Controlling glycemic levels and diabetes in hospitalized patients is one of the biggest ongoing challenges hospitalists face. Now, hospitalists can help their hospitals come up with system-wide improvements to address glycemic control.

SHM’s Glycemic Control Mentored Implementation (GCMI) Program gives hospitalists the tools they need to make system-level changes in their hospital and pairs them with a mentor to help make it happen.

SHM is accepting applications for the 2014 GCMI program, but act soon. Applications are due September 30. For more information, visit www.hospitalmedicine.org/gcmi.

Controlling glycemic levels and diabetes in hospitalized patients is one of the biggest ongoing challenges hospitalists face. Now, hospitalists can help their hospitals come up with system-wide improvements to address glycemic control.

SHM’s Glycemic Control Mentored Implementation (GCMI) Program gives hospitalists the tools they need to make system-level changes in their hospital and pairs them with a mentor to help make it happen.

SHM is accepting applications for the 2014 GCMI program, but act soon. Applications are due September 30. For more information, visit www.hospitalmedicine.org/gcmi.

Controlling glycemic levels and diabetes in hospitalized patients is one of the biggest ongoing challenges hospitalists face. Now, hospitalists can help their hospitals come up with system-wide improvements to address glycemic control.

SHM’s Glycemic Control Mentored Implementation (GCMI) Program gives hospitalists the tools they need to make system-level changes in their hospital and pairs them with a mentor to help make it happen.

SHM is accepting applications for the 2014 GCMI program, but act soon. Applications are due September 30. For more information, visit www.hospitalmedicine.org/gcmi.

Have you ever worried about which billing code is appropriate? Worried that your coding decisions could be called into question, but reading up on the topic only left you more confused?

SHM’s new, first-of-its-kind online educational tool can help.

CODE-H Interactive—short for “Coding Optimally for Documenting Effectively for Hospitalists”—gives hospitalists an online guided tour through six different coding scenarios, enabling them to choose the codes they believe are appropriate. Then, SHM’s coding expert highlights the correct codes and offers rationales for each.

HM groups can enroll multiple team members using a single subscription, making educating entire teams easy. Each participant receives a certificate documenting his or her participation in the program.

CODE-H Interactive is available today at www.hospitalmedicine.org/codehi.

Have you ever worried about which billing code is appropriate? Worried that your coding decisions could be called into question, but reading up on the topic only left you more confused?

SHM’s new, first-of-its-kind online educational tool can help.

CODE-H Interactive—short for “Coding Optimally for Documenting Effectively for Hospitalists”—gives hospitalists an online guided tour through six different coding scenarios, enabling them to choose the codes they believe are appropriate. Then, SHM’s coding expert highlights the correct codes and offers rationales for each.

HM groups can enroll multiple team members using a single subscription, making educating entire teams easy. Each participant receives a certificate documenting his or her participation in the program.

CODE-H Interactive is available today at www.hospitalmedicine.org/codehi.

Have you ever worried about which billing code is appropriate? Worried that your coding decisions could be called into question, but reading up on the topic only left you more confused?

SHM’s new, first-of-its-kind online educational tool can help.

CODE-H Interactive—short for “Coding Optimally for Documenting Effectively for Hospitalists”—gives hospitalists an online guided tour through six different coding scenarios, enabling them to choose the codes they believe are appropriate. Then, SHM’s coding expert highlights the correct codes and offers rationales for each.

HM groups can enroll multiple team members using a single subscription, making educating entire teams easy. Each participant receives a certificate documenting his or her participation in the program.

CODE-H Interactive is available today at www.hospitalmedicine.org/codehi.

More than a thousand hospitalists have earned the right to affix “FHM” or “SFHM” alongside their other credentials. Now, you can learn from them about how to apply for Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designations in a first of its kind webinar hosted by SHM (Sept. 24, 1 pm EST). Speakers will include current FHM and Master in Hospital Medicine (MHM) designees. They will talk about the process and how the designation has impacted their careers as hospitalizes.

