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Patient education
The Institute of Medicine has defined patient centered care as one of the six aims for healthcare improvements in the 21st century. Patient centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in health care decisions and management.
KNOWLEDGE
Hospitalists should be able to:
Describe the guiding principles for patient education.
Explain the factors that impact the success or failure of behavior change strategies.
Identify institutional resources for patient education materials and programs.
Summarize the evidence for the primacy of patient education as a means to improve the quality of health care.
Discuss the contextual factors that influence a patient's readiness to learn new information.
Describe the role of patient education in the management of chronic diseases, which may include diabetes, congestive heart failure, and asthma.
Explain how each patient's socio‐cultural background affects his or her health beliefs and behavior.
Identify barriers to implementation of patient education, including literacy levels and language fluency.
Determine the utility and appropriateness of patient education materials based on specific patient characteristics, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.
SKILLS
Hospitalists should be able to:
Identify and assist patients and families who require additional education about their medical illnesses.
Communicate effectively with patients from diverse backgrounds.
Formulate specific patient centered care plans that may include pain management; integration of psychiatric, social, and other support services; and discharge planning.
Describe different methods of delivering patient education and effectively apply this knowledge to the care of individual patients.
Utilize and/or develop methods and materials to fully inform patients and families.
Determine patient and family understanding of severity of illness, prognosis, and their role in determining the goals of care.
Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow‐up.
ATTITUDES
Hospitalists should be able to:
Recognize the potential for patient education to improve the quality of health care.
Encourage patients to ask questions, keep accurate medication lists and obtain test results.
Ensure that patients understand anticipated therapies, procedures and/or surgery.
Convey diagnosis, prognosis, treatment and support options available for patients and families in a clear, concise, compassionate, culturally sensitive and timely manner.
Provide or arrange for patient education materials and programs for patients with chronic diseases.
Advocate incorporation of patient wishes into care plans.
Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.
Lead, coordinate or participate in the development of team‐based approaches to patient education.
Lead, coordinate or participate in the development of effective quality measures sensitive to the effects of patient education.
The Institute of Medicine has defined patient centered care as one of the six aims for healthcare improvements in the 21st century. Patient centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in health care decisions and management.
KNOWLEDGE
Hospitalists should be able to:
Describe the guiding principles for patient education.
Explain the factors that impact the success or failure of behavior change strategies.
Identify institutional resources for patient education materials and programs.
Summarize the evidence for the primacy of patient education as a means to improve the quality of health care.
Discuss the contextual factors that influence a patient's readiness to learn new information.
Describe the role of patient education in the management of chronic diseases, which may include diabetes, congestive heart failure, and asthma.
Explain how each patient's socio‐cultural background affects his or her health beliefs and behavior.
Identify barriers to implementation of patient education, including literacy levels and language fluency.
Determine the utility and appropriateness of patient education materials based on specific patient characteristics, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.
SKILLS
Hospitalists should be able to:
Identify and assist patients and families who require additional education about their medical illnesses.
Communicate effectively with patients from diverse backgrounds.
Formulate specific patient centered care plans that may include pain management; integration of psychiatric, social, and other support services; and discharge planning.
Describe different methods of delivering patient education and effectively apply this knowledge to the care of individual patients.
Utilize and/or develop methods and materials to fully inform patients and families.
Determine patient and family understanding of severity of illness, prognosis, and their role in determining the goals of care.
Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow‐up.
ATTITUDES
Hospitalists should be able to:
Recognize the potential for patient education to improve the quality of health care.
Encourage patients to ask questions, keep accurate medication lists and obtain test results.
Ensure that patients understand anticipated therapies, procedures and/or surgery.
Convey diagnosis, prognosis, treatment and support options available for patients and families in a clear, concise, compassionate, culturally sensitive and timely manner.
Provide or arrange for patient education materials and programs for patients with chronic diseases.
Advocate incorporation of patient wishes into care plans.
Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.
Lead, coordinate or participate in the development of team‐based approaches to patient education.
Lead, coordinate or participate in the development of effective quality measures sensitive to the effects of patient education.
The Institute of Medicine has defined patient centered care as one of the six aims for healthcare improvements in the 21st century. Patient centered care requires that physicians and members of multidisciplinary teams effectively inform, educate, reassure and empower patients and families to participate in the creation and implementation of a care plan. Patient safety initiatives focus on the role of patient education in improving the quality of care from the perspective of both patients and clinicians. Hospitalists can develop and promote strategies to improve patient education initiatives and foster greater patient and family involvement in health care decisions and management.
KNOWLEDGE
Hospitalists should be able to:
Describe the guiding principles for patient education.
Explain the factors that impact the success or failure of behavior change strategies.
Identify institutional resources for patient education materials and programs.
Summarize the evidence for the primacy of patient education as a means to improve the quality of health care.
Discuss the contextual factors that influence a patient's readiness to learn new information.
Describe the role of patient education in the management of chronic diseases, which may include diabetes, congestive heart failure, and asthma.
Explain how each patient's socio‐cultural background affects his or her health beliefs and behavior.
Identify barriers to implementation of patient education, including literacy levels and language fluency.
Determine the utility and appropriateness of patient education materials based on specific patient characteristics, which may include culture, literacy, cognitive ability, age, native language, and visual or other sensory impairments.
SKILLS
Hospitalists should be able to:
Identify and assist patients and families who require additional education about their medical illnesses.
Communicate effectively with patients from diverse backgrounds.
Formulate specific patient centered care plans that may include pain management; integration of psychiatric, social, and other support services; and discharge planning.
Describe different methods of delivering patient education and effectively apply this knowledge to the care of individual patients.
Utilize and/or develop methods and materials to fully inform patients and families.
Determine patient and family understanding of severity of illness, prognosis, and their role in determining the goals of care.
Provide patients with safety tips at the time of transfer of care, which may include instructions about medications, tests, procedures, alert symptoms to initiate a physician call, and follow‐up.
ATTITUDES
Hospitalists should be able to:
Recognize the potential for patient education to improve the quality of health care.
Encourage patients to ask questions, keep accurate medication lists and obtain test results.
Ensure that patients understand anticipated therapies, procedures and/or surgery.
Convey diagnosis, prognosis, treatment and support options available for patients and families in a clear, concise, compassionate, culturally sensitive and timely manner.
Provide or arrange for patient education materials and programs for patients with chronic diseases.
Advocate incorporation of patient wishes into care plans.
Appreciate patient education as a tool to improve the experience of clinical care for both patients and families.
Lead, coordinate or participate in the development of team‐based approaches to patient education.
Lead, coordinate or participate in the development of effective quality measures sensitive to the effects of patient education.
Copyright © 2006 Society of Hospital Medicine
Gastrointestinal bleed
Gastrointestinal (GI) bleed refers to any bleeding that originates in the GI tract. Bleeding is generally defined as upper (between the mouth and ligament of Treitz) or lower (from the ligament of Treitz to the anus). Healthcare Cost and Utilization Project (HCUP) 2002 data for the Diagnosis Related Group (DRG) for GI bleed with complications or co‐morbidities reveals approximately 409,000 discharges with an in‐hospital mortality of 3.0%. The mean length‐of‐stay for these patients was 4.4 days, with mean charges of $15,000. Hospitalists provide immediate care for these patients, who often require coordination of care across multiple specialties. Hospitalists lead quality improvement initiatives that optimize the efficiency and quality of care for these patients.
