User login
Local Factors Play Major Role in Determining Compensation Rates for Pediatric Hospitalists
Although pediatricians make up less than 6% of the hospitalists surveyed by the Medical Group Management Association (MGMA), they represent a very different data profile from other specialties reported in SHM’s 2012 State of Hospital Medicine report.
The nonpediatric HM specialties (internal medicine, family medicine, and med/peds) have similar data profiles with regard to productivity and compensation statistics. They are all within 2% of the $233,855 “all adult hospitalists” median compensation. Although there is a bit more variability in the productivity data, all three groups are clustered within 10% of each other. The key to understanding their similarity is that they all serve mostly adult inpatients. While some of these physicians may also care for hospitalized children, I suspect this population is a small proportion of their daily workload.
Pediatric hospitalists only treat pediatric patients and differ significantly from adult hospitalists, as summarized in Table 1.
Pediatricians remain among the lowest-earning specialties nationally, whether in the office or on children’s wards. The key to understanding the differences between adult and pediatric hospitalists is that they derive their compensation and productivity expectations from two separate and distinct physician marketplaces. Adult hospitalists benefit from more than a decade of rapidly growing demand for their services, as well as higher compensation for their office-based counterparts. Meanwhile, the market for pediatric hospitalists remains smaller and more segmented, allowing local factors to drive compensation more than a national demand for their services would.
Pediatric hospitalists appear to earn about a quarter less than their adult counterparts while receiving a similarly lower amount of hospital financial support per provider. Pediatric hospitalists also appear to work less than adult hospitalists, reflected in fewer shifts annually and fewer hours per shift; 75% of adult hospitalist groups report shift lengths of 12 hours or more, compared with 48% of pediatric hospitalist groups. This may stem from the frequent lulls in census common to a community hospital pediatrics service, in contrast to more consistent demand posed by geriatric populations. Although pediatric hospitalists receive more compensation per encounter or wRVU, they cannot generate those encounters or work RVUs at the same clip as adult hospitalists. Pediatricians must hold a family meeting for every single patient, and even something as seemingly simple as obtaining intravenous access might consume 45 minutes of a hospitalist’s time.
Thus, pediatric hospitalists find themselves caught in the same market as other pediatric specialists. These providers remain undervalued compared to virtually all other physicians. Those who seek to improve their financial prospects likely need to work more shifts or generate more workload relative to the expectations of their pediatrician peers.
Personally, I can’t help but wonder what attention pediatric care might enjoy if kids had a vote, a pension, an entitlement program, and a lobby on K Street like their grandparents do.
Dr. Ahlstrom is clinical director of Hospitalists of Northern Michigan and a member of SHM’s Practice Analysis Committee.
Although pediatricians make up less than 6% of the hospitalists surveyed by the Medical Group Management Association (MGMA), they represent a very different data profile from other specialties reported in SHM’s 2012 State of Hospital Medicine report.
The nonpediatric HM specialties (internal medicine, family medicine, and med/peds) have similar data profiles with regard to productivity and compensation statistics. They are all within 2% of the $233,855 “all adult hospitalists” median compensation. Although there is a bit more variability in the productivity data, all three groups are clustered within 10% of each other. The key to understanding their similarity is that they all serve mostly adult inpatients. While some of these physicians may also care for hospitalized children, I suspect this population is a small proportion of their daily workload.
Pediatric hospitalists only treat pediatric patients and differ significantly from adult hospitalists, as summarized in Table 1.
Pediatricians remain among the lowest-earning specialties nationally, whether in the office or on children’s wards. The key to understanding the differences between adult and pediatric hospitalists is that they derive their compensation and productivity expectations from two separate and distinct physician marketplaces. Adult hospitalists benefit from more than a decade of rapidly growing demand for their services, as well as higher compensation for their office-based counterparts. Meanwhile, the market for pediatric hospitalists remains smaller and more segmented, allowing local factors to drive compensation more than a national demand for their services would.
Pediatric hospitalists appear to earn about a quarter less than their adult counterparts while receiving a similarly lower amount of hospital financial support per provider. Pediatric hospitalists also appear to work less than adult hospitalists, reflected in fewer shifts annually and fewer hours per shift; 75% of adult hospitalist groups report shift lengths of 12 hours or more, compared with 48% of pediatric hospitalist groups. This may stem from the frequent lulls in census common to a community hospital pediatrics service, in contrast to more consistent demand posed by geriatric populations. Although pediatric hospitalists receive more compensation per encounter or wRVU, they cannot generate those encounters or work RVUs at the same clip as adult hospitalists. Pediatricians must hold a family meeting for every single patient, and even something as seemingly simple as obtaining intravenous access might consume 45 minutes of a hospitalist’s time.
Thus, pediatric hospitalists find themselves caught in the same market as other pediatric specialists. These providers remain undervalued compared to virtually all other physicians. Those who seek to improve their financial prospects likely need to work more shifts or generate more workload relative to the expectations of their pediatrician peers.
Personally, I can’t help but wonder what attention pediatric care might enjoy if kids had a vote, a pension, an entitlement program, and a lobby on K Street like their grandparents do.
Dr. Ahlstrom is clinical director of Hospitalists of Northern Michigan and a member of SHM’s Practice Analysis Committee.
Although pediatricians make up less than 6% of the hospitalists surveyed by the Medical Group Management Association (MGMA), they represent a very different data profile from other specialties reported in SHM’s 2012 State of Hospital Medicine report.
The nonpediatric HM specialties (internal medicine, family medicine, and med/peds) have similar data profiles with regard to productivity and compensation statistics. They are all within 2% of the $233,855 “all adult hospitalists” median compensation. Although there is a bit more variability in the productivity data, all three groups are clustered within 10% of each other. The key to understanding their similarity is that they all serve mostly adult inpatients. While some of these physicians may also care for hospitalized children, I suspect this population is a small proportion of their daily workload.
Pediatric hospitalists only treat pediatric patients and differ significantly from adult hospitalists, as summarized in Table 1.
Pediatricians remain among the lowest-earning specialties nationally, whether in the office or on children’s wards. The key to understanding the differences between adult and pediatric hospitalists is that they derive their compensation and productivity expectations from two separate and distinct physician marketplaces. Adult hospitalists benefit from more than a decade of rapidly growing demand for their services, as well as higher compensation for their office-based counterparts. Meanwhile, the market for pediatric hospitalists remains smaller and more segmented, allowing local factors to drive compensation more than a national demand for their services would.
Pediatric hospitalists appear to earn about a quarter less than their adult counterparts while receiving a similarly lower amount of hospital financial support per provider. Pediatric hospitalists also appear to work less than adult hospitalists, reflected in fewer shifts annually and fewer hours per shift; 75% of adult hospitalist groups report shift lengths of 12 hours or more, compared with 48% of pediatric hospitalist groups. This may stem from the frequent lulls in census common to a community hospital pediatrics service, in contrast to more consistent demand posed by geriatric populations. Although pediatric hospitalists receive more compensation per encounter or wRVU, they cannot generate those encounters or work RVUs at the same clip as adult hospitalists. Pediatricians must hold a family meeting for every single patient, and even something as seemingly simple as obtaining intravenous access might consume 45 minutes of a hospitalist’s time.