SHM Fellows Webinar

Sept. 24

1 p.m. (EST)

www.hospitalmedicine.org/fellows

More than a thousand hospitalists have earned the right to affix “FHM” or “SFHM” alongside their other credentials. Now, you can learn from them about how to apply for Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designations in a first of its kind webinar hosted by SHM (Sept. 24, 1 pm EST). Speakers will include current FHM and Master in Hospital Medicine (MHM) designees. They will talk about the process and how the designation has impacted their careers as hospitalizes.

SHM Fellows Webinar

Sept. 24

1 p.m. (EST)

www.hospitalmedicine.org/fellows

More than a thousand hospitalists have earned the right to affix “FHM” or “SFHM” alongside their other credentials. Now, you can learn from them about how to apply for Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designations in a first of its kind webinar hosted by SHM (Sept. 24, 1 pm EST). Speakers will include current FHM and Master in Hospital Medicine (MHM) designees. They will talk about the process and how the designation has impacted their careers as hospitalizes.

SHM Fellows Webinar

Sept. 24

1 p.m. (EST)

www.hospitalmedicine.org/fellows

Academic hospitalists: Now is the time to set your sights on new career goals in 2015. The Academic Hospitalist Academy helps academic hospitalists map out a career in teaching and scholarship while at the same time learning directly from the best academic hospitalists in the field.

Spaces for Academic Hospitalist Academy are limited, and it’s only a month away. Register today.

Academic Hospitalist Academy

October 20-23

Englewood, Colorado

www.academichospitalist.org/

Academic hospitalists: Now is the time to set your sights on new career goals in 2015. The Academic Hospitalist Academy helps academic hospitalists map out a career in teaching and scholarship while at the same time learning directly from the best academic hospitalists in the field.

Spaces for Academic Hospitalist Academy are limited, and it’s only a month away. Register today.

Academic Hospitalist Academy

October 20-23

Englewood, Colorado

www.academichospitalist.org/

Academic hospitalists: Now is the time to set your sights on new career goals in 2015. The Academic Hospitalist Academy helps academic hospitalists map out a career in teaching and scholarship while at the same time learning directly from the best academic hospitalists in the field.

Spaces for Academic Hospitalist Academy are limited, and it’s only a month away. Register today.

Academic Hospitalist Academy

October 20-23

Englewood, Colorado

www.academichospitalist.org/

Medical school and residency are the first steps toward being a first-rate hospitalist, but will they prepare you for the demands of managing a new project in the hospital? Or taking a leadership position within a hospital medicine group? How about making the financial case for changes you’d like to see in your hospital?

SHM established its popular Leadership Academy to help hospitalists take the next steps into leadership positions. The three courses of Leadership Academy teach skills like practicing team and physician engagement, speaking the language of hospital finances, and using your own personal attributes to create an effective and authentic leadership style.

And now, you can demonstrate your experience in Leadership Academy by applying for SHM’s Certificate of Leadership in Hospital Medicine (CLHM). The certificate program requires attending all three Leadership Academy courses and completing a mentored leadership program at your hospital.

A limited number of reservations are still available for the November Leadership Academy in Honolulu. Visit www.hospitalmedicine.org/leadership for more information.

SHM Leadership Academy

November 3-6

Honolulu, Hawaii

www.hospitalmedicine.org/leadership

Medical school and residency are the first steps toward being a first-rate hospitalist, but will they prepare you for the demands of managing a new project in the hospital? Or taking a leadership position within a hospital medicine group? How about making the financial case for changes you’d like to see in your hospital?

SHM established its popular Leadership Academy to help hospitalists take the next steps into leadership positions. The three courses of Leadership Academy teach skills like practicing team and physician engagement, speaking the language of hospital finances, and using your own personal attributes to create an effective and authentic leadership style.

And now, you can demonstrate your experience in Leadership Academy by applying for SHM’s Certificate of Leadership in Hospital Medicine (CLHM). The certificate program requires attending all three Leadership Academy courses and completing a mentored leadership program at your hospital.

A limited number of reservations are still available for the November Leadership Academy in Honolulu. Visit www.hospitalmedicine.org/leadership for more information.