KNOWLEDGE
Hospitalists should be able to:
Explain the multiple potential etiologies or pathophysiologic processes that lead to GI bleeds.
Describe and differentiate the clinical features and presentations of upper and lower GI bleeds.
Explain the differential diagnosis for the most common causes of upper and lower GI bleeds.
Describe the indicated tests required to evaluate GI bleeds.
Explain the risk factors for upper and lower GI bleeds, and clinical indicators of patients at high risk for complications.
Explain the factors that may require early aggressive interventions or increase patient risk for recurrent bleeds.
Risk stratify patients with GI bleeds and determine the level of care required.
Describe the indications for transfusion therapy in GI bleeds, and explain the various methods of treatment for coagulopathy.
Compare the advantages and disadvantages of medical, endoscopic, and surgical treatments for patients with upper and lower GI bleeds.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat GI bleeds.
Explain patient characteristics that on admission portend poor prognosis.
Identify clinical, laboratory and imaging studies that indicate severity of disease.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history, including a directed medication, family and social history.
Perform a physical examination and identify clinical indicators of upper and lower GI bleeds, and evidence of underlying states, which may include liver disease.
Recognize physical findings that indicate clinical instability due to acute blood loss, including digital rectal examination, and interpretation of orthostatic blood pressure and pulse measurements.
Insert a nasogastric tube, perform a gastric lavage, and interpret the results.
Order and interpret results of appropriate laboratory, imaging, and endoscopic testing.
Synthesize results of physical examination, laboratory and imaging studies to determine the best management and care plan for the patient.
Formulate an evidence based treatment plan including nutritional recommendations, pharmacologic agents and dosing, and coordination of endoscopic and surgical interventions tailored to the individual patient.
Determine frequency for laboratory monitoring and transfusion during hospitalization.
Assure adequate intravenous access to allow rapid volume and blood product resuscitation.
Perform rapid hemodynamic resuscitation.
Recognize and treat signs of clinical decompensation and recurrent bleeding.
Assess patients with suspected GI bleeds in a timely manner, and manage or co‐manage the patient with the primary requesting service.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the disease etiology, prognosis, risk reduction strategies, and symptoms of recurrent GI bleed.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain risks, benefits, and alternatives to transfusion therapy.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize the indications for early specialty consultation, which may include interventional radiology, gastroenterology and surgery.
Initiate prevention measures including avoidance of NSAIDs, stress ulcer prophylaxis in critically ill patients, dietary modification, and evidence based medical therapies.
Employ a multidisciplinary approach, which may include nursing, pharmacy and nutrition services, and specialty and referring physicians, to the care of patients with GI bleeds.
Employ a multidisciplinary approach to the care of patients with GI bleed that begins at admission and continues through all care transitions.
Establish and maintain an open dialogue with patients and families regarding care goals and limitations, including palliative care and end‐of‐life wishes.
Address resuscitation status early during hospital stay; discuss and implement end‐of‐life decisions by patient or family when indicated or desired.
Inform receiving physician of pending study results.
Employ multidisciplinary teams to facilitate discharge planning and communicate to outpatient providers the notable events of the hospitalization and anticipated post‐discharge needs.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in the development and promotion of guidelines and/or pathways that facilitate efficient and timely evaluation and treatment of patients with GI bleeds.
Lead, coordinate or participate in multidisciplinary teams, which may include emergency medicine physicians, gastroenterologists and nurses, to develop quality improvement initiatives that promote early identification of GI bleeds and reduce preventable complications.
Develop systems that provide timely reports of pending study results to outpatient providers.
Integrate outcomes research, institution‐specific laboratory policies, and hospital formulary to create indicated and cost‐effective diagnostic and management strategies for patients with GI bleeds.
Gastrointestinal (GI) bleed refers to any bleeding that originates in the GI tract. Bleeding is generally defined as upper (between the mouth and ligament of Treitz) or lower (from the ligament of Treitz to the anus). Healthcare Cost and Utilization Project (HCUP) 2002 data for the Diagnosis Related Group (DRG) for GI bleed with complications or co‐morbidities reveals approximately 409,000 discharges with an in‐hospital mortality of 3.0%. The mean length‐of‐stay for these patients was 4.4 days, with mean charges of $15,000. Hospitalists provide immediate care for these patients, who often require coordination of care across multiple specialties. Hospitalists lead quality improvement initiatives that optimize the efficiency and quality of care for these patients.
KNOWLEDGE
Hospitalists should be able to:
Explain the multiple potential etiologies or pathophysiologic processes that lead to GI bleeds.
Describe and differentiate the clinical features and presentations of upper and lower GI bleeds.
Explain the differential diagnosis for the most common causes of upper and lower GI bleeds.
Describe the indicated tests required to evaluate GI bleeds.
Explain the risk factors for upper and lower GI bleeds, and clinical indicators of patients at high risk for complications.
Explain the factors that may require early aggressive interventions or increase patient risk for recurrent bleeds.
Risk stratify patients with GI bleeds and determine the level of care required.
Describe the indications for transfusion therapy in GI bleeds, and explain the various methods of treatment for coagulopathy.
Compare the advantages and disadvantages of medical, endoscopic, and surgical treatments for patients with upper and lower GI bleeds.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat GI bleeds.
Explain patient characteristics that on admission portend poor prognosis.
Identify clinical, laboratory and imaging studies that indicate severity of disease.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history, including a directed medication, family and social history.
Perform a physical examination and identify clinical indicators of upper and lower GI bleeds, and evidence of underlying states, which may include liver disease.
Recognize physical findings that indicate clinical instability due to acute blood loss, including digital rectal examination, and interpretation of orthostatic blood pressure and pulse measurements.
Insert a nasogastric tube, perform a gastric lavage, and interpret the results.
Order and interpret results of appropriate laboratory, imaging, and endoscopic testing.
Synthesize results of physical examination, laboratory and imaging studies to determine the best management and care plan for the patient.
Formulate an evidence based treatment plan including nutritional recommendations, pharmacologic agents and dosing, and coordination of endoscopic and surgical interventions tailored to the individual patient.
Determine frequency for laboratory monitoring and transfusion during hospitalization.
Assure adequate intravenous access to allow rapid volume and blood product resuscitation.
Perform rapid hemodynamic resuscitation.
Recognize and treat signs of clinical decompensation and recurrent bleeding.
Assess patients with suspected GI bleeds in a timely manner, and manage or co‐manage the patient with the primary requesting service.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the disease etiology, prognosis, risk reduction strategies, and symptoms of recurrent GI bleed.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain risks, benefits, and alternatives to transfusion therapy.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize the indications for early specialty consultation, which may include interventional radiology, gastroenterology and surgery.
Initiate prevention measures including avoidance of NSAIDs, stress ulcer prophylaxis in critically ill patients, dietary modification, and evidence based medical therapies.
Employ a multidisciplinary approach, which may include nursing, pharmacy and nutrition services, and specialty and referring physicians, to the care of patients with GI bleeds.
Employ a multidisciplinary approach to the care of patients with GI bleed that begins at admission and continues through all care transitions.
Establish and maintain an open dialogue with patients and families regarding care goals and limitations, including palliative care and end‐of‐life wishes.
Address resuscitation status early during hospital stay; discuss and implement end‐of‐life decisions by patient or family when indicated or desired.
