JOHN G. BARTLETT, MD, professor of medicine in the Department of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, mesmerized a standing-room-only crowd of more than 500 at his lecture about the increase of Clostridium difficile in U.S. hospitals.

C. diff incidence has more than doubled since the mid-1990s, to more than 160 cases per 100,000 patients, and currently outnumbers the annual total of MRSA cases in the U.S., according to Dr. Bartlett, one of the foremost scholars on the subject. For hospitalists encountering patients with questions about the disease and where it comes from, Dr. Bartlett encouraged providers to punt that question: “The fact is, we don’t know most of the time.”

Most patients acquire C. diff during a hospital stay (74%) or a previous hospital stay (21%), and research shows the longer patients stay in the hospital, the more likely they are to acquire the disease.

“It’s embedded in the fabric of hospitals,” Dr. Bartlett said. “The longer you are in the hospital, the more likely you are to get colonized.”

Prevention guidelines include:

• Hand hygiene;
• Advocate gloves and gowns;
• Patients with C. diff should be in single rooms;
• Maintain precautions until diarrhea resolves; and
• Clean with chlorine antiseptic.

Dr. Bartlett was excited to share his experience with RT-PCR testing, which he termed the “new, slick, fast” testing option for C. diff. In trials, it has been shown to be 99% sensitive and 98% specific. “If your lab does PCR, it is the best test currently available,” Dr. Bartlett said, although he cautioned that “this test detects the bug, not the toxin.”

Treatment of C. diff disease happens in the colon, and medications must make it there to be effective. The most common treatments, vancomycin and metronidazole, have pluses and minuses, Dr. Bartlett explained. Vancomycin is FDA-approved and unbeaten in clinical trials; however, it is the more expensive choice. Metronidazole is cheaper ($5 per day) and proven to be effective in mild to moderate cases, but is not FDA-approved and is unproven in severe cases.

Dr. Bartlett’s guidelines for C. diff treatment:

• Mild cases: no treatment;
• Moderate: metronidazole 250 mg four times a day for 10 to 14 days; and
• Serious: vancomycin 125 mg four times a day for 10 to 14 days.

“If metro doesn’t work, switch to oral vanco,” Dr. Bartlett said. HM10

JOHN G. BARTLETT, MD, professor of medicine in the Department of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, mesmerized a standing-room-only crowd of more than 500 at his lecture about the increase of Clostridium difficile in U.S. hospitals.

C. diff incidence has more than doubled since the mid-1990s, to more than 160 cases per 100,000 patients, and currently outnumbers the annual total of MRSA cases in the U.S., according to Dr. Bartlett, one of the foremost scholars on the subject. For hospitalists encountering patients with questions about the disease and where it comes from, Dr. Bartlett encouraged providers to punt that question: “The fact is, we don’t know most of the time.”

Most patients acquire C. diff during a hospital stay (74%) or a previous hospital stay (21%), and research shows the longer patients stay in the hospital, the more likely they are to acquire the disease.

“It’s embedded in the fabric of hospitals,” Dr. Bartlett said. “The longer you are in the hospital, the more likely you are to get colonized.”

Prevention guidelines include:

• Hand hygiene;
• Advocate gloves and gowns;
• Patients with C. diff should be in single rooms;
• Maintain precautions until diarrhea resolves; and
• Clean with chlorine antiseptic.

Dr. Bartlett was excited to share his experience with RT-PCR testing, which he termed the “new, slick, fast” testing option for C. diff. In trials, it has been shown to be 99% sensitive and 98% specific. “If your lab does PCR, it is the best test currently available,” Dr. Bartlett said, although he cautioned that “this test detects the bug, not the toxin.”

Treatment of C. diff disease happens in the colon, and medications must make it there to be effective. The most common treatments, vancomycin and metronidazole, have pluses and minuses, Dr. Bartlett explained. Vancomycin is FDA-approved and unbeaten in clinical trials; however, it is the more expensive choice. Metronidazole is cheaper ($5 per day) and proven to be effective in mild to moderate cases, but is not FDA-approved and is unproven in severe cases.

Dr. Bartlett’s guidelines for C. diff treatment:

• Mild cases: no treatment;
• Moderate: metronidazole 250 mg four times a day for 10 to 14 days; and
• Serious: vancomycin 125 mg four times a day for 10 to 14 days.

“If metro doesn’t work, switch to oral vanco,” Dr. Bartlett said. HM10

JOHN G. BARTLETT, MD, professor of medicine in the Department of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, mesmerized a standing-room-only crowd of more than 500 at his lecture about the increase of Clostridium difficile in U.S. hospitals.

C. diff incidence has more than doubled since the mid-1990s, to more than 160 cases per 100,000 patients, and currently outnumbers the annual total of MRSA cases in the U.S., according to Dr. Bartlett, one of the foremost scholars on the subject. For hospitalists encountering patients with questions about the disease and where it comes from, Dr. Bartlett encouraged providers to punt that question: “The fact is, we don’t know most of the time.”

Most patients acquire C. diff during a hospital stay (74%) or a previous hospital stay (21%), and research shows the longer patients stay in the hospital, the more likely they are to acquire the disease.

“It’s embedded in the fabric of hospitals,” Dr. Bartlett said. “The longer you are in the hospital, the more likely you are to get colonized.”

Prevention guidelines include:

• Hand hygiene;
• Advocate gloves and gowns;
• Patients with C. diff should be in single rooms;
• Maintain precautions until diarrhea resolves; and
• Clean with chlorine antiseptic.

Dr. Bartlett was excited to share his experience with RT-PCR testing, which he termed the “new, slick, fast” testing option for C. diff. In trials, it has been shown to be 99% sensitive and 98% specific. “If your lab does PCR, it is the best test currently available,” Dr. Bartlett said, although he cautioned that “this test detects the bug, not the toxin.”

Treatment of C. diff disease happens in the colon, and medications must make it there to be effective. The most common treatments, vancomycin and metronidazole, have pluses and minuses, Dr. Bartlett explained. Vancomycin is FDA-approved and unbeaten in clinical trials; however, it is the more expensive choice. Metronidazole is cheaper ($5 per day) and proven to be effective in mild to moderate cases, but is not FDA-approved and is unproven in severe cases.

Dr. Bartlett’s guidelines for C. diff treatment:

• Mild cases: no treatment;
• Moderate: metronidazole 250 mg four times a day for 10 to 14 days; and
• Serious: vancomycin 125 mg four times a day for 10 to 14 days.

“If metro doesn’t work, switch to oral vanco,” Dr. Bartlett said. HM10

PHYSICIAN ASSISTANTS (PAs) and nurse practitioners can do almost anything a physician can do, and many have skill sets physicians lack, according to David Friar, MD, FHM, president of Hospitalists of Northwest Michigan based in Traverse City.

“As we go forward, with continued physician shortages and with the growing responsibilities of the hospitalist movement, we are going to need more and more people with different skill sets,” Dr. Friar said during his presentation at HM10. “I think one of those important areas is nonphysician providers.”

A quick survey of the 300 or so hospitalists at the session showed most HM groups employ NPPs, but less than a third of those thought they were “using NPPs well.” Dr. Friar, who has worked with NPs and PAs for 14 years, said he has found NPPs “to be an integral part of our practice. They have become indispensable to us in the way we provide services to our hospitals and patients.”

