t be a downer,” he says. “I still think we’re in great shape, but I am a bit worried, in part, because of our successes. We grew so fast, and we became so important to our organizations. We have to be sure we’re taking care of ourselves.”

So many hospitalists now have leadership roles. That’s a good thing, he adds, “but it does mean that as people are beginning to be burned out or organizations are struggling with dealing with initiative fatigue, we’re the first ones that are going to feel that because we are disproportionately involved.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

Take a look at the HM16 program, and you get a snapshot of the most pressing topics in hospital medicine. Specifically, four new educational tracks are being rolled out at this year’s annual meeting, including a new track on the patient-doctor relationship, which is so crucial with today’s growing emphasis on patient satisfaction, and a track focused on perioperative medicine, an important area with a fast-moving frontier. Another new track covers post-acute care, a setting in which more and more hospitalists find themselves practicing. Then there’s the big daddy: health information technology (IT) for hospitalists.

Course Director Melissa Mattison, MD, SFHM, also points to a new twist in the way the conference will attempt to tackle the tough topic of work-life balance.

Read the full interview with Melissa Mattison, MD, SFHM. 

Here’s a look at what’s new for HM16 attendees.

Health IT for Hospitalists

“There’s not a hospitalist in the country who’s not affected by IT and updates to their [electronic medical records (EMR)], new adoption of EMR technology, different vendors,” Dr. Mattison says. “We’re always searching for something to make our lives better and make the care that we provide more high quality.”

There will be sessions of a general nature, such as “There’s an App for That,” a review of mobile apps helpful to hospitalists. And there will be those for the more passionate technophiles, such as a session on clinical informatics and “Using IT to Help Drive the Shift from Volume to Value.”

“We’ve spent a lot of time trying to make sure there’s something for everyone,” says Kendall Rogers, MD, SFHM, chair of SHM’s IT Committee. “And even within each individual talk, we’ve tried to make sure that there is material that can be applicable from the frontline hospitalist to the CMIO of a hospital.”

Dr. Rogers says the committee has “really been pushing” to have its own track at the annual meeting.

Listen to more of our interview with Dr. Rogers.

“Health IT continues to be an area of great frustration and great promise,” he says. “I think most of the frustration that hospitalists have is because they realize the potential of health IT, and they see how far it is from the reality of what they’re working with every day.

“Hospitalists are well-suited for actively being involved in clinical informatics, but many of us would be far more effective in our roles with more formal education and training.”

Post-Acute Care

It’s estimated that as many as 35% of hospitalists work in the post-acute setting. The number very much surprised Dr. Mattison. When she heard of the figure, “[the committee] lobbied very hard to get a track for post-acute care.”

One session, “Building and Managing a PAC Practice,” will review setting up a staff, relevant regulations, billing, and collecting, and it should be of interest to both managers and physicians, says Sean Muldoon, MD, senior vice president and chief medical officer of the hospitalist division at Louisville, Ken.–based Kindred Healthcare and chair of SHM’s Post-Acute Care Task Force.

Another session, “Lost in Transitions,” will review information gaps and propose solutions “to the well-known voltage drop of information that can happen in transfer from the hospital to post-acute care.”

At Kindred, Dr. Muldoon says he has seen the benefits of hospitalist involvement in post-acute care.

“In many markets, we seek out and often are able to become a practice site for a large hospitalist medical group,” he says. “That’s really good for us, the patients, and, we think, the hospitalists because it allows the hospitalists to be exposed to the practice and benefits of post-acute care without having to make a full commitment to be a skilled-nursing physician or a long-term acute-care physician.”

 

It also makes transitions of care smoother and less disruptive, he says, “because a patient is simply transferred from one hospitalist in a group to another or often maintaining that same hospitalist in the post-acute-care setting.”

Dr. Muldoon says the new track is of value to any hospitalist, whether they actually work in post-acute care or not.

“A hospitalist would be hard-pressed to provide knowledgeable input into where a patient should receive post-acute care without a working knowledge of which patients should be directed to which post-acute-care setting,” he says.

Doctor-Patient Relationship

This topic was a pre-course last year, and organizers decided to make this a full track on the final day of the meeting schedule.

“It’s really about communication style,” Dr. Mattison says. “There’s one session called ‘The Language of Empathy and Engagement: Communication Essentials for Patient-Centered Care.’ There’s one on unconscious biases and our underlying assumptions and how it affects how we care for patients. [Another is focused] on improving the patient experience in the hospital.”

Co-Management/ Perioperative Medicine

“There are a lot of challenges around anticoagulation management, optimizing patients’ physical heath prior to the surgery, what things should we be doing, what medications should we be giving, what ones shouldn’t we be giving,” Dr. Mattison says. “It’s an evolving field that has, every year, new information.”

Hidden Gems

Dr. Mattison draws special attention to “Work-Life Balance: Is It Possible?” (Tuesday, March 8, 4:20–5:40 p.m.). This year, this problem—all too familiar to hospitalists—will be addressed in a panel discussion, which is a change from previous years.

“There’s been, year after year after year, a lot of discussion around, how can I make my job manageable if my boss isn’t listening to me or is not attuned to work-life balance? How can I navigate this process?” she says. “I’m hopeful that the panel discussion will provide people with some real examples and strategies for success.”

She also draws attention to the session “Perioperative Pitfalls: Overcoming Common Challenges in Managing Medical Problems in Surgical Patients” (Monday, March 7, 3:05–4:20 p.m.).

“There are some true leaders in perioperative management, and they’re going to come together and have a panel discussion,” she says. “It’ll be an opportunity to see some of the great minds think, if you will.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

Take a look at the HM16 program, and you get a snapshot of the most pressing topics in hospital medicine. Specifically, four new educational tracks are being rolled out at this year’s annual meeting, including a new track on the patient-doctor relationship, which is so crucial with today’s growing emphasis on patient satisfaction, and a track focused on perioperative medicine, an important area with a fast-moving frontier. Another new track covers post-acute care, a setting in which more and more hospitalists find themselves practicing. Then there’s the big daddy: health information technology (IT) for hospitalists.

Course Director Melissa Mattison, MD, SFHM, also points to a new twist in the way the conference will attempt to tackle the tough topic of work-life balance.

Read the full interview with Melissa Mattison, MD, SFHM. 

Here’s a look at what’s new for HM16 attendees.

Health IT for Hospitalists

“There’s not a hospitalist in the country who’s not affected by IT and updates to their [electronic medical records (EMR)], new adoption of EMR technology, different vendors,” Dr. Mattison says. “We’re always searching for something to make our lives better and make the care that we provide more high quality.”

There will be sessions of a general nature, such as “There’s an App for That,” a review of mobile apps helpful to hospitalists. And there will be those for the more passionate technophiles, such as a session on clinical informatics and “Using IT to Help Drive the Shift from Volume to Value.”

“We’ve spent a lot of time trying to make sure there’s something for everyone,” says Kendall Rogers, MD, SFHM, chair of SHM’s IT Committee. “And even within each individual talk, we’ve tried to make sure that there is material that can be applicable from the frontline hospitalist to the CMIO of a hospital.”

Dr. Rogers says the committee has “really been pushing” to have its own track at the annual meeting.

Listen to more of our interview with Dr. Rogers.

“Health IT continues to be an area of great frustration and great promise,” he says. “I think most of the frustration that hospitalists have is because they realize the potential of health IT, and they see how far it is from the reality of what they’re working with every day.

“Hospitalists are well-suited for actively being involved in clinical informatics, but many of us would be far more effective in our roles with more formal education and training.”

Post-Acute Care

It’s estimated that as many as 35% of hospitalists work in the post-acute setting. The number very much surprised Dr. Mattison. When she heard of the figure, “[the committee] lobbied very hard to get a track for post-acute care.”

One session, “Building and Managing a PAC Practice,” will review setting up a staff, relevant regulations, billing, and collecting, and it should be of interest to both managers and physicians, says Sean Muldoon, MD, senior vice president and chief medical officer of the hospitalist division at Louisville, Ken.–based Kindred Healthcare and chair of SHM’s Post-Acute Care Task Force.

Another session, “Lost in Transitions,” will review information gaps and propose solutions “to the well-known voltage drop of information that can happen in transfer from the hospital to post-acute care.”

At Kindred, Dr. Muldoon says he has seen the benefits of hospitalist involvement in post-acute care.

“In many markets, we seek out and often are able to become a practice site for a large hospitalist medical group,” he says. “That’s really good for us, the patients, and, we think, the hospitalists because it allows the hospitalists to be exposed to the practice and benefits of post-acute care without having to make a full commitment to be a skilled-nursing physician or a long-term acute-care physician.”

 

It also makes transitions of care smoother and less disruptive, he says, “because a patient is simply transferred from one hospitalist in a group to another or often maintaining that same hospitalist in the post-acute-care setting.”

Dr. Muldoon says the new track is of value to any hospitalist, whether they actually work in post-acute care or not.

“A hospitalist would be hard-pressed to provide knowledgeable input into where a patient should receive post-acute care without a working knowledge of which patients should be directed to which post-acute-care setting,” he says.

Doctor-Patient Relationship

This topic was a pre-course last year, and organizers decided to make this a full track on the final day of the meeting schedule.

“It’s really about communication style,” Dr. Mattison says. “There’s one session called ‘The Language of Empathy and Engagement: Communication Essentials for Patient-Centered Care.’ There’s one on unconscious biases and our underlying assumptions and how it affects how we care for patients. [Another is focused] on improving the patient experience in the hospital.”

Co-Management/ Perioperative Medicine

“There are a lot of challenges around anticoagulation management, optimizing patients’ physical heath prior to the surgery, what things should we be doing, what medications should we be giving, what ones shouldn’t we be giving,” Dr. Mattison says. “It’s an evolving field that has, every year, new information.”

Hidden Gems

Dr. Mattison draws special attention to “Work-Life Balance: Is It Possible?” (Tuesday, March 8, 4:20–5:40 p.m.). This year, this problem—all too familiar to hospitalists—will be addressed in a panel discussion, which is a change from previous years.

“There’s been, year after year after year, a lot of discussion around, how can I make my job manageable if my boss isn’t listening to me or is not attuned to work-life balance? How can I navigate this process?” she says. “I’m hopeful that the panel discussion will provide people with some real examples and strategies for success.”

She also draws attention to the session “Perioperative Pitfalls: Overcoming Common Challenges in Managing Medical Problems in Surgical Patients” (Monday, March 7, 3:05–4:20 p.m.).

“There are some true leaders in perioperative management, and they’re going to come together and have a panel discussion,” she says. “It’ll be an opportunity to see some of the great minds think, if you will.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

Take a look at the HM16 program, and you get a snapshot of the most pressing topics in hospital medicine. Specifically, four new educational tracks are being rolled out at this year’s annual meeting, including a new track on the patient-doctor relationship, which is so crucial with today’s growing emphasis on patient satisfaction, and a track focused on perioperative medicine, an important area with a fast-moving frontier. Another new track covers post-acute care, a setting in which more and more hospitalists find themselves practicing. Then there’s the big daddy: health information technology (IT) for hospitalists.

Course Director Melissa Mattison, MD, SFHM, also points to a new twist in the way the conference will attempt to tackle the tough topic of work-life balance.