Inform receiving physician of pending study results.
Employ multidisciplinary teams to facilitate discharge planning and communicate to outpatient providers the notable events of the hospitalization and anticipated post‐discharge needs.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in the development and promotion of guidelines and/or pathways that facilitate efficient and timely evaluation and treatment of patients with GI bleeds.
Lead, coordinate or participate in multidisciplinary teams, which may include emergency medicine physicians, gastroenterologists and nurses, to develop quality improvement initiatives that promote early identification of GI bleeds and reduce preventable complications.
Develop systems that provide timely reports of pending study results to outpatient providers.
Integrate outcomes research, institution‐specific laboratory policies, and hospital formulary to create indicated and cost‐effective diagnostic and management strategies for patients with GI bleeds.
Gastrointestinal (GI) bleed refers to any bleeding that originates in the GI tract. Bleeding is generally defined as upper (between the mouth and ligament of Treitz) or lower (from the ligament of Treitz to the anus). Healthcare Cost and Utilization Project (HCUP) 2002 data for the Diagnosis Related Group (DRG) for GI bleed with complications or co‐morbidities reveals approximately 409,000 discharges with an in‐hospital mortality of 3.0%. The mean length‐of‐stay for these patients was 4.4 days, with mean charges of $15,000. Hospitalists provide immediate care for these patients, who often require coordination of care across multiple specialties. Hospitalists lead quality improvement initiatives that optimize the efficiency and quality of care for these patients.
KNOWLEDGE
Hospitalists should be able to:
Explain the multiple potential etiologies or pathophysiologic processes that lead to GI bleeds.
Describe and differentiate the clinical features and presentations of upper and lower GI bleeds.
Explain the differential diagnosis for the most common causes of upper and lower GI bleeds.
Describe the indicated tests required to evaluate GI bleeds.
Explain the risk factors for upper and lower GI bleeds, and clinical indicators of patients at high risk for complications.
Explain the factors that may require early aggressive interventions or increase patient risk for recurrent bleeds.
Risk stratify patients with GI bleeds and determine the level of care required.
Describe the indications for transfusion therapy in GI bleeds, and explain the various methods of treatment for coagulopathy.
Compare the advantages and disadvantages of medical, endoscopic, and surgical treatments for patients with upper and lower GI bleeds.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat GI bleeds.
Explain patient characteristics that on admission portend poor prognosis.
Identify clinical, laboratory and imaging studies that indicate severity of disease.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history, including a directed medication, family and social history.
Perform a physical examination and identify clinical indicators of upper and lower GI bleeds, and evidence of underlying states, which may include liver disease.
Recognize physical findings that indicate clinical instability due to acute blood loss, including digital rectal examination, and interpretation of orthostatic blood pressure and pulse measurements.
Insert a nasogastric tube, perform a gastric lavage, and interpret the results.
Order and interpret results of appropriate laboratory, imaging, and endoscopic testing.
Synthesize results of physical examination, laboratory and imaging studies to determine the best management and care plan for the patient.
Formulate an evidence based treatment plan including nutritional recommendations, pharmacologic agents and dosing, and coordination of endoscopic and surgical interventions tailored to the individual patient.
Determine frequency for laboratory monitoring and transfusion during hospitalization.
Assure adequate intravenous access to allow rapid volume and blood product resuscitation.
Perform rapid hemodynamic resuscitation.
Recognize and treat signs of clinical decompensation and recurrent bleeding.
Assess patients with suspected GI bleeds in a timely manner, and manage or co‐manage the patient with the primary requesting service.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the disease etiology, prognosis, risk reduction strategies, and symptoms of recurrent GI bleed.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain risks, benefits, and alternatives to transfusion therapy.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize the indications for early specialty consultation, which may include interventional radiology, gastroenterology and surgery.
Initiate prevention measures including avoidance of NSAIDs, stress ulcer prophylaxis in critically ill patients, dietary modification, and evidence based medical therapies.
Employ a multidisciplinary approach, which may include nursing, pharmacy and nutrition services, and specialty and referring physicians, to the care of patients with GI bleeds.
Employ a multidisciplinary approach to the care of patients with GI bleed that begins at admission and continues through all care transitions.
Establish and maintain an open dialogue with patients and families regarding care goals and limitations, including palliative care and end‐of‐life wishes.
Address resuscitation status early during hospital stay; discuss and implement end‐of‐life decisions by patient or family when indicated or desired.
Inform receiving physician of pending study results.
Employ multidisciplinary teams to facilitate discharge planning and communicate to outpatient providers the notable events of the hospitalization and anticipated post‐discharge needs.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in the development and promotion of guidelines and/or pathways that facilitate efficient and timely evaluation and treatment of patients with GI bleeds.
Lead, coordinate or participate in multidisciplinary teams, which may include emergency medicine physicians, gastroenterologists and nurses, to develop quality improvement initiatives that promote early identification of GI bleeds and reduce preventable complications.
Develop systems that provide timely reports of pending study results to outpatient providers.
Integrate outcomes research, institution‐specific laboratory policies, and hospital formulary to create indicated and cost‐effective diagnostic and management strategies for patients with GI bleeds.
Copyright © 2006 Society of Hospital Medicine
Nutrition and the hospitalized patient
Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, and overall increased morbidity and mortality. The prevalence of malnutrition has been reported in up to 50% of hospitalized patients. Early screening for nutritional risk allows for appropriate intervention in the hospital setting, as well as planning for appropriate home services and follow‐up for outpatient nutritional care. Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.
KNOWLEDGE
Hospitalists should be able to:
Describe methods of screening for malnutrition.
Identify when a nutrition evaluation by a registered dietitian is required.
Differentiate between basic modified diets and explain the indications for each (sodium, diabetic, renal, and different dietary consistencies).
Explain the indications and contraindications for enteral nutrition.
Describe the indications for parenteral nutrition.
Describe potential complications associated with enteral and parenteral nutrition.
Explain risk factors for the re‐feeding syndrome.
SKILLS
Hospitalists should be able to:
Use objective criteria to determine if a patient is malnourished.
Determine appropriate laboratory measures to ascertain presence of malnutrition.
Utilize individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, based on the patient's medical condition.
Choose an appropriate enteral nutrition formula when indicated.
Treat for electrolyte abnormalities associated with the re‐feeding syndrome.
Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.
ATTITUDES
Hospitalists should be able to:
Recognize the importance of adequate nutrition in hospitalized patients.
Recognize when a nutrition evaluation by a registered dietitian is required.
Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.
Collaborate with clinical nutrition staff to implement the nutrition care plan.
Utilize a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.
Recognize that specialized nutritional supplementation may be required in certain patient populations, which may include patients with extensive wounds or increased catabolic needs.
Implement routine nutrition screening to identify malnourished patients early in admission.
Lead, coordinate or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.
Coordinate follow‐up nutrition care as part of discharge plans for those patients requiring nutritional support.
Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, and overall increased morbidity and mortality. The prevalence of malnutrition has been reported in up to 50% of hospitalized patients. Early screening for nutritional risk allows for appropriate intervention in the hospital setting, as well as planning for appropriate home services and follow‐up for outpatient nutritional care. Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.
KNOWLEDGE
Hospitalists should be able to:
Describe methods of screening for malnutrition.
Identify when a nutrition evaluation by a registered dietitian is required.