Still, many hospitalist groups waste NPP potential, Dr. Friar explained. He suggested HM groups evaluate their NPP roster and duties, and make necessary changes. “Make sure you treat them as if they are part of the team. That is very important,” he said. “NPPs can and should take care of patients throughout all stages of the hospital stay, from admission to discharge.”

When hiring NPPs, look for team players who are flexible and willing to learn. Make sure the NPP knows their limits and is comfortable asking for help. Target local training programs or other departments in the hospital as fertile ground for new hires. But, most importantly, know what you are getting when you hire an NPP.

“Don’t underestimate the cost of the inexperienced NPP in terms of training. If you think it’s two weeks or two months, you are fooling yourself,” Dr. Friar emphasized, adding an inexperienced NPP could take from six months to two years to reach full competency in hospitalist service. “Know the tradeoffs,” he said. “It might be more important for you to hire the more experienced—and more costly—NPP so you don’t have to spend two years to get them up to speed.” HM10

PHYSICIAN ASSISTANTS (PAs) and nurse practitioners can do almost anything a physician can do, and many have skill sets physicians lack, according to David Friar, MD, FHM, president of Hospitalists of Northwest Michigan based in Traverse City.

“As we go forward, with continued physician shortages and with the growing responsibilities of the hospitalist movement, we are going to need more and more people with different skill sets,” Dr. Friar said during his presentation at HM10. “I think one of those important areas is nonphysician providers.”

A quick survey of the 300 or so hospitalists at the session showed most HM groups employ NPPs, but less than a third of those thought they were “using NPPs well.” Dr. Friar, who has worked with NPs and PAs for 14 years, said he has found NPPs “to be an integral part of our practice. They have become indispensable to us in the way we provide services to our hospitals and patients.”

Still, many hospitalist groups waste NPP potential, Dr. Friar explained. He suggested HM groups evaluate their NPP roster and duties, and make necessary changes. “Make sure you treat them as if they are part of the team. That is very important,” he said. “NPPs can and should take care of patients throughout all stages of the hospital stay, from admission to discharge.”

When hiring NPPs, look for team players who are flexible and willing to learn. Make sure the NPP knows their limits and is comfortable asking for help. Target local training programs or other departments in the hospital as fertile ground for new hires. But, most importantly, know what you are getting when you hire an NPP.

“Don’t underestimate the cost of the inexperienced NPP in terms of training. If you think it’s two weeks or two months, you are fooling yourself,” Dr. Friar emphasized, adding an inexperienced NPP could take from six months to two years to reach full competency in hospitalist service. “Know the tradeoffs,” he said. “It might be more important for you to hire the more experienced—and more costly—NPP so you don’t have to spend two years to get them up to speed.” HM10

PHYSICIAN ASSISTANTS (PAs) and nurse practitioners can do almost anything a physician can do, and many have skill sets physicians lack, according to David Friar, MD, FHM, president of Hospitalists of Northwest Michigan based in Traverse City.

“As we go forward, with continued physician shortages and with the growing responsibilities of the hospitalist movement, we are going to need more and more people with different skill sets,” Dr. Friar said during his presentation at HM10. “I think one of those important areas is nonphysician providers.”

A quick survey of the 300 or so hospitalists at the session showed most HM groups employ NPPs, but less than a third of those thought they were “using NPPs well.” Dr. Friar, who has worked with NPs and PAs for 14 years, said he has found NPPs “to be an integral part of our practice. They have become indispensable to us in the way we provide services to our hospitals and patients.”

Still, many hospitalist groups waste NPP potential, Dr. Friar explained. He suggested HM groups evaluate their NPP roster and duties, and make necessary changes. “Make sure you treat them as if they are part of the team. That is very important,” he said. “NPPs can and should take care of patients throughout all stages of the hospital stay, from admission to discharge.”

When hiring NPPs, look for team players who are flexible and willing to learn. Make sure the NPP knows their limits and is comfortable asking for help. Target local training programs or other departments in the hospital as fertile ground for new hires. But, most importantly, know what you are getting when you hire an NPP.

“Don’t underestimate the cost of the inexperienced NPP in terms of training. If you think it’s two weeks or two months, you are fooling yourself,” Dr. Friar emphasized, adding an inexperienced NPP could take from six months to two years to reach full competency in hospitalist service. “Know the tradeoffs,” he said. “It might be more important for you to hire the more experienced—and more costly—NPP so you don’t have to spend two years to get them up to speed.” HM10

ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

• Treat UEDVT seriously;
• Understand there is a higher rate of PE than previously thought;
• Insert central-vein catheters judiciously, and keep them in if you still need them;
• Manage the duration of therapy parallel to that of lower extremity DVT; and
• Routine thrombolytics use isn’t indicated at this time. HM10

ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

• Treat UEDVT seriously;
• Understand there is a higher rate of PE than previously thought;
• Insert central-vein catheters judiciously, and keep them in if you still need them;
• Manage the duration of therapy parallel to that of lower extremity DVT; and
• Routine thrombolytics use isn’t indicated at this time. HM10

ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

• Treat UEDVT seriously;
• Understand there is a higher rate of PE than previously thought;
• Insert central-vein catheters judiciously, and keep them in if you still need them;
• Manage the duration of therapy parallel to that of lower extremity DVT; and
• Routine thrombolytics use isn’t indicated at this time. HM10

BUILDING QUALITY improvement (QI) into the healthcare process starts with education, but to date, standardized QI curriculums have not taken root across academic medical centers.

A quartet of academic hospitalists pushed the concept during an HM10 session titled “Quality Improvement Curriculum: How to Get Started and to Keep Going.” All four speakers agreed that QI “empowers providers to create change.”

The presentation was based on a 1998 book from first author David Kern, MD, MPH, FACP, professor at the Johns Hopkins University School of Medicine in Baltimore: “Curriculum Development for Medical Education: A Six-Step Process.” Some of the take-home points included:

• Problem identification and a general-needs assessment, followed by a targeted needs assessment. Combined, the two steps create a construct for an issue, such as “residents lack knowledge skills in QI,” and then hone in with such queries as “What is the baseline knowledge?”
• Goals and objectives. There is a difference between the two. Goals are broad-based with little specificity; objectives are measurable items that gauge progress.
• Educational strategies. Cognitive objectives can be taught via lectures or team-based projects; however, skill-based objectives traditionally are better taught via hands-on experience.
• Implementation, evaluation, and feedback. Many programs try to move too quickly and put something in place before fully planning out the curriculum.

“Take a step back,” said Arpana Vidyarthi, MD, assistant professor and director of quality University of California at San Francisco. “What you do in implementing your curriculum ought to be connected to what your goals and objectives are.” HM10

BUILDING QUALITY improvement (QI) into the healthcare process starts with education, but to date, standardized QI curriculums have not taken root across academic medical centers.

A quartet of academic hospitalists pushed the concept during an HM10 session titled “Quality Improvement Curriculum: How to Get Started and to Keep Going.” All four speakers agreed that QI “empowers providers to create change.”