Read the full interview with Melissa Mattison, MD, SFHM. 

Here’s a look at what’s new for HM16 attendees.

Health IT for Hospitalists

“There’s not a hospitalist in the country who’s not affected by IT and updates to their [electronic medical records (EMR)], new adoption of EMR technology, different vendors,” Dr. Mattison says. “We’re always searching for something to make our lives better and make the care that we provide more high quality.”

There will be sessions of a general nature, such as “There’s an App for That,” a review of mobile apps helpful to hospitalists. And there will be those for the more passionate technophiles, such as a session on clinical informatics and “Using IT to Help Drive the Shift from Volume to Value.”

“We’ve spent a lot of time trying to make sure there’s something for everyone,” says Kendall Rogers, MD, SFHM, chair of SHM’s IT Committee. “And even within each individual talk, we’ve tried to make sure that there is material that can be applicable from the frontline hospitalist to the CMIO of a hospital.”

Dr. Rogers says the committee has “really been pushing” to have its own track at the annual meeting.

Listen to more of our interview with Dr. Rogers.

“Health IT continues to be an area of great frustration and great promise,” he says. “I think most of the frustration that hospitalists have is because they realize the potential of health IT, and they see how far it is from the reality of what they’re working with every day.

“Hospitalists are well-suited for actively being involved in clinical informatics, but many of us would be far more effective in our roles with more formal education and training.”

Post-Acute Care

It’s estimated that as many as 35% of hospitalists work in the post-acute setting. The number very much surprised Dr. Mattison. When she heard of the figure, “[the committee] lobbied very hard to get a track for post-acute care.”

One session, “Building and Managing a PAC Practice,” will review setting up a staff, relevant regulations, billing, and collecting, and it should be of interest to both managers and physicians, says Sean Muldoon, MD, senior vice president and chief medical officer of the hospitalist division at Louisville, Ken.–based Kindred Healthcare and chair of SHM’s Post-Acute Care Task Force.

Another session, “Lost in Transitions,” will review information gaps and propose solutions “to the well-known voltage drop of information that can happen in transfer from the hospital to post-acute care.”

At Kindred, Dr. Muldoon says he has seen the benefits of hospitalist involvement in post-acute care.

“In many markets, we seek out and often are able to become a practice site for a large hospitalist medical group,” he says. “That’s really good for us, the patients, and, we think, the hospitalists because it allows the hospitalists to be exposed to the practice and benefits of post-acute care without having to make a full commitment to be a skilled-nursing physician or a long-term acute-care physician.”

 

It also makes transitions of care smoother and less disruptive, he says, “because a patient is simply transferred from one hospitalist in a group to another or often maintaining that same hospitalist in the post-acute-care setting.”

Dr. Muldoon says the new track is of value to any hospitalist, whether they actually work in post-acute care or not.

“A hospitalist would be hard-pressed to provide knowledgeable input into where a patient should receive post-acute care without a working knowledge of which patients should be directed to which post-acute-care setting,” he says.

Doctor-Patient Relationship

This topic was a pre-course last year, and organizers decided to make this a full track on the final day of the meeting schedule.

“It’s really about communication style,” Dr. Mattison says. “There’s one session called ‘The Language of Empathy and Engagement: Communication Essentials for Patient-Centered Care.’ There’s one on unconscious biases and our underlying assumptions and how it affects how we care for patients. [Another is focused] on improving the patient experience in the hospital.”

Co-Management/ Perioperative Medicine

“There are a lot of challenges around anticoagulation management, optimizing patients’ physical heath prior to the surgery, what things should we be doing, what medications should we be giving, what ones shouldn’t we be giving,” Dr. Mattison says. “It’s an evolving field that has, every year, new information.”

Hidden Gems

Dr. Mattison draws special attention to “Work-Life Balance: Is It Possible?” (Tuesday, March 8, 4:20–5:40 p.m.). This year, this problem—all too familiar to hospitalists—will be addressed in a panel discussion, which is a change from previous years.

“There’s been, year after year after year, a lot of discussion around, how can I make my job manageable if my boss isn’t listening to me or is not attuned to work-life balance? How can I navigate this process?” she says. “I’m hopeful that the panel discussion will provide people with some real examples and strategies for success.”

She also draws attention to the session “Perioperative Pitfalls: Overcoming Common Challenges in Managing Medical Problems in Surgical Patients” (Monday, March 7, 3:05–4:20 p.m.).

“There are some true leaders in perioperative management, and they’re going to come together and have a panel discussion,” she says. “It’ll be an opportunity to see some of the great minds think, if you will.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

HM16 course director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School in Boston, took some time out of her busy schedule to chat with The Hospitalist about how the annual meeting program comes together, the continued relevance of SHM meetings, resisting the lure of San Diego beaches, and more.

Read more about what's new at HM16

Question: There’s a lot packed into just a few days at every annual meeting. What is the process for determining what makes it into the program?

Answer: The annual meeting committee starts meeting in the spring, basically around 12 to 13 months before the annual meeting. So even as the current annual meeting is going on, the next one is well under way in terms of planning.

The annual meeting committee then meets every single week, if not more frequently, by conference call to map out and assign jobs and whatnot to the group. We usually start by reviewing workshops. The workshop proposals are received by SHM through an open-access submission process, whereby pretty much anyone can submit a proposal for a workshop. The annual meeting committee reviews all of the workshops. This year, we had 160 or 170 workshop submissions. We were only able to accept 16, I believe. …

Listen to more of our interview with Dr. Mattison.

At the same time the workshops are being selected, we work with the leaders of practice management, the leaders of the academic and research committees, and the leaders of quality and pediatrics committees to have them help us identify content for their various tracks, suggest speakers and talks. After all of that’s done, we move on to the remaining didactic sessions, and we look at what things were popular in previous years, what things had good reviews, which speakers were highly regarded, etc., and spend some time thinking deliberately about tracks that we feel we ought to include again, like the “Young Hospitalists” track and tracks that we think deserve to be included that haven’t previously been included—those that warrant some sort of attention because of widespread appeal and usefulness to the attendee of SHM.

Q: It’s very easy for hospitalists to stream videos of talks, access literature online, and talk about important topics in online chat rooms. In this day and age, what is the advantage to physically taking part in an annual meeting in an actual brick-and-mortar building?

A: The content itself is enough to draw someone. It’s packed content in terms of topics that would be of interest and benefit to the average hospitalist; pretty much any hospitalist who’s practicing medicine will find multiple, multiple sessions of interest and value. And you don’t have to go far for them. You don’t have to go hunting for them. They’re all there. …

Aside from actual didactics and content of the annual meeting, there’s the value of networking and of collaboration and meeting and talking to hospitalists from around the country and around the world. I mean, I think that one of the biggest values I’ve had is just meeting other people who are facing challenges in their work environment that I have [and learning] how they solve their challenges.

I think the [special interest] groups that meet Monday evening at 4:30 p.m. … those are great opportunities to go and meet people who have interests that are similar to yours or concerns that are similar to yours.

 

Q: Technology has a presence in the program this year. Why is it so important to highlight this?

A: The challenge of healthcare and incorporating technology into providing care to patients in a way that is efficient and helpful is there. That is a challenge that has been written about by many, many folks. Dr. Bob Wachter gave a whole keynote on it last year. And we’re all seeking ways to work with the technology that we have and identify opportunities to improve the care we’re providing using and harnessing the technology that’s available to us.

So whether that’s with new apps or with figuring out ways to embed decision support into our local systems of care, we need to do that. I think hospitalists are, time and time again, looked at as leaders at their institutions in this domain. It’s going to be 2016, this is the world we live in, and to ignore technology would be foolhardy.

Q: One of the new tracks is focused on post-acute care. Is the importance of the post-acute setting a sign that hospital medicine is, in some ways, reinventing itself?

A: I wouldn’t say reinventing. I think that hospitalists and internists that have become hospitalists have filled the gap in care over the past 20 years. It’s been 20 years since the name “hospitalist” was used in the New England Journal of Medicine. And in that time, the breadth and depth of care that hospitalists provide across the continuum in the acute-care setting has grown. …

Our older patients are often discharged from the acute-care setting but unable to return directly to their home environment safely. [They] require a period of a week or two, or sometimes longer, in a post-acute-care setting to continue to receive both the medical and the physical rehabilitation care that they need. And we know that there are not enough geriatricians in the world, and hospitalists are really sort of stepping up to provide this post-acute care. And it makes sense because the patients are coming from the hospital directly, and a lot of folks would say they’re sicker than ever in the post-acute-care setting. You don’t stay in the hospital for long anymore, and when you get to the post-acute-care setting, often the illness is ongoing but stabilized, and the patient is on the mend from whatever has befallen them. But they still require a fair amount of medical management. So it makes sense that hospitalists are going into that sphere.

Q: How will you go about resisting the temptation to stealthily leave the convention center during the day and hit the beach? Or will you be able to resist?

A: [Laughter.] I do like that question. I think that … I think that the conference, while it’s busy, there’s some time in the evening to go out and have a nice meal or [to] the beach and see friends. And then the last day, if you have time, if you don’t need to race off, you have a good half a day where you could go to the beach, or you could come early and come a day before or stay an extra couple of days and enjoy San Diego.

But I think if you skip the conference for the beach, you’re not doing yourself a service. You’re going to miss out on the opportunity to learn new clinical information, new strategies for communication. You’re also going to miss out on opportunities to network with your colleagues from across the country. TH

---

 

Thomas R. Collins is a freelance writer in South Florida.

HM16 course director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School in Boston, took some time out of her busy schedule to chat with The Hospitalist about how the annual meeting program comes together, the continued relevance of SHM meetings, resisting the lure of San Diego beaches, and more.

Read more about what's new at HM16

Question: There’s a lot packed into just a few days at every annual meeting. What is the process for determining what makes it into the program?

Answer: The annual meeting committee starts meeting in the spring, basically around 12 to 13 months before the annual meeting. So even as the current annual meeting is going on, the next one is well under way in terms of planning.

The annual meeting committee then meets every single week, if not more frequently, by conference call to map out and assign jobs and whatnot to the group. We usually start by reviewing workshops. The workshop proposals are received by SHM through an open-access submission process, whereby pretty much anyone can submit a proposal for a workshop. The annual meeting committee reviews all of the workshops. This year, we had 160 or 170 workshop submissions. We were only able to accept 16, I believe. …

Listen to more of our interview with Dr. Mattison.

At the same time the workshops are being selected, we work with the leaders of practice management, the leaders of the academic and research committees, and the leaders of quality and pediatrics committees to have them help us identify content for their various tracks, suggest speakers and talks. After all of that’s done, we move on to the remaining didactic sessions, and we look at what things were popular in previous years, what things had good reviews, which speakers were highly regarded, etc., and spend some time thinking deliberately about tracks that we feel we ought to include again, like the “Young Hospitalists” track and tracks that we think deserve to be included that haven’t previously been included—those that warrant some sort of attention because of widespread appeal and usefulness to the attendee of SHM.

Q: It’s very easy for hospitalists to stream videos of talks, access literature online, and talk about important topics in online chat rooms. In this day and age, what is the advantage to physically taking part in an annual meeting in an actual brick-and-mortar building?