Differentiate between basic modified diets and explain the indications for each (sodium, diabetic, renal, and different dietary consistencies).
Explain the indications and contraindications for enteral nutrition.
Describe the indications for parenteral nutrition.
Describe potential complications associated with enteral and parenteral nutrition.
Explain risk factors for the re‐feeding syndrome.
SKILLS
Hospitalists should be able to:
Use objective criteria to determine if a patient is malnourished.
Determine appropriate laboratory measures to ascertain presence of malnutrition.
Utilize individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, based on the patient's medical condition.
Choose an appropriate enteral nutrition formula when indicated.
Treat for electrolyte abnormalities associated with the re‐feeding syndrome.
Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.
ATTITUDES
Hospitalists should be able to:
Recognize the importance of adequate nutrition in hospitalized patients.
Recognize when a nutrition evaluation by a registered dietitian is required.
Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.
Collaborate with clinical nutrition staff to implement the nutrition care plan.
Utilize a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.
Recognize that specialized nutritional supplementation may be required in certain patient populations, which may include patients with extensive wounds or increased catabolic needs.
Implement routine nutrition screening to identify malnourished patients early in admission.
Lead, coordinate or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.
Coordinate follow‐up nutrition care as part of discharge plans for those patients requiring nutritional support.
Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, and overall increased morbidity and mortality. The prevalence of malnutrition has been reported in up to 50% of hospitalized patients. Early screening for nutritional risk allows for appropriate intervention in the hospital setting, as well as planning for appropriate home services and follow‐up for outpatient nutritional care. Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.
KNOWLEDGE
Hospitalists should be able to:
Describe methods of screening for malnutrition.
Identify when a nutrition evaluation by a registered dietitian is required.
Differentiate between basic modified diets and explain the indications for each (sodium, diabetic, renal, and different dietary consistencies).
Explain the indications and contraindications for enteral nutrition.
Describe the indications for parenteral nutrition.
Describe potential complications associated with enteral and parenteral nutrition.
Explain risk factors for the re‐feeding syndrome.
SKILLS
Hospitalists should be able to:
Use objective criteria to determine if a patient is malnourished.
Determine appropriate laboratory measures to ascertain presence of malnutrition.
Utilize individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, based on the patient's medical condition.
Choose an appropriate enteral nutrition formula when indicated.
Treat for electrolyte abnormalities associated with the re‐feeding syndrome.
Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.
ATTITUDES
Hospitalists should be able to:
Recognize the importance of adequate nutrition in hospitalized patients.
Recognize when a nutrition evaluation by a registered dietitian is required.
Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.
Collaborate with clinical nutrition staff to implement the nutrition care plan.
Utilize a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.
Recognize that specialized nutritional supplementation may be required in certain patient populations, which may include patients with extensive wounds or increased catabolic needs.
Implement routine nutrition screening to identify malnourished patients early in admission.
Lead, coordinate or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.
Coordinate follow‐up nutrition care as part of discharge plans for those patients requiring nutritional support.
Copyright © 2006 Society of Hospital Medicine
Evidence based medicine
Evidence based medicine (EBM) uses a systematic approach to medical decision making and patient care, combining the highest‐available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, an EBM approach helps clinicians collaborate with patients to make the best possible decisions for their inpatient care. Hospitalists use study evidence to answer clinical questions and to develop quality improvement projects, including protocols and clinical pathways that can improve the efficiency, quality, and safety of care within their organizations. Hospitalists further provide leadership in educational efforts that foster a rigorous evidence based approach among medical trainees, hospital staff, and physician colleagues.
KNOWLEDGE
Hospitalists should be able to:
Describe the necessary steps required to ask and answer clinical questions using standardized EBM methods.
Describe the four core components of framing clinical questions using an EBM approach.
Identify peer‐reviewed databases and other resources to search for study evidence to answer clinical and systems questions.
Differentiate between filtered and non‐filtered resources, list examples of each, and describe the advantages and disadvantages of each.
Describe major study types including therapy, diagnosis, prognosis, harm, meta‐analysis (systematic review), economic analysis, and decision analysis.
Describe and differentiate the important strengths and weaknesses of the following study designs: randomized controlled trials, meta‐analyses, cohort studies, case‐control studies, case series, cost‐effectiveness studies, and clinical decision analysis studies.
Explain the core components and core statistical concepts used in therapy studies, including relative risk, Relative Risk Reduction (RRR), Absolute Risk Reduction (ARR), Number Needed to Treat (NNT) and diagnosis studies, which may include sensitivity, specificity, and likelihood ratio.
SKILLS
Hospitalists should be able to:
Formulate a well‐designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.
Identify the most appropriate study design(s) for the specific clinical or systems based question at hand.
Search filtered and non‐filtered information resources efficiently to find answers to clinical questions.
Critically appraise the validity of individual study methodology and reporting.
Evaluate and interpret study results, including useful point estimates and precision analysis.
Apply relevant results of validated studies to individual patient care or systems improvement projects.
ATTITUDES
Hospitalists should be able to:
Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.
Appreciate that filtered resources allow greater efficiency than non‐filtered resources in searching for answers to clinical and systems questions and locating high‐quality evidence.
Reflect upon individual practice patterns to identify new questions.
Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.
Serve as a role model for evidence based point‐of‐care practice.
Influence and support other clinicians to develop and utilize EBM skills to improve clinical practice and systems or processes within practice.
Lead, coordinate or participate in systems interventions to improve the quality, efficiency and standardization of care based on EBM review of the literature.
Advocate for the institution to provide or facilitate access to high quality point‐of‐care EBM information resources.
Evidence based medicine (EBM) uses a systematic approach to medical decision making and patient care, combining the highest‐available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, an EBM approach helps clinicians collaborate with patients to make the best possible decisions for their inpatient care. Hospitalists use study evidence to answer clinical questions and to develop quality improvement projects, including protocols and clinical pathways that can improve the efficiency, quality, and safety of care within their organizations. Hospitalists further provide leadership in educational efforts that foster a rigorous evidence based approach among medical trainees, hospital staff, and physician colleagues.
KNOWLEDGE
Hospitalists should be able to:
Describe the necessary steps required to ask and answer clinical questions using standardized EBM methods.
Describe the four core components of framing clinical questions using an EBM approach.
Identify peer‐reviewed databases and other resources to search for study evidence to answer clinical and systems questions.
Differentiate between filtered and non‐filtered resources, list examples of each, and describe the advantages and disadvantages of each.
Describe major study types including therapy, diagnosis, prognosis, harm, meta‐analysis (systematic review), economic analysis, and decision analysis.
Describe and differentiate the important strengths and weaknesses of the following study designs: randomized controlled trials, meta‐analyses, cohort studies, case‐control studies, case series, cost‐effectiveness studies, and clinical decision analysis studies.
Explain the core components and core statistical concepts used in therapy studies, including relative risk, Relative Risk Reduction (RRR), Absolute Risk Reduction (ARR), Number Needed to Treat (NNT) and diagnosis studies, which may include sensitivity, specificity, and likelihood ratio.
SKILLS
Hospitalists should be able to:
Formulate a well‐designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.
Identify the most appropriate study design(s) for the specific clinical or systems based question at hand.
Search filtered and non‐filtered information resources efficiently to find answers to clinical questions.
Critically appraise the validity of individual study methodology and reporting.
Evaluate and interpret study results, including useful point estimates and precision analysis.