The presentation was based on a 1998 book from first author David Kern, MD, MPH, FACP, professor at the Johns Hopkins University School of Medicine in Baltimore: “Curriculum Development for Medical Education: A Six-Step Process.” Some of the take-home points included:

• Problem identification and a general-needs assessment, followed by a targeted needs assessment. Combined, the two steps create a construct for an issue, such as “residents lack knowledge skills in QI,” and then hone in with such queries as “What is the baseline knowledge?”
• Goals and objectives. There is a difference between the two. Goals are broad-based with little specificity; objectives are measurable items that gauge progress.
• Educational strategies. Cognitive objectives can be taught via lectures or team-based projects; however, skill-based objectives traditionally are better taught via hands-on experience.
• Implementation, evaluation, and feedback. Many programs try to move too quickly and put something in place before fully planning out the curriculum.

“Take a step back,” said Arpana Vidyarthi, MD, assistant professor and director of quality University of California at San Francisco. “What you do in implementing your curriculum ought to be connected to what your goals and objectives are.” HM10

BUILDING QUALITY improvement (QI) into the healthcare process starts with education, but to date, standardized QI curriculums have not taken root across academic medical centers.

A quartet of academic hospitalists pushed the concept during an HM10 session titled “Quality Improvement Curriculum: How to Get Started and to Keep Going.” All four speakers agreed that QI “empowers providers to create change.”

The presentation was based on a 1998 book from first author David Kern, MD, MPH, FACP, professor at the Johns Hopkins University School of Medicine in Baltimore: “Curriculum Development for Medical Education: A Six-Step Process.” Some of the take-home points included:

• Problem identification and a general-needs assessment, followed by a targeted needs assessment. Combined, the two steps create a construct for an issue, such as “residents lack knowledge skills in QI,” and then hone in with such queries as “What is the baseline knowledge?”
• Goals and objectives. There is a difference between the two. Goals are broad-based with little specificity; objectives are measurable items that gauge progress.
• Educational strategies. Cognitive objectives can be taught via lectures or team-based projects; however, skill-based objectives traditionally are better taught via hands-on experience.
• Implementation, evaluation, and feedback. Many programs try to move too quickly and put something in place before fully planning out the curriculum.

“Take a step back,” said Arpana Vidyarthi, MD, assistant professor and director of quality University of California at San Francisco. “What you do in implementing your curriculum ought to be connected to what your goals and objectives are.” HM10

SIT DOWN.

A simple piece of advice, to be sure, but one that can also humanize a hospitalist in the eyes of a patient, said panelists of “The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting and Benchmarking.”

“As many doctors are figuring out, perception is reality,” said Patrick Blakeslee, DO, a hospitalist with Premiere Medical Partners in Cuyahoga Falls, Ohio. The credentialing process at his hospital takes into account patient-satisfaction levels. “This is articulation ability, not necessarily your technical skill,” he said.

But like any other facet of medicine, with training, hospitalists can improve the patient’s interaction with physicians. Some tips:

• Craft a script for introductions. While it might sound rehearsed, it also gives the hospitalist a chance to lay out ahead of time what they want to say instead of curtailing the message because of a daily time crunch.
• Develop a business card with your picture or a brochure with an FAQ. Give the patient a sense of what they can expect from their doctor and vice versa.
• End with an open-ended question. This technique engages the patient in their treatment.

HM leaders looking to go even further with patient-satisfaction programs can develop an in-house survey that might gauge responses more accurately, said Nancy Mihevc, PhD, president of The Research Group in Florence, Mass. Outside surveys can be valuable, depending on the methodology they use, she said.

“We’re all, at this point, being measured in this realm,” said Winthrop Whitcomb, MD, MHM, medical director for healthcare quality at Baystate Medical Center in Springfield, Mass. “Should you as a hospitalist be compared to all programs, or should you be compared to just hospitalists?” HM10

SIT DOWN.

A simple piece of advice, to be sure, but one that can also humanize a hospitalist in the eyes of a patient, said panelists of “The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting and Benchmarking.”

“As many doctors are figuring out, perception is reality,” said Patrick Blakeslee, DO, a hospitalist with Premiere Medical Partners in Cuyahoga Falls, Ohio. The credentialing process at his hospital takes into account patient-satisfaction levels. “This is articulation ability, not necessarily your technical skill,” he said.

But like any other facet of medicine, with training, hospitalists can improve the patient’s interaction with physicians. Some tips:

• Craft a script for introductions. While it might sound rehearsed, it also gives the hospitalist a chance to lay out ahead of time what they want to say instead of curtailing the message because of a daily time crunch.
• Develop a business card with your picture or a brochure with an FAQ. Give the patient a sense of what they can expect from their doctor and vice versa.
• End with an open-ended question. This technique engages the patient in their treatment.

HM leaders looking to go even further with patient-satisfaction programs can develop an in-house survey that might gauge responses more accurately, said Nancy Mihevc, PhD, president of The Research Group in Florence, Mass. Outside surveys can be valuable, depending on the methodology they use, she said.

“We’re all, at this point, being measured in this realm,” said Winthrop Whitcomb, MD, MHM, medical director for healthcare quality at Baystate Medical Center in Springfield, Mass. “Should you as a hospitalist be compared to all programs, or should you be compared to just hospitalists?” HM10

SIT DOWN.

A simple piece of advice, to be sure, but one that can also humanize a hospitalist in the eyes of a patient, said panelists of “The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting and Benchmarking.”

“As many doctors are figuring out, perception is reality,” said Patrick Blakeslee, DO, a hospitalist with Premiere Medical Partners in Cuyahoga Falls, Ohio. The credentialing process at his hospital takes into account patient-satisfaction levels. “This is articulation ability, not necessarily your technical skill,” he said.

But like any other facet of medicine, with training, hospitalists can improve the patient’s interaction with physicians. Some tips:

• Craft a script for introductions. While it might sound rehearsed, it also gives the hospitalist a chance to lay out ahead of time what they want to say instead of curtailing the message because of a daily time crunch.
• Develop a business card with your picture or a brochure with an FAQ. Give the patient a sense of what they can expect from their doctor and vice versa.
• End with an open-ended question. This technique engages the patient in their treatment.

HM leaders looking to go even further with patient-satisfaction programs can develop an in-house survey that might gauge responses more accurately, said Nancy Mihevc, PhD, president of The Research Group in Florence, Mass. Outside surveys can be valuable, depending on the methodology they use, she said.

“We’re all, at this point, being measured in this realm,” said Winthrop Whitcomb, MD, MHM, medical director for healthcare quality at Baystate Medical Center in Springfield, Mass. “Should you as a hospitalist be compared to all programs, or should you be compared to just hospitalists?” HM10

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10

NATIONAL HARBOR, Md.—It’s happened to every hospitalist who has pushed for a quality improvement (QI) project in their hospital: A chief says no because there’s no money for it. Doesn’t matter if it was the chief medical officer, chief operating officer, or the chief financial officer—the answer is no, no, no.

The best way to change the answer? Change the question.

“Think like they do,” said Mahalakshmi K. Halasymani, MD, SFHM, vice president for quality and systems improvement
at Saint Joseph Mercy Health System in Ann Arbor, Mich. “Think about how healthcare is paid for. … [Administrators are] much more likely to release resources if it matters to the institution’s ability to collect money, or get a better survey next time.”