Thus, pediatric hospitalists find themselves caught in the same market as other pediatric specialists. These providers remain undervalued compared to virtually all other physicians. Those who seek to improve their financial prospects likely need to work more shifts or generate more workload relative to the expectations of their pediatrician peers.
Personally, I can’t help but wonder what attention pediatric care might enjoy if kids had a vote, a pension, an entitlement program, and a lobby on K Street like their grandparents do.
Dr. Ahlstrom is clinical director of Hospitalists of Northern Michigan and a member of SHM’s Practice Analysis Committee.
Hospitalists to Unveil Patient Care Recommendations As Part of Choosing Wisely Campaign
This month, hospitalists will be a vital part of Choosing Wisely, an important public initiative from the American Board of Internal Medicine (ABIM) Foundation that identifies treatments and procedures that might be overused by caregivers.
On Feb. 21 in Washington, D.C., the ABIM Foundation, SHM, and more than a dozen other medical specialties will announce recommendations that, in the ABIM Foundation’s words, “represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation.” Hospitalists who helped SHM develop its recommendations will be in attendance to help field questions about SHM’s work with Choosing Wisely and its lists.
SHM has developed two lists of recommendations: one for adult HM and another for pediatric HM. SHM will make a special announcement Feb. 21 in The Hospitalist eWire with both lists and commentary for how hospitalists can have informed conversations with their patients about the lists. The Hospitalist will follow up with a feature story and other information about Choosing Wisely in its March issue.
As part of the campaign, the ABIM Foundation, SHM, and consumer magazine Consumer Reports have teamed up to develop material specifically designed to educate patients about the Choosing Wisely recommendations. Materials will be available on the ABIM Foundation and SHM websites.
SHM will continue the conversation about high-value care and working with patients to make wise decisions well beyond February and March. At HM13, SHM’s annual meeting in Washington, D.C., SHM will offer a pre-course on Choosing Wisely and its philosophy. The pre-course is May 16, the day before the official start of HM13.
For more information about Choosing Wisely, visit www.choosingwisely.org. To register for the Choosing Wisely pre-course at HM13, visit www.hospitalmedicine2013.org.
This month, hospitalists will be a vital part of Choosing Wisely, an important public initiative from the American Board of Internal Medicine (ABIM) Foundation that identifies treatments and procedures that might be overused by caregivers.
On Feb. 21 in Washington, D.C., the ABIM Foundation, SHM, and more than a dozen other medical specialties will announce recommendations that, in the ABIM Foundation’s words, “represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation.” Hospitalists who helped SHM develop its recommendations will be in attendance to help field questions about SHM’s work with Choosing Wisely and its lists.
SHM has developed two lists of recommendations: one for adult HM and another for pediatric HM. SHM will make a special announcement Feb. 21 in The Hospitalist eWire with both lists and commentary for how hospitalists can have informed conversations with their patients about the lists. The Hospitalist will follow up with a feature story and other information about Choosing Wisely in its March issue.
As part of the campaign, the ABIM Foundation, SHM, and consumer magazine Consumer Reports have teamed up to develop material specifically designed to educate patients about the Choosing Wisely recommendations. Materials will be available on the ABIM Foundation and SHM websites.
SHM will continue the conversation about high-value care and working with patients to make wise decisions well beyond February and March. At HM13, SHM’s annual meeting in Washington, D.C., SHM will offer a pre-course on Choosing Wisely and its philosophy. The pre-course is May 16, the day before the official start of HM13.
For more information about Choosing Wisely, visit www.choosingwisely.org. To register for the Choosing Wisely pre-course at HM13, visit www.hospitalmedicine2013.org.
This month, hospitalists will be a vital part of Choosing Wisely, an important public initiative from the American Board of Internal Medicine (ABIM) Foundation that identifies treatments and procedures that might be overused by caregivers.
On Feb. 21 in Washington, D.C., the ABIM Foundation, SHM, and more than a dozen other medical specialties will announce recommendations that, in the ABIM Foundation’s words, “represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation.” Hospitalists who helped SHM develop its recommendations will be in attendance to help field questions about SHM’s work with Choosing Wisely and its lists.
SHM has developed two lists of recommendations: one for adult HM and another for pediatric HM. SHM will make a special announcement Feb. 21 in The Hospitalist eWire with both lists and commentary for how hospitalists can have informed conversations with their patients about the lists. The Hospitalist will follow up with a feature story and other information about Choosing Wisely in its March issue.
As part of the campaign, the ABIM Foundation, SHM, and consumer magazine Consumer Reports have teamed up to develop material specifically designed to educate patients about the Choosing Wisely recommendations. Materials will be available on the ABIM Foundation and SHM websites.
SHM will continue the conversation about high-value care and working with patients to make wise decisions well beyond February and March. At HM13, SHM’s annual meeting in Washington, D.C., SHM will offer a pre-course on Choosing Wisely and its philosophy. The pre-course is May 16, the day before the official start of HM13.
For more information about Choosing Wisely, visit www.choosingwisely.org. To register for the Choosing Wisely pre-course at HM13, visit www.hospitalmedicine2013.org.
Pharmacist-Hospitalist Collaboration Can Improve Care, Save Money
A healthy collaboration between hospitalists and pharmacists can generate cost savings and promote positive outcomes, such as preventing adverse drug events and improving care transitions, says Jonathan Edwards, PharmD, BCPS, a clinical pharmacy specialist at Huntsville Hospital in Alabama.
At the 2012 national conference of the American College of Clinical Pharmacy in Hollywood, Fla., Edwards presented a poster that detailed the effectiveness of such interdisciplinary collaboration at Huntsville Hospital, where pharmacists and physicians developed six order sets, a collaborative practice, and a patient interaction program from November 2011 to February 2012. During the study period, researchers documented a total cost savings of $9,825 resulting from 156 patient interventions.
Edwards’ collaborative study at Huntsville started with two physicians who had launched a service teaching hospitalists what pharmacists do, and how they could help in their efforts.
“We got together and developed an order set for treating acute alcohol withdrawal. That went well, so we did five more order sets,” Edwards says. “Then we thought: What if pharmacists got more involved by meeting directly with patients in the hospital to optimize their medication management and help them reach their goals for treatment? We now evaluate patients on the hospitalist service in three units.”
For Edwards, key factors that make the hospitalist-pharmacist relationship work include communicating the pharmacist’s availability to help with the hospitalist’s patients, identifying the physician’s openness to help, and clarifying how the physician prefers to be contacted.
Last October, the American Society of Health-System Pharmacists (ASHP) and the American Pharmacists Association (APhA) recognized eight care-transitions programs for best practices that improved patient outcomes and reduced hospital readmissions as part of the Medication Management in Care Transitions (MMCT) Project.
“The MMCT project highlights the valuable role pharmacists can play in addressing medication-related problems that can lead to hospital readmissions,” APhA chief executive officer Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, said in a news release. “By putting together these best practices, our goal is to provide a model for better coordination of care and better connectivity between pharmacists and healthcare providers in different practice settings that leads to improved patient health.”