A: The content itself is enough to draw someone. It’s packed content in terms of topics that would be of interest and benefit to the average hospitalist; pretty much any hospitalist who’s practicing medicine will find multiple, multiple sessions of interest and value. And you don’t have to go far for them. You don’t have to go hunting for them. They’re all there. …

Aside from actual didactics and content of the annual meeting, there’s the value of networking and of collaboration and meeting and talking to hospitalists from around the country and around the world. I mean, I think that one of the biggest values I’ve had is just meeting other people who are facing challenges in their work environment that I have [and learning] how they solve their challenges.

I think the [special interest] groups that meet Monday evening at 4:30 p.m. … those are great opportunities to go and meet people who have interests that are similar to yours or concerns that are similar to yours.

 

Q: Technology has a presence in the program this year. Why is it so important to highlight this?

A: The challenge of healthcare and incorporating technology into providing care to patients in a way that is efficient and helpful is there. That is a challenge that has been written about by many, many folks. Dr. Bob Wachter gave a whole keynote on it last year. And we’re all seeking ways to work with the technology that we have and identify opportunities to improve the care we’re providing using and harnessing the technology that’s available to us.

So whether that’s with new apps or with figuring out ways to embed decision support into our local systems of care, we need to do that. I think hospitalists are, time and time again, looked at as leaders at their institutions in this domain. It’s going to be 2016, this is the world we live in, and to ignore technology would be foolhardy.

Q: One of the new tracks is focused on post-acute care. Is the importance of the post-acute setting a sign that hospital medicine is, in some ways, reinventing itself?

A: I wouldn’t say reinventing. I think that hospitalists and internists that have become hospitalists have filled the gap in care over the past 20 years. It’s been 20 years since the name “hospitalist” was used in the New England Journal of Medicine. And in that time, the breadth and depth of care that hospitalists provide across the continuum in the acute-care setting has grown. …

Our older patients are often discharged from the acute-care setting but unable to return directly to their home environment safely. [They] require a period of a week or two, or sometimes longer, in a post-acute-care setting to continue to receive both the medical and the physical rehabilitation care that they need. And we know that there are not enough geriatricians in the world, and hospitalists are really sort of stepping up to provide this post-acute care. And it makes sense because the patients are coming from the hospital directly, and a lot of folks would say they’re sicker than ever in the post-acute-care setting. You don’t stay in the hospital for long anymore, and when you get to the post-acute-care setting, often the illness is ongoing but stabilized, and the patient is on the mend from whatever has befallen them. But they still require a fair amount of medical management. So it makes sense that hospitalists are going into that sphere.

Q: How will you go about resisting the temptation to stealthily leave the convention center during the day and hit the beach? Or will you be able to resist?

A: [Laughter.] I do like that question. I think that … I think that the conference, while it’s busy, there’s some time in the evening to go out and have a nice meal or [to] the beach and see friends. And then the last day, if you have time, if you don’t need to race off, you have a good half a day where you could go to the beach, or you could come early and come a day before or stay an extra couple of days and enjoy San Diego.

But I think if you skip the conference for the beach, you’re not doing yourself a service. You’re going to miss out on the opportunity to learn new clinical information, new strategies for communication. You’re also going to miss out on opportunities to network with your colleagues from across the country. TH

---

 

Thomas R. Collins is a freelance writer in South Florida.

HM16 course director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School in Boston, took some time out of her busy schedule to chat with The Hospitalist about how the annual meeting program comes together, the continued relevance of SHM meetings, resisting the lure of San Diego beaches, and more.

Read more about what's new at HM16

Question: There’s a lot packed into just a few days at every annual meeting. What is the process for determining what makes it into the program?

Answer: The annual meeting committee starts meeting in the spring, basically around 12 to 13 months before the annual meeting. So even as the current annual meeting is going on, the next one is well under way in terms of planning.

The annual meeting committee then meets every single week, if not more frequently, by conference call to map out and assign jobs and whatnot to the group. We usually start by reviewing workshops. The workshop proposals are received by SHM through an open-access submission process, whereby pretty much anyone can submit a proposal for a workshop. The annual meeting committee reviews all of the workshops. This year, we had 160 or 170 workshop submissions. We were only able to accept 16, I believe. …

Listen to more of our interview with Dr. Mattison.

At the same time the workshops are being selected, we work with the leaders of practice management, the leaders of the academic and research committees, and the leaders of quality and pediatrics committees to have them help us identify content for their various tracks, suggest speakers and talks. After all of that’s done, we move on to the remaining didactic sessions, and we look at what things were popular in previous years, what things had good reviews, which speakers were highly regarded, etc., and spend some time thinking deliberately about tracks that we feel we ought to include again, like the “Young Hospitalists” track and tracks that we think deserve to be included that haven’t previously been included—those that warrant some sort of attention because of widespread appeal and usefulness to the attendee of SHM.

Q: It’s very easy for hospitalists to stream videos of talks, access literature online, and talk about important topics in online chat rooms. In this day and age, what is the advantage to physically taking part in an annual meeting in an actual brick-and-mortar building?

A: The content itself is enough to draw someone. It’s packed content in terms of topics that would be of interest and benefit to the average hospitalist; pretty much any hospitalist who’s practicing medicine will find multiple, multiple sessions of interest and value. And you don’t have to go far for them. You don’t have to go hunting for them. They’re all there. …

Aside from actual didactics and content of the annual meeting, there’s the value of networking and of collaboration and meeting and talking to hospitalists from around the country and around the world. I mean, I think that one of the biggest values I’ve had is just meeting other people who are facing challenges in their work environment that I have [and learning] how they solve their challenges.

I think the [special interest] groups that meet Monday evening at 4:30 p.m. … those are great opportunities to go and meet people who have interests that are similar to yours or concerns that are similar to yours.

 

Q: Technology has a presence in the program this year. Why is it so important to highlight this?

A: The challenge of healthcare and incorporating technology into providing care to patients in a way that is efficient and helpful is there. That is a challenge that has been written about by many, many folks. Dr. Bob Wachter gave a whole keynote on it last year. And we’re all seeking ways to work with the technology that we have and identify opportunities to improve the care we’re providing using and harnessing the technology that’s available to us.

So whether that’s with new apps or with figuring out ways to embed decision support into our local systems of care, we need to do that. I think hospitalists are, time and time again, looked at as leaders at their institutions in this domain. It’s going to be 2016, this is the world we live in, and to ignore technology would be foolhardy.

Q: One of the new tracks is focused on post-acute care. Is the importance of the post-acute setting a sign that hospital medicine is, in some ways, reinventing itself?

A: I wouldn’t say reinventing. I think that hospitalists and internists that have become hospitalists have filled the gap in care over the past 20 years. It’s been 20 years since the name “hospitalist” was used in the New England Journal of Medicine. And in that time, the breadth and depth of care that hospitalists provide across the continuum in the acute-care setting has grown. …

Our older patients are often discharged from the acute-care setting but unable to return directly to their home environment safely. [They] require a period of a week or two, or sometimes longer, in a post-acute-care setting to continue to receive both the medical and the physical rehabilitation care that they need. And we know that there are not enough geriatricians in the world, and hospitalists are really sort of stepping up to provide this post-acute care. And it makes sense because the patients are coming from the hospital directly, and a lot of folks would say they’re sicker than ever in the post-acute-care setting. You don’t stay in the hospital for long anymore, and when you get to the post-acute-care setting, often the illness is ongoing but stabilized, and the patient is on the mend from whatever has befallen them. But they still require a fair amount of medical management. So it makes sense that hospitalists are going into that sphere.

Q: How will you go about resisting the temptation to stealthily leave the convention center during the day and hit the beach? Or will you be able to resist?

A: [Laughter.] I do like that question. I think that … I think that the conference, while it’s busy, there’s some time in the evening to go out and have a nice meal or [to] the beach and see friends. And then the last day, if you have time, if you don’t need to race off, you have a good half a day where you could go to the beach, or you could come early and come a day before or stay an extra couple of days and enjoy San Diego.

But I think if you skip the conference for the beach, you’re not doing yourself a service. You’re going to miss out on the opportunity to learn new clinical information, new strategies for communication. You’re also going to miss out on opportunities to network with your colleagues from across the country. TH

---

 

Thomas R. Collins is a freelance writer in South Florida.

Weijen Chang, MD, SFHM, associate clinical professor at the University of California at San Diego, has a concern: If people attending HM16 don’t get out and about, he worries, they might leave with the impression that his town is sort of, well, normal.

“San Diego is a very laid-back place in general,” says Dr. Chang, director of the hospitalist service in the La Jolla location of the UCSD Health System and longtime pediatrics editor for The Hospitalist. “I think tourists end up being in very touristy areas and don’t generally get a sense of that.”

Read more about the new tracks, speakers at HM16.

Like a good doctor, he’s here to offer a cure. Here are Dr. Chang’s tips for seeing the city. Some are fairly standard and, yes, even a little touristy. But some do give you a taste of that true San Diego vibe, if you’re up for it. He hopes you are.

Mission Beach, Pacific Beach

“Mission Beach is kind of funky,” Dr. Chang says. “Pacific Beach is a little less funky, but it kind of gives you that sort of funky San Diego feeling that a lot of people don’t get when they’re in touristy areas.”

If you make it to Pacific Beach, he says, keep an eye out for “Slomo,” the nickname of a neurologist-turned-Rollerblader who constantly skates up and down the promenade and is nationally known.

“He’s kind of like a fixture,” Dr. Chang says. “Literally, he’s there every single day.”

Harbor Cruise

“If you don’t have access to a car, a really fun and easy thing is a harbor cruise,” Dr. Chang says. “It takes you around all the different ships in the harbor.”

The cruise also goes to Coronado, an island just across the San Diego Bay from downtown.

Lunch at Hotel del Coronado

For those willing to hitch a ride via Uber, Lyft, or a regular taxi—you don’t really need a car to see quite a bit in San Diego—this is a good option. “It’s not super-expensive, and you could see the hotel and walk around the beach there,” Dr. Chang says.

Torrey Pines State Natural Reserve, La Jolla Cove

Torrey Pines is north of downtown and is a good choice for a family outing, Dr. Chang suggests.

“It’s a beautiful hike. They have cliffs in that area. It’s a good family thing to do because the whole family can hike along,” he says. “They have a museum there.”

And beautiful Torrey pine trees are unique to that area.

Also, La Jolla Cove is an option. It’s a touristy spot but a “really pretty” one, Dr. Chang adds.

Balboa Park, Gaslamp Quarter, Little Italy

Dr. Chang suggests Panama 66, a restaurant in Balboa Park.

“It’s in a sculpture garden, and there’s usually a live band playing,” he says. “You can buy a beer or glass of wine and have dinner, too. Or you can just get a couple snacks and hang out and listen to music. That’s sort of my speed when it comes to nightlife. And I imagine for most doctors, it’s sort of their speed.”

There’s also the Old Globe theater in the park. Attendees might want to catch a show. “Just walking around Balboa Park at night is kind of fun,” he says.

Hitting the Gaslamp Quarter, a trendy restaurant and shop area near the convention center, is a nice, “easy thing to do,” he says. One spot there worth checking out is a new speakeasy-style place called Prohibition.