Dr. Halasymani, an SHM board member, co-led the session “The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI” with hospitalist Mark Novotny, MD, FHM, who held several C-suite positions at Southwestern Vermont Medical Center in Bennington, Vt., before parting ways with the hospital in early April. Both physicians urge getting organized before taking any case to hospital or health system administrators. Some of their tips:

• Define the scope of your proposal. Tackling too many issues can appear over-reaching. Attain a reasonable goal and build on success; that works better than swinging and missing with loftier goals.
• Attack topic areas with metrics. QI projects are only as good as the data they produce.
• Be interactive. Bring a C-suite member along on daily rounds for a week to showcase the problem you hope to address. When an administrator sees a need for improvement in real time, the issue is personalized. If administrators won’t come to rounds, go to them wherever they are—medical executive committee meetings, patient safety sessions, etc.

“Create a compelling story so people can see you not as an enemy, but as an ally,” Dr. Halasymani said. “To do that, you have to be where the conversations take place.” HM10

NATIONAL HARBOR, Md.—It’s happened to every hospitalist who has pushed for a quality improvement (QI) project in their hospital: A chief says no because there’s no money for it. Doesn’t matter if it was the chief medical officer, chief operating officer, or the chief financial officer—the answer is no, no, no.

The best way to change the answer? Change the question.

“Think like they do,” said Mahalakshmi K. Halasymani, MD, SFHM, vice president for quality and systems improvement
at Saint Joseph Mercy Health System in Ann Arbor, Mich. “Think about how healthcare is paid for. … [Administrators are] much more likely to release resources if it matters to the institution’s ability to collect money, or get a better survey next time.”

Dr. Halasymani, an SHM board member, co-led the session “The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI” with hospitalist Mark Novotny, MD, FHM, who held several C-suite positions at Southwestern Vermont Medical Center in Bennington, Vt., before parting ways with the hospital in early April. Both physicians urge getting organized before taking any case to hospital or health system administrators. Some of their tips:

• Define the scope of your proposal. Tackling too many issues can appear over-reaching. Attain a reasonable goal and build on success; that works better than swinging and missing with loftier goals.
• Attack topic areas with metrics. QI projects are only as good as the data they produce.
• Be interactive. Bring a C-suite member along on daily rounds for a week to showcase the problem you hope to address. When an administrator sees a need for improvement in real time, the issue is personalized. If administrators won’t come to rounds, go to them wherever they are—medical executive committee meetings, patient safety sessions, etc.

“Create a compelling story so people can see you not as an enemy, but as an ally,” Dr. Halasymani said. “To do that, you have to be where the conversations take place.” HM10

NATIONAL HARBOR, Md.—It’s happened to every hospitalist who has pushed for a quality improvement (QI) project in their hospital: A chief says no because there’s no money for it. Doesn’t matter if it was the chief medical officer, chief operating officer, or the chief financial officer—the answer is no, no, no.

The best way to change the answer? Change the question.

“Think like they do,” said Mahalakshmi K. Halasymani, MD, SFHM, vice president for quality and systems improvement
at Saint Joseph Mercy Health System in Ann Arbor, Mich. “Think about how healthcare is paid for. … [Administrators are] much more likely to release resources if it matters to the institution’s ability to collect money, or get a better survey next time.”

Dr. Halasymani, an SHM board member, co-led the session “The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI” with hospitalist Mark Novotny, MD, FHM, who held several C-suite positions at Southwestern Vermont Medical Center in Bennington, Vt., before parting ways with the hospital in early April. Both physicians urge getting organized before taking any case to hospital or health system administrators. Some of their tips:

• Define the scope of your proposal. Tackling too many issues can appear over-reaching. Attain a reasonable goal and build on success; that works better than swinging and missing with loftier goals.
• Attack topic areas with metrics. QI projects are only as good as the data they produce.
• Be interactive. Bring a C-suite member along on daily rounds for a week to showcase the problem you hope to address. When an administrator sees a need for improvement in real time, the issue is personalized. If administrators won’t come to rounds, go to them wherever they are—medical executive committee meetings, patient safety sessions, etc.

“Create a compelling story so people can see you not as an enemy, but as an ally,” Dr. Halasymani said. “To do that, you have to be where the conversations take place.” HM10

NATIONAL HARBOR, Md.—As HM10 wound down in this tony Washington, D.C., outpost, a trio of hospitalists from St. Louis smiled widely and brightly as a stranger took their picture in front of the main stage.

Each raved about the quality of the meeting they had just completed, particularly the way it linked HM leaders from across the country to such ubiquitous problems as transitional care and patient falls found in institutions from Seattle to Cincinnati to South Carolina. And with a record 2,500 hospitalists attending SHM’s annual meeting this year, what better time to smile?

“Your world suddenly becomes much smaller because you can reach out to people, rather than feel like you’re lost in this massive machine,” said Lois Richard, MD, PhD, FHM, a hospitalist with Washington University Physicians at the Washington University School of Medicine in St. Louis.

Dr. Richard’s commentary on belonging to a larger scene is a fitting allegory for the state of HM, as the field has grown beyond its neophyte stage. Now that the field has swelled to an estimated 30,000 nationwide, SHM’s new president said the time has come to move past the adolescent phase. Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, wants hospitalists to continue championing quality-improvement (QI) programs and patient-safety efforts.

“We’re at a stage as an organization that we need to continue to do the quality-education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” he said during a keynote address, adding later that “we have great heterogeneity in the society. Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert but are to the left on the continuum, still learning how to do it.”

The path to quality development began anew with the four-day meeting April 8-11 at the Gaylord National Resort & Convention Center on the banks of the Potomac River. The largest meeting in SHM history kicked off with its largest menu of pre-course sessions, designed to offer educational credits to CME-hungry physicians. This year’s choices included a pair of new sessions, one geared toward neurology and the other aimed at early-career hospitalists. The increased offerings worked, as SHM officials reported a preliminary pre-course attendance increase of 10% from last year’s meeting.

Another big draw for the meeting was the keynote address from Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston. Levy has quickly built himself a national platform to push for QI in the nation’s hospitals, along with public reporting and transparency. Levy said “we still do too much harm in our hospitals,” but wants to see that improved not because of radical changes in payment streams, but because of physicians who want to do better by their patients.

“Ignore the healthcare reform bill,” he said in his address. “Ignore all the fuss about it. Focus instead on the underlying values that you each have individually, and that you have collectively, as to why you became docs in the first place.”

The theme of quality and the future continued speaker after speaker, session after session. Meeting faculty used their microphones to expound on how the recently passed healthcare legislation does more to expand access to healthcare than change the current rules governing it. Most talked about the potential role hospitalists can play in the fluid landscape bound to develop in the next few years, with SHM CEO Larry Wellikson, MD, SFHM, going as far as to describe the field as “the rocketship moving upward almost to a limitless future.”

Still, the future only comes once the past has been recognized, and this year’s meeting will be remembered for the first three physicians who were honored as Masters in Hospital Medicine: John Nelson, Robert Wachter, and Winthrop Whitcomb. The latter described the ceremony as a moving experience for himself and his family.