Visit our website for more information about maximizing patient care through pharmacist-hospitalist collaboration.
Larry Beresford is a freelance writer in Oakland, Calif.
Articles first published in the Jan. 16, 2013, edition of The Hospitalist eWire.
A healthy collaboration between hospitalists and pharmacists can generate cost savings and promote positive outcomes, such as preventing adverse drug events and improving care transitions, says Jonathan Edwards, PharmD, BCPS, a clinical pharmacy specialist at Huntsville Hospital in Alabama.
At the 2012 national conference of the American College of Clinical Pharmacy in Hollywood, Fla., Edwards presented a poster that detailed the effectiveness of such interdisciplinary collaboration at Huntsville Hospital, where pharmacists and physicians developed six order sets, a collaborative practice, and a patient interaction program from November 2011 to February 2012. During the study period, researchers documented a total cost savings of $9,825 resulting from 156 patient interventions.
Edwards’ collaborative study at Huntsville started with two physicians who had launched a service teaching hospitalists what pharmacists do, and how they could help in their efforts.
“We got together and developed an order set for treating acute alcohol withdrawal. That went well, so we did five more order sets,” Edwards says. “Then we thought: What if pharmacists got more involved by meeting directly with patients in the hospital to optimize their medication management and help them reach their goals for treatment? We now evaluate patients on the hospitalist service in three units.”
For Edwards, key factors that make the hospitalist-pharmacist relationship work include communicating the pharmacist’s availability to help with the hospitalist’s patients, identifying the physician’s openness to help, and clarifying how the physician prefers to be contacted.
Last October, the American Society of Health-System Pharmacists (ASHP) and the American Pharmacists Association (APhA) recognized eight care-transitions programs for best practices that improved patient outcomes and reduced hospital readmissions as part of the Medication Management in Care Transitions (MMCT) Project.
“The MMCT project highlights the valuable role pharmacists can play in addressing medication-related problems that can lead to hospital readmissions,” APhA chief executive officer Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, said in a news release. “By putting together these best practices, our goal is to provide a model for better coordination of care and better connectivity between pharmacists and healthcare providers in different practice settings that leads to improved patient health.”
Visit our website for more information about maximizing patient care through pharmacist-hospitalist collaboration.
Larry Beresford is a freelance writer in Oakland, Calif.
Articles first published in the Jan. 16, 2013, edition of The Hospitalist eWire.
A healthy collaboration between hospitalists and pharmacists can generate cost savings and promote positive outcomes, such as preventing adverse drug events and improving care transitions, says Jonathan Edwards, PharmD, BCPS, a clinical pharmacy specialist at Huntsville Hospital in Alabama.
At the 2012 national conference of the American College of Clinical Pharmacy in Hollywood, Fla., Edwards presented a poster that detailed the effectiveness of such interdisciplinary collaboration at Huntsville Hospital, where pharmacists and physicians developed six order sets, a collaborative practice, and a patient interaction program from November 2011 to February 2012. During the study period, researchers documented a total cost savings of $9,825 resulting from 156 patient interventions.
Edwards’ collaborative study at Huntsville started with two physicians who had launched a service teaching hospitalists what pharmacists do, and how they could help in their efforts.
“We got together and developed an order set for treating acute alcohol withdrawal. That went well, so we did five more order sets,” Edwards says. “Then we thought: What if pharmacists got more involved by meeting directly with patients in the hospital to optimize their medication management and help them reach their goals for treatment? We now evaluate patients on the hospitalist service in three units.”
For Edwards, key factors that make the hospitalist-pharmacist relationship work include communicating the pharmacist’s availability to help with the hospitalist’s patients, identifying the physician’s openness to help, and clarifying how the physician prefers to be contacted.
Last October, the American Society of Health-System Pharmacists (ASHP) and the American Pharmacists Association (APhA) recognized eight care-transitions programs for best practices that improved patient outcomes and reduced hospital readmissions as part of the Medication Management in Care Transitions (MMCT) Project.
“The MMCT project highlights the valuable role pharmacists can play in addressing medication-related problems that can lead to hospital readmissions,” APhA chief executive officer Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, said in a news release. “By putting together these best practices, our goal is to provide a model for better coordination of care and better connectivity between pharmacists and healthcare providers in different practice settings that leads to improved patient health.”
Visit our website for more information about maximizing patient care through pharmacist-hospitalist collaboration.
Larry Beresford is a freelance writer in Oakland, Calif.
Articles first published in the Jan. 16, 2013, edition of The Hospitalist eWire.
The Patient-Doctor Relationship Gap
Physicians who rank poorly in their communication skills with patients were associated with reduced rates of medication adherence in a new report.
A cross-sectional study of nearly 9,4000 patients in the Diabetes Study of Northern California (DISTANCE) found roughly 30% of patients who gave their physicians poor ratings when it came to involving them in decisions, understanding their problems with medications, and eliciting their trust were less likely to refill their cardiometabolic medications than those whose doctors were deemed to be good communicators, researchers found. For each 10-point decrease in the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS), the prevalence of poor medication adherence increased by 0.9% (P +0.1), the researchers added.
“One of the tricks is that medication adherence is an inherently physician-centric concept,” says lead author Neda Ratanawongsa, MD, MPH, assistant professor in the department of medicine at the University of California at San Francisco (UCSF). “We’re asking you to take medicine that we think will be best for you. That’s been the way that physicians operate for years, often appropriately so. But part of this is figuring out how to encourage the patients to disclose their decision that ‘Yes, I do want to take that medicine’ or ‘No, here’s why I don’t want to take that medicine.’”
Dr. Ratanawongsa adds that hospitalists and other physicians have to develop a sense of trust with patients to build relationships. Future studies could then track patient satisfaction and adherence over time to see if a corollary exists. Also, she says, hospitalists shouldn’t be discouraged that most of their relationships aren’t long-term ones like those found in other specialties.
“I wouldn’t underestimate the impact a hospitalist could have, whether one-time interaction or not, to change an existing therapy program,” Dr. Ratanawongsa says. “It’s important for hospitalists to understand the power of their words.”
Richard Quinn is a freelance writer in New Jersey.
Physicians who rank poorly in their communication skills with patients were associated with reduced rates of medication adherence in a new report.
A cross-sectional study of nearly 9,4000 patients in the Diabetes Study of Northern California (DISTANCE) found roughly 30% of patients who gave their physicians poor ratings when it came to involving them in decisions, understanding their problems with medications, and eliciting their trust were less likely to refill their cardiometabolic medications than those whose doctors were deemed to be good communicators, researchers found. For each 10-point decrease in the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS), the prevalence of poor medication adherence increased by 0.9% (P +0.1), the researchers added.
“One of the tricks is that medication adherence is an inherently physician-centric concept,” says lead author Neda Ratanawongsa, MD, MPH, assistant professor in the department of medicine at the University of California at San Francisco (UCSF). “We’re asking you to take medicine that we think will be best for you. That’s been the way that physicians operate for years, often appropriately so. But part of this is figuring out how to encourage the patients to disclose their decision that ‘Yes, I do want to take that medicine’ or ‘No, here’s why I don’t want to take that medicine.’”