SHM Leadership Academy

November 3-6

Honolulu, Hawaii

www.hospitalmedicine.org/leadership

Medical school and residency are the first steps toward being a first-rate hospitalist, but will they prepare you for the demands of managing a new project in the hospital? Or taking a leadership position within a hospital medicine group? How about making the financial case for changes you’d like to see in your hospital?

SHM established its popular Leadership Academy to help hospitalists take the next steps into leadership positions. The three courses of Leadership Academy teach skills like practicing team and physician engagement, speaking the language of hospital finances, and using your own personal attributes to create an effective and authentic leadership style.

And now, you can demonstrate your experience in Leadership Academy by applying for SHM’s Certificate of Leadership in Hospital Medicine (CLHM). The certificate program requires attending all three Leadership Academy courses and completing a mentored leadership program at your hospital.

A limited number of reservations are still available for the November Leadership Academy in Honolulu. Visit www.hospitalmedicine.org/leadership for more information.

SHM Leadership Academy

November 3-6

Honolulu, Hawaii

www.hospitalmedicine.org/leadership

If you are a hospitalist working for Kaiser, IPC, or another of the large healthcare systems, you may wonder what the Veterans Health Administration Healthcare System (VA) could possibly have to do with your practice. In many ways, the VA is the prototype, risk-adjusted, capitated accountable care organization (ACO) focused on expanding access to affordable healthcare, lowering costs, and improving quality. We care for complex, diverse, often vulnerable patient populations. We are incented to keep them healthy and out of the hospital. As a highly integrated healthcare system with 152 medical centers and more than 400 hospitalists, the VA has been able to coordinate hospital care, primary care, and post-acute care in a way that many health systems hope to achieve.

VA hospitalists care for veterans with multiple issues, including acute MI, heart failure, pneumonia, and COPD. In short, we care for the same types of patients as hospitalists across the country, with measured outcomes of similar or better quality as non-VA patients.

The VA has utilized an advanced electronic health record (CPRS) since 1997. It allows for effective patient care and is successfully leveraged for large-scale health services research.

The VA has been the site of groundbreaking, Nobel Prize-winning research that has shaped the care of hospitalized patients worldwide: beta blockers for heart failure, steroids for COPD exacerbations, and the invention of implantable cardiac pacemakers and computerized axial tomography (CAT) scans all have as their foundation research performed at VAs.

VA hospitalists educate the next generation of physicians through robust academic affiliations with most of our nation’s most-renowned medical schools and have administered residency training programs for almost 60 years. More than half of all medical students and residents complete part of their training at VAs.

VA hospitalists are also leaders in quality and patient safety.

Over the next year, SHM’s VA Task Force will be sharing 10 of the innovative approaches VA hospitalists are taking to provide care for our nation’s heroes. We will dispel a few myths about the “VA Spa” along the way and, hopefully, share some ideas you can use to better care for your patients.

Many of The Hospitalist’s readers have family members who have served in the military. For all of you, this IS your granddad’s VA—and it’s pretty darn good.

Dr. Odden is a hospitalist at the VA in Ann Arbor, Mich. Dr. Kartha is a hospitalist at the VA in Boston. Both are members of SHM’s VA Task Force.

If you are a hospitalist working for Kaiser, IPC, or another of the large healthcare systems, you may wonder what the Veterans Health Administration Healthcare System (VA) could possibly have to do with your practice. In many ways, the VA is the prototype, risk-adjusted, capitated accountable care organization (ACO) focused on expanding access to affordable healthcare, lowering costs, and improving quality. We care for complex, diverse, often vulnerable patient populations. We are incented to keep them healthy and out of the hospital. As a highly integrated healthcare system with 152 medical centers and more than 400 hospitalists, the VA has been able to coordinate hospital care, primary care, and post-acute care in a way that many health systems hope to achieve.

VA hospitalists care for veterans with multiple issues, including acute MI, heart failure, pneumonia, and COPD. In short, we care for the same types of patients as hospitalists across the country, with measured outcomes of similar or better quality as non-VA patients.