“When John and I first started working on this in October 1996, and we had the first substantive conversation, I had a really strong feeling that this was going to be successful,” Dr. Whitcomb said. “I saw the forces gathering to drive this, but I definitely didn’t have any idea it was going to be this thing. I don’t think any of us did. . . . What we did want was to have a community.”

This year’s meeting continued to draw scores of first-timers looking to experience a bit of that community. Meeting attendance has nearly doubled since the 2008 meeting in San Diego, with a significant percentage of attendees falling into the early-career hospitalist category.

That includes physicians like Matthew Mechtenberg, DO, a hospitalist at Parkview Adventist Medical Center in Brunswick, Maine. A two-year hospitalist who formerly worked in private practice, he traveled to the meeting as part of his hospital’s focus on performance measures and QI. He was heartened to learn tricks of the trade—billing for encephalopathy instead of “altered mental status” might capture more costs for some patients—but just as importantly, it was comforting to know many of his institution’s problems are universal.

“Some of the issues I have in my hospital are the same as they have in Beth Israel Deaconess,” Dr. Mechtenberg said. “Issues translate whether you’re in a 50-bed hospital or an 800-bed hospital. That’s reassuring.”

And then there was Bihar Dianati, MD, a hospitalist at Belleville Memorial Hospital in Belleville, Ill., who previously couldn’t attend the annual meeting because he worked a Monday-Friday schedule. With his recent switch to “seven-on, seven-off,” he decided to use his week off for professional development.

Dr. Dianati bounced between sessions, finding some “self-promoting” but others “incredibly helpful.” But any professional meeting is only successful if it draws repeat business. So will Dr. Dianati be back next year for HM11 at the Gaylord Hotel in Grapevine, Texas?

“Oh, definitely,” Dr. Dianati said. “I already took the registration papers for next year.” HM10

Richard Quinn is a freelance writer based in New Jersey.

NATIONAL HARBOR, Md.—As HM10 wound down in this tony Washington, D.C., outpost, a trio of hospitalists from St. Louis smiled widely and brightly as a stranger took their picture in front of the main stage.

Each raved about the quality of the meeting they had just completed, particularly the way it linked HM leaders from across the country to such ubiquitous problems as transitional care and patient falls found in institutions from Seattle to Cincinnati to South Carolina. And with a record 2,500 hospitalists attending SHM’s annual meeting this year, what better time to smile?

“Your world suddenly becomes much smaller because you can reach out to people, rather than feel like you’re lost in this massive machine,” said Lois Richard, MD, PhD, FHM, a hospitalist with Washington University Physicians at the Washington University School of Medicine in St. Louis.

Dr. Richard’s commentary on belonging to a larger scene is a fitting allegory for the state of HM, as the field has grown beyond its neophyte stage. Now that the field has swelled to an estimated 30,000 nationwide, SHM’s new president said the time has come to move past the adolescent phase. Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, wants hospitalists to continue championing quality-improvement (QI) programs and patient-safety efforts.

“We’re at a stage as an organization that we need to continue to do the quality-education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” he said during a keynote address, adding later that “we have great heterogeneity in the society. Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert but are to the left on the continuum, still learning how to do it.”

The path to quality development began anew with the four-day meeting April 8-11 at the Gaylord National Resort & Convention Center on the banks of the Potomac River. The largest meeting in SHM history kicked off with its largest menu of pre-course sessions, designed to offer educational credits to CME-hungry physicians. This year’s choices included a pair of new sessions, one geared toward neurology and the other aimed at early-career hospitalists. The increased offerings worked, as SHM officials reported a preliminary pre-course attendance increase of 10% from last year’s meeting.

Another big draw for the meeting was the keynote address from Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston. Levy has quickly built himself a national platform to push for QI in the nation’s hospitals, along with public reporting and transparency. Levy said “we still do too much harm in our hospitals,” but wants to see that improved not because of radical changes in payment streams, but because of physicians who want to do better by their patients.

“Ignore the healthcare reform bill,” he said in his address. “Ignore all the fuss about it. Focus instead on the underlying values that you each have individually, and that you have collectively, as to why you became docs in the first place.”

The theme of quality and the future continued speaker after speaker, session after session. Meeting faculty used their microphones to expound on how the recently passed healthcare legislation does more to expand access to healthcare than change the current rules governing it. Most talked about the potential role hospitalists can play in the fluid landscape bound to develop in the next few years, with SHM CEO Larry Wellikson, MD, SFHM, going as far as to describe the field as “the rocketship moving upward almost to a limitless future.”

Still, the future only comes once the past has been recognized, and this year’s meeting will be remembered for the first three physicians who were honored as Masters in Hospital Medicine: John Nelson, Robert Wachter, and Winthrop Whitcomb. The latter described the ceremony as a moving experience for himself and his family.

“When John and I first started working on this in October 1996, and we had the first substantive conversation, I had a really strong feeling that this was going to be successful,” Dr. Whitcomb said. “I saw the forces gathering to drive this, but I definitely didn’t have any idea it was going to be this thing. I don’t think any of us did. . . . What we did want was to have a community.”

This year’s meeting continued to draw scores of first-timers looking to experience a bit of that community. Meeting attendance has nearly doubled since the 2008 meeting in San Diego, with a significant percentage of attendees falling into the early-career hospitalist category.

That includes physicians like Matthew Mechtenberg, DO, a hospitalist at Parkview Adventist Medical Center in Brunswick, Maine. A two-year hospitalist who formerly worked in private practice, he traveled to the meeting as part of his hospital’s focus on performance measures and QI. He was heartened to learn tricks of the trade—billing for encephalopathy instead of “altered mental status” might capture more costs for some patients—but just as importantly, it was comforting to know many of his institution’s problems are universal.

“Some of the issues I have in my hospital are the same as they have in Beth Israel Deaconess,” Dr. Mechtenberg said. “Issues translate whether you’re in a 50-bed hospital or an 800-bed hospital. That’s reassuring.”

And then there was Bihar Dianati, MD, a hospitalist at Belleville Memorial Hospital in Belleville, Ill., who previously couldn’t attend the annual meeting because he worked a Monday-Friday schedule. With his recent switch to “seven-on, seven-off,” he decided to use his week off for professional development.

Dr. Dianati bounced between sessions, finding some “self-promoting” but others “incredibly helpful.” But any professional meeting is only successful if it draws repeat business. So will Dr. Dianati be back next year for HM11 at the Gaylord Hotel in Grapevine, Texas?

“Oh, definitely,” Dr. Dianati said. “I already took the registration papers for next year.” HM10

Richard Quinn is a freelance writer based in New Jersey.

NATIONAL HARBOR, Md.—As HM10 wound down in this tony Washington, D.C., outpost, a trio of hospitalists from St. Louis smiled widely and brightly as a stranger took their picture in front of the main stage.

Each raved about the quality of the meeting they had just completed, particularly the way it linked HM leaders from across the country to such ubiquitous problems as transitional care and patient falls found in institutions from Seattle to Cincinnati to South Carolina. And with a record 2,500 hospitalists attending SHM’s annual meeting this year, what better time to smile?