Dr. Ratanawongsa adds that hospitalists and other physicians have to develop a sense of trust with patients to build relationships. Future studies could then track patient satisfaction and adherence over time to see if a corollary exists. Also, she says, hospitalists shouldn’t be discouraged that most of their relationships aren’t long-term ones like those found in other specialties.
“I wouldn’t underestimate the impact a hospitalist could have, whether one-time interaction or not, to change an existing therapy program,” Dr. Ratanawongsa says. “It’s important for hospitalists to understand the power of their words.”
Richard Quinn is a freelance writer in New Jersey.
Physicians who rank poorly in their communication skills with patients were associated with reduced rates of medication adherence in a new report.
A cross-sectional study of nearly 9,4000 patients in the Diabetes Study of Northern California (DISTANCE) found roughly 30% of patients who gave their physicians poor ratings when it came to involving them in decisions, understanding their problems with medications, and eliciting their trust were less likely to refill their cardiometabolic medications than those whose doctors were deemed to be good communicators, researchers found. For each 10-point decrease in the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS), the prevalence of poor medication adherence increased by 0.9% (P +0.1), the researchers added.
“One of the tricks is that medication adherence is an inherently physician-centric concept,” says lead author Neda Ratanawongsa, MD, MPH, assistant professor in the department of medicine at the University of California at San Francisco (UCSF). “We’re asking you to take medicine that we think will be best for you. That’s been the way that physicians operate for years, often appropriately so. But part of this is figuring out how to encourage the patients to disclose their decision that ‘Yes, I do want to take that medicine’ or ‘No, here’s why I don’t want to take that medicine.’”
Dr. Ratanawongsa adds that hospitalists and other physicians have to develop a sense of trust with patients to build relationships. Future studies could then track patient satisfaction and adherence over time to see if a corollary exists. Also, she says, hospitalists shouldn’t be discouraged that most of their relationships aren’t long-term ones like those found in other specialties.
“I wouldn’t underestimate the impact a hospitalist could have, whether one-time interaction or not, to change an existing therapy program,” Dr. Ratanawongsa says. “It’s important for hospitalists to understand the power of their words.”
Richard Quinn is a freelance writer in New Jersey.
New Oral Anticoagulants Advance Treatment Options, Create Complications for Hospitalists
New oral anticoagulants promise to impact hospitalists and their patients—but the question is how much
When the FDA gave the nod to factor Xa-inhibitor rivaroxaban in November for use in treating acute DVT and pulmonary embolism (PE), it was just the latest development in the swiftly evolving world of oral anticoagulants—a world that hospitalists had better get used to living in, and quick.
As many as 80% of the patients that hospitalists encounter are on some kind of anticoagulant, experts say. But the extent to which the emergence of the new drugs— particularly rivaroxaban, which also is approved for stroke prevention in nonvalvular atrial fibrillation (afib) and for DVT and PE prevention in knee and hip replacement patients—will affect the daily routines of hospitalists remains to be seen.
Hospitalists specializing in VTE prevention and vascular experts say that the new drugs will make life simpler for hospitalists in some ways, mainly because for some patients, a pill will replace the injectable enoxaparin that has been used to bridge patients to warfarin. But with more options available, things will become more complicated as well, they say.
Approvals for the new agents, which aim to replace warfarin and its need for constant monitoring and concern over drug and food interactions, have been coming rapid-fire. Along with rivaroxaban in the new oral anticoagulant group are dabigatran, approved in late 2010 for stroke prevention in nonvalvular afib, and apixaban, which is expected to be approved for the same indication this year.
“Of all three drugs, [rivaroxaban] has the broadest indications for use,” said Hiren Shah, MD, assistant professor of medicine at Northwestern University’s Feinberg School of Medicine and medical director of hospital medicine at Northwestern Memorial Hospital in Chicago. “Because of that, it’s likely that it’s going to be the agent that will be adopted much more broadly and more easily than dabigatran.”
But apixaban might come on strong in the U.S. when it’s approved because it shows better promise for patients with renal impairment and has a lower risk of intracranial hemorrhage, says Geno Merli, MD, director of the Jefferson Center for Vascular Disease and chief medical officer at Thomas Jefferson University Hospital in Philadelphia.
“I think the two other [manufacturers] are afraid of apixaban because apixaban’s safety profile was much better,” he says.
Steven Deitelzweig, MD, FACP, SFHM, secretary of the Gulf State chapter of SHM and a DVT prevention specialist at Ochsner Health System New Orleans, says hurdles to adoption of the new agents will include whether a system is integrated and can assure appropriate follow-up and concerns over proper patient selection and cost, as the cost-benefit analyses haven’t been done yet.
“The learning curve, or the adoption curve, is really going to be very variable around the country,” he says.
Experts agree changes are on the way as the new anticoagulants gain more traction. Here are some things they say hospitalists should watch out for.
Care and Discharge
Dr. Shah says the availability of the oral agents will streamline care and discharge of patients.
“The care and coordination process that needs to occur with the use of parenteral agents and warfarin is significantly more complex than the patient education and care coordination that will be required with the new oral anticoagulants,” he says. “That’s where there’s a significant time savings.”
Ian Jenkins, MD, assistant professor in the division of hospital medicine at the University of California at San Diego, says the windfall of time saved might not hit hospitalists directly, at least at some centers.
“The education is being done by pharmacy here for warfarin, and nurses handle enoxaparin injection teaching,” he says. “So the workload that benefits may be that of our colleagues.”
Dr. Shah notes that the responsibility in patient counseling ultimately falls within hospitalists’ purview, so he predicts that any greater simplicity in that regard would help hospitalists.
Who Ends up Hospitalized?
The option of oral agents might help diminish the number of patients who have to stay in the hospital for enoxaparin injections that bridge them to warfarin, a topic at a recent roundtable discussion Dr. Shah attended.
“It was shocking to me that I have many colleagues throughout the country who have patients who are in the hospital simply to get parenteral injections because they can’t take them themselves at home and have no loved ones or friends to help them,” he says.
Dr. Merli agrees that the new agents might affect hospitalists’ patient census. Many patients, he says, will be discharged straight from the ED.
“The DVT patients probably won’t get [admitted]. You’re going to put them on rivaroxaban and send them home,” he says. “You’re not going to get [admitted] with a DVT anymore, unless it’s extensive. And if it’s an extensive DVT, you’re not going to get rivaroxaban. You’re going to get enoxaparin or you’re going to get thrombolytics therapy followed by IV heparin followed by enoxaparin. So I don’t see rivaroxaban jumping into the marketplace and being a boon to hospitalists immediately.”
If patients skip hospitalization and are discharged straight from the ED, Dr. Deitelzweig says, “there will be patients who will backfill those spots.”
“I think most of the people will come in as observation status, if not inpatient,” he says, although simpler DVT patients will be likelier candidates for discharge from the ER. He predicts that stays might be shorter, though.
