One in 10 hospitalists has worked locum tenens in the past year, according to a study of the practice released this week.

Locum Leaders, a locum tenens staffing agency in Alpharetta, Ga., put the study together this summer to define for the first time just how prevalent the practice of temporary staffing is and what motivates physicians to do the work. The report found that of hospitalists who work as locums tenens, 82% do it in addition to their full-time jobs and 11% do it as their full-time jobs.

Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and an SHM board member, says the phenomenon allows some hospitalists to learn more about an institution before signing a long-term contract. It also affords other physicians flexibility, higher earning potential, or just the chance to "try something on for size before they buy."

"On the physician side, there are opportunities out there for you to not strain yourself immensely to increase your compensation, to travel to places you may not normally get to go, and to see how different programs are structured and operate," he says. "To see a more worldly view of hospital medicine."

For hospitals, even though locum physicians can cost more in salary, they can provide an opportunity for savings, as the hospital does not have to contribute to healthcare, pensions, or other costs. To wit, locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

"They're all independent contractors," Dr. Harrington adds. "The increase in compensation that locum tenens physicians are able to demand, for the most part, comes from the difference between having a full-time employee versus an independent contractor."

One in 10 hospitalists has worked locum tenens in the past year, according to a study of the practice released this week.

Locum Leaders, a locum tenens staffing agency in Alpharetta, Ga., put the study together this summer to define for the first time just how prevalent the practice of temporary staffing is and what motivates physicians to do the work. The report found that of hospitalists who work as locums tenens, 82% do it in addition to their full-time jobs and 11% do it as their full-time jobs.

Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and an SHM board member, says the phenomenon allows some hospitalists to learn more about an institution before signing a long-term contract. It also affords other physicians flexibility, higher earning potential, or just the chance to "try something on for size before they buy."

"On the physician side, there are opportunities out there for you to not strain yourself immensely to increase your compensation, to travel to places you may not normally get to go, and to see how different programs are structured and operate," he says. "To see a more worldly view of hospital medicine."

For hospitals, even though locum physicians can cost more in salary, they can provide an opportunity for savings, as the hospital does not have to contribute to healthcare, pensions, or other costs. To wit, locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

"They're all independent contractors," Dr. Harrington adds. "The increase in compensation that locum tenens physicians are able to demand, for the most part, comes from the difference between having a full-time employee versus an independent contractor."

One in 10 hospitalists has worked locum tenens in the past year, according to a study of the practice released this week.

Locum Leaders, a locum tenens staffing agency in Alpharetta, Ga., put the study together this summer to define for the first time just how prevalent the practice of temporary staffing is and what motivates physicians to do the work. The report found that of hospitalists who work as locums tenens, 82% do it in addition to their full-time jobs and 11% do it as their full-time jobs.

Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and an SHM board member, says the phenomenon allows some hospitalists to learn more about an institution before signing a long-term contract. It also affords other physicians flexibility, higher earning potential, or just the chance to "try something on for size before they buy."

"On the physician side, there are opportunities out there for you to not strain yourself immensely to increase your compensation, to travel to places you may not normally get to go, and to see how different programs are structured and operate," he says. "To see a more worldly view of hospital medicine."

For hospitals, even though locum physicians can cost more in salary, they can provide an opportunity for savings, as the hospital does not have to contribute to healthcare, pensions, or other costs. To wit, locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

"They're all independent contractors," Dr. Harrington adds. "The increase in compensation that locum tenens physicians are able to demand, for the most part, comes from the difference between having a full-time employee versus an independent contractor."

What's the appropriate number of patients that an FTE hospitalist should see in one day? More than half of those surveyed on the-hospitalist.org believe they should see between 11 and 15 patients. According to two members of Team Hospitalist, 10 to 20 patients per day is a reasonable guideline.

"On average, 15 to 18 patients per day is a pretty easy-to-manage number," says Rachel George, MD, MBA, FHM, CPE, chief operating officer for Cogent HMG's west and north-central regions. But daily patient census depends on several factors, such as the types of patients admitted, the length of the doctor's shift, and the level of support from other staff on duty, she explains.

Readers were given one of five choices to respond with: "10 or fewer patients," "11-15," "16-20," "21-25," and "more than 25." Of the 421 responses, 51% felt that the average full-time hospitalist should see from 11 to 15 patients per day, followed by 35% who say they'd prefer to see 16 to 20 patients. Six percent voted for "10 or fewer." Only 4% of respondents said 20 or more patients a day was optimum.