 

“It’s quieter; it’s got nice jazz and is a little more laid-back than perhaps a big loud, bustling bar would be,” he notes.

Little Italy, a long walk or a taxi ride from the conference, is an area “that some people overlook that has a lot of nice restaurants and bars. And it’s a little more laid-back than the Gaslamp,” Dr. Chang says. “The Gaslamp can sometimes be a little bit overwhelming.”

Coronado, Mission Beach

If you want suggestions for seeing a great sunset, he says, Coronado and Mission Beach would be worthwhile, but “anywhere along the westward-facing beach is pretty spectacular.”

 

---

Thomas R. Collins is a freelance writer in South Florida.

Weijen Chang, MD, SFHM, associate clinical professor at the University of California at San Diego, has a concern: If people attending HM16 don’t get out and about, he worries, they might leave with the impression that his town is sort of, well, normal.

“San Diego is a very laid-back place in general,” says Dr. Chang, director of the hospitalist service in the La Jolla location of the UCSD Health System and longtime pediatrics editor for The Hospitalist. “I think tourists end up being in very touristy areas and don’t generally get a sense of that.”

Read more about the new tracks, speakers at HM16.

Like a good doctor, he’s here to offer a cure. Here are Dr. Chang’s tips for seeing the city. Some are fairly standard and, yes, even a little touristy. But some do give you a taste of that true San Diego vibe, if you’re up for it. He hopes you are.

Mission Beach, Pacific Beach

“Mission Beach is kind of funky,” Dr. Chang says. “Pacific Beach is a little less funky, but it kind of gives you that sort of funky San Diego feeling that a lot of people don’t get when they’re in touristy areas.”

If you make it to Pacific Beach, he says, keep an eye out for “Slomo,” the nickname of a neurologist-turned-Rollerblader who constantly skates up and down the promenade and is nationally known.

“He’s kind of like a fixture,” Dr. Chang says. “Literally, he’s there every single day.”

Harbor Cruise

“If you don’t have access to a car, a really fun and easy thing is a harbor cruise,” Dr. Chang says. “It takes you around all the different ships in the harbor.”

The cruise also goes to Coronado, an island just across the San Diego Bay from downtown.

Lunch at Hotel del Coronado

For those willing to hitch a ride via Uber, Lyft, or a regular taxi—you don’t really need a car to see quite a bit in San Diego—this is a good option. “It’s not super-expensive, and you could see the hotel and walk around the beach there,” Dr. Chang says.

Torrey Pines State Natural Reserve, La Jolla Cove

Torrey Pines is north of downtown and is a good choice for a family outing, Dr. Chang suggests.

“It’s a beautiful hike. They have cliffs in that area. It’s a good family thing to do because the whole family can hike along,” he says. “They have a museum there.”

And beautiful Torrey pine trees are unique to that area.

Also, La Jolla Cove is an option. It’s a touristy spot but a “really pretty” one, Dr. Chang adds.

Balboa Park, Gaslamp Quarter, Little Italy

Dr. Chang suggests Panama 66, a restaurant in Balboa Park.

“It’s in a sculpture garden, and there’s usually a live band playing,” he says. “You can buy a beer or glass of wine and have dinner, too. Or you can just get a couple snacks and hang out and listen to music. That’s sort of my speed when it comes to nightlife. And I imagine for most doctors, it’s sort of their speed.”

There’s also the Old Globe theater in the park. Attendees might want to catch a show. “Just walking around Balboa Park at night is kind of fun,” he says.

Hitting the Gaslamp Quarter, a trendy restaurant and shop area near the convention center, is a nice, “easy thing to do,” he says. One spot there worth checking out is a new speakeasy-style place called Prohibition.

 

“It’s quieter; it’s got nice jazz and is a little more laid-back than perhaps a big loud, bustling bar would be,” he notes.

Little Italy, a long walk or a taxi ride from the conference, is an area “that some people overlook that has a lot of nice restaurants and bars. And it’s a little more laid-back than the Gaslamp,” Dr. Chang says. “The Gaslamp can sometimes be a little bit overwhelming.”

Coronado, Mission Beach

If you want suggestions for seeing a great sunset, he says, Coronado and Mission Beach would be worthwhile, but “anywhere along the westward-facing beach is pretty spectacular.”

 

---

Thomas R. Collins is a freelance writer in South Florida.

Weijen Chang, MD, SFHM, associate clinical professor at the University of California at San Diego, has a concern: If people attending HM16 don’t get out and about, he worries, they might leave with the impression that his town is sort of, well, normal.

“San Diego is a very laid-back place in general,” says Dr. Chang, director of the hospitalist service in the La Jolla location of the UCSD Health System and longtime pediatrics editor for The Hospitalist. “I think tourists end up being in very touristy areas and don’t generally get a sense of that.”

Read more about the new tracks, speakers at HM16.

Like a good doctor, he’s here to offer a cure. Here are Dr. Chang’s tips for seeing the city. Some are fairly standard and, yes, even a little touristy. But some do give you a taste of that true San Diego vibe, if you’re up for it. He hopes you are.

Mission Beach, Pacific Beach

“Mission Beach is kind of funky,” Dr. Chang says. “Pacific Beach is a little less funky, but it kind of gives you that sort of funky San Diego feeling that a lot of people don’t get when they’re in touristy areas.”

If you make it to Pacific Beach, he says, keep an eye out for “Slomo,” the nickname of a neurologist-turned-Rollerblader who constantly skates up and down the promenade and is nationally known.

“He’s kind of like a fixture,” Dr. Chang says. “Literally, he’s there every single day.”

Harbor Cruise

“If you don’t have access to a car, a really fun and easy thing is a harbor cruise,” Dr. Chang says. “It takes you around all the different ships in the harbor.”

The cruise also goes to Coronado, an island just across the San Diego Bay from downtown.

Lunch at Hotel del Coronado

For those willing to hitch a ride via Uber, Lyft, or a regular taxi—you don’t really need a car to see quite a bit in San Diego—this is a good option. “It’s not super-expensive, and you could see the hotel and walk around the beach there,” Dr. Chang says.

Torrey Pines State Natural Reserve, La Jolla Cove

Torrey Pines is north of downtown and is a good choice for a family outing, Dr. Chang suggests.

“It’s a beautiful hike. They have cliffs in that area. It’s a good family thing to do because the whole family can hike along,” he says. “They have a museum there.”

And beautiful Torrey pine trees are unique to that area.

Also, La Jolla Cove is an option. It’s a touristy spot but a “really pretty” one, Dr. Chang adds.

Balboa Park, Gaslamp Quarter, Little Italy

Dr. Chang suggests Panama 66, a restaurant in Balboa Park.

“It’s in a sculpture garden, and there’s usually a live band playing,” he says. “You can buy a beer or glass of wine and have dinner, too. Or you can just get a couple snacks and hang out and listen to music. That’s sort of my speed when it comes to nightlife. And I imagine for most doctors, it’s sort of their speed.”

There’s also the Old Globe theater in the park. Attendees might want to catch a show. “Just walking around Balboa Park at night is kind of fun,” he says.

Hitting the Gaslamp Quarter, a trendy restaurant and shop area near the convention center, is a nice, “easy thing to do,” he says. One spot there worth checking out is a new speakeasy-style place called Prohibition.

 

“It’s quieter; it’s got nice jazz and is a little more laid-back than perhaps a big loud, bustling bar would be,” he notes.

Little Italy, a long walk or a taxi ride from the conference, is an area “that some people overlook that has a lot of nice restaurants and bars. And it’s a little more laid-back than the Gaslamp,” Dr. Chang says. “The Gaslamp can sometimes be a little bit overwhelming.”

Coronado, Mission Beach

If you want suggestions for seeing a great sunset, he says, Coronado and Mission Beach would be worthwhile, but “anywhere along the westward-facing beach is pretty spectacular.”

 

---

Thomas R. Collins is a freelance writer in South Florida.

If you can’t find anything that interests you at HM16, check your caffeine level. You might need a cup.

There’s so much in store, you can practically hear the binding of the program straining to contain it all.

If there is a dominant theme at this year’s conference, it’s health information technology (IT), which will be featured in a new track that will span electronic medical records, using IT for documentation and shifting from volume to value, and social media. The keynote address will cover health IT as well.

But even a quick glance captures the diversity of the program: applying for jobs, inpatient management, apps, cost-value questions, ischemic stroke, X-ray, endocrinology, and dying and the counseling of families.

Better buckle up.

Here’s some of what you need to know:

• There will be new tracks on health IT for the hospitalist, the doctor-patient relationship, post-acute care, and perioperative medicine.
• The popular “Young Hospitalist” track is back after a successful debut last year. This track covers, among other things, the application process, how to be a good mentee, how to negotiate a first job, and an introduction to quality improvement projects.

  

• To kick off the meeting, a panel will discuss the field’s expansion, or “hospital medicine at the edges.” It will feature big names, including Laurence Wellikson, MD, MHM, SHM’s chief executive officer.
• Keynote speaker Karen DeSalvo, MD, MPH, MSc, national coordinator for health information technology and acting assistant secretary for the U.S. Department of Health & Human Services, will discuss hospital medicine and technology.
• A series of 90-minute workshops will tackle thought-provoking and relevant topics: “Rule Your Inbox, Rule Your Life”; “Attending 101: Everything You Want and Need to Know”; and “Case-Based Discussion of Essential Issues on Anticoagulation Management.”

Plus, the tracks that form a kind of foundation for the meeting—practice management, academic/research, pediatrics, and quality improvement—will be back.

Get some tips on things to do in San Diego at HM16.

“The annual meeting will have the core content that brings hospitalists back year after year, including something for practice administrators and leaders of practice groups [with] the practice management track, including academics and researchers for the academic and research track, and a quality track for all those [involved in quality projects], and many, many hospitalists are engaged in quality and patient safety efforts across the country,” says Course Director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School in Boston.

The panel on hospital expansion will cover four main areas that are seeing rapid change, according to Dr. Wellikson.

“Hospitalists continue to see their scope of practice evolve and expand,” he says. “In this presentation, we will hear from national leaders about the expanding roles of hospitalists.”

Topics will include palliative care, covered by Steve Pantilat, MD, SFHM, medical director of the University of California at San Francisco School of Medicine palliative care service; alternative payment models, covered by Ron Greeno, MD, MHM, executive vice president for strategy and innovation at Cogent Healthcare; post-acute care, covered by SHM President Bob Harrington, MD, SFHM, CMO at Reliant Post-Acute Care Solutions; and perioperative care, covered by Rachel Thompson, MD, MPH, FHM, associate professor of medicine at the University of Washington.

Dr. Mattison and other organizers thought it was imperative to bring back the “Young Hospitalist” track, which “was wildly successful last year” in both attendance and reviews.

“It’s for people who are aspiring hospitalists—medical students and residents in training—who hope to go on to hospital medicine careers, as well as people who are newly minted hospitalists, people who are probably between one and five years out of their training,” Dr. Mattison explains.