But Dr. Merli says hospitalists shouldn’t expect a big effect on length of stay.
“I don’t think you’re going to reduce dramatically length of stay because you have an oral pill,” he says.
QI Initiatives
What might be a boon, though, are opportunities for quality-improvement (QI) initiatives related to the new therapies, Dr. Jenkins says. “Many of these projects that are being done with anticoagulants … do focus on warfarin safety; it’s a frequent part of readmission and patient harm,” he says. “Having it much simpler to treat and educate these patients is actually going to be a boon, I think, for hospitalists working on quality-improvement projects, and for people who do that education, whether that is a hospitalist or a pharmacist or some other member of the staff.”
There are downsides, though, he notes. One is cost. Another is reversibility. Warfarin can be easily reversed in the event of a bleed, but that’s not the case with rivaroxaban and dabigatran. And none of the new therapies are suitable for patients with renal failure.
“Right now, we’re stuck with IV heparin and Coumadin in the hospital, and rivaroxaban won’t change this,” he says. “Rivaroxaban patients one might help with PCC; but with dabigatran, I don’t think much will help besides time and dialysis, which is dangerous in unstable anticoagulated patients.”
Dr. Shah, though, says he’s aware of only two times that bleeding reversal protocols—based on anecdotal evidence, because no method has been scientifically proven—had to be invoked at Northwestern in the past year.
It might be “more of a theoretical problem than one in reality,” he explains, “simply because we have not found the need to reverse oral anticoagulants very often given their short half-lives.”
The new agents, all the experts agree, will require hospitalists to stay on their toes.
“There are so many different facets in each case, whether it’s the age or the renal function or whether there’s a fall risk and what their compliance is, what their funding is, what the exact indication is,” Dr. Jenkins says. “Keeping up with those things is actually quite challenging.”
His main resources are the American College of Chest Physicians’ guidelines on anticoagulants, his center’s own protocols, and the primary literature for the main trials (see “Additional Reading,” right). He also looks to the inpatient pharmacist for guidance.
Dr. Shah says it is important to be aware of the patient-inclusion criteria, study design, and outcomes measured for each agent through their trials.
“There is a lot of information out there, and there are very subtle aspects of some of these trials and you’ve got to really understand: Does it apply to the patient that is front of me?” he said. “There’s a lot to know, there’s no doubt about it.”
Thomas R. Collins is a freelance writer in South Florida.
New oral anticoagulants promise to impact hospitalists and their patients—but the question is how much
When the FDA gave the nod to factor Xa-inhibitor rivaroxaban in November for use in treating acute DVT and pulmonary embolism (PE), it was just the latest development in the swiftly evolving world of oral anticoagulants—a world that hospitalists had better get used to living in, and quick.
As many as 80% of the patients that hospitalists encounter are on some kind of anticoagulant, experts say. But the extent to which the emergence of the new drugs— particularly rivaroxaban, which also is approved for stroke prevention in nonvalvular atrial fibrillation (afib) and for DVT and PE prevention in knee and hip replacement patients—will affect the daily routines of hospitalists remains to be seen.
Hospitalists specializing in VTE prevention and vascular experts say that the new drugs will make life simpler for hospitalists in some ways, mainly because for some patients, a pill will replace the injectable enoxaparin that has been used to bridge patients to warfarin. But with more options available, things will become more complicated as well, they say.
Approvals for the new agents, which aim to replace warfarin and its need for constant monitoring and concern over drug and food interactions, have been coming rapid-fire. Along with rivaroxaban in the new oral anticoagulant group are dabigatran, approved in late 2010 for stroke prevention in nonvalvular afib, and apixaban, which is expected to be approved for the same indication this year.
“Of all three drugs, [rivaroxaban] has the broadest indications for use,” said Hiren Shah, MD, assistant professor of medicine at Northwestern University’s Feinberg School of Medicine and medical director of hospital medicine at Northwestern Memorial Hospital in Chicago. “Because of that, it’s likely that it’s going to be the agent that will be adopted much more broadly and more easily than dabigatran.”
But apixaban might come on strong in the U.S. when it’s approved because it shows better promise for patients with renal impairment and has a lower risk of intracranial hemorrhage, says Geno Merli, MD, director of the Jefferson Center for Vascular Disease and chief medical officer at Thomas Jefferson University Hospital in Philadelphia.
“I think the two other [manufacturers] are afraid of apixaban because apixaban’s safety profile was much better,” he says.
Steven Deitelzweig, MD, FACP, SFHM, secretary of the Gulf State chapter of SHM and a DVT prevention specialist at Ochsner Health System New Orleans, says hurdles to adoption of the new agents will include whether a system is integrated and can assure appropriate follow-up and concerns over proper patient selection and cost, as the cost-benefit analyses haven’t been done yet.
“The learning curve, or the adoption curve, is really going to be very variable around the country,” he says.
Experts agree changes are on the way as the new anticoagulants gain more traction. Here are some things they say hospitalists should watch out for.
Care and Discharge
Dr. Shah says the availability of the oral agents will streamline care and discharge of patients.
“The care and coordination process that needs to occur with the use of parenteral agents and warfarin is significantly more complex than the patient education and care coordination that will be required with the new oral anticoagulants,” he says. “That’s where there’s a significant time savings.”
Ian Jenkins, MD, assistant professor in the division of hospital medicine at the University of California at San Diego, says the windfall of time saved might not hit hospitalists directly, at least at some centers.
“The education is being done by pharmacy here for warfarin, and nurses handle enoxaparin injection teaching,” he says. “So the workload that benefits may be that of our colleagues.”
Dr. Shah notes that the responsibility in patient counseling ultimately falls within hospitalists’ purview, so he predicts that any greater simplicity in that regard would help hospitalists.
Who Ends up Hospitalized?
The option of oral agents might help diminish the number of patients who have to stay in the hospital for enoxaparin injections that bridge them to warfarin, a topic at a recent roundtable discussion Dr. Shah attended.
“It was shocking to me that I have many colleagues throughout the country who have patients who are in the hospital simply to get parenteral injections because they can’t take them themselves at home and have no loved ones or friends to help them,” he says.
Dr. Merli agrees that the new agents might affect hospitalists’ patient census. Many patients, he says, will be discharged straight from the ED.
“The DVT patients probably won’t get [admitted]. You’re going to put them on rivaroxaban and send them home,” he says. “You’re not going to get [admitted] with a DVT anymore, unless it’s extensive. And if it’s an extensive DVT, you’re not going to get rivaroxaban. You’re going to get enoxaparin or you’re going to get thrombolytics therapy followed by IV heparin followed by enoxaparin. So I don’t see rivaroxaban jumping into the marketplace and being a boon to hospitalists immediately.”
If patients skip hospitalization and are discharged straight from the ED, Dr. Deitelzweig says, “there will be patients who will backfill those spots.”
“I think most of the people will come in as observation status, if not inpatient,” he says, although simpler DVT patients will be likelier candidates for discharge from the ER. He predicts that stays might be shorter, though.
But Dr. Merli says hospitalists shouldn’t expect a big effect on length of stay.