Apply relevant results of validated studies to individual patient care or systems improvement projects.
ATTITUDES
Hospitalists should be able to:
Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.
Appreciate that filtered resources allow greater efficiency than non‐filtered resources in searching for answers to clinical and systems questions and locating high‐quality evidence.
Reflect upon individual practice patterns to identify new questions.
Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.
Serve as a role model for evidence based point‐of‐care practice.
Influence and support other clinicians to develop and utilize EBM skills to improve clinical practice and systems or processes within practice.
Lead, coordinate or participate in systems interventions to improve the quality, efficiency and standardization of care based on EBM review of the literature.
Advocate for the institution to provide or facilitate access to high quality point‐of‐care EBM information resources.
Evidence based medicine (EBM) uses a systematic approach to medical decision making and patient care, combining the highest‐available level of scientific evidence with practitioner clinical judgment and patient values and preferences. For hospitalists facing multiple critical medical choices daily, an EBM approach helps clinicians collaborate with patients to make the best possible decisions for their inpatient care. Hospitalists use study evidence to answer clinical questions and to develop quality improvement projects, including protocols and clinical pathways that can improve the efficiency, quality, and safety of care within their organizations. Hospitalists further provide leadership in educational efforts that foster a rigorous evidence based approach among medical trainees, hospital staff, and physician colleagues.
KNOWLEDGE
Hospitalists should be able to:
Describe the necessary steps required to ask and answer clinical questions using standardized EBM methods.
Describe the four core components of framing clinical questions using an EBM approach.
Identify peer‐reviewed databases and other resources to search for study evidence to answer clinical and systems questions.
Differentiate between filtered and non‐filtered resources, list examples of each, and describe the advantages and disadvantages of each.
Describe major study types including therapy, diagnosis, prognosis, harm, meta‐analysis (systematic review), economic analysis, and decision analysis.
Describe and differentiate the important strengths and weaknesses of the following study designs: randomized controlled trials, meta‐analyses, cohort studies, case‐control studies, case series, cost‐effectiveness studies, and clinical decision analysis studies.
Explain the core components and core statistical concepts used in therapy studies, including relative risk, Relative Risk Reduction (RRR), Absolute Risk Reduction (ARR), Number Needed to Treat (NNT) and diagnosis studies, which may include sensitivity, specificity, and likelihood ratio.
SKILLS
Hospitalists should be able to:
Formulate a well‐designed clinical question using the Patient Intervention Comparison Outcome (PICO) approach.
Identify the most appropriate study design(s) for the specific clinical or systems based question at hand.
Search filtered and non‐filtered information resources efficiently to find answers to clinical questions.
Critically appraise the validity of individual study methodology and reporting.
Evaluate and interpret study results, including useful point estimates and precision analysis.
Apply relevant results of validated studies to individual patient care or systems improvement projects.
ATTITUDES
Hospitalists should be able to:
Seek the best available evidence to support clinical decisions and process improvements at the individual and institutional level.
Appreciate that filtered resources allow greater efficiency than non‐filtered resources in searching for answers to clinical and systems questions and locating high‐quality evidence.
Reflect upon individual practice patterns to identify new questions.
Develop a process for the ongoing incorporation of new information into existing clinical practice and system improvement projects.
Serve as a role model for evidence based point‐of‐care practice.
Influence and support other clinicians to develop and utilize EBM skills to improve clinical practice and systems or processes within practice.
Lead, coordinate or participate in systems interventions to improve the quality, efficiency and standardization of care based on EBM review of the literature.
Advocate for the institution to provide or facilitate access to high quality point‐of‐care EBM information resources.
Copyright © 2006 Society of Hospital Medicine
Organizations cited in text
ABIM American Board of Internal Medicine (
ABP American Board of Pediatrics (
ACC American College of Cardiology (
ACGME Accreditation Council for Graduate Medical Education (
ACLS Advanced Cardiac Life Support (
ADA American Diabetes Association (
AHA American Heart Association (
AHRQ Agency for Healthcare Research and Quality (
ATS American Thoracic Society (
BLS Basic Life Support (
CDCP Centers for Disease Control and Prevention (
EMTALA Emergency Medical Treatment and Active Labor Act (
FDA Food and Drug Administration (
HCUP Healthcare Cost and Utilization Project (
HIPAA Health Insurance Portability and Accountability Act (
IASP International Association for the Study of Pain (
IDSA Infectious Diseases Society of America (
IOM Institute of Medicine (
JCAHO Joint Commission on Accreditation of Healthcare Organizations (
NPSF National Patient Safety Foundation (
NIS Nationwide Inpatient Sample (
SHM Society of Hospital Medicine (
WHO World Health Organization (
ABIM American Board of Internal Medicine (
ABP American Board of Pediatrics (
ACC American College of Cardiology (
ACGME Accreditation Council for Graduate Medical Education (
ACLS Advanced Cardiac Life Support (
ADA American Diabetes Association (
AHA American Heart Association (
AHRQ Agency for Healthcare Research and Quality (
ATS American Thoracic Society (
BLS Basic Life Support (
CDCP Centers for Disease Control and Prevention (
EMTALA Emergency Medical Treatment and Active Labor Act (
FDA Food and Drug Administration (
HCUP Healthcare Cost and Utilization Project (
HIPAA Health Insurance Portability and Accountability Act (
IASP International Association for the Study of Pain (
IDSA Infectious Diseases Society of America (
IOM Institute of Medicine (
JCAHO Joint Commission on Accreditation of Healthcare Organizations (
NPSF National Patient Safety Foundation (
NIS Nationwide Inpatient Sample (
SHM Society of Hospital Medicine (
WHO World Health Organization (
ABIM American Board of Internal Medicine (
ABP American Board of Pediatrics (
ACC American College of Cardiology (
ACGME Accreditation Council for Graduate Medical Education (
ACLS Advanced Cardiac Life Support (
ADA American Diabetes Association (
AHA American Heart Association (
AHRQ Agency for Healthcare Research and Quality (
ATS American Thoracic Society (
BLS Basic Life Support (
CDCP Centers for Disease Control and Prevention (
EMTALA Emergency Medical Treatment and Active Labor Act (
FDA Food and Drug Administration (
HCUP Healthcare Cost and Utilization Project (
HIPAA Health Insurance Portability and Accountability Act (
IASP International Association for the Study of Pain (
IDSA Infectious Diseases Society of America (
IOM Institute of Medicine (
JCAHO Joint Commission on Accreditation of Healthcare Organizations (
NPSF National Patient Safety Foundation (
NIS Nationwide Inpatient Sample (
SHM Society of Hospital Medicine (
WHO World Health Organization (
Copyright © 2006 Society of Hospital Medicine
Arthrocentesis
Arthrocentesis, the aspiration of synovial fluid from a joint, is frequently performed in the diagnosis and management of joint effusions. These effusions are associated with infectious, traumatic, and rheumatologic conditions. The Healthcare Cost and Utilization Project (HCUP) reports that arthrocentesis was performed in 32,961 hospitalized patients in 2002. Hospitalists may identify a joint effusion during the history and physical examination, and should use clinical expertise and evidence based decision making to determine whether arthrocentesis is required in the diagnosis and management of the patient's illness.
KNOWLEDGE
Hospitalists should be able to:
Identify and locate anatomic landmarks to guide proper entry points for arthrocentesis.