“Your world suddenly becomes much smaller because you can reach out to people, rather than feel like you’re lost in this massive machine,” said Lois Richard, MD, PhD, FHM, a hospitalist with Washington University Physicians at the Washington University School of Medicine in St. Louis.

Dr. Richard’s commentary on belonging to a larger scene is a fitting allegory for the state of HM, as the field has grown beyond its neophyte stage. Now that the field has swelled to an estimated 30,000 nationwide, SHM’s new president said the time has come to move past the adolescent phase. Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, wants hospitalists to continue championing quality-improvement (QI) programs and patient-safety efforts.

“We’re at a stage as an organization that we need to continue to do the quality-education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” he said during a keynote address, adding later that “we have great heterogeneity in the society. Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert but are to the left on the continuum, still learning how to do it.”

The path to quality development began anew with the four-day meeting April 8-11 at the Gaylord National Resort & Convention Center on the banks of the Potomac River. The largest meeting in SHM history kicked off with its largest menu of pre-course sessions, designed to offer educational credits to CME-hungry physicians. This year’s choices included a pair of new sessions, one geared toward neurology and the other aimed at early-career hospitalists. The increased offerings worked, as SHM officials reported a preliminary pre-course attendance increase of 10% from last year’s meeting.

Another big draw for the meeting was the keynote address from Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston. Levy has quickly built himself a national platform to push for QI in the nation’s hospitals, along with public reporting and transparency. Levy said “we still do too much harm in our hospitals,” but wants to see that improved not because of radical changes in payment streams, but because of physicians who want to do better by their patients.

“Ignore the healthcare reform bill,” he said in his address. “Ignore all the fuss about it. Focus instead on the underlying values that you each have individually, and that you have collectively, as to why you became docs in the first place.”

The theme of quality and the future continued speaker after speaker, session after session. Meeting faculty used their microphones to expound on how the recently passed healthcare legislation does more to expand access to healthcare than change the current rules governing it. Most talked about the potential role hospitalists can play in the fluid landscape bound to develop in the next few years, with SHM CEO Larry Wellikson, MD, SFHM, going as far as to describe the field as “the rocketship moving upward almost to a limitless future.”

Still, the future only comes once the past has been recognized, and this year’s meeting will be remembered for the first three physicians who were honored as Masters in Hospital Medicine: John Nelson, Robert Wachter, and Winthrop Whitcomb. The latter described the ceremony as a moving experience for himself and his family.

“When John and I first started working on this in October 1996, and we had the first substantive conversation, I had a really strong feeling that this was going to be successful,” Dr. Whitcomb said. “I saw the forces gathering to drive this, but I definitely didn’t have any idea it was going to be this thing. I don’t think any of us did. . . . What we did want was to have a community.”

This year’s meeting continued to draw scores of first-timers looking to experience a bit of that community. Meeting attendance has nearly doubled since the 2008 meeting in San Diego, with a significant percentage of attendees falling into the early-career hospitalist category.

That includes physicians like Matthew Mechtenberg, DO, a hospitalist at Parkview Adventist Medical Center in Brunswick, Maine. A two-year hospitalist who formerly worked in private practice, he traveled to the meeting as part of his hospital’s focus on performance measures and QI. He was heartened to learn tricks of the trade—billing for encephalopathy instead of “altered mental status” might capture more costs for some patients—but just as importantly, it was comforting to know many of his institution’s problems are universal.

“Some of the issues I have in my hospital are the same as they have in Beth Israel Deaconess,” Dr. Mechtenberg said. “Issues translate whether you’re in a 50-bed hospital or an 800-bed hospital. That’s reassuring.”

And then there was Bihar Dianati, MD, a hospitalist at Belleville Memorial Hospital in Belleville, Ill., who previously couldn’t attend the annual meeting because he worked a Monday-Friday schedule. With his recent switch to “seven-on, seven-off,” he decided to use his week off for professional development.

Dr. Dianati bounced between sessions, finding some “self-promoting” but others “incredibly helpful.” But any professional meeting is only successful if it draws repeat business. So will Dr. Dianati be back next year for HM11 at the Gaylord Hotel in Grapevine, Texas?

“Oh, definitely,” Dr. Dianati said. “I already took the registration papers for next year.” HM10

Richard Quinn is a freelance writer based in New Jersey.

NATIONAL HARBOR, Md.—;Amie Dlouhy, RN, BSN, hospitalist program manager with Saint Mary’s Health Care in Grand Rapids, Mich., couldn’t scribble notes furiously enough during the practice-management pre-course at HM10. Dlouhy was promoted to her new position as an administrator some six weeks before the annual meeting at the Gaylord National Resort & Convention Center in early April.

So the first-time meeting attendee decided she would jot down as many tips as she could. She quickly realized the trip was worth it, as she learned that a departmental dashboard is a relatively simple way to gather key information in one place. She also likes the idea of drawing up a brochure that tells patients what they can expect from their hospitalists—and perhaps vice versa. And what new HM group leader doesn’t want advice on building a schedule that adds individualized wrinkles to the “seven-on, seven-off” structure?

“It is a business and you need to treat it as if it’s a business,” Dlouhy said. “It’s an ongoing process, and you want to make sure you have a concrete foundation.”

The tidbits Dlouhy gleaned from her pre-course were among scores of nuggets discussed during eight of the accredited educational sessions. This year’s pre-courses boosted to a new high of 20 the number of Category 1 credits physicians could earn toward the American Medical Association’s (AMA) Physician Recognition Award. Last year, the total was 15.

Offering more classes—and more varied topics—worked pretty well, as this year’s slate of pre-courses was more popular than ever, according to SHM officials. At HM09 in Chicago, more than 800 attendees participated in six sessions. At HM10, the total attendance was roughly 10% higher.

A main driver of the growth was the addition of two new courses—“Essential Neurology for the Hospitalist” and “Early Career Hospitalist: Skills for Success.” Another was a packed room of hospitalists answering questions—some right, some wrong—and preparing for the new Focused Practice in Hospital Medicine (FPHM) via the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC). The learning session pre-course debuted last year, but the new HM pathway to board recertification helped push attendance higher this year.

“The nice thing about the audience-response system is that you can actually see that not everybody is always going straight to the right answer on all of the questions,” said Julius Yang, MD, PhD, a hospitalist at Beth Israel Deaconess Medical Center in Boston and the MOC course director. “It’s really serving as an important refresher of our medical knowledge base.”

Dr. Yang said the “mini-retreat” environment of an annual convention is the perfect place to focus on granular professional development. “Trying to do these types of MOCs when you’re working to keep current with all of your other duties, you don’t get as much out of it,” Dr. Yang said. “Here, you get it all.”

He adds that those physicians who take the time and spend the money to travel for an educational session tend to be very focused on taking advantage of the program, not just showing up to be counted.

“All of these [questions] are very much directed at growing as a hospitalist,” Dr. Yang said. “It’s a different focus than the rest of the meeting. This is about every individual bringing something back to their institution.”

That’s what keeps bringing Troy Ahlstrom, MD, FHM, back. Dr. Ahlstrom, of Hos-pitalists of Northwest Michigan in Traverse City, has been to three annual meetings, and he said he tries to hit a pre-course every time. Last year, it was a session on how to more completely capture costs from billing and coding.