“I don’t think you’re going to reduce dramatically length of stay because you have an oral pill,” he says.
QI Initiatives
What might be a boon, though, are opportunities for quality-improvement (QI) initiatives related to the new therapies, Dr. Jenkins says. “Many of these projects that are being done with anticoagulants … do focus on warfarin safety; it’s a frequent part of readmission and patient harm,” he says. “Having it much simpler to treat and educate these patients is actually going to be a boon, I think, for hospitalists working on quality-improvement projects, and for people who do that education, whether that is a hospitalist or a pharmacist or some other member of the staff.”
There are downsides, though, he notes. One is cost. Another is reversibility. Warfarin can be easily reversed in the event of a bleed, but that’s not the case with rivaroxaban and dabigatran. And none of the new therapies are suitable for patients with renal failure.
“Right now, we’re stuck with IV heparin and Coumadin in the hospital, and rivaroxaban won’t change this,” he says. “Rivaroxaban patients one might help with PCC; but with dabigatran, I don’t think much will help besides time and dialysis, which is dangerous in unstable anticoagulated patients.”
Dr. Shah, though, says he’s aware of only two times that bleeding reversal protocols—based on anecdotal evidence, because no method has been scientifically proven—had to be invoked at Northwestern in the past year.
It might be “more of a theoretical problem than one in reality,” he explains, “simply because we have not found the need to reverse oral anticoagulants very often given their short half-lives.”
The new agents, all the experts agree, will require hospitalists to stay on their toes.
“There are so many different facets in each case, whether it’s the age or the renal function or whether there’s a fall risk and what their compliance is, what their funding is, what the exact indication is,” Dr. Jenkins says. “Keeping up with those things is actually quite challenging.”
His main resources are the American College of Chest Physicians’ guidelines on anticoagulants, his center’s own protocols, and the primary literature for the main trials (see “Additional Reading,” right). He also looks to the inpatient pharmacist for guidance.
Dr. Shah says it is important to be aware of the patient-inclusion criteria, study design, and outcomes measured for each agent through their trials.
“There is a lot of information out there, and there are very subtle aspects of some of these trials and you’ve got to really understand: Does it apply to the patient that is front of me?” he said. “There’s a lot to know, there’s no doubt about it.”
Thomas R. Collins is a freelance writer in South Florida.
New oral anticoagulants promise to impact hospitalists and their patients—but the question is how much
When the FDA gave the nod to factor Xa-inhibitor rivaroxaban in November for use in treating acute DVT and pulmonary embolism (PE), it was just the latest development in the swiftly evolving world of oral anticoagulants—a world that hospitalists had better get used to living in, and quick.
As many as 80% of the patients that hospitalists encounter are on some kind of anticoagulant, experts say. But the extent to which the emergence of the new drugs— particularly rivaroxaban, which also is approved for stroke prevention in nonvalvular atrial fibrillation (afib) and for DVT and PE prevention in knee and hip replacement patients—will affect the daily routines of hospitalists remains to be seen.
Hospitalists specializing in VTE prevention and vascular experts say that the new drugs will make life simpler for hospitalists in some ways, mainly because for some patients, a pill will replace the injectable enoxaparin that has been used to bridge patients to warfarin. But with more options available, things will become more complicated as well, they say.
Approvals for the new agents, which aim to replace warfarin and its need for constant monitoring and concern over drug and food interactions, have been coming rapid-fire. Along with rivaroxaban in the new oral anticoagulant group are dabigatran, approved in late 2010 for stroke prevention in nonvalvular afib, and apixaban, which is expected to be approved for the same indication this year.
“Of all three drugs, [rivaroxaban] has the broadest indications for use,” said Hiren Shah, MD, assistant professor of medicine at Northwestern University’s Feinberg School of Medicine and medical director of hospital medicine at Northwestern Memorial Hospital in Chicago. “Because of that, it’s likely that it’s going to be the agent that will be adopted much more broadly and more easily than dabigatran.”
But apixaban might come on strong in the U.S. when it’s approved because it shows better promise for patients with renal impairment and has a lower risk of intracranial hemorrhage, says Geno Merli, MD, director of the Jefferson Center for Vascular Disease and chief medical officer at Thomas Jefferson University Hospital in Philadelphia.
“I think the two other [manufacturers] are afraid of apixaban because apixaban’s safety profile was much better,” he says.
Steven Deitelzweig, MD, FACP, SFHM, secretary of the Gulf State chapter of SHM and a DVT prevention specialist at Ochsner Health System New Orleans, says hurdles to adoption of the new agents will include whether a system is integrated and can assure appropriate follow-up and concerns over proper patient selection and cost, as the cost-benefit analyses haven’t been done yet.
“The learning curve, or the adoption curve, is really going to be very variable around the country,” he says.
Experts agree changes are on the way as the new anticoagulants gain more traction. Here are some things they say hospitalists should watch out for.
Care and Discharge
Dr. Shah says the availability of the oral agents will streamline care and discharge of patients.
“The care and coordination process that needs to occur with the use of parenteral agents and warfarin is significantly more complex than the patient education and care coordination that will be required with the new oral anticoagulants,” he says. “That’s where there’s a significant time savings.”
Ian Jenkins, MD, assistant professor in the division of hospital medicine at the University of California at San Diego, says the windfall of time saved might not hit hospitalists directly, at least at some centers.
“The education is being done by pharmacy here for warfarin, and nurses handle enoxaparin injection teaching,” he says. “So the workload that benefits may be that of our colleagues.”
Dr. Shah notes that the responsibility in patient counseling ultimately falls within hospitalists’ purview, so he predicts that any greater simplicity in that regard would help hospitalists.
Who Ends up Hospitalized?
The option of oral agents might help diminish the number of patients who have to stay in the hospital for enoxaparin injections that bridge them to warfarin, a topic at a recent roundtable discussion Dr. Shah attended.
“It was shocking to me that I have many colleagues throughout the country who have patients who are in the hospital simply to get parenteral injections because they can’t take them themselves at home and have no loved ones or friends to help them,” he says.
Dr. Merli agrees that the new agents might affect hospitalists’ patient census. Many patients, he says, will be discharged straight from the ED.
“The DVT patients probably won’t get [admitted]. You’re going to put them on rivaroxaban and send them home,” he says. “You’re not going to get [admitted] with a DVT anymore, unless it’s extensive. And if it’s an extensive DVT, you’re not going to get rivaroxaban. You’re going to get enoxaparin or you’re going to get thrombolytics therapy followed by IV heparin followed by enoxaparin. So I don’t see rivaroxaban jumping into the marketplace and being a boon to hospitalists immediately.”
If patients skip hospitalization and are discharged straight from the ED, Dr. Deitelzweig says, “there will be patients who will backfill those spots.”
“I think most of the people will come in as observation status, if not inpatient,” he says, although simpler DVT patients will be likelier candidates for discharge from the ER. He predicts that stays might be shorter, though.
But Dr. Merli says hospitalists shouldn’t expect a big effect on length of stay.
“I don’t think you’re going to reduce dramatically length of stay because you have an oral pill,” he says.