Define and differentiate the disease processes that may lead to the development of joint effusion.
Explain the indications and contraindications for arthrocentesis, including potential risks and complications.
Explain the appropriate diagnostic testing for synovial fluid.
Describe indications for use of ultrasonography to guide arthrocentesis.
Select the necessary equipment to perform an arthrocentesis at the bedside.
SKILLS
Hospitalists should be able to:
Distinguish between the clinical features of a joint effusion and soft tissue swelling surrounding a joint.
Demonstrate the optimal position for the patient and the patient's joint during an arthrocentesis.
Select and use the correct equipment for a given joint.
Use sterile techniques during preparation for and performance of arthrocentesis.
Maintain clinician safety with appropriate protective wear.
Manage the complications of arthrocentesis.
Order radiographic studies and interpret findings.
Order and interpret results of synovial fluid cell count, differential, crystal morphology, gram stain and culture.
Order and interpret platelet and coagulation studies when indicated.
Develop management plan based on results of fluid testing.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, recovery period, and potential and expected outcomes; and to obtain informed consent.
Discuss with patients and families pain management strategies for discomfort during and after arthrocentesis.
Relieve pain with splinting and analgesia targeted to the joint inflammation.
Employ multidisciplinary teams, including physical and occupational therapy when appropriate, to assist with inpatient and outpatient rehabilitation.
Recognize indications for specialty consultation, which may include rheumatology, orthopaedics or infectious disease.
Consider early consultation in the management of effusion in a prosthetic joint.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of arthrocentesis.
Lead, coordinate or participate in efforts to organize and consolidate arthrocentesis equipment in an identifiable location in the hospital, easily assessable to clinicians who perform the procedure.
Arthrocentesis, the aspiration of synovial fluid from a joint, is frequently performed in the diagnosis and management of joint effusions. These effusions are associated with infectious, traumatic, and rheumatologic conditions. The Healthcare Cost and Utilization Project (HCUP) reports that arthrocentesis was performed in 32,961 hospitalized patients in 2002. Hospitalists may identify a joint effusion during the history and physical examination, and should use clinical expertise and evidence based decision making to determine whether arthrocentesis is required in the diagnosis and management of the patient's illness.
KNOWLEDGE
Hospitalists should be able to:
Identify and locate anatomic landmarks to guide proper entry points for arthrocentesis.
Define and differentiate the disease processes that may lead to the development of joint effusion.
Explain the indications and contraindications for arthrocentesis, including potential risks and complications.
Explain the appropriate diagnostic testing for synovial fluid.
Describe indications for use of ultrasonography to guide arthrocentesis.
Select the necessary equipment to perform an arthrocentesis at the bedside.
SKILLS
Hospitalists should be able to:
Distinguish between the clinical features of a joint effusion and soft tissue swelling surrounding a joint.
Demonstrate the optimal position for the patient and the patient's joint during an arthrocentesis.
Select and use the correct equipment for a given joint.
Use sterile techniques during preparation for and performance of arthrocentesis.
Maintain clinician safety with appropriate protective wear.
Manage the complications of arthrocentesis.
Order radiographic studies and interpret findings.
Order and interpret results of synovial fluid cell count, differential, crystal morphology, gram stain and culture.
Order and interpret platelet and coagulation studies when indicated.
Develop management plan based on results of fluid testing.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, recovery period, and potential and expected outcomes; and to obtain informed consent.
Discuss with patients and families pain management strategies for discomfort during and after arthrocentesis.
Relieve pain with splinting and analgesia targeted to the joint inflammation.
Employ multidisciplinary teams, including physical and occupational therapy when appropriate, to assist with inpatient and outpatient rehabilitation.
Recognize indications for specialty consultation, which may include rheumatology, orthopaedics or infectious disease.
Consider early consultation in the management of effusion in a prosthetic joint.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of arthrocentesis.
Lead, coordinate or participate in efforts to organize and consolidate arthrocentesis equipment in an identifiable location in the hospital, easily assessable to clinicians who perform the procedure.
Arthrocentesis, the aspiration of synovial fluid from a joint, is frequently performed in the diagnosis and management of joint effusions. These effusions are associated with infectious, traumatic, and rheumatologic conditions. The Healthcare Cost and Utilization Project (HCUP) reports that arthrocentesis was performed in 32,961 hospitalized patients in 2002. Hospitalists may identify a joint effusion during the history and physical examination, and should use clinical expertise and evidence based decision making to determine whether arthrocentesis is required in the diagnosis and management of the patient's illness.
KNOWLEDGE
Hospitalists should be able to:
Identify and locate anatomic landmarks to guide proper entry points for arthrocentesis.
Define and differentiate the disease processes that may lead to the development of joint effusion.
Explain the indications and contraindications for arthrocentesis, including potential risks and complications.
Explain the appropriate diagnostic testing for synovial fluid.
Describe indications for use of ultrasonography to guide arthrocentesis.
Select the necessary equipment to perform an arthrocentesis at the bedside.
SKILLS
Hospitalists should be able to:
Distinguish between the clinical features of a joint effusion and soft tissue swelling surrounding a joint.
Demonstrate the optimal position for the patient and the patient's joint during an arthrocentesis.
Select and use the correct equipment for a given joint.
Use sterile techniques during preparation for and performance of arthrocentesis.
Maintain clinician safety with appropriate protective wear.
Manage the complications of arthrocentesis.
Order radiographic studies and interpret findings.
Order and interpret results of synovial fluid cell count, differential, crystal morphology, gram stain and culture.
Order and interpret platelet and coagulation studies when indicated.
Develop management plan based on results of fluid testing.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, recovery period, and potential and expected outcomes; and to obtain informed consent.
Discuss with patients and families pain management strategies for discomfort during and after arthrocentesis.
Relieve pain with splinting and analgesia targeted to the joint inflammation.
Employ multidisciplinary teams, including physical and occupational therapy when appropriate, to assist with inpatient and outpatient rehabilitation.
Recognize indications for specialty consultation, which may include rheumatology, orthopaedics or infectious disease.
Consider early consultation in the management of effusion in a prosthetic joint.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of arthrocentesis.
Lead, coordinate or participate in efforts to organize and consolidate arthrocentesis equipment in an identifiable location in the hospital, easily assessable to clinicians who perform the procedure.
Copyright © 2006 Society of Hospital Medicine
Electrocardiogram interpretation
Heart disease continues to be the leading cause of hospital admissions and mortality in the United States, accounting for an estimated 13% of admissions in 2001, and 21% of in‐hospital deaths in 2000. The electrocardiogram (EKG), a graphical representation of cardiac electrical potentials, is a noninvasive, readily available diagnostic tool. It remains the most commonly used investigative modality for the initial evaluation of cardiovascular disease. Hospitalists interpret these results expediently and apply the results to estimate risk, diagnose disease, and determine therapeutic needs in the hospitalized patient.
KNOWLEDGE
Hospitalists should be able to:
Explain the anatomy and physiology of normal and pathologic cardiac tissues, including spatial relationships, vascular supply, automaticity, conduction, and autonomic innervations and how these affect EKG interpretation.
Compare the diagnostic utility of rhythm strips and telemetry monitors to 12‐lead EKG.
Explain indications for ordering an EKG, including right‐sided EKG.
Describe the implications of the acquisition, amplification, display, and standardization of electrocardiographic waveforms in different leads.
Describe the relevant components of the EKG tracing.