 

Darlene Tad-y, MD, FHM, assistant professor of medicine at University of Colorado at Denver and chair of SHM’s Physicians in Training Committee, says the offerings for young hospitalists come in response to requests from students, residents, and junior faculty. The track intends to give its audience a sense of how to apply for jobs and start shaping a career path, as well as an understanding of the contours of the hospital medicine field.

Dr. Tad-y says she wants the track to reflect her past experiences at SHM meetings (she’s been to five in a row) of a vibrant, engaged community.

“We wanted our students, residents, and young hospitalists to be able to interact with the whole spectrum of hospitalists—folks who are medical educators, folks who are group leaders, folks who are doing quality and safety work,” she says. “All of our sessions are designed to give them those opportunities.”

Hospitalists, she says, “broadly are game changers.”

“We really want our students, residents, and junior hospitalists to engage with us and see how they can be part of this,” she adds.

Dr. Mattison hopes the annual meeting continues to build on its solid reputation.

“I’ve always enjoyed the annual meeting,” she says. “There are a lot of strengths in SHM’s annual meeting year after year. I think the challenge in planning another annual meeting is building upon that strength and continuing it, and finding new topics and new tracks, and evolving with the times.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

If you can’t find anything that interests you at HM16, check your caffeine level. You might need a cup.

There’s so much in store, you can practically hear the binding of the program straining to contain it all.

If there is a dominant theme at this year’s conference, it’s health information technology (IT), which will be featured in a new track that will span electronic medical records, using IT for documentation and shifting from volume to value, and social media. The keynote address will cover health IT as well.

But even a quick glance captures the diversity of the program: applying for jobs, inpatient management, apps, cost-value questions, ischemic stroke, X-ray, endocrinology, and dying and the counseling of families.

Better buckle up.

Here’s some of what you need to know:

• There will be new tracks on health IT for the hospitalist, the doctor-patient relationship, post-acute care, and perioperative medicine.
• The popular “Young Hospitalist” track is back after a successful debut last year. This track covers, among other things, the application process, how to be a good mentee, how to negotiate a first job, and an introduction to quality improvement projects.

  

• To kick off the meeting, a panel will discuss the field’s expansion, or “hospital medicine at the edges.” It will feature big names, including Laurence Wellikson, MD, MHM, SHM’s chief executive officer.
• Keynote speaker Karen DeSalvo, MD, MPH, MSc, national coordinator for health information technology and acting assistant secretary for the U.S. Department of Health & Human Services, will discuss hospital medicine and technology.
• A series of 90-minute workshops will tackle thought-provoking and relevant topics: “Rule Your Inbox, Rule Your Life”; “Attending 101: Everything You Want and Need to Know”; and “Case-Based Discussion of Essential Issues on Anticoagulation Management.”

Plus, the tracks that form a kind of foundation for the meeting—practice management, academic/research, pediatrics, and quality improvement—will be back.

Get some tips on things to do in San Diego at HM16.

“The annual meeting will have the core content that brings hospitalists back year after year, including something for practice administrators and leaders of practice groups [with] the practice management track, including academics and researchers for the academic and research track, and a quality track for all those [involved in quality projects], and many, many hospitalists are engaged in quality and patient safety efforts across the country,” says Course Director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School in Boston.

The panel on hospital expansion will cover four main areas that are seeing rapid change, according to Dr. Wellikson.

“Hospitalists continue to see their scope of practice evolve and expand,” he says. “In this presentation, we will hear from national leaders about the expanding roles of hospitalists.”

Topics will include palliative care, covered by Steve Pantilat, MD, SFHM, medical director of the University of California at San Francisco School of Medicine palliative care service; alternative payment models, covered by Ron Greeno, MD, MHM, executive vice president for strategy and innovation at Cogent Healthcare; post-acute care, covered by SHM President Bob Harrington, MD, SFHM, CMO at Reliant Post-Acute Care Solutions; and perioperative care, covered by Rachel Thompson, MD, MPH, FHM, associate professor of medicine at the University of Washington.

Dr. Mattison and other organizers thought it was imperative to bring back the “Young Hospitalist” track, which “was wildly successful last year” in both attendance and reviews.

“It’s for people who are aspiring hospitalists—medical students and residents in training—who hope to go on to hospital medicine careers, as well as people who are newly minted hospitalists, people who are probably between one and five years out of their training,” Dr. Mattison explains.

 

Darlene Tad-y, MD, FHM, assistant professor of medicine at University of Colorado at Denver and chair of SHM’s Physicians in Training Committee, says the offerings for young hospitalists come in response to requests from students, residents, and junior faculty. The track intends to give its audience a sense of how to apply for jobs and start shaping a career path, as well as an understanding of the contours of the hospital medicine field.

Dr. Tad-y says she wants the track to reflect her past experiences at SHM meetings (she’s been to five in a row) of a vibrant, engaged community.

“We wanted our students, residents, and young hospitalists to be able to interact with the whole spectrum of hospitalists—folks who are medical educators, folks who are group leaders, folks who are doing quality and safety work,” she says. “All of our sessions are designed to give them those opportunities.”

Hospitalists, she says, “broadly are game changers.”

“We really want our students, residents, and junior hospitalists to engage with us and see how they can be part of this,” she adds.

Dr. Mattison hopes the annual meeting continues to build on its solid reputation.

“I’ve always enjoyed the annual meeting,” she says. “There are a lot of strengths in SHM’s annual meeting year after year. I think the challenge in planning another annual meeting is building upon that strength and continuing it, and finding new topics and new tracks, and evolving with the times.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

If you can’t find anything that interests you at HM16, check your caffeine level. You might need a cup.

There’s so much in store, you can practically hear the binding of the program straining to contain it all.

If there is a dominant theme at this year’s conference, it’s health information technology (IT), which will be featured in a new track that will span electronic medical records, using IT for documentation and shifting from volume to value, and social media. The keynote address will cover health IT as well.

But even a quick glance captures the diversity of the program: applying for jobs, inpatient management, apps, cost-value questions, ischemic stroke, X-ray, endocrinology, and dying and the counseling of families.

Better buckle up.

Here’s some of what you need to know:

• There will be new tracks on health IT for the hospitalist, the doctor-patient relationship, post-acute care, and perioperative medicine.
• The popular “Young Hospitalist” track is back after a successful debut last year. This track covers, among other things, the application process, how to be a good mentee, how to negotiate a first job, and an introduction to quality improvement projects.

  

• To kick off the meeting, a panel will discuss the field’s expansion, or “hospital medicine at the edges.” It will feature big names, including Laurence Wellikson, MD, MHM, SHM’s chief executive officer.
• Keynote speaker Karen DeSalvo, MD, MPH, MSc, national coordinator for health information technology and acting assistant secretary for the U.S. Department of Health & Human Services, will discuss hospital medicine and technology.
• A series of 90-minute workshops will tackle thought-provoking and relevant topics: “Rule Your Inbox, Rule Your Life”; “Attending 101: Everything You Want and Need to Know”; and “Case-Based Discussion of Essential Issues on Anticoagulation Management.”

Plus, the tracks that form a kind of foundation for the meeting—practice management, academic/research, pediatrics, and quality improvement—will be back.

Get some tips on things to do in San Diego at HM16.

“The annual meeting will have the core content that brings hospitalists back year after year, including something for practice administrators and leaders of practice groups [with] the practice management track, including academics and researchers for the academic and research track, and a quality track for all those [involved in quality projects], and many, many hospitalists are engaged in quality and patient safety efforts across the country,” says Course Director Melissa Mattison, MD, SFHM, assistant professor of medicine at Harvard Medical School in Boston.

The panel on hospital expansion will cover four main areas that are seeing rapid change, according to Dr. Wellikson.

“Hospitalists continue to see their scope of practice evolve and expand,” he says. “In this presentation, we will hear from national leaders about the expanding roles of hospitalists.”

Topics will include palliative care, covered by Steve Pantilat, MD, SFHM, medical director of the University of California at San Francisco School of Medicine palliative care service; alternative payment models, covered by Ron Greeno, MD, MHM, executive vice president for strategy and innovation at Cogent Healthcare; post-acute care, covered by SHM President Bob Harrington, MD, SFHM, CMO at Reliant Post-Acute Care Solutions; and perioperative care, covered by Rachel Thompson, MD, MPH, FHM, associate professor of medicine at the University of Washington.

Dr. Mattison and other organizers thought it was imperative to bring back the “Young Hospitalist” track, which “was wildly successful last year” in both attendance and reviews.

“It’s for people who are aspiring hospitalists—medical students and residents in training—who hope to go on to hospital medicine careers, as well as people who are newly minted hospitalists, people who are probably between one and five years out of their training,” Dr. Mattison explains.

 

Darlene Tad-y, MD, FHM, assistant professor of medicine at University of Colorado at Denver and chair of SHM’s Physicians in Training Committee, says the offerings for young hospitalists come in response to requests from students, residents, and junior faculty. The track intends to give its audience a sense of how to apply for jobs and start shaping a career path, as well as an understanding of the contours of the hospital medicine field.

Dr. Tad-y says she wants the track to reflect her past experiences at SHM meetings (she’s been to five in a row) of a vibrant, engaged community.

“We wanted our students, residents, and young hospitalists to be able to interact with the whole spectrum of hospitalists—folks who are medical educators, folks who are group leaders, folks who are doing quality and safety work,” she says. “All of our sessions are designed to give them those opportunities.”

Hospitalists, she says, “broadly are game changers.”

“We really want our students, residents, and junior hospitalists to engage with us and see how they can be part of this,” she adds.

Dr. Mattison hopes the annual meeting continues to build on its solid reputation.

“I’ve always enjoyed the annual meeting,” she says. “There are a lot of strengths in SHM’s annual meeting year after year. I think the challenge in planning another annual meeting is building upon that strength and continuing it, and finding new topics and new tracks, and evolving with the times.” TH

---

Thomas R. Collins is a freelance writer in South Florida.

More than 3,000 hospitalists, nurses, administrators, medical residents, and students will ensconce themselves in Spanish Revival architecture, palm trees, fish tacos, and the latest in hospital medicine education March 6–9, converging at the San Diego Convention Center for the 2016 SHM annual meeting.

A great thing about San Diego is that the weather there is to a meteorologist as the common cold is to a doctor: not too challenging. If you guess mild and sunny, you won’t be far off.

Read more about the new tracks, speakers at HM16.

The HM16 program, on the other hand, might be a challenge. There’s a lot to choose from. The latest in clinical care, technology, practice management, building better relationships with patients—it all will be covered and then some. TH

More than 3,000 hospitalists, nurses, administrators, medical residents, and students will ensconce themselves in Spanish Revival architecture, palm trees, fish tacos, and the latest in hospital medicine education March 6–9, converging at the San Diego Convention Center for the 2016 SHM annual meeting.

A great thing about San Diego is that the weather there is to a meteorologist as the common cold is to a doctor: not too challenging. If you guess mild and sunny, you won’t be far off.

Read more about the new tracks, speakers at HM16.

The HM16 program, on the other hand, might be a challenge. There’s a lot to choose from. The latest in clinical care, technology, practice management, building better relationships with patients—it all will be covered and then some. TH

More than 3,000 hospitalists, nurses, administrators, medical residents, and students will ensconce themselves in Spanish Revival architecture, palm trees, fish tacos, and the latest in hospital medicine education March 6–9, converging at the San Diego Convention Center for the 2016 SHM annual meeting.