"Honestly, I try not to get fixated on numbers," says Ken Simone, DO, SFHM, founder and president of Hospitalist and Practice Solutions in Veazie, Maine. As a consultant, he says that rather than trying to expect physicians to attend to a standard census, HM groups should focus on acuity of illness and quality of care, and let patient needs dictate the staff required. Dr. Simone also recalled working with some groups who have delegated one or more staff members to handle admitting and screening, so that hospitalists can concentrate on the patients already in beds.

What's the appropriate number of patients that an FTE hospitalist should see in one day? More than half of those surveyed on the-hospitalist.org believe they should see between 11 and 15 patients. According to two members of Team Hospitalist, 10 to 20 patients per day is a reasonable guideline.

"On average, 15 to 18 patients per day is a pretty easy-to-manage number," says Rachel George, MD, MBA, FHM, CPE, chief operating officer for Cogent HMG's west and north-central regions. But daily patient census depends on several factors, such as the types of patients admitted, the length of the doctor's shift, and the level of support from other staff on duty, she explains.

Readers were given one of five choices to respond with: "10 or fewer patients," "11-15," "16-20," "21-25," and "more than 25." Of the 421 responses, 51% felt that the average full-time hospitalist should see from 11 to 15 patients per day, followed by 35% who say they'd prefer to see 16 to 20 patients. Six percent voted for "10 or fewer." Only 4% of respondents said 20 or more patients a day was optimum.

"Honestly, I try not to get fixated on numbers," says Ken Simone, DO, SFHM, founder and president of Hospitalist and Practice Solutions in Veazie, Maine. As a consultant, he says that rather than trying to expect physicians to attend to a standard census, HM groups should focus on acuity of illness and quality of care, and let patient needs dictate the staff required. Dr. Simone also recalled working with some groups who have delegated one or more staff members to handle admitting and screening, so that hospitalists can concentrate on the patients already in beds.

What's the appropriate number of patients that an FTE hospitalist should see in one day? More than half of those surveyed on the-hospitalist.org believe they should see between 11 and 15 patients. According to two members of Team Hospitalist, 10 to 20 patients per day is a reasonable guideline.

"On average, 15 to 18 patients per day is a pretty easy-to-manage number," says Rachel George, MD, MBA, FHM, CPE, chief operating officer for Cogent HMG's west and north-central regions. But daily patient census depends on several factors, such as the types of patients admitted, the length of the doctor's shift, and the level of support from other staff on duty, she explains.

Readers were given one of five choices to respond with: "10 or fewer patients," "11-15," "16-20," "21-25," and "more than 25." Of the 421 responses, 51% felt that the average full-time hospitalist should see from 11 to 15 patients per day, followed by 35% who say they'd prefer to see 16 to 20 patients. Six percent voted for "10 or fewer." Only 4% of respondents said 20 or more patients a day was optimum.

"Honestly, I try not to get fixated on numbers," says Ken Simone, DO, SFHM, founder and president of Hospitalist and Practice Solutions in Veazie, Maine. As a consultant, he says that rather than trying to expect physicians to attend to a standard census, HM groups should focus on acuity of illness and quality of care, and let patient needs dictate the staff required. Dr. Simone also recalled working with some groups who have delegated one or more staff members to handle admitting and screening, so that hospitalists can concentrate on the patients already in beds.

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

According to a new study in American Economic Journal: Applied Economics by MIT economist Joseph Doyle, a $4,000 increase in per-patient hospital expenditures equates to a 1.4% decrease in mortality rates. Doyle studied 37,000 hospitalized patients in Florida who entered through the ED from 1996 to 2003. However, he focused on those visiting from other states in order to identify variation resulting from the level of care itself, not the prior health of the patients. The greater expense—and benefits—of care in the higher-cost hospital appeared to come from the broader application of ICU tools and greater complement of medical personnel, he notes.

“There are smart ways to spend money and ineffective ways to spend money,” he says, “and we’re still trying to figure out which are which, as much as possible.”

A pilot project that transferred “boarded” patients from one hospital’s ED to an inpatient bed at another nearby hospital in the same health system suggests that the concept could save hospitals millions.

“Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach” was the subject of an oral presentation at HM11 in Dallas. Lead researcher Diego Martinez-Vasquez, MD, MPH, FACP, CPE, medical director for clinical resource utilization at Franklin Square Hospital Center in Baltimore, conducted the research in the University of Maryland medical system.