This year: “Comprehensive Critical Care in 2010: An Interactive Course.” The former appealed to him given that every HM group needs to capture as many of its charges as possible, and the latter because his group helps staff the critical-care units of three hospitals.

Several physicians noted that the critical-care pre-course was particularly appealing to attendees, as more hospitalists are handling those duties at their respective institutions. The format was popular, too, and was structured in the same way as the ABIM learning session, with course director David Schul-man, MD, MPH, chief of pulmonary and critical-care medicine at Emory University Hospital in Atlanta, leading a room full of hospitalists through a multiple-choice exam.

Dr. Ahlstrom and others noted that aside from the engagement in education that the daylong pre-courses offer, the sessions are set up with take-home guides, reference materials, and earnest pledges for mentoring from speakers and SHM staff.

“Most medical meetings have a scientific focus with a couple of practical aspects,” Dr. Ahlstrom said. “SHM’s meeting is very practical. It presents research, but it’s research you will use in your practice.”

Gerald Johnson, MD, a hospitalist at Texoma Medical Center in Denison, Texas, signed up for the “Best Practices in Managing a Hospital Medicine Program” pre-course during his first visit to an SHM meeting. A hospitalist for about four years, Dr. Johnson decided to take the pre-course at the urging of senior colleagues. He said the most helpful lessons he gleaned were about compensation plans, scheduling, and staffing.

“It’s not one person getting up there and presenting ‘This is how it needs to be done,’ ” Dr. Johnson said. “They present you with several ways. It really gives you something to adapt to your personal environment.”

Dr. Johnson, who gushed about “the gurus” of HM leading his session, also likes the fact that people with both a financial pedigree and a background in clinical work present the information. In fact, several attendees of the best-practices session noted that the attention to both medicine and management helps fill in the gaps between being a clinician and being a businessman.

“You’ve got to do both well,” Dr. Ahlstrom said. “You’ve got to take good care of patients. But in order to take good care of patients, you have to run a good business model, too.” HM10

Richard Quinn is a freelance writer based in New Jersey.

NATIONAL HARBOR, Md.—;Amie Dlouhy, RN, BSN, hospitalist program manager with Saint Mary’s Health Care in Grand Rapids, Mich., couldn’t scribble notes furiously enough during the practice-management pre-course at HM10. Dlouhy was promoted to her new position as an administrator some six weeks before the annual meeting at the Gaylord National Resort & Convention Center in early April.

So the first-time meeting attendee decided she would jot down as many tips as she could. She quickly realized the trip was worth it, as she learned that a departmental dashboard is a relatively simple way to gather key information in one place. She also likes the idea of drawing up a brochure that tells patients what they can expect from their hospitalists—and perhaps vice versa. And what new HM group leader doesn’t want advice on building a schedule that adds individualized wrinkles to the “seven-on, seven-off” structure?

“It is a business and you need to treat it as if it’s a business,” Dlouhy said. “It’s an ongoing process, and you want to make sure you have a concrete foundation.”

The tidbits Dlouhy gleaned from her pre-course were among scores of nuggets discussed during eight of the accredited educational sessions. This year’s pre-courses boosted to a new high of 20 the number of Category 1 credits physicians could earn toward the American Medical Association’s (AMA) Physician Recognition Award. Last year, the total was 15.

Offering more classes—and more varied topics—worked pretty well, as this year’s slate of pre-courses was more popular than ever, according to SHM officials. At HM09 in Chicago, more than 800 attendees participated in six sessions. At HM10, the total attendance was roughly 10% higher.

A main driver of the growth was the addition of two new courses—“Essential Neurology for the Hospitalist” and “Early Career Hospitalist: Skills for Success.” Another was a packed room of hospitalists answering questions—some right, some wrong—and preparing for the new Focused Practice in Hospital Medicine (FPHM) via the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC). The learning session pre-course debuted last year, but the new HM pathway to board recertification helped push attendance higher this year.

“The nice thing about the audience-response system is that you can actually see that not everybody is always going straight to the right answer on all of the questions,” said Julius Yang, MD, PhD, a hospitalist at Beth Israel Deaconess Medical Center in Boston and the MOC course director. “It’s really serving as an important refresher of our medical knowledge base.”

Dr. Yang said the “mini-retreat” environment of an annual convention is the perfect place to focus on granular professional development. “Trying to do these types of MOCs when you’re working to keep current with all of your other duties, you don’t get as much out of it,” Dr. Yang said. “Here, you get it all.”

He adds that those physicians who take the time and spend the money to travel for an educational session tend to be very focused on taking advantage of the program, not just showing up to be counted.

“All of these [questions] are very much directed at growing as a hospitalist,” Dr. Yang said. “It’s a different focus than the rest of the meeting. This is about every individual bringing something back to their institution.”

That’s what keeps bringing Troy Ahlstrom, MD, FHM, back. Dr. Ahlstrom, of Hos-pitalists of Northwest Michigan in Traverse City, has been to three annual meetings, and he said he tries to hit a pre-course every time. Last year, it was a session on how to more completely capture costs from billing and coding.

This year: “Comprehensive Critical Care in 2010: An Interactive Course.” The former appealed to him given that every HM group needs to capture as many of its charges as possible, and the latter because his group helps staff the critical-care units of three hospitals.

Several physicians noted that the critical-care pre-course was particularly appealing to attendees, as more hospitalists are handling those duties at their respective institutions. The format was popular, too, and was structured in the same way as the ABIM learning session, with course director David Schul-man, MD, MPH, chief of pulmonary and critical-care medicine at Emory University Hospital in Atlanta, leading a room full of hospitalists through a multiple-choice exam.

Dr. Ahlstrom and others noted that aside from the engagement in education that the daylong pre-courses offer, the sessions are set up with take-home guides, reference materials, and earnest pledges for mentoring from speakers and SHM staff.

“Most medical meetings have a scientific focus with a couple of practical aspects,” Dr. Ahlstrom said. “SHM’s meeting is very practical. It presents research, but it’s research you will use in your practice.”

Gerald Johnson, MD, a hospitalist at Texoma Medical Center in Denison, Texas, signed up for the “Best Practices in Managing a Hospital Medicine Program” pre-course during his first visit to an SHM meeting. A hospitalist for about four years, Dr. Johnson decided to take the pre-course at the urging of senior colleagues. He said the most helpful lessons he gleaned were about compensation plans, scheduling, and staffing.

“It’s not one person getting up there and presenting ‘This is how it needs to be done,’ ” Dr. Johnson said. “They present you with several ways. It really gives you something to adapt to your personal environment.”

Dr. Johnson, who gushed about “the gurus” of HM leading his session, also likes the fact that people with both a financial pedigree and a background in clinical work present the information. In fact, several attendees of the best-practices session noted that the attention to both medicine and management helps fill in the gaps between being a clinician and being a businessman.

“You’ve got to do both well,” Dr. Ahlstrom said. “You’ve got to take good care of patients. But in order to take good care of patients, you have to run a good business model, too.” HM10

Richard Quinn is a freelance writer based in New Jersey.