A great thing about San Diego is that the weather there is to a meteorologist as the common cold is to a doctor: not too challenging. If you guess mild and sunny, you won’t be far off.

Read more about the new tracks, speakers at HM16.

The HM16 program, on the other hand, might be a challenge. There’s a lot to choose from. The latest in clinical care, technology, practice management, building better relationships with patients—it all will be covered and then some. TH

The best antibiotic stewardship programs weave improvements into the routines of hospitalists. But at the end of the day, developing and overseeing these important programs does require some level of time and money. And setting aside that time and money has been the exception rather than the rule.

According to early results from an SHM survey, nine of 123 hospitalists said that they are compensated for work on antimicrobial stewardship programs at their hospitals. That’s a mere 7%. Only 10 out of 122 respondents said they have “protected time” for work on an antimicrobial stewardship program. That’s about 8%. And it’s possible that the survey results are actually skewed somewhat, receiving responses from more proactive centers. One hundred fifteen out of 178 respondents, or 65%, said that they have an antimicrobial stewardship program at their centers.

Arjun Srinivasan, the CDC’s associate director for healthcare-associated infection prevention programs, says he has found that typically about half of U.S. hospitals have such programs. Eric Howell, MD, SFHM, director of the collaborative inpatient medicine service at Johns Hopkins Bayview Medical Center in Baltimore, says change can be a slow process, but he expects initiatives like SHM’s new antibiotic stewardship campaign to help tip the scales toward more resources and more change. It’s a matter of “making the case that, No. 1, this is a problem and, No. 2, there are solutions out there and, No. 3, these solutions are cost effective, as well as improving quality.” Demonstrating the effects on cost and outcomes, he says, is “likely the tipping point [where] we will see real change.”

“If we don’t change, we’re going to run out of antibiotics,” says Dr. Howell, who is also senior physician advisor to SHM’s Center for Hospital Innovation and Improvement. “People are sort of really panic-stricken. And that fear is helping to motivate them to drive change, too.”

Jonathan Zenilman, MD, chief of the division of infectious diseases at Bayview, says that his team worked with a non-Hopkins hospital in Delaware and found they saved about $80,000 a year just by eliminating the use of ertapenem for pre-operative prophylaxis for abdominal surgery. Numbers like that, he says, show that the case for savings can be made to hospital administration. Then again, it’s often easier to make the case before a program is started—and harder to keep it going after that first year.

“Between the second and the third year, you’re not going to generate much savings, if anything,” he says. If a new administrator is in place, it can be a challenge to get them to realize that costs will go back up once a program is dismantled.

Listen to Dr. Zenilman discuss details of Bayview’s antibiotic stewardship program and the challenge of getting such programs funded.

“They look at this as an additional business model,” Dr. Zenilman explains. “They’ll say, ‘Where does my revenue offset the costs?’ And sometimes they just don’t get the value proposition…It needs to be pitched as a value proposition and not as a revenue proposition.”

The culture change toward value in the U.S. is helping, though, he says. “Now the business case is easier,” he says, “because there’s clearly this regulatory push towards doing it.” TH

The best antibiotic stewardship programs weave improvements into the routines of hospitalists. But at the end of the day, developing and overseeing these important programs does require some level of time and money. And setting aside that time and money has been the exception rather than the rule.

According to early results from an SHM survey, nine of 123 hospitalists said that they are compensated for work on antimicrobial stewardship programs at their hospitals. That’s a mere 7%. Only 10 out of 122 respondents said they have “protected time” for work on an antimicrobial stewardship program. That’s about 8%. And it’s possible that the survey results are actually skewed somewhat, receiving responses from more proactive centers. One hundred fifteen out of 178 respondents, or 65%, said that they have an antimicrobial stewardship program at their centers.

Arjun Srinivasan, the CDC’s associate director for healthcare-associated infection prevention programs, says he has found that typically about half of U.S. hospitals have such programs. Eric Howell, MD, SFHM, director of the collaborative inpatient medicine service at Johns Hopkins Bayview Medical Center in Baltimore, says change can be a slow process, but he expects initiatives like SHM’s new antibiotic stewardship campaign to help tip the scales toward more resources and more change. It’s a matter of “making the case that, No. 1, this is a problem and, No. 2, there are solutions out there and, No. 3, these solutions are cost effective, as well as improving quality.” Demonstrating the effects on cost and outcomes, he says, is “likely the tipping point [where] we will see real change.”

“If we don’t change, we’re going to run out of antibiotics,” says Dr. Howell, who is also senior physician advisor to SHM’s Center for Hospital Innovation and Improvement. “People are sort of really panic-stricken. And that fear is helping to motivate them to drive change, too.”

Jonathan Zenilman, MD, chief of the division of infectious diseases at Bayview, says that his team worked with a non-Hopkins hospital in Delaware and found they saved about $80,000 a year just by eliminating the use of ertapenem for pre-operative prophylaxis for abdominal surgery. Numbers like that, he says, show that the case for savings can be made to hospital administration. Then again, it’s often easier to make the case before a program is started—and harder to keep it going after that first year.

“Between the second and the third year, you’re not going to generate much savings, if anything,” he says. If a new administrator is in place, it can be a challenge to get them to realize that costs will go back up once a program is dismantled.

Listen to Dr. Zenilman discuss details of Bayview’s antibiotic stewardship program and the challenge of getting such programs funded.

“They look at this as an additional business model,” Dr. Zenilman explains. “They’ll say, ‘Where does my revenue offset the costs?’ And sometimes they just don’t get the value proposition…It needs to be pitched as a value proposition and not as a revenue proposition.”

The culture change toward value in the U.S. is helping, though, he says. “Now the business case is easier,” he says, “because there’s clearly this regulatory push towards doing it.” TH

The best antibiotic stewardship programs weave improvements into the routines of hospitalists. But at the end of the day, developing and overseeing these important programs does require some level of time and money. And setting aside that time and money has been the exception rather than the rule.

According to early results from an SHM survey, nine of 123 hospitalists said that they are compensated for work on antimicrobial stewardship programs at their hospitals. That’s a mere 7%. Only 10 out of 122 respondents said they have “protected time” for work on an antimicrobial stewardship program. That’s about 8%. And it’s possible that the survey results are actually skewed somewhat, receiving responses from more proactive centers. One hundred fifteen out of 178 respondents, or 65%, said that they have an antimicrobial stewardship program at their centers.

Arjun Srinivasan, the CDC’s associate director for healthcare-associated infection prevention programs, says he has found that typically about half of U.S. hospitals have such programs. Eric Howell, MD, SFHM, director of the collaborative inpatient medicine service at Johns Hopkins Bayview Medical Center in Baltimore, says change can be a slow process, but he expects initiatives like SHM’s new antibiotic stewardship campaign to help tip the scales toward more resources and more change. It’s a matter of “making the case that, No. 1, this is a problem and, No. 2, there are solutions out there and, No. 3, these solutions are cost effective, as well as improving quality.” Demonstrating the effects on cost and outcomes, he says, is “likely the tipping point [where] we will see real change.”

“If we don’t change, we’re going to run out of antibiotics,” says Dr. Howell, who is also senior physician advisor to SHM’s Center for Hospital Innovation and Improvement. “People are sort of really panic-stricken. And that fear is helping to motivate them to drive change, too.”

Jonathan Zenilman, MD, chief of the division of infectious diseases at Bayview, says that his team worked with a non-Hopkins hospital in Delaware and found they saved about $80,000 a year just by eliminating the use of ertapenem for pre-operative prophylaxis for abdominal surgery. Numbers like that, he says, show that the case for savings can be made to hospital administration. Then again, it’s often easier to make the case before a program is started—and harder to keep it going after that first year.

“Between the second and the third year, you’re not going to generate much savings, if anything,” he says. If a new administrator is in place, it can be a challenge to get them to realize that costs will go back up once a program is dismantled.

Listen to Dr. Zenilman discuss details of Bayview’s antibiotic stewardship program and the challenge of getting such programs funded.

“They look at this as an additional business model,” Dr. Zenilman explains. “They’ll say, ‘Where does my revenue offset the costs?’ And sometimes they just don’t get the value proposition…It needs to be pitched as a value proposition and not as a revenue proposition.”

The culture change toward value in the U.S. is helping, though, he says. “Now the business case is easier,” he says, “because there’s clearly this regulatory push towards doing it.” TH

In 2006, infectious disease specialists and pharmacists at Johns Hopkins Bayview Medical Center in Baltimore took a look at the pharmacy budget and were jarred by the numbers.

“The proportion of the pharmacy budget that was antimicrobials was much larger than we would expect,” says Jonathan Zenilman, MD, chief of infectious diseases at Bayview.

The pharmacy and ID teams implemented antibiotic stewardship tools, including medication reassessments after two or three days and quicker conversion to oral drugs when appropriate. They also did something that was fairly new at the time: A hospitalist was incorporated into the team. The tactic was employed out of need—the ID department was stretched too thin—but it made perfect sense, Dr. Zenilman says. Most of the patients seen by hospitalists have bread-and-butter conditions that comprise a lot of the center’s antibiotic use.

“Patients on a typical hospital medicine series are not on advanced antifungals and complicated antibiotic regimens,” he says.

The arrangement worked: The center achieved a more than 50% reduction in the main target drug, Zosyn, and a hospitalist is still typically part of the antibiotic stewardship team.

That might have been a new concept then, but fast forward a decade: ID and public health experts are increasingly seeing hospitalists as central to the effort to limit antibiotic overuse and stall the development of drug resistance in antimicrobial organisms.

Now, SHM is about to launch a campaign to get more hospitalists to see themselves as central to that effort. SHM will formally kick off the “Fight the Resistance” campaign on November 9. It’s an awareness and behavior change campaign that builds on SHM’s participation in a White House forum on antibiotic resistance that was held in June.

“We wanted to not only enhance awareness among hospitalists about what appropriate antimicrobial prescribing is, but also to change behaviors and ultimately change culture to facilitate appropriate antibiotic use,” says Jenna Goldstein, director of SHM’s Center for Hospital Innovation and Improvement (CHII), who is leading the initiative along with Mobola Owolabi, SHM project manager.

Behavior Change

The society will provide educational inserts hospitalists can use at their hospitals, as well as downloadable posters that will help raise awareness on appropriate antibiotic use. The campaign will be highlighted in SHM’s online and social media presence.

Hospitalists will be asked to make behavior changes in their antibiotic-related practices that will promote better stewardship, such as taking an antibiotic “timeout” during which usage is revisited and changed or discontinued if antibiotic use is not appropriate.

“We’re specifically asking hospitalists to engage in behavior changes and we plan to assess outcomes and results after implementation,” Goldstein says. “Our ultimate goal, although we realize this is a much longer-term goal and certainly more arduous to measure, is to change the culture in the hospital related to prescribing, so that hospitalists are prescribing only when appropriate, only when there’s an indicated infection, and according to the evidence base for prescribing antimicrobials for their patients.”