In the project, 265 patients who consented were transferred 1.3 miles to a sister hospital. Without “boarders”—admitted patients held in the ED—Dr. Martinez-Vasquez’s team found that the referring hospital could have regained enough capacity for an additional 2.9 patients per day. The project also showed median net revenue of $520,000 for the referring hospital and $1.9 million for the accepting hospital.

“The hospitalist group at the receiving hospital was the instrument that facilitated this program,” Dr. Martinez-Vasquez says. “But really what kept my attention was that healthcare systems sometimes don’t use resources effectively. So when I looked at the problem that this particular hospital was having regarding increased boarding time and decreased treatment capacity, I said, ‘Well, one way to resolve this issue is to develop a process that connects two system hospitals and their bed resources.’ ”

A pilot project that transferred “boarded” patients from one hospital’s ED to an inpatient bed at another nearby hospital in the same health system suggests that the concept could save hospitals millions.

“Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach” was the subject of an oral presentation at HM11 in Dallas. Lead researcher Diego Martinez-Vasquez, MD, MPH, FACP, CPE, medical director for clinical resource utilization at Franklin Square Hospital Center in Baltimore, conducted the research in the University of Maryland medical system.

In the project, 265 patients who consented were transferred 1.3 miles to a sister hospital. Without “boarders”—admitted patients held in the ED—Dr. Martinez-Vasquez’s team found that the referring hospital could have regained enough capacity for an additional 2.9 patients per day. The project also showed median net revenue of $520,000 for the referring hospital and $1.9 million for the accepting hospital.

“The hospitalist group at the receiving hospital was the instrument that facilitated this program,” Dr. Martinez-Vasquez says. “But really what kept my attention was that healthcare systems sometimes don’t use resources effectively. So when I looked at the problem that this particular hospital was having regarding increased boarding time and decreased treatment capacity, I said, ‘Well, one way to resolve this issue is to develop a process that connects two system hospitals and their bed resources.’ ”

A pilot project that transferred “boarded” patients from one hospital’s ED to an inpatient bed at another nearby hospital in the same health system suggests that the concept could save hospitals millions.

“Improvement in Emergency Department Treatment Capacity: A Health System Integration Approach” was the subject of an oral presentation at HM11 in Dallas. Lead researcher Diego Martinez-Vasquez, MD, MPH, FACP, CPE, medical director for clinical resource utilization at Franklin Square Hospital Center in Baltimore, conducted the research in the University of Maryland medical system.

In the project, 265 patients who consented were transferred 1.3 miles to a sister hospital. Without “boarders”—admitted patients held in the ED—Dr. Martinez-Vasquez’s team found that the referring hospital could have regained enough capacity for an additional 2.9 patients per day. The project also showed median net revenue of $520,000 for the referring hospital and $1.9 million for the accepting hospital.

“The hospitalist group at the receiving hospital was the instrument that facilitated this program,” Dr. Martinez-Vasquez says. “But really what kept my attention was that healthcare systems sometimes don’t use resources effectively. So when I looked at the problem that this particular hospital was having regarding increased boarding time and decreased treatment capacity, I said, ‘Well, one way to resolve this issue is to develop a process that connects two system hospitals and their bed resources.’ ”

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644).

A total of 400,000 heart patients were studied, and 283 participating hospitals were stratified into thirds based on their adherence to core quality measures for each disease, with the upper third labeled superior in performance. Lead author Tracy Wang, MD, MHS, MSc, of the Duke Clinical Research Institute in Durham, N.C., and colleagues found that superior performance for only one of the two diseases led to such end-result outcomes as in-hospital mortality that were no better than for hospitals that were not high performers for either condition. But hospitals with superior performance for both conditions had lower in-hospital mortality rates.

“Perhaps quality is more than just following checklists,” Dr. Wang says. “There’s something special about these high-performing hospitals across the board, with better QI, perhaps a little more investment in infrastructure for quality.”

This result, Dr. Wang says, should give ammunition for hospitalists and other physicians to go to their hospital administrators to request more investment in quality improvement overall, not just for specific conditions.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

A new Joint Commission program offering advanced certification for hospital-based palliative-care services is accepting applications and conducting daylong surveys through the end of this month. As with the Joint Commission’s reviews of other specialty services (e.g. primary stroke centers), certification is narrower in scope, with service-specific evaluation of care and outcomes, than a full accreditation survey—which is an organizationwide evaluation of core processes and functions.