QI Initiatives
What might be a boon, though, are opportunities for quality-improvement (QI) initiatives related to the new therapies, Dr. Jenkins says. “Many of these projects that are being done with anticoagulants … do focus on warfarin safety; it’s a frequent part of readmission and patient harm,” he says. “Having it much simpler to treat and educate these patients is actually going to be a boon, I think, for hospitalists working on quality-improvement projects, and for people who do that education, whether that is a hospitalist or a pharmacist or some other member of the staff.”
There are downsides, though, he notes. One is cost. Another is reversibility. Warfarin can be easily reversed in the event of a bleed, but that’s not the case with rivaroxaban and dabigatran. And none of the new therapies are suitable for patients with renal failure.
“Right now, we’re stuck with IV heparin and Coumadin in the hospital, and rivaroxaban won’t change this,” he says. “Rivaroxaban patients one might help with PCC; but with dabigatran, I don’t think much will help besides time and dialysis, which is dangerous in unstable anticoagulated patients.”
Dr. Shah, though, says he’s aware of only two times that bleeding reversal protocols—based on anecdotal evidence, because no method has been scientifically proven—had to be invoked at Northwestern in the past year.
It might be “more of a theoretical problem than one in reality,” he explains, “simply because we have not found the need to reverse oral anticoagulants very often given their short half-lives.”
The new agents, all the experts agree, will require hospitalists to stay on their toes.
“There are so many different facets in each case, whether it’s the age or the renal function or whether there’s a fall risk and what their compliance is, what their funding is, what the exact indication is,” Dr. Jenkins says. “Keeping up with those things is actually quite challenging.”
His main resources are the American College of Chest Physicians’ guidelines on anticoagulants, his center’s own protocols, and the primary literature for the main trials (see “Additional Reading,” right). He also looks to the inpatient pharmacist for guidance.
Dr. Shah says it is important to be aware of the patient-inclusion criteria, study design, and outcomes measured for each agent through their trials.
“There is a lot of information out there, and there are very subtle aspects of some of these trials and you’ve got to really understand: Does it apply to the patient that is front of me?” he said. “There’s a lot to know, there’s no doubt about it.”
Thomas R. Collins is a freelance writer in South Florida.
Quality Improvement Project Helps Hospital Patients Get Needed Prescriptions
A quality-improvement (QI) project to give high-risk patients ready access to prescribed medications at the time of hospital discharge achieved an 86% success rate, according to an abstract poster presented at HM12 in San Diego last April.1
Lead author Elizabeth Le, MD, then a resident at the University of California at San Francisco Medical Center (UCSF) and now a practicing hospitalist at the Veterans Administration Medical Center in Palo Alto, Calif., says the multidisciplinary “brown bag medications” project involved training house staff to recognize patients at risk. Staff meetings and rounds were used to identify appropriate candidates—those with limited mobility or cognitive issues, lacking insurance coverage or financial resources, a history of medication noncompliance, or leaving the hospital against medical advice—as well as those prescribed medications with a greater urgency for administration on schedule, such as anticoagulants or antibiotics.
About one-quarter of patients on the unit where this approach was first tested were found to need the service, which involved faxing prescriptions to an outpatient pharmacy across the street from the hospital for either pick-up by the family or delivery to the patient’s hospital room. For those with financial impediments, hospital social workers and case managers explored other options, including the social work department’s discretionary use fund, to pay for the drugs.
Dr. Le believes the project could be replicated in other facilities that lack access to in-house pharmacy services at discharge. She recommends involving social workers and case managers in the planning.
At UCSF, recent EHR implementation has automated the ordering of medications, but the challenge of recognizing who could benefit from extra help in obtaining their discharge medications remains a critical issue for hospitals trying to bring readmissions under control.
For more information about the brown bag medications program, contact Dr. Le at [email protected].
References
A quality-improvement (QI) project to give high-risk patients ready access to prescribed medications at the time of hospital discharge achieved an 86% success rate, according to an abstract poster presented at HM12 in San Diego last April.1
Lead author Elizabeth Le, MD, then a resident at the University of California at San Francisco Medical Center (UCSF) and now a practicing hospitalist at the Veterans Administration Medical Center in Palo Alto, Calif., says the multidisciplinary “brown bag medications” project involved training house staff to recognize patients at risk. Staff meetings and rounds were used to identify appropriate candidates—those with limited mobility or cognitive issues, lacking insurance coverage or financial resources, a history of medication noncompliance, or leaving the hospital against medical advice—as well as those prescribed medications with a greater urgency for administration on schedule, such as anticoagulants or antibiotics.
About one-quarter of patients on the unit where this approach was first tested were found to need the service, which involved faxing prescriptions to an outpatient pharmacy across the street from the hospital for either pick-up by the family or delivery to the patient’s hospital room. For those with financial impediments, hospital social workers and case managers explored other options, including the social work department’s discretionary use fund, to pay for the drugs.
Dr. Le believes the project could be replicated in other facilities that lack access to in-house pharmacy services at discharge. She recommends involving social workers and case managers in the planning.
At UCSF, recent EHR implementation has automated the ordering of medications, but the challenge of recognizing who could benefit from extra help in obtaining their discharge medications remains a critical issue for hospitals trying to bring readmissions under control.
For more information about the brown bag medications program, contact Dr. Le at [email protected].
References
A quality-improvement (QI) project to give high-risk patients ready access to prescribed medications at the time of hospital discharge achieved an 86% success rate, according to an abstract poster presented at HM12 in San Diego last April.1
Lead author Elizabeth Le, MD, then a resident at the University of California at San Francisco Medical Center (UCSF) and now a practicing hospitalist at the Veterans Administration Medical Center in Palo Alto, Calif., says the multidisciplinary “brown bag medications” project involved training house staff to recognize patients at risk. Staff meetings and rounds were used to identify appropriate candidates—those with limited mobility or cognitive issues, lacking insurance coverage or financial resources, a history of medication noncompliance, or leaving the hospital against medical advice—as well as those prescribed medications with a greater urgency for administration on schedule, such as anticoagulants or antibiotics.
About one-quarter of patients on the unit where this approach was first tested were found to need the service, which involved faxing prescriptions to an outpatient pharmacy across the street from the hospital for either pick-up by the family or delivery to the patient’s hospital room. For those with financial impediments, hospital social workers and case managers explored other options, including the social work department’s discretionary use fund, to pay for the drugs.
Dr. Le believes the project could be replicated in other facilities that lack access to in-house pharmacy services at discharge. She recommends involving social workers and case managers in the planning.
At UCSF, recent EHR implementation has automated the ordering of medications, but the challenge of recognizing who could benefit from extra help in obtaining their discharge medications remains a critical issue for hospitals trying to bring readmissions under control.
For more information about the brown bag medications program, contact Dr. Le at [email protected].
References
Bloodsteam Infections in ICU Patients Plummet
Reduction in bloodstream infection rates resulting from a simple intervention: bathing all ICU patients daily with antimicrobial chlorhexidine soap rather than the widely mandated practice of screening ICU patients to determine which ones harbor methicillin-resistant Staphylococcus aureus (MRSA) and then implementing an MRSA treatment protocol for them.