Explain the effect of cardiovascular, metabolic, toxic, and systemic disease processes on cardiac electrical potentials of the EKG.
Explain the limitations of various EKG findings, including computerized interpretations.
SKILLS
Hospitalists should be able to:
Demonstrate correct lead placement.
Accurately measure and interpret the atrial and ventricular rates, voltages and intervals of EKG tracings.
Recognize normal EKG findings, including variations associated with demographics, artifact, lead placement, and other technical problems.
Recognize and categorize abnormal EKG findings, including abnormalities of conduction, automaticity, anatomy, and manifestations of non‐cardiac disease.
Identify paced rhythms and describe the limitations of related EKG interpretations.
Synthesize EKG data with other clinical information to risk stratify patients and develop a clinical plan.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain results of the EKG and how the findings impact the care plan.
Personally and promptly interpret EKGs and compare them to previously recorded EKGs, when available.
Review each EKG with a standard and consistent approach.
Consult and collaborate with cardiologists in interpreting complex EKGs, and in ordering further diagnostic studies or procedures based on EKG interpretation.
Determine the need for specialist intervention based on the urgency and patient risk.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve quality and efficiency within their organizations, Hospitalists should:
Lead, coordinate or participate in efforts to expedite acquisition and interpretation of EKGs for hospitalized patients.
Heart disease continues to be the leading cause of hospital admissions and mortality in the United States, accounting for an estimated 13% of admissions in 2001, and 21% of in‐hospital deaths in 2000. The electrocardiogram (EKG), a graphical representation of cardiac electrical potentials, is a noninvasive, readily available diagnostic tool. It remains the most commonly used investigative modality for the initial evaluation of cardiovascular disease. Hospitalists interpret these results expediently and apply the results to estimate risk, diagnose disease, and determine therapeutic needs in the hospitalized patient.
KNOWLEDGE
Hospitalists should be able to:
Explain the anatomy and physiology of normal and pathologic cardiac tissues, including spatial relationships, vascular supply, automaticity, conduction, and autonomic innervations and how these affect EKG interpretation.
Compare the diagnostic utility of rhythm strips and telemetry monitors to 12‐lead EKG.
Explain indications for ordering an EKG, including right‐sided EKG.
Describe the implications of the acquisition, amplification, display, and standardization of electrocardiographic waveforms in different leads.
Describe the relevant components of the EKG tracing.
Explain the effect of cardiovascular, metabolic, toxic, and systemic disease processes on cardiac electrical potentials of the EKG.
Explain the limitations of various EKG findings, including computerized interpretations.
SKILLS
Hospitalists should be able to:
Demonstrate correct lead placement.
Accurately measure and interpret the atrial and ventricular rates, voltages and intervals of EKG tracings.
Recognize normal EKG findings, including variations associated with demographics, artifact, lead placement, and other technical problems.
Recognize and categorize abnormal EKG findings, including abnormalities of conduction, automaticity, anatomy, and manifestations of non‐cardiac disease.
Identify paced rhythms and describe the limitations of related EKG interpretations.
Synthesize EKG data with other clinical information to risk stratify patients and develop a clinical plan.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain results of the EKG and how the findings impact the care plan.
Personally and promptly interpret EKGs and compare them to previously recorded EKGs, when available.
Review each EKG with a standard and consistent approach.
Consult and collaborate with cardiologists in interpreting complex EKGs, and in ordering further diagnostic studies or procedures based on EKG interpretation.
Determine the need for specialist intervention based on the urgency and patient risk.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve quality and efficiency within their organizations, Hospitalists should:
Lead, coordinate or participate in efforts to expedite acquisition and interpretation of EKGs for hospitalized patients.
Heart disease continues to be the leading cause of hospital admissions and mortality in the United States, accounting for an estimated 13% of admissions in 2001, and 21% of in‐hospital deaths in 2000. The electrocardiogram (EKG), a graphical representation of cardiac electrical potentials, is a noninvasive, readily available diagnostic tool. It remains the most commonly used investigative modality for the initial evaluation of cardiovascular disease. Hospitalists interpret these results expediently and apply the results to estimate risk, diagnose disease, and determine therapeutic needs in the hospitalized patient.
KNOWLEDGE
Hospitalists should be able to:
Explain the anatomy and physiology of normal and pathologic cardiac tissues, including spatial relationships, vascular supply, automaticity, conduction, and autonomic innervations and how these affect EKG interpretation.
Compare the diagnostic utility of rhythm strips and telemetry monitors to 12‐lead EKG.
Explain indications for ordering an EKG, including right‐sided EKG.
Describe the implications of the acquisition, amplification, display, and standardization of electrocardiographic waveforms in different leads.
Describe the relevant components of the EKG tracing.
Explain the effect of cardiovascular, metabolic, toxic, and systemic disease processes on cardiac electrical potentials of the EKG.
Explain the limitations of various EKG findings, including computerized interpretations.
SKILLS
Hospitalists should be able to:
Demonstrate correct lead placement.
Accurately measure and interpret the atrial and ventricular rates, voltages and intervals of EKG tracings.
Recognize normal EKG findings, including variations associated with demographics, artifact, lead placement, and other technical problems.
Recognize and categorize abnormal EKG findings, including abnormalities of conduction, automaticity, anatomy, and manifestations of non‐cardiac disease.
Identify paced rhythms and describe the limitations of related EKG interpretations.
Synthesize EKG data with other clinical information to risk stratify patients and develop a clinical plan.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain results of the EKG and how the findings impact the care plan.
Personally and promptly interpret EKGs and compare them to previously recorded EKGs, when available.
Review each EKG with a standard and consistent approach.
Consult and collaborate with cardiologists in interpreting complex EKGs, and in ordering further diagnostic studies or procedures based on EKG interpretation.
Determine the need for specialist intervention based on the urgency and patient risk.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve quality and efficiency within their organizations, Hospitalists should:
Lead, coordinate or participate in efforts to expedite acquisition and interpretation of EKGs for hospitalized patients.
Copyright © 2006 Society of Hospital Medicine
Team approach and multidsciplinary care
Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.
KNOWLEDGE
Hospitalists should be able to:
Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.
List major barriers to effective team interactions.
Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.
List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.
SKILLS
Hospitalists should be able to:
Determine an effective team composition and designate individual group member functions.
Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.
Assess individual member's strengths and incorporate them effectively and productively into the team.
Assess group dynamics and facilitate optimal team functioning.
Integrate the assessments and recommendations of all contributing team members into the care plan.
Conduct effective multidisciplinary team rounds, which may include patients and their families.
Utilize team members' time effectively, maximizing efficiency and consistency.
Ensure the delivery of timely and accurate information.
Assess performance of team members, including self‐assessment, and identify opportunities for improvement.
ATTITUDES
Hospitalists should be able to:
Employ active listening techniques during interactions with team members and engage team participation.
Communicate frequently with all members of the multidisciplinary team.
Emphasize the importance of mutual respect among team members.
Act as a role model in professional conflict resolution and discussion of disagreements.
Share decision making responsibilities, within the appropriate scopes of practice, with care team members.
Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.
Facilitate opportunities for interactive education among team members and for team members to educate patients and families.
Coordinate seamless transitions of care by utilizing combined expertise of team members.
Establish a hospital wide, non‐punitive culture of error reporting and prevention.
Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.