NATIONAL HARBOR, Md.—;Amie Dlouhy, RN, BSN, hospitalist program manager with Saint Mary’s Health Care in Grand Rapids, Mich., couldn’t scribble notes furiously enough during the practice-management pre-course at HM10. Dlouhy was promoted to her new position as an administrator some six weeks before the annual meeting at the Gaylord National Resort & Convention Center in early April.

So the first-time meeting attendee decided she would jot down as many tips as she could. She quickly realized the trip was worth it, as she learned that a departmental dashboard is a relatively simple way to gather key information in one place. She also likes the idea of drawing up a brochure that tells patients what they can expect from their hospitalists—and perhaps vice versa. And what new HM group leader doesn’t want advice on building a schedule that adds individualized wrinkles to the “seven-on, seven-off” structure?

“It is a business and you need to treat it as if it’s a business,” Dlouhy said. “It’s an ongoing process, and you want to make sure you have a concrete foundation.”

The tidbits Dlouhy gleaned from her pre-course were among scores of nuggets discussed during eight of the accredited educational sessions. This year’s pre-courses boosted to a new high of 20 the number of Category 1 credits physicians could earn toward the American Medical Association’s (AMA) Physician Recognition Award. Last year, the total was 15.

Offering more classes—and more varied topics—worked pretty well, as this year’s slate of pre-courses was more popular than ever, according to SHM officials. At HM09 in Chicago, more than 800 attendees participated in six sessions. At HM10, the total attendance was roughly 10% higher.

A main driver of the growth was the addition of two new courses—“Essential Neurology for the Hospitalist” and “Early Career Hospitalist: Skills for Success.” Another was a packed room of hospitalists answering questions—some right, some wrong—and preparing for the new Focused Practice in Hospital Medicine (FPHM) via the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC). The learning session pre-course debuted last year, but the new HM pathway to board recertification helped push attendance higher this year.

“The nice thing about the audience-response system is that you can actually see that not everybody is always going straight to the right answer on all of the questions,” said Julius Yang, MD, PhD, a hospitalist at Beth Israel Deaconess Medical Center in Boston and the MOC course director. “It’s really serving as an important refresher of our medical knowledge base.”

Dr. Yang said the “mini-retreat” environment of an annual convention is the perfect place to focus on granular professional development. “Trying to do these types of MOCs when you’re working to keep current with all of your other duties, you don’t get as much out of it,” Dr. Yang said. “Here, you get it all.”

He adds that those physicians who take the time and spend the money to travel for an educational session tend to be very focused on taking advantage of the program, not just showing up to be counted.

“All of these [questions] are very much directed at growing as a hospitalist,” Dr. Yang said. “It’s a different focus than the rest of the meeting. This is about every individual bringing something back to their institution.”

That’s what keeps bringing Troy Ahlstrom, MD, FHM, back. Dr. Ahlstrom, of Hos-pitalists of Northwest Michigan in Traverse City, has been to three annual meetings, and he said he tries to hit a pre-course every time. Last year, it was a session on how to more completely capture costs from billing and coding.

This year: “Comprehensive Critical Care in 2010: An Interactive Course.” The former appealed to him given that every HM group needs to capture as many of its charges as possible, and the latter because his group helps staff the critical-care units of three hospitals.

Several physicians noted that the critical-care pre-course was particularly appealing to attendees, as more hospitalists are handling those duties at their respective institutions. The format was popular, too, and was structured in the same way as the ABIM learning session, with course director David Schul-man, MD, MPH, chief of pulmonary and critical-care medicine at Emory University Hospital in Atlanta, leading a room full of hospitalists through a multiple-choice exam.

Dr. Ahlstrom and others noted that aside from the engagement in education that the daylong pre-courses offer, the sessions are set up with take-home guides, reference materials, and earnest pledges for mentoring from speakers and SHM staff.

“Most medical meetings have a scientific focus with a couple of practical aspects,” Dr. Ahlstrom said. “SHM’s meeting is very practical. It presents research, but it’s research you will use in your practice.”

Gerald Johnson, MD, a hospitalist at Texoma Medical Center in Denison, Texas, signed up for the “Best Practices in Managing a Hospital Medicine Program” pre-course during his first visit to an SHM meeting. A hospitalist for about four years, Dr. Johnson decided to take the pre-course at the urging of senior colleagues. He said the most helpful lessons he gleaned were about compensation plans, scheduling, and staffing.

“It’s not one person getting up there and presenting ‘This is how it needs to be done,’ ” Dr. Johnson said. “They present you with several ways. It really gives you something to adapt to your personal environment.”

Dr. Johnson, who gushed about “the gurus” of HM leading his session, also likes the fact that people with both a financial pedigree and a background in clinical work present the information. In fact, several attendees of the best-practices session noted that the attention to both medicine and management helps fill in the gaps between being a clinician and being a businessman.

“You’ve got to do both well,” Dr. Ahlstrom said. “You’ve got to take good care of patients. But in order to take good care of patients, you have to run a good business model, too.” HM10

Richard Quinn is a freelance writer based in New Jersey.

“We are the champions.”

The emotion-triggering tune that blares nightly at sports stadiums across the country was pretty much a slogan at SHM’s annual meeting, held April 8-11 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside Washington, D.C.

From new SHM President Jeff Weise’s use of the lyric to analogize HM’s arrival as a force in healthcare reform to the Hall of Fame-tinged ceremony inducting the first three Masters in Hospital Medicine—John Nelson, Robert Wachter, and Winthrop Whitcomb—this once-a-year gathering is no longer about seeking respect as a specialty. It’s blossomed into a sold-out, four-day strategy session looking at various ways to improve the delivery of care to patients.

“What we say is going to be taken seriously,” said Dr. Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “Which means that it has to be the right message—which means that it has to be about patient care.” HM10

“We are the champions.”

The emotion-triggering tune that blares nightly at sports stadiums across the country was pretty much a slogan at SHM’s annual meeting, held April 8-11 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside Washington, D.C.

From new SHM President Jeff Weise’s use of the lyric to analogize HM’s arrival as a force in healthcare reform to the Hall of Fame-tinged ceremony inducting the first three Masters in Hospital Medicine—John Nelson, Robert Wachter, and Winthrop Whitcomb—this once-a-year gathering is no longer about seeking respect as a specialty. It’s blossomed into a sold-out, four-day strategy session looking at various ways to improve the delivery of care to patients.

“What we say is going to be taken seriously,” said Dr. Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “Which means that it has to be the right message—which means that it has to be about patient care.” HM10

“We are the champions.”

The emotion-triggering tune that blares nightly at sports stadiums across the country was pretty much a slogan at SHM’s annual meeting, held April 8-11 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside Washington, D.C.

From new SHM President Jeff Weise’s use of the lyric to analogize HM’s arrival as a force in healthcare reform to the Hall of Fame-tinged ceremony inducting the first three Masters in Hospital Medicine—John Nelson, Robert Wachter, and Winthrop Whitcomb—this once-a-year gathering is no longer about seeking respect as a specialty. It’s blossomed into a sold-out, four-day strategy session looking at various ways to improve the delivery of care to patients.

“What we say is going to be taken seriously,” said Dr. Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans. “Which means that it has to be the right message—which means that it has to be about patient care.” HM10