According to data on 75,000 patients at hospitals in 16 states presented in October at the Infectious Diseases Society of America annual meeting, there also was a 37% reduction in patients with MRSA.
Lead researcher Susan Huang, MD, an infectious-disease specialist at the University of California at Irvine, says the results show the benefits of this preventive approach, which included applying an antibiotic ointment to the patient’s nasal passage, and could make ICU screening for drug-resistant organisms, such as MRSA, unnecessary.
Reduction in bloodstream infection rates resulting from a simple intervention: bathing all ICU patients daily with antimicrobial chlorhexidine soap rather than the widely mandated practice of screening ICU patients to determine which ones harbor methicillin-resistant Staphylococcus aureus (MRSA) and then implementing an MRSA treatment protocol for them.
According to data on 75,000 patients at hospitals in 16 states presented in October at the Infectious Diseases Society of America annual meeting, there also was a 37% reduction in patients with MRSA.
Lead researcher Susan Huang, MD, an infectious-disease specialist at the University of California at Irvine, says the results show the benefits of this preventive approach, which included applying an antibiotic ointment to the patient’s nasal passage, and could make ICU screening for drug-resistant organisms, such as MRSA, unnecessary.
Reduction in bloodstream infection rates resulting from a simple intervention: bathing all ICU patients daily with antimicrobial chlorhexidine soap rather than the widely mandated practice of screening ICU patients to determine which ones harbor methicillin-resistant Staphylococcus aureus (MRSA) and then implementing an MRSA treatment protocol for them.
According to data on 75,000 patients at hospitals in 16 states presented in October at the Infectious Diseases Society of America annual meeting, there also was a 37% reduction in patients with MRSA.
Lead researcher Susan Huang, MD, an infectious-disease specialist at the University of California at Irvine, says the results show the benefits of this preventive approach, which included applying an antibiotic ointment to the patient’s nasal passage, and could make ICU screening for drug-resistant organisms, such as MRSA, unnecessary.
Hospitalists Should Consider Fall Risks with Sleep Agent
An author of a new study associating the hypnotic zolpidem (Ambien) with higher rates of patient falls says hospitalists should keep the popular drug’s risks front of mind.
The retrospective cohort study in the Journal of Hospital Medicine, “Zolpidem is Independently Associated with Increased Risk of Inpatient Falls,” found that the rate of falls increased nearly six times among patients taking the sleep agent.1 The research team at the Center for Sleep Medicine at the Mayo Clinic in Rochester, N.Y., calculated one additional fall for every 55 admitted patients who were administered the treatment.
“What this says to me is if one is going to use zolpidem, you have to be aware you’re increasing the risk of fall,” says sleep specialist Timothy Morgenthaler, MD, the Mayo Clinic’s chief patient officer. “Knowledgeable of that, one ought to consider whether there are alternatives or whether the risks outweigh the goal in that setting.”
Dr. Morgenthaler says zolpidem is the most commonly prescribed hypnotic at his hospital, and believes it to be the most common treatment in the U.S. He began studying the issue after nurses reported that it appeared patients were falling after taking the agent. In response to the study, Mayo Clinic removed zolpidem from many of its admission order sets and attempted to help improve patient sleep via other methods, including noise reduction.
“We haven’t removed it from our formulary, and I’m not saying it doesn’t have a role in some points,” he says, “but rather than encouraging it as an option in patients being admitted into the patient, we’re choosing instead now to encourage nonpharmacologic sleep enhancements.”
Visit the-hospitalist.org for more information about HM’s approach to patient falls.
Reference
An author of a new study associating the hypnotic zolpidem (Ambien) with higher rates of patient falls says hospitalists should keep the popular drug’s risks front of mind.
The retrospective cohort study in the Journal of Hospital Medicine, “Zolpidem is Independently Associated with Increased Risk of Inpatient Falls,” found that the rate of falls increased nearly six times among patients taking the sleep agent.1 The research team at the Center for Sleep Medicine at the Mayo Clinic in Rochester, N.Y., calculated one additional fall for every 55 admitted patients who were administered the treatment.
“What this says to me is if one is going to use zolpidem, you have to be aware you’re increasing the risk of fall,” says sleep specialist Timothy Morgenthaler, MD, the Mayo Clinic’s chief patient officer. “Knowledgeable of that, one ought to consider whether there are alternatives or whether the risks outweigh the goal in that setting.”
Dr. Morgenthaler says zolpidem is the most commonly prescribed hypnotic at his hospital, and believes it to be the most common treatment in the U.S. He began studying the issue after nurses reported that it appeared patients were falling after taking the agent. In response to the study, Mayo Clinic removed zolpidem from many of its admission order sets and attempted to help improve patient sleep via other methods, including noise reduction.
“We haven’t removed it from our formulary, and I’m not saying it doesn’t have a role in some points,” he says, “but rather than encouraging it as an option in patients being admitted into the patient, we’re choosing instead now to encourage nonpharmacologic sleep enhancements.”
Visit the-hospitalist.org for more information about HM’s approach to patient falls.
Reference
An author of a new study associating the hypnotic zolpidem (Ambien) with higher rates of patient falls says hospitalists should keep the popular drug’s risks front of mind.
The retrospective cohort study in the Journal of Hospital Medicine, “Zolpidem is Independently Associated with Increased Risk of Inpatient Falls,” found that the rate of falls increased nearly six times among patients taking the sleep agent.1 The research team at the Center for Sleep Medicine at the Mayo Clinic in Rochester, N.Y., calculated one additional fall for every 55 admitted patients who were administered the treatment.
“What this says to me is if one is going to use zolpidem, you have to be aware you’re increasing the risk of fall,” says sleep specialist Timothy Morgenthaler, MD, the Mayo Clinic’s chief patient officer. “Knowledgeable of that, one ought to consider whether there are alternatives or whether the risks outweigh the goal in that setting.”
Dr. Morgenthaler says zolpidem is the most commonly prescribed hypnotic at his hospital, and believes it to be the most common treatment in the U.S. He began studying the issue after nurses reported that it appeared patients were falling after taking the agent. In response to the study, Mayo Clinic removed zolpidem from many of its admission order sets and attempted to help improve patient sleep via other methods, including noise reduction.
“We haven’t removed it from our formulary, and I’m not saying it doesn’t have a role in some points,” he says, “but rather than encouraging it as an option in patients being admitted into the patient, we’re choosing instead now to encourage nonpharmacologic sleep enhancements.”
Visit the-hospitalist.org for more information about HM’s approach to patient falls.
Reference
Adherence to CHF Measures Doesn’t Improve Hospital Readmission Rates
A study of the relationship between hospital adherence to congestive heart failure (CHF) quality performance measures and 30-day readmission rates found little association, except for the assessment of left ventricular function, which, if not performed according to guidelines, was associated with higher readmissions.1
Lead author Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, looked at adherence to the performance measures, which in recent years have been adopted by quality organizations and third-party payors as surrogate markers for quality of care. These include documented ordering of angiotensin-converting