Advanced certification in palliative care is voluntary for the steadily growing number of acute-care hospitals offering palliative-care services (1,568, according to the latest count by the American Hospital Association), but the hospital seeking it must be accredited by the Joint Commission.1 Certification is intended for formal, defined, inpatient palliative care, whether dedicated units or consultation services, with the ability to direct clinical management of patients.

The core palliative-care team includes “licensed independent practitioners” (typically physicians), registered nurses, chaplains, and social workers.2 The service should follow palliative-care guidelines and evidence-based practice, and it must collect quality data on four performance measures—two of them clinical—and use these data to improve performance.

According to Michelle Sacco, the Joint Commission’s executive director for palliative care, evidence-based practice includes ensuring appropriate transitions to other community resources, such as hospices. She thinks the program is perfect for hospitalists, as HM increasingly is participating in palliative care in their hospitals. “This is also an opportunity to change the mindset that palliative care is for the end-stage only,” Sacco says.

Two-year certification costs $9,655, including the onsite review. For more information, visit the Joint Commission website (www.jointcommission.org/certification) or the Center to Advance Palliative Care’s site (www.capc.org).

References

1. Palliative care in hospitals continues rapid growth for 10th straight year, according to latest analysis. Center to Advance Palliative Care website. Available at: www.capc.org/news-and-events/releases/07-14-11. Accessed Aug. 30, 2011.
2. The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. The National Consensus Project website. Available at: www.nationalconsensusproject.org/. Accessed Aug. 31, 2011.

MIAMI BEACH – Patients with Hodgkin’s lymphoma may be spared additional radiotherapy following chemotherapy if they have a negative positron-emission tomography result, investigators from the German Hodgkin Study Group reported.

The negative predictive value for FDG (¹⁸fluorodeoxyglucose)–PET at 1 year was 94%, said Dr. Rolf P. Mueller of the University of Cologne (Germany). Among patients who had residual tumors measuring 2.5 cm or greater in diameter following chemotherapy, only 4% of those who were negative for residual disease on FDG-PET scans relapsed or required additional radiotherapy, compared with 11% of FDG-PET–positive patients.

"Thus, only those advanced-stage Hodgkin lymphoma patients with residual disease who are PET-positive patients might need additional radiotherapy," Dr. Mueller said at the annual meeting of the American Society of Radiation Oncology (ASTRO).

The investigators also found a significant difference in time-to-progression favoring PET-negative patients (P =.008) with Hodgkin’s lymphoma, also known as Hodgkin’s disease.

The percentage of patients who received radiation in this clinical trial, designated GHSG (German Hodgkin Study Group) HD-15, was 11%, compared with 70% of patients in the group’s GHSG-9 trial, Mueller noted. GHSG-15 studied the role of FDG-PET for evaluating residual disease and relapse risk among patients with advanced-stage Hodgkin’s lymphoma who had undergone six to eight cycles of chemotherapy with the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) (J. Clin. Oncol. 2003;21:1734-9).

Early results were published in 2008 (Blood 2008;112: 3989-94). In the current report, Mueller presented data on a larger cohort.

All patients with a partial response or better and a residual mass measuring 2.5 cm or greater received FDG-PET scans. Of the 728 patients with residual disease following BEACOPP, 540 (74.2%) were PET negative, and 188 were PET positive. Mueller presented data on 701 patients who had at least 1 year of follow-up.

At 1 year, 96% (522) of PET-negative patients had neither progression nor relapse, compared with 11% of those who were PET positive. Of the PET-negative patients, 23 experienced disease progression (eight in the residual mass, six with new disease outside of the mass, and nine with progression/relapse in both areas). An additional eight PET-negative patients required additional radiotherapy.

The study was funded by the member centers of the GSHG. Dr. Mueller had no conflict of interest disclosures.

MIAMI BEACH – Patients with Hodgkin’s lymphoma may be spared additional radiotherapy following chemotherapy if they have a negative positron-emission tomography result, investigators from the German Hodgkin Study Group reported.

The negative predictive value for FDG (¹⁸fluorodeoxyglucose)–PET at 1 year was 94%, said Dr. Rolf P. Mueller of the University of Cologne (Germany). Among patients who had residual tumors measuring 2.5 cm or greater in diameter following chemotherapy, only 4% of those who were negative for residual disease on FDG-PET scans relapsed or required additional radiotherapy, compared with 11% of FDG-PET–positive patients.

"Thus, only those advanced-stage Hodgkin lymphoma patients with residual disease who are PET-positive patients might need additional radiotherapy," Dr. Mueller said at the annual meeting of the American Society of Radiation Oncology (ASTRO).