The VA has utilized an advanced electronic health record (CPRS) since 1997. It allows for effective patient care and is successfully leveraged for large-scale health services research.

The VA has been the site of groundbreaking, Nobel Prize-winning research that has shaped the care of hospitalized patients worldwide: beta blockers for heart failure, steroids for COPD exacerbations, and the invention of implantable cardiac pacemakers and computerized axial tomography (CAT) scans all have as their foundation research performed at VAs.

VA hospitalists educate the next generation of physicians through robust academic affiliations with most of our nation’s most-renowned medical schools and have administered residency training programs for almost 60 years. More than half of all medical students and residents complete part of their training at VAs.

VA hospitalists are also leaders in quality and patient safety.

Over the next year, SHM’s VA Task Force will be sharing 10 of the innovative approaches VA hospitalists are taking to provide care for our nation’s heroes. We will dispel a few myths about the “VA Spa” along the way and, hopefully, share some ideas you can use to better care for your patients.

Many of The Hospitalist’s readers have family members who have served in the military. For all of you, this IS your granddad’s VA—and it’s pretty darn good.

Dr. Odden is a hospitalist at the VA in Ann Arbor, Mich. Dr. Kartha is a hospitalist at the VA in Boston. Both are members of SHM’s VA Task Force.

If you are a hospitalist working for Kaiser, IPC, or another of the large healthcare systems, you may wonder what the Veterans Health Administration Healthcare System (VA) could possibly have to do with your practice. In many ways, the VA is the prototype, risk-adjusted, capitated accountable care organization (ACO) focused on expanding access to affordable healthcare, lowering costs, and improving quality. We care for complex, diverse, often vulnerable patient populations. We are incented to keep them healthy and out of the hospital. As a highly integrated healthcare system with 152 medical centers and more than 400 hospitalists, the VA has been able to coordinate hospital care, primary care, and post-acute care in a way that many health systems hope to achieve.

VA hospitalists care for veterans with multiple issues, including acute MI, heart failure, pneumonia, and COPD. In short, we care for the same types of patients as hospitalists across the country, with measured outcomes of similar or better quality as non-VA patients.

The VA has utilized an advanced electronic health record (CPRS) since 1997. It allows for effective patient care and is successfully leveraged for large-scale health services research.

The VA has been the site of groundbreaking, Nobel Prize-winning research that has shaped the care of hospitalized patients worldwide: beta blockers for heart failure, steroids for COPD exacerbations, and the invention of implantable cardiac pacemakers and computerized axial tomography (CAT) scans all have as their foundation research performed at VAs.

VA hospitalists educate the next generation of physicians through robust academic affiliations with most of our nation’s most-renowned medical schools and have administered residency training programs for almost 60 years. More than half of all medical students and residents complete part of their training at VAs.

VA hospitalists are also leaders in quality and patient safety.

Over the next year, SHM’s VA Task Force will be sharing 10 of the innovative approaches VA hospitalists are taking to provide care for our nation’s heroes. We will dispel a few myths about the “VA Spa” along the way and, hopefully, share some ideas you can use to better care for your patients.

Many of The Hospitalist’s readers have family members who have served in the military. For all of you, this IS your granddad’s VA—and it’s pretty darn good.

Dr. Odden is a hospitalist at the VA in Ann Arbor, Mich. Dr. Kartha is a hospitalist at the VA in Boston. Both are members of SHM’s VA Task Force.

The Hospitalist has grabbed the attention and interest of physicians and industry professionals across the country for 18 years. Now, it has the attention of another type of professional

body—the Awards for Publication Excellence (APEX), which presented the publication with the APEX Grand Award for Magazines, Journals, and Tabloids. [http://www.apexawards.com/A2014_Win.List.pdf].

The annual awards, presented to corporate and nonprofit publications, received 2,075 total applications, including nearly 500 entries to the Magazines, Journals, and Tabloids category. Only 10 Grand Awards were presented in the category.

The Hospitalist also received an Award of Excellence in Health and Medical Writing for writer Bryn Nelson’s special report on the Affordable Care Act in the January 2014 issue.