 

Future plans will include developing a mentored implementation program in which SHM will provide guidance for hospitalists who want to develop or improve a stewardship program at their hospital. The guidance will be based in part on the CDC’s “Core Elements of Hospital Antibiotic Stewardship Programs,” a kind of guidebook on antibiotic stewardship.¹

Read more about antibiotic stewardship resources.

Eric Howell, MD, SFHM, director of the collaborative inpatient medicine service at Bayview, associate professor of medicine at Johns Hopkins University School of Medicine, and CHII’s senior physician advisor, says it’s time for hospitalists to take on a bigger role.

“Doing ‘just in case’ antibiotics is really not appropriate and should be strongly discouraged, unless the risks are very high for a specific patient,” he says. A past president of SHM, Dr. Howell has long advocated that hospitalists take the time to explain the risk of excessive antibiotic use to their patients, even on a busy day.

“It’s our duty as physicians to make sure our patients get the best care possible, and often that means the physicians themselves have to do the educating,” he says. “I would say that, in general, it doesn’t take that much time. Having a conversation with your patient to educate them about anything—heart failure, diabetes, appropriate antibiotics—must be built into the care that we provide our patients somehow.”

That communication doesn’t necessarily have to be performed by the hospitalist, he notes. The pharmacist, nurse, or written material can relay this information. But somewhere along the line, he says, the antibiotic education must happen.

SHM’s initiative should help, simply because “knowledge is good,” says Dr. Zenilman, the ID expert at Hopkins Bayview. Key to success, he says, will be what happens when hospitalists are taking care of a patient—will they actually be willing to cut their regimens?

“People overuse antibiotics, sometimes not out of education issues, but because they’re anxious,” Dr. Zenilman says. “The more challenging part is getting people to deal with the uncertainty and recognizing intuitively that overuse has enormous complications.”

The literature is now replete with studies showing how antibiotic stewardship measures help curb resistance, eliminate incorrect antibiotic prescribing, lower antibiotic use, and lower costs.

A web-based program was projected to save almost $400,000 a year linked to restricted antibiotic use at Johns Hopkins, according to a 2008 study.²

In Canada, according to a 2007 study, a program including recommendations for alternative drugs and shorter, guideline-based treatment durations helped reduce Clostridium difficile infections by 60% over a two-year period.³

An analysis published in August, using data from the CDC’s National Healthcare Safety Network and Emerging Infections Program, concluded that a nationwide infection control and antibiotic stewardship intervention could, over five years, avoid an estimated 619,000 hospital-acquired infections from carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. diff.⁴

In spite of the evidence, preliminary results of a recent SHM survey on antibiotic stewardship found very little support, in terms of money and protected time, for hospitalists to be involved in antibiotic stewardship programs.

UM’s Success Story

A kind of microcosm of what is possible can be seen at the University of Michigan. There, Scott Flanders, MD, MHM, clinical professor of internal medicine and past president of SHM, has led an effort, along with the CDC and the Institute for Healthcare Improvement, to look at hospitalist-led interventions for smarter antimicrobial use.

 

Hospitalists in several programs around the country were asked to focus on a few key improvement strategies that are believed to improve use. For instance, when guidelines give a range of duration of dosing, physicians often lean toward the higher end (when the range is seven to 21 days, the default was typically closer to 21), even when that might not be necessary in a given situation. So, more specific guidelines for common situations were applied.

Hospitalists also worked to improve documentation to make antibiotic use more visible at the point of care: which drug it is, when it was started, what day of therapy it is that day, how many more days are left.

An antibiotic “timeout” at 48 to 72 hours was implemented to determine whether the treatment course should be maintained, changed, or eliminated.

The idea was for hospitalists to track this as part of the usual care process.

“We didn’t want people to create whole new systems to do these things,” says Dr. Flanders, who has consulted with SHM for its stewardship initiative. “We wanted people, for example, to use their multidisciplinary rounds that they were already having to just add one thing to the checklist.”

The process was shown to be workable. All steps of the stewardship protocol were performed 70% of the time after the initiative began, compared with just 20% of the time before it began, Dr. Flanders says. Additionally, about 25% of patients had a “significant and important” change made to their antibiotic treatment following the “timeout.”

“During this timeout, a lot of action happened,” Dr. Flanders says. More study is needed to show exactly how much of a change occurred and whether it led to cost savings, he says, but “I suspect it will.”

Much-Anticipated Partnership

Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, says he is eager to continue to work with SHM on its antibiotic stewardship efforts, but he cautions that hospitalists should not try to do too much too quickly in implementing change.

“Success generally comes from starting small, from starting with a focused approach to something that you know is a problem in your facility,” Dr. Srinivasan says. “When you try to delve into everything all at once, you can very quickly get overwhelmed.”

Although smaller centers might have less manpower and face a bigger challenge in leading a stewardship program, it can be done, he says.

“We see some very small hospitals that have fantastic stewardship programs and some very small hospitals that are struggling,” he says. “We know it’s doable across the spectrum of the sizes of hospital.”

Hospitalists, he adds, “are the tip of the spear. They are probably prescribing most of the antibiotics [for inpatients] … and diagnosing most of the infections. So arming them with the information they need, working with them to develop a process that makes prescribing optimal and most efficient is obviously hugely beneficial.

“You’re going to have a tremendous impact by reaching that particular group.”

---

Tom Collins is a freelance writer in South Florida.

References

1. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. May 7, 2015. Accessed October 6, 2015.
2. Agwu AL, Lee CK, Jain SK. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008 Sep 15;47(6):747-753.
3. Valiquette L, Cossette B, Garant MP, Diab H, Pépin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis. 2007;45 Suppl 2:S112-S121.
4. Slayton RB, Toth D, Lee BY, et al. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - United States. MMWR Morb Mortal Wkly Rep. 2015;64(30):826-831.

In 2006, infectious disease specialists and pharmacists at Johns Hopkins Bayview Medical Center in Baltimore took a look at the pharmacy budget and were jarred by the numbers.

“The proportion of the pharmacy budget that was antimicrobials was much larger than we would expect,” says Jonathan Zenilman, MD, chief of infectious diseases at Bayview.

The pharmacy and ID teams implemented antibiotic stewardship tools, including medication reassessments after two or three days and quicker conversion to oral drugs when appropriate. They also did something that was fairly new at the time: A hospitalist was incorporated into the team. The tactic was employed out of need—the ID department was stretched too thin—but it made perfect sense, Dr. Zenilman says. Most of the patients seen by hospitalists have bread-and-butter conditions that comprise a lot of the center’s antibiotic use.

“Patients on a typical hospital medicine series are not on advanced antifungals and complicated antibiotic regimens,” he says.

The arrangement worked: The center achieved a more than 50% reduction in the main target drug, Zosyn, and a hospitalist is still typically part of the antibiotic stewardship team.

That might have been a new concept then, but fast forward a decade: ID and public health experts are increasingly seeing hospitalists as central to the effort to limit antibiotic overuse and stall the development of drug resistance in antimicrobial organisms.

Now, SHM is about to launch a campaign to get more hospitalists to see themselves as central to that effort. SHM will formally kick off the “Fight the Resistance” campaign on November 9. It’s an awareness and behavior change campaign that builds on SHM’s participation in a White House forum on antibiotic resistance that was held in June.

“We wanted to not only enhance awareness among hospitalists about what appropriate antimicrobial prescribing is, but also to change behaviors and ultimately change culture to facilitate appropriate antibiotic use,” says Jenna Goldstein, director of SHM’s Center for Hospital Innovation and Improvement (CHII), who is leading the initiative along with Mobola Owolabi, SHM project manager.

Behavior Change

The society will provide educational inserts hospitalists can use at their hospitals, as well as downloadable posters that will help raise awareness on appropriate antibiotic use. The campaign will be highlighted in SHM’s online and social media presence.

Hospitalists will be asked to make behavior changes in their antibiotic-related practices that will promote better stewardship, such as taking an antibiotic “timeout” during which usage is revisited and changed or discontinued if antibiotic use is not appropriate.

“We’re specifically asking hospitalists to engage in behavior changes and we plan to assess outcomes and results after implementation,” Goldstein says. “Our ultimate goal, although we realize this is a much longer-term goal and certainly more arduous to measure, is to change the culture in the hospital related to prescribing, so that hospitalists are prescribing only when appropriate, only when there’s an indicated infection, and according to the evidence base for prescribing antimicrobials for their patients.”

 

Future plans will include developing a mentored implementation program in which SHM will provide guidance for hospitalists who want to develop or improve a stewardship program at their hospital. The guidance will be based in part on the CDC’s “Core Elements of Hospital Antibiotic Stewardship Programs,” a kind of guidebook on antibiotic stewardship.¹

Read more about antibiotic stewardship resources.

Eric Howell, MD, SFHM, director of the collaborative inpatient medicine service at Bayview, associate professor of medicine at Johns Hopkins University School of Medicine, and CHII’s senior physician advisor, says it’s time for hospitalists to take on a bigger role.

“Doing ‘just in case’ antibiotics is really not appropriate and should be strongly discouraged, unless the risks are very high for a specific patient,” he says. A past president of SHM, Dr. Howell has long advocated that hospitalists take the time to explain the risk of excessive antibiotic use to their patients, even on a busy day.

“It’s our duty as physicians to make sure our patients get the best care possible, and often that means the physicians themselves have to do the educating,” he says. “I would say that, in general, it doesn’t take that much time. Having a conversation with your patient to educate them about anything—heart failure, diabetes, appropriate antibiotics—must be built into the care that we provide our patients somehow.”

That communication doesn’t necessarily have to be performed by the hospitalist, he notes. The pharmacist, nurse, or written material can relay this information. But somewhere along the line, he says, the antibiotic education must happen.

SHM’s initiative should help, simply because “knowledge is good,” says Dr. Zenilman, the ID expert at Hopkins Bayview. Key to success, he says, will be what happens when hospitalists are taking care of a patient—will they actually be willing to cut their regimens?

“People overuse antibiotics, sometimes not out of education issues, but because they’re anxious,” Dr. Zenilman says. “The more challenging part is getting people to deal with the uncertainty and recognizing intuitively that overuse has enormous complications.”

The literature is now replete with studies showing how antibiotic stewardship measures help curb resistance, eliminate incorrect antibiotic prescribing, lower antibiotic use, and lower costs.

A web-based program was projected to save almost $400,000 a year linked to restricted antibiotic use at Johns Hopkins, according to a 2008 study.²

In Canada, according to a 2007 study, a program including recommendations for alternative drugs and shorter, guideline-based treatment durations helped reduce Clostridium difficile infections by 60% over a two-year period.³

An analysis published in August, using data from the CDC’s National Healthcare Safety Network and Emerging Infections Program, concluded that a nationwide infection control and antibiotic stewardship intervention could, over five years, avoid an estimated 619,000 hospital-acquired infections from carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. diff.⁴

In spite of the evidence, preliminary results of a recent SHM survey on antibiotic stewardship found very little support, in terms of money and protected time, for hospitalists to be involved in antibiotic stewardship programs.

UM’s Success Story

A kind of microcosm of what is possible can be seen at the University of Michigan. There, Scott Flanders, MD, MHM, clinical professor of internal medicine and past president of SHM, has led an effort, along with the CDC and the Institute for Healthcare Improvement, to look at hospitalist-led interventions for smarter antimicrobial use.