The investigators also found a significant difference in time-to-progression favoring PET-negative patients (P =.008) with Hodgkin’s lymphoma, also known as Hodgkin’s disease.

The percentage of patients who received radiation in this clinical trial, designated GHSG (German Hodgkin Study Group) HD-15, was 11%, compared with 70% of patients in the group’s GHSG-9 trial, Mueller noted. GHSG-15 studied the role of FDG-PET for evaluating residual disease and relapse risk among patients with advanced-stage Hodgkin’s lymphoma who had undergone six to eight cycles of chemotherapy with the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) (J. Clin. Oncol. 2003;21:1734-9).

Early results were published in 2008 (Blood 2008;112: 3989-94). In the current report, Mueller presented data on a larger cohort.

All patients with a partial response or better and a residual mass measuring 2.5 cm or greater received FDG-PET scans. Of the 728 patients with residual disease following BEACOPP, 540 (74.2%) were PET negative, and 188 were PET positive. Mueller presented data on 701 patients who had at least 1 year of follow-up.

At 1 year, 96% (522) of PET-negative patients had neither progression nor relapse, compared with 11% of those who were PET positive. Of the PET-negative patients, 23 experienced disease progression (eight in the residual mass, six with new disease outside of the mass, and nine with progression/relapse in both areas). An additional eight PET-negative patients required additional radiotherapy.

The study was funded by the member centers of the GSHG. Dr. Mueller had no conflict of interest disclosures.

MIAMI BEACH – Patients with Hodgkin’s lymphoma may be spared additional radiotherapy following chemotherapy if they have a negative positron-emission tomography result, investigators from the German Hodgkin Study Group reported.

The negative predictive value for FDG (¹⁸fluorodeoxyglucose)–PET at 1 year was 94%, said Dr. Rolf P. Mueller of the University of Cologne (Germany). Among patients who had residual tumors measuring 2.5 cm or greater in diameter following chemotherapy, only 4% of those who were negative for residual disease on FDG-PET scans relapsed or required additional radiotherapy, compared with 11% of FDG-PET–positive patients.

"Thus, only those advanced-stage Hodgkin lymphoma patients with residual disease who are PET-positive patients might need additional radiotherapy," Dr. Mueller said at the annual meeting of the American Society of Radiation Oncology (ASTRO).

The investigators also found a significant difference in time-to-progression favoring PET-negative patients (P =.008) with Hodgkin’s lymphoma, also known as Hodgkin’s disease.

The percentage of patients who received radiation in this clinical trial, designated GHSG (German Hodgkin Study Group) HD-15, was 11%, compared with 70% of patients in the group’s GHSG-9 trial, Mueller noted. GHSG-15 studied the role of FDG-PET for evaluating residual disease and relapse risk among patients with advanced-stage Hodgkin’s lymphoma who had undergone six to eight cycles of chemotherapy with the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) (J. Clin. Oncol. 2003;21:1734-9).

Early results were published in 2008 (Blood 2008;112: 3989-94). In the current report, Mueller presented data on a larger cohort.

All patients with a partial response or better and a residual mass measuring 2.5 cm or greater received FDG-PET scans. Of the 728 patients with residual disease following BEACOPP, 540 (74.2%) were PET negative, and 188 were PET positive. Mueller presented data on 701 patients who had at least 1 year of follow-up.

At 1 year, 96% (522) of PET-negative patients had neither progression nor relapse, compared with 11% of those who were PET positive. Of the PET-negative patients, 23 experienced disease progression (eight in the residual mass, six with new disease outside of the mass, and nine with progression/relapse in both areas). An additional eight PET-negative patients required additional radiotherapy.

The study was funded by the member centers of the GSHG. Dr. Mueller had no conflict of interest disclosures.

The challenges of academic HM are different from other sectors of the specialty. Academic hospitalists, division chiefs, and administrators at academic teaching hospitals contend with the pressure of receiving grants, presenting at grand rounds, and reserving time for research and educational projects.

While it can be overwhelming, especially for academic hospitalists early in their careers, the Academic Hospitalist Academy helps untangle those challenges and turn them into long-term professional opportunities. Hosted jointly by SHM, the Society of General Internal Medicine (SGIM), and the Association of Chiefs and Leaders of General Internal Medicine (ACLGIM), the academy is a three-day course dedicated to education, scholarship, and professional success for academic hospitalists.