On the APEX website [www.apexawards.com/apex2014grandawardcomments], category judges complimented The Hospitalist for its “appealing spreads, effective use of sidebars, numbered lists, and a bold headline schedule—all combining to complement the well written copy, which is informative and clearly well researched. The Obamacare special report insert is particularly informative and well designed.”

Published by Wiley Inc., The Hospitalist is the official newsmagazine of the Society of Hospital Medicine. The monthly newsmagazine has a circulation of about 25,000 and provides news, features, and information specific to hospitalists and the healthcare industry.

SHM President Burke Kealey, MD, SFHM, expressed his pride for the individuals who bring The Hospitalist together.

“SHM constantly strives to bring the very best to our members and other leaders in healthcare. These two APEX awards, especially the Grand Award, are evidence that we are delivering on that goal,” he wrote in an e-mail.

The Hospitalist has garnered seven APEX Awards in the past six years, as well as attaining finalist status for “Best Healthcare Business Publication” from Medical Marketing and Media in 2009.

Physician Editor Danielle Scheurer, MD, MSCR, SFHM, considers the high quality of writing and practical, relevant article topics two of the magazine’s biggest strengths. She thanked the editors for designing a creative repertoire of stories and for thinking of new ways to cover topics.

“A huge part of our success is keeping our finger on the pulse of our customer base and trying to figure out…what kind of information they’re seeking from a magazine like The Hospitalist,” she said. “We are continuously ensuring that we’re hearing the voice of the customer.”

Erin Petenko is a contributing writer for The Hospitalist.

The Hospitalist has grabbed the attention and interest of physicians and industry professionals across the country for 18 years. Now, it has the attention of another type of professional

body—the Awards for Publication Excellence (APEX), which presented the publication with the APEX Grand Award for Magazines, Journals, and Tabloids. [http://www.apexawards.com/A2014_Win.List.pdf].

The annual awards, presented to corporate and nonprofit publications, received 2,075 total applications, including nearly 500 entries to the Magazines, Journals, and Tabloids category. Only 10 Grand Awards were presented in the category.

The Hospitalist also received an Award of Excellence in Health and Medical Writing for writer Bryn Nelson’s special report on the Affordable Care Act in the January 2014 issue.

On the APEX website [www.apexawards.com/apex2014grandawardcomments], category judges complimented The Hospitalist for its “appealing spreads, effective use of sidebars, numbered lists, and a bold headline schedule—all combining to complement the well written copy, which is informative and clearly well researched. The Obamacare special report insert is particularly informative and well designed.”

Published by Wiley Inc., The Hospitalist is the official newsmagazine of the Society of Hospital Medicine. The monthly newsmagazine has a circulation of about 25,000 and provides news, features, and information specific to hospitalists and the healthcare industry.

SHM President Burke Kealey, MD, SFHM, expressed his pride for the individuals who bring The Hospitalist together.

“SHM constantly strives to bring the very best to our members and other leaders in healthcare. These two APEX awards, especially the Grand Award, are evidence that we are delivering on that goal,” he wrote in an e-mail.

The Hospitalist has garnered seven APEX Awards in the past six years, as well as attaining finalist status for “Best Healthcare Business Publication” from Medical Marketing and Media in 2009.

Physician Editor Danielle Scheurer, MD, MSCR, SFHM, considers the high quality of writing and practical, relevant article topics two of the magazine’s biggest strengths. She thanked the editors for designing a creative repertoire of stories and for thinking of new ways to cover topics.

“A huge part of our success is keeping our finger on the pulse of our customer base and trying to figure out…what kind of information they’re seeking from a magazine like The Hospitalist,” she said. “We are continuously ensuring that we’re hearing the voice of the customer.”

Erin Petenko is a contributing writer for The Hospitalist.

The Hospitalist has grabbed the attention and interest of physicians and industry professionals across the country for 18 years. Now, it has the attention of another type of professional

body—the Awards for Publication Excellence (APEX), which presented the publication with the APEX Grand Award for Magazines, Journals, and Tabloids. [http://www.apexawards.com/A2014_Win.List.pdf].