KNOWLEDGE
Hospitalists should be able to:
Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.
List major barriers to effective team interactions.
Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.
List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.
SKILLS
Hospitalists should be able to:
Determine an effective team composition and designate individual group member functions.
Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.
Assess individual member's strengths and incorporate them effectively and productively into the team.
Assess group dynamics and facilitate optimal team functioning.
Integrate the assessments and recommendations of all contributing team members into the care plan.
Conduct effective multidisciplinary team rounds, which may include patients and their families.
Utilize team members' time effectively, maximizing efficiency and consistency.
Ensure the delivery of timely and accurate information.
Assess performance of team members, including self‐assessment, and identify opportunities for improvement.
ATTITUDES
Hospitalists should be able to:
Employ active listening techniques during interactions with team members and engage team participation.
Communicate frequently with all members of the multidisciplinary team.
Emphasize the importance of mutual respect among team members.
Act as a role model in professional conflict resolution and discussion of disagreements.
Share decision making responsibilities, within the appropriate scopes of practice, with care team members.
Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.
Facilitate opportunities for interactive education among team members and for team members to educate patients and families.
Coordinate seamless transitions of care by utilizing combined expertise of team members.
Establish a hospital wide, non‐punitive culture of error reporting and prevention.
Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.
KNOWLEDGE
Hospitalists should be able to:
Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.
List major barriers to effective team interactions.
Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.
List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.
SKILLS
Hospitalists should be able to:
Determine an effective team composition and designate individual group member functions.
Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.
Assess individual member's strengths and incorporate them effectively and productively into the team.
Assess group dynamics and facilitate optimal team functioning.
Integrate the assessments and recommendations of all contributing team members into the care plan.
Conduct effective multidisciplinary team rounds, which may include patients and their families.
Utilize team members' time effectively, maximizing efficiency and consistency.
Ensure the delivery of timely and accurate information.
Assess performance of team members, including self‐assessment, and identify opportunities for improvement.
ATTITUDES
Hospitalists should be able to:
Employ active listening techniques during interactions with team members and engage team participation.
Communicate frequently with all members of the multidisciplinary team.
Emphasize the importance of mutual respect among team members.
Act as a role model in professional conflict resolution and discussion of disagreements.
Share decision making responsibilities, within the appropriate scopes of practice, with care team members.
Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.
Facilitate opportunities for interactive education among team members and for team members to educate patients and families.
Coordinate seamless transitions of care by utilizing combined expertise of team members.
Establish a hospital wide, non‐punitive culture of error reporting and prevention.
Copyright © 2006 Society of Hospital Medicine
Management practices
Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third‐party payer contracts on hospital reimbursement.
Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.
Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.
Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the personnel file, its contents and usage.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Develop practice staffing arrangements and schedules.
Market the hospital medicine program.
Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.
Develop strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and non‐physician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third party payers.
Interpret hospital generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.
Recognize the importance of meeting or exceeding customer and colleague expectations.
Recognize the importance of best management practice.
Recognize the importance of marketing and public relations to foster sustainable practice growth.
Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third‐party payer contracts on hospital reimbursement.
Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.
Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.
Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the personnel file, its contents and usage.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Develop practice staffing arrangements and schedules.
Market the hospital medicine program.
Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.
Develop strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and non‐physician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third party payers.
Interpret hospital generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.
Recognize the importance of meeting or exceeding customer and colleague expectations.
Recognize the importance of best management practice.
Recognize the importance of marketing and public relations to foster sustainable practice growth.
Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third‐party payer contracts on hospital reimbursement.
Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.
Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.
Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the personnel file, its contents and usage.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Develop practice staffing arrangements and schedules.
Market the hospital medicine program.
Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.
Develop strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and non‐physician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third party payers.
Interpret hospital generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.
Recognize the importance of meeting or exceeding customer and colleague expectations.
Recognize the importance of best management practice.
Recognize the importance of marketing and public relations to foster sustainable practice growth.
Copyright © 2006 Society of Hospital Medicine
Professionalism and medical ethics
Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.
Describe the concept of double effect.
Define and differentiate competency and decision making capacity.
Explain the utility of power of attorney and advance directives in medical care.
List the key elements of informed consent.
Explain determination of decision making capacity and steps required for surrogate decision making.
Describe local laws and regulations relevant to the practice of hospital medicine.
Explain medical futility.
SKILLS
Hospitalists should be able to:
Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.
Communicate with patient and family members on a regular basis.
Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.
Evaluate patients for medical decision making capacity.
Obtain informed consent when indicated.
Review power of attorney and advanced directives with patients and family members.
Provide compassionate and relevant end of life care.
Apply ethical principles to inpatient care.
Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.
ATTITUDES
Hospitalists should be able to:
Commit to life‐long self learning, maintenance of skills, and clinical excellence.
Promote access to medical care for the community.
Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.
Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.
Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.
Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.
Appreciate that physicians are not required to provide care that is medically futile.
Demonstrate empathy for hospitalized patients.
Endorse that physicians have an obligation not to discriminate against any patient or group of patients.
Observe the boundaries of the physician‐patient relationship.
Promote cost effective care.
Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.
Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.
Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.
Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.
Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.
Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.
Describe the concept of double effect.
Define and differentiate competency and decision making capacity.
Explain the utility of power of attorney and advance directives in medical care.
List the key elements of informed consent.
Explain determination of decision making capacity and steps required for surrogate decision making.
Describe local laws and regulations relevant to the practice of hospital medicine.
Explain medical futility.
SKILLS
Hospitalists should be able to:
Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.
Communicate with patient and family members on a regular basis.
Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.
Evaluate patients for medical decision making capacity.
Obtain informed consent when indicated.
Review power of attorney and advanced directives with patients and family members.
Provide compassionate and relevant end of life care.
Apply ethical principles to inpatient care.
Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.
ATTITUDES
Hospitalists should be able to:
Commit to life‐long self learning, maintenance of skills, and clinical excellence.
Promote access to medical care for the community.
Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.
Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.
Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.
Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.
Appreciate that physicians are not required to provide care that is medically futile.
Demonstrate empathy for hospitalized patients.
Endorse that physicians have an obligation not to discriminate against any patient or group of patients.
Observe the boundaries of the physician‐patient relationship.
Promote cost effective care.
Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.
Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.
Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.
Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.
Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.
Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.
Describe the concept of double effect.
Define and differentiate competency and decision making capacity.
Explain the utility of power of attorney and advance directives in medical care.
List the key elements of informed consent.
Explain determination of decision making capacity and steps required for surrogate decision making.
Describe local laws and regulations relevant to the practice of hospital medicine.
Explain medical futility.
SKILLS
Hospitalists should be able to:
Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.
Communicate with patient and family members on a regular basis.
Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.
Evaluate patients for medical decision making capacity.
Obtain informed consent when indicated.
Review power of attorney and advanced directives with patients and family members.
Provide compassionate and relevant end of life care.
Apply ethical principles to inpatient care.
Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.
ATTITUDES
Hospitalists should be able to:
Commit to life‐long self learning, maintenance of skills, and clinical excellence.
Promote access to medical care for the community.
Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.
Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.
Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.
Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.
Appreciate that physicians are not required to provide care that is medically futile.
Demonstrate empathy for hospitalized patients.
Endorse that physicians have an obligation not to discriminate against any patient or group of patients.
Observe the boundaries of the physician‐patient relationship.
Promote cost effective care.
Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.
Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.
Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.
Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.
Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.
Copyright © 2006 Society of Hospital Medicine