In addition to helping them become better hospitalists, Academic Hospitalist Academy uses didactic sessions, small-group exercises, and other interactive techniques to help academic hospitalists become better teachers, create and publish scholarly work, and get first in line for promotions.

Now in its third year, Academic Hospitalist Academy is consistently met with rave reviews from attendees. According to evaluations from the 2010 academy, attendees unanimously felt the course was worth their time and money; 99% said they would recommend it to a colleague.

The challenges of academic HM are different from other sectors of the specialty. Academic hospitalists, division chiefs, and administrators at academic teaching hospitals contend with the pressure of receiving grants, presenting at grand rounds, and reserving time for research and educational projects.

While it can be overwhelming, especially for academic hospitalists early in their careers, the Academic Hospitalist Academy helps untangle those challenges and turn them into long-term professional opportunities. Hosted jointly by SHM, the Society of General Internal Medicine (SGIM), and the Association of Chiefs and Leaders of General Internal Medicine (ACLGIM), the academy is a three-day course dedicated to education, scholarship, and professional success for academic hospitalists.

In addition to helping them become better hospitalists, Academic Hospitalist Academy uses didactic sessions, small-group exercises, and other interactive techniques to help academic hospitalists become better teachers, create and publish scholarly work, and get first in line for promotions.

Now in its third year, Academic Hospitalist Academy is consistently met with rave reviews from attendees. According to evaluations from the 2010 academy, attendees unanimously felt the course was worth their time and money; 99% said they would recommend it to a colleague.

The challenges of academic HM are different from other sectors of the specialty. Academic hospitalists, division chiefs, and administrators at academic teaching hospitals contend with the pressure of receiving grants, presenting at grand rounds, and reserving time for research and educational projects.

While it can be overwhelming, especially for academic hospitalists early in their careers, the Academic Hospitalist Academy helps untangle those challenges and turn them into long-term professional opportunities. Hosted jointly by SHM, the Society of General Internal Medicine (SGIM), and the Association of Chiefs and Leaders of General Internal Medicine (ACLGIM), the academy is a three-day course dedicated to education, scholarship, and professional success for academic hospitalists.

In addition to helping them become better hospitalists, Academic Hospitalist Academy uses didactic sessions, small-group exercises, and other interactive techniques to help academic hospitalists become better teachers, create and publish scholarly work, and get first in line for promotions.

Now in its third year, Academic Hospitalist Academy is consistently met with rave reviews from attendees. According to evaluations from the 2010 academy, attendees unanimously felt the course was worth their time and money; 99% said they would recommend it to a colleague.

Hospitalists interested in promoting their research still have time to submit applications for SHM’s Research, Innovation, and Clinical Vignettes (RIV) competition. RIV abstracts will be presented at HM12 in San Diego.

SHM also is accepting nominations for its annual awards program, which honors hospitalists who demonstrate excellence in clinical work, teaching, scholarly research, and service to the specialty.

Applications for both programs can be obtained at www.hospitalmedicine.org. The deadline for SHM’s annual award submissions is Nov. 1; applications for RIV abstracts will be accepted until Dec. 1.

Both sets of awards will be presented live on stage at HM12.

The annual awards often are a precursor to even more prestige within the specialty. In 2005, SHM’s immediate past president Jeff Wiese, MD, SFHM, FACP won the “Excellence in Teaching” award, SHM president Joseph Ming-Wah Li, MD, SFHM, won for “Outstanding Service in Hospital Medicine,” and SHM president-elect Shaun Frost, MD, won for “Clinical Excellence.”

Hospitalists interested in promoting their research still have time to submit applications for SHM’s Research, Innovation, and Clinical Vignettes (RIV) competition. RIV abstracts will be presented at HM12 in San Diego.

SHM also is accepting nominations for its annual awards program, which honors hospitalists who demonstrate excellence in clinical work, teaching, scholarly research, and service to the specialty.

Applications for both programs can be obtained at www.hospitalmedicine.org. The deadline for SHM’s annual award submissions is Nov. 1; applications for RIV abstracts will be accepted until Dec. 1.

Both sets of awards will be presented live on stage at HM12.

The annual awards often are a precursor to even more prestige within the specialty. In 2005, SHM’s immediate past president Jeff Wiese, MD, SFHM, FACP won the “Excellence in Teaching” award, SHM president Joseph Ming-Wah Li, MD, SFHM, won for “Outstanding Service in Hospital Medicine,” and SHM president-elect Shaun Frost, MD, won for “Clinical Excellence.”