The annual awards, presented to corporate and nonprofit publications, received 2,075 total applications, including nearly 500 entries to the Magazines, Journals, and Tabloids category. Only 10 Grand Awards were presented in the category.

The Hospitalist also received an Award of Excellence in Health and Medical Writing for writer Bryn Nelson’s special report on the Affordable Care Act in the January 2014 issue.

On the APEX website [www.apexawards.com/apex2014grandawardcomments], category judges complimented The Hospitalist for its “appealing spreads, effective use of sidebars, numbered lists, and a bold headline schedule—all combining to complement the well written copy, which is informative and clearly well researched. The Obamacare special report insert is particularly informative and well designed.”

Published by Wiley Inc., The Hospitalist is the official newsmagazine of the Society of Hospital Medicine. The monthly newsmagazine has a circulation of about 25,000 and provides news, features, and information specific to hospitalists and the healthcare industry.

SHM President Burke Kealey, MD, SFHM, expressed his pride for the individuals who bring The Hospitalist together.

“SHM constantly strives to bring the very best to our members and other leaders in healthcare. These two APEX awards, especially the Grand Award, are evidence that we are delivering on that goal,” he wrote in an e-mail.

The Hospitalist has garnered seven APEX Awards in the past six years, as well as attaining finalist status for “Best Healthcare Business Publication” from Medical Marketing and Media in 2009.

Physician Editor Danielle Scheurer, MD, MSCR, SFHM, considers the high quality of writing and practical, relevant article topics two of the magazine’s biggest strengths. She thanked the editors for designing a creative repertoire of stories and for thinking of new ways to cover topics.

“A huge part of our success is keeping our finger on the pulse of our customer base and trying to figure out…what kind of information they’re seeking from a magazine like The Hospitalist,” she said. “We are continuously ensuring that we’re hearing the voice of the customer.”

Erin Petenko is a contributing writer for The Hospitalist.

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Summary

One of PHM2014’s first breakout sessions, coming on the heels of Dr. Meuthing’s opening talk on reducing serious safety events, focused on the topic of overdiagnosis in pediatric HM and its contribution to patient harm. The first key point was the distinction between overdiagnosis and misdiagnosis. Overdiagnosis is the identification of an abnormality where detection will not benefit the patient. This is different from misdiagnosis or incorrect diagnosis. Overdiagnosis has grown over the years due to several causes, including our fear of missing a diagnosis and the increasing use of screening tests.

The speakers outlined many, varied drivers of overdiagnosis, including physicians’ unawareness of overdiagnosis, physicians’ discomfort with uncertainty, physicians’ inherent belief in technology and its results, quality measures based on usage and testing, a perceived imperative to use testing and technology because it is available, and system incentives such as fee for service, which reimburses or rewards increased testing. The classic example of overdiagnosis in pediatrics is asymptomatic urinary screening for neuroblastomas, where studies showed an increase in testing and an increase in diagnosis but no change in mortality. A current example is children receiving head CT scans for minor head trauma, which can lead to a diagnosis of small asymptomatic head bleeds or nondisplaced skull fractures, which can in turn lead to PICU admissions, transfers to higher level centers, prophylactic administration of anti-seizure medications, and repeat CT scans.

From the patient perspective, overdiagnosis can lead to unnecessary hospitalizations, inappropriate medications and treatments, and increased patient or parental anxiety secondary to a diagnosis or disease label.

Summary

Behavioral emergencies occur when a patient is physically aggressive or potentially harmful to himself/herself or others. Although they may be rare, behavioral emergencies are high-risk situations, and untrained staff might be uncomfortable dealing with these events.

Patients with underlying psychiatric or developmental disorders, those who have ingested substances, or those who have a medication side effect are at the highest risk for becoming violent. Triggers for these events could be pain, hunger, isolation, change in routine, or even the hospital’s physical environment. Early warning signs for a behavioral emergency can include verbal threats, yelling, or silence. Physical signs may include pacing, crossed arms, furrowed brow, or throwing objects.

The first response to a potential behavioral emergency is to try to de-escalate the situation. Speak in a quiet, calm voice; back off and give personal space. Try to reduce a source of discomfort, and use distractions or rewards. If de-escalation is not successful and a patient becomes violent, the provider’s first role is to be safe: Get away and get help. Hospitals should have—or should develop—a violent patient response team, which may then physically restrain the patient. Medications can be used to treat medical issues but should not be used solely for chemical restraint.

Once a patient is safely restrained, a number of Joint Commission on Accreditation of Healthcare Organizations-mandated actions must occur. The legal guardian and attending of record must be notified. A debrief must occur regarding the events; this must be documented in the medical record. Finally, a strategy must be formulated to enable the patient to be safely removed from restraints as soon as it is safe.

The presenters demonstrated various personal safety techniques to escape from a violent patient, as well as the use of physical restraints. Participants engaged in a mock behavioral emergency to experience the chaos of these events.

Summary

Behavioral emergencies occur when a patient is physically aggressive or potentially harmful to himself/herself or others. Although they may be rare, behavioral emergencies are high-risk situations, and untrained staff might be uncomfortable dealing with these events.

Patients with underlying psychiatric or developmental disorders, those who have ingested substances, or those who have a medication side effect are at the highest risk for becoming violent. Triggers for these events could be pain, hunger, isolation, change in routine, or even the hospital’s physical environment. Early warning signs for a behavioral emergency can include verbal threats, yelling, or silence. Physical signs may include pacing, crossed arms, furrowed brow, or throwing objects.

The first response to a potential behavioral emergency is to try to de-escalate the situation. Speak in a quiet, calm voice; back off and give personal space. Try to reduce a source of discomfort, and use distractions or rewards. If de-escalation is not successful and a patient becomes violent, the provider’s first role is to be safe: Get away and get help. Hospitals should have—or should develop—a violent patient response team, which may then physically restrain the patient. Medications can be used to treat medical issues but should not be used solely for chemical restraint.

Once a patient is safely restrained, a number of Joint Commission on Accreditation of Healthcare Organizations-mandated actions must occur. The legal guardian and attending of record must be notified. A debrief must occur regarding the events; this must be documented in the medical record. Finally, a strategy must be formulated to enable the patient to be safely removed from restraints as soon as it is safe.

The presenters demonstrated various personal safety techniques to escape from a violent patient, as well as the use of physical restraints. Participants engaged in a mock behavioral emergency to experience the chaos of these events.

Summary

Behavioral emergencies occur when a patient is physically aggressive or potentially harmful to himself/herself or others. Although they may be rare, behavioral emergencies are high-risk situations, and untrained staff might be uncomfortable dealing with these events.

Patients with underlying psychiatric or developmental disorders, those who have ingested substances, or those who have a medication side effect are at the highest risk for becoming violent. Triggers for these events could be pain, hunger, isolation, change in routine, or even the hospital’s physical environment. Early warning signs for a behavioral emergency can include verbal threats, yelling, or silence. Physical signs may include pacing, crossed arms, furrowed brow, or throwing objects.

The first response to a potential behavioral emergency is to try to de-escalate the situation. Speak in a quiet, calm voice; back off and give personal space. Try to reduce a source of discomfort, and use distractions or rewards. If de-escalation is not successful and a patient becomes violent, the provider’s first role is to be safe: Get away and get help. Hospitals should have—or should develop—a violent patient response team, which may then physically restrain the patient. Medications can be used to treat medical issues but should not be used solely for chemical restraint.

Once a patient is safely restrained, a number of Joint Commission on Accreditation of Healthcare Organizations-mandated actions must occur. The legal guardian and attending of record must be notified. A debrief must occur regarding the events; this must be documented in the medical record. Finally, a strategy must be formulated to enable the patient to be safely removed from restraints as soon as it is safe.

The presenters demonstrated various personal safety techniques to escape from a violent patient, as well as the use of physical restraints. Participants engaged in a mock behavioral emergency to experience the chaos of these events.