 

Hospitalists in several programs around the country were asked to focus on a few key improvement strategies that are believed to improve use. For instance, when guidelines give a range of duration of dosing, physicians often lean toward the higher end (when the range is seven to 21 days, the default was typically closer to 21), even when that might not be necessary in a given situation. So, more specific guidelines for common situations were applied.

Hospitalists also worked to improve documentation to make antibiotic use more visible at the point of care: which drug it is, when it was started, what day of therapy it is that day, how many more days are left.

An antibiotic “timeout” at 48 to 72 hours was implemented to determine whether the treatment course should be maintained, changed, or eliminated.

The idea was for hospitalists to track this as part of the usual care process.

“We didn’t want people to create whole new systems to do these things,” says Dr. Flanders, who has consulted with SHM for its stewardship initiative. “We wanted people, for example, to use their multidisciplinary rounds that they were already having to just add one thing to the checklist.”

The process was shown to be workable. All steps of the stewardship protocol were performed 70% of the time after the initiative began, compared with just 20% of the time before it began, Dr. Flanders says. Additionally, about 25% of patients had a “significant and important” change made to their antibiotic treatment following the “timeout.”

“During this timeout, a lot of action happened,” Dr. Flanders says. More study is needed to show exactly how much of a change occurred and whether it led to cost savings, he says, but “I suspect it will.”

Much-Anticipated Partnership

Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, says he is eager to continue to work with SHM on its antibiotic stewardship efforts, but he cautions that hospitalists should not try to do too much too quickly in implementing change.

“Success generally comes from starting small, from starting with a focused approach to something that you know is a problem in your facility,” Dr. Srinivasan says. “When you try to delve into everything all at once, you can very quickly get overwhelmed.”

Although smaller centers might have less manpower and face a bigger challenge in leading a stewardship program, it can be done, he says.

“We see some very small hospitals that have fantastic stewardship programs and some very small hospitals that are struggling,” he says. “We know it’s doable across the spectrum of the sizes of hospital.”

Hospitalists, he adds, “are the tip of the spear. They are probably prescribing most of the antibiotics [for inpatients] … and diagnosing most of the infections. So arming them with the information they need, working with them to develop a process that makes prescribing optimal and most efficient is obviously hugely beneficial.

“You’re going to have a tremendous impact by reaching that particular group.”

---

Tom Collins is a freelance writer in South Florida.

References

1. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. May 7, 2015. Accessed October 6, 2015.
2. Agwu AL, Lee CK, Jain SK. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008 Sep 15;47(6):747-753.
3. Valiquette L, Cossette B, Garant MP, Diab H, Pépin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis. 2007;45 Suppl 2:S112-S121.
4. Slayton RB, Toth D, Lee BY, et al. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - United States. MMWR Morb Mortal Wkly Rep. 2015;64(30):826-831.

In 2006, infectious disease specialists and pharmacists at Johns Hopkins Bayview Medical Center in Baltimore took a look at the pharmacy budget and were jarred by the numbers.

“The proportion of the pharmacy budget that was antimicrobials was much larger than we would expect,” says Jonathan Zenilman, MD, chief of infectious diseases at Bayview.

The pharmacy and ID teams implemented antibiotic stewardship tools, including medication reassessments after two or three days and quicker conversion to oral drugs when appropriate. They also did something that was fairly new at the time: A hospitalist was incorporated into the team. The tactic was employed out of need—the ID department was stretched too thin—but it made perfect sense, Dr. Zenilman says. Most of the patients seen by hospitalists have bread-and-butter conditions that comprise a lot of the center’s antibiotic use.

“Patients on a typical hospital medicine series are not on advanced antifungals and complicated antibiotic regimens,” he says.

The arrangement worked: The center achieved a more than 50% reduction in the main target drug, Zosyn, and a hospitalist is still typically part of the antibiotic stewardship team.

That might have been a new concept then, but fast forward a decade: ID and public health experts are increasingly seeing hospitalists as central to the effort to limit antibiotic overuse and stall the development of drug resistance in antimicrobial organisms.

Now, SHM is about to launch a campaign to get more hospitalists to see themselves as central to that effort. SHM will formally kick off the “Fight the Resistance” campaign on November 9. It’s an awareness and behavior change campaign that builds on SHM’s participation in a White House forum on antibiotic resistance that was held in June.

“We wanted to not only enhance awareness among hospitalists about what appropriate antimicrobial prescribing is, but also to change behaviors and ultimately change culture to facilitate appropriate antibiotic use,” says Jenna Goldstein, director of SHM’s Center for Hospital Innovation and Improvement (CHII), who is leading the initiative along with Mobola Owolabi, SHM project manager.

Behavior Change

The society will provide educational inserts hospitalists can use at their hospitals, as well as downloadable posters that will help raise awareness on appropriate antibiotic use. The campaign will be highlighted in SHM’s online and social media presence.

Hospitalists will be asked to make behavior changes in their antibiotic-related practices that will promote better stewardship, such as taking an antibiotic “timeout” during which usage is revisited and changed or discontinued if antibiotic use is not appropriate.

“We’re specifically asking hospitalists to engage in behavior changes and we plan to assess outcomes and results after implementation,” Goldstein says. “Our ultimate goal, although we realize this is a much longer-term goal and certainly more arduous to measure, is to change the culture in the hospital related to prescribing, so that hospitalists are prescribing only when appropriate, only when there’s an indicated infection, and according to the evidence base for prescribing antimicrobials for their patients.”

 

Future plans will include developing a mentored implementation program in which SHM will provide guidance for hospitalists who want to develop or improve a stewardship program at their hospital. The guidance will be based in part on the CDC’s “Core Elements of Hospital Antibiotic Stewardship Programs,” a kind of guidebook on antibiotic stewardship.¹

Read more about antibiotic stewardship resources.

Eric Howell, MD, SFHM, director of the collaborative inpatient medicine service at Bayview, associate professor of medicine at Johns Hopkins University School of Medicine, and CHII’s senior physician advisor, says it’s time for hospitalists to take on a bigger role.

“Doing ‘just in case’ antibiotics is really not appropriate and should be strongly discouraged, unless the risks are very high for a specific patient,” he says. A past president of SHM, Dr. Howell has long advocated that hospitalists take the time to explain the risk of excessive antibiotic use to their patients, even on a busy day.

“It’s our duty as physicians to make sure our patients get the best care possible, and often that means the physicians themselves have to do the educating,” he says. “I would say that, in general, it doesn’t take that much time. Having a conversation with your patient to educate them about anything—heart failure, diabetes, appropriate antibiotics—must be built into the care that we provide our patients somehow.”

That communication doesn’t necessarily have to be performed by the hospitalist, he notes. The pharmacist, nurse, or written material can relay this information. But somewhere along the line, he says, the antibiotic education must happen.

SHM’s initiative should help, simply because “knowledge is good,” says Dr. Zenilman, the ID expert at Hopkins Bayview. Key to success, he says, will be what happens when hospitalists are taking care of a patient—will they actually be willing to cut their regimens?

“People overuse antibiotics, sometimes not out of education issues, but because they’re anxious,” Dr. Zenilman says. “The more challenging part is getting people to deal with the uncertainty and recognizing intuitively that overuse has enormous complications.”

The literature is now replete with studies showing how antibiotic stewardship measures help curb resistance, eliminate incorrect antibiotic prescribing, lower antibiotic use, and lower costs.

A web-based program was projected to save almost $400,000 a year linked to restricted antibiotic use at Johns Hopkins, according to a 2008 study.²

In Canada, according to a 2007 study, a program including recommendations for alternative drugs and shorter, guideline-based treatment durations helped reduce Clostridium difficile infections by 60% over a two-year period.³

An analysis published in August, using data from the CDC’s National Healthcare Safety Network and Emerging Infections Program, concluded that a nationwide infection control and antibiotic stewardship intervention could, over five years, avoid an estimated 619,000 hospital-acquired infections from carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. diff.⁴

In spite of the evidence, preliminary results of a recent SHM survey on antibiotic stewardship found very little support, in terms of money and protected time, for hospitalists to be involved in antibiotic stewardship programs.

UM’s Success Story

A kind of microcosm of what is possible can be seen at the University of Michigan. There, Scott Flanders, MD, MHM, clinical professor of internal medicine and past president of SHM, has led an effort, along with the CDC and the Institute for Healthcare Improvement, to look at hospitalist-led interventions for smarter antimicrobial use.

 

Hospitalists in several programs around the country were asked to focus on a few key improvement strategies that are believed to improve use. For instance, when guidelines give a range of duration of dosing, physicians often lean toward the higher end (when the range is seven to 21 days, the default was typically closer to 21), even when that might not be necessary in a given situation. So, more specific guidelines for common situations were applied.

Hospitalists also worked to improve documentation to make antibiotic use more visible at the point of care: which drug it is, when it was started, what day of therapy it is that day, how many more days are left.

An antibiotic “timeout” at 48 to 72 hours was implemented to determine whether the treatment course should be maintained, changed, or eliminated.

The idea was for hospitalists to track this as part of the usual care process.

“We didn’t want people to create whole new systems to do these things,” says Dr. Flanders, who has consulted with SHM for its stewardship initiative. “We wanted people, for example, to use their multidisciplinary rounds that they were already having to just add one thing to the checklist.”

The process was shown to be workable. All steps of the stewardship protocol were performed 70% of the time after the initiative began, compared with just 20% of the time before it began, Dr. Flanders says. Additionally, about 25% of patients had a “significant and important” change made to their antibiotic treatment following the “timeout.”

“During this timeout, a lot of action happened,” Dr. Flanders says. More study is needed to show exactly how much of a change occurred and whether it led to cost savings, he says, but “I suspect it will.”

Much-Anticipated Partnership

Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, says he is eager to continue to work with SHM on its antibiotic stewardship efforts, but he cautions that hospitalists should not try to do too much too quickly in implementing change.

“Success generally comes from starting small, from starting with a focused approach to something that you know is a problem in your facility,” Dr. Srinivasan says. “When you try to delve into everything all at once, you can very quickly get overwhelmed.”

Although smaller centers might have less manpower and face a bigger challenge in leading a stewardship program, it can be done, he says.

“We see some very small hospitals that have fantastic stewardship programs and some very small hospitals that are struggling,” he says. “We know it’s doable across the spectrum of the sizes of hospital.”

Hospitalists, he adds, “are the tip of the spear. They are probably prescribing most of the antibiotics [for inpatients] … and diagnosing most of the infections. So arming them with the information they need, working with them to develop a process that makes prescribing optimal and most efficient is obviously hugely beneficial.

“You’re going to have a tremendous impact by reaching that particular group.”

---

Tom Collins is a freelance writer in South Florida.

References

1. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. May 7, 2015. Accessed October 6, 2015.
2. Agwu AL, Lee CK, Jain SK. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008 Sep 15;47(6):747-753.
3. Valiquette L, Cossette B, Garant MP, Diab H, Pépin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis. 2007;45 Suppl 2:S112-S121.
4. Slayton RB, Toth D, Lee BY, et al. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - United States. MMWR Morb Mortal Wkly Rep. 2015;64(30):826-831.