Hospitalists interested in promoting their research still have time to submit applications for SHM’s Research, Innovation, and Clinical Vignettes (RIV) competition. RIV abstracts will be presented at HM12 in San Diego.

SHM also is accepting nominations for its annual awards program, which honors hospitalists who demonstrate excellence in clinical work, teaching, scholarly research, and service to the specialty.

Applications for both programs can be obtained at www.hospitalmedicine.org. The deadline for SHM’s annual award submissions is Nov. 1; applications for RIV abstracts will be accepted until Dec. 1.

Both sets of awards will be presented live on stage at HM12.

The annual awards often are a precursor to even more prestige within the specialty. In 2005, SHM’s immediate past president Jeff Wiese, MD, SFHM, FACP won the “Excellence in Teaching” award, SHM president Joseph Ming-Wah Li, MD, SFHM, won for “Outstanding Service in Hospital Medicine,” and SHM president-elect Shaun Frost, MD, won for “Clinical Excellence.”

Establishing mutual respect and trust between hospitalists and nurses is an important part of ensuring patient safety, whether you’re on your first job or your 20th, says Angela Beck, RN, director of critical-care services at Nebraska Medical Center in Omaha.

“Nurses are important coordinators of care,” she says. “Recognizing and valuing nurses for that is truly the most important thing for the patient, and can also help hospitalists build relationships.”

Key Partners

Forming a collaborative relationship with the nursing service might depend on where you start. At Northwestern Memorial Hospital in Chicago, the nursing service enjoys a “close and collaborative relationship” with hospitalists, according to Kristin Ramsey, RN, MSN, MPPM, NE-BC, associate chief nurse and executive director of operations. New hospitalists are oriented to the care-delivery models on the inpatient care units. In addition, hospitalists are acculturated into the hospital’s coleadership model.

“We have partnered with our hospitalists to create a model in which the physician and nurse leader collaboratively lead the development of multidisciplinary, subspecialty teams to ensure quality outcomes,” Ramsey says. “The model is so successful with the hospitalists that we are now extending it to other areas in the organization.”

Round Sharing

Absent a formalized training protocol for partnering with nursing, hospitalists still can learn a great deal by listening to and communicating with the nursing staff, says Connie Ogden, RN, MSN, NEA-BC, executive director of adult acute services at Nebraska Medical Center. “Nurses are there around the clock caring for patients and may have a different insight” about patients’ evolving conditions, she says.

Care for the patient improves if everyone is on the same page, Ogden adds. That’s why it makes sense, she says, to include nurses during rounds. Beck agrees: “If nurses aren’t there to hear how the plan of care comes about, there is no reason to believe they can effectively describe it once the physician turns around and walks away to see another patient.”

In critical-care units, according to Beck, nurses can function as a bridge between patients and physicians. For example, they can help patients define and express their goals. Some of these goals can be incremental, she notes, such as “I really want to get out of bed this afternoon,” or “I really want my family here to listen to this message.”

Different Role, Same Goal

As director of adult acute services, Ogden often receives complaints from physicians about calls they receive from nurses. Often, these calls emanate from a concern for the patient (e.g. a 2 a.m. call for a Tylenol order to address a headache) or from the requirement that nurses follow policy and clarify orders. If hospitalists understand the back story of the call, their perception of its purpose can change.

Although there have been strides toward better nurse-physician collaboration, “we still have a lot of opportunities for improvement,” Beck asserts.

Establishing mutual respect and trust is not an overnight accomplishment. As Ogden explains, physicians and nurses have different roles, but they share the same goal: quality outcomes in patient care.

Gretchen Henkel is a freelance writer based in southern California.

Establishing mutual respect and trust between hospitalists and nurses is an important part of ensuring patient safety, whether you’re on your first job or your 20th, says Angela Beck, RN, director of critical-care services at Nebraska Medical Center in Omaha.

“Nurses are important coordinators of care,” she says. “Recognizing and valuing nurses for that is truly the most important thing for the patient, and can also help hospitalists build relationships.”

Key Partners

Forming a collaborative relationship with the nursing service might depend on where you start. At Northwestern Memorial Hospital in Chicago, the nursing service enjoys a “close and collaborative relationship” with hospitalists, according to Kristin Ramsey, RN, MSN, MPPM, NE-BC, associate chief nurse and executive director of operations. New hospitalists are oriented to the care-delivery models on the inpatient care units. In addition, hospitalists are acculturated into the hospital’s coleadership model.

“We have partnered with our hospitalists to create a model in which the physician and nurse leader collaboratively lead the development of multidisciplinary, subspecialty teams to ensure quality outcomes,” Ramsey says. “The model is so successful with the hospitalists that we are now extending it to other areas in the organization.”

Round Sharing

Absent a formalized training protocol for partnering with nursing, hospitalists still can learn a great deal by listening to and communicating with the nursing staff, says Connie Ogden, RN, MSN, NEA-BC, executive director of adult acute services at Nebraska Medical Center. “Nurses are there around the clock caring for patients and may have a different insight” about patients’ evolving conditions, she says.

Care for the patient improves if everyone is on the same page, Ogden adds. That’s why it makes sense, she says, to include nurses during rounds. Beck agrees: “If nurses aren’t there to hear how the plan of care comes about, there is no reason to believe they can effectively describe it once the physician turns around and walks away to see another patient.”

In critical-care units, according to Beck, nurses can function as a bridge between patients and physicians. For example, they can help patients define and express their goals. Some of these goals can be incremental, she notes, such as “I really want to get out of bed this afternoon,” or “I really want my family here to listen to this message.”

Different Role, Same Goal

As director of adult acute services, Ogden often receives complaints from physicians about calls they receive from nurses. Often, these calls emanate from a concern for the patient (e.g. a 2 a.m. call for a Tylenol order to address a headache) or from the requirement that nurses follow policy and clarify orders. If hospitalists understand the back story of the call, their perception of its purpose can change.

Although there have been strides toward better nurse-physician collaboration, “we still have a lot of opportunities for improvement,” Beck asserts.

Establishing mutual respect and trust is not an overnight accomplishment. As Ogden explains, physicians and nurses have different roles, but they share the same goal: quality outcomes in patient care.

Gretchen Henkel is a freelance writer based in southern California.

Establishing mutual respect and trust between hospitalists and nurses is an important part of ensuring patient safety, whether you’re on your first job or your 20th, says Angela Beck, RN, director of critical-care services at Nebraska Medical Center in Omaha.

“Nurses are important coordinators of care,” she says. “Recognizing and valuing nurses for that is truly the most important thing for the patient, and can also help hospitalists build relationships.”

Key Partners

Forming a collaborative relationship with the nursing service might depend on where you start. At Northwestern Memorial Hospital in Chicago, the nursing service enjoys a “close and collaborative relationship” with hospitalists, according to Kristin Ramsey, RN, MSN, MPPM, NE-BC, associate chief nurse and executive director of operations. New hospitalists are oriented to the care-delivery models on the inpatient care units. In addition, hospitalists are acculturated into the hospital’s coleadership model.

“We have partnered with our hospitalists to create a model in which the physician and nurse leader collaboratively lead the development of multidisciplinary, subspecialty teams to ensure quality outcomes,” Ramsey says. “The model is so successful with the hospitalists that we are now extending it to other areas in the organization.”

Round Sharing

Absent a formalized training protocol for partnering with nursing, hospitalists still can learn a great deal by listening to and communicating with the nursing staff, says Connie Ogden, RN, MSN, NEA-BC, executive director of adult acute services at Nebraska Medical Center. “Nurses are there around the clock caring for patients and may have a different insight” about patients’ evolving conditions, she says.

Care for the patient improves if everyone is on the same page, Ogden adds. That’s why it makes sense, she says, to include nurses during rounds. Beck agrees: “If nurses aren’t there to hear how the plan of care comes about, there is no reason to believe they can effectively describe it once the physician turns around and walks away to see another patient.”

In critical-care units, according to Beck, nurses can function as a bridge between patients and physicians. For example, they can help patients define and express their goals. Some of these goals can be incremental, she notes, such as “I really want to get out of bed this afternoon,” or “I really want my family here to listen to this message.”

Different Role, Same Goal

As director of adult acute services, Ogden often receives complaints from physicians about calls they receive from nurses. Often, these calls emanate from a concern for the patient (e.g. a 2 a.m. call for a Tylenol order to address a headache) or from the requirement that nurses follow policy and clarify orders. If hospitalists understand the back story of the call, their perception of its purpose can change.

Although there have been strides toward better nurse-physician collaboration, “we still have a lot of opportunities for improvement,” Beck asserts.

Establishing mutual respect and trust is not an overnight accomplishment. As Ogden explains, physicians and nurses have different roles, but they share the same goal: quality outcomes in patient care.

Gretchen Henkel is a freelance writer based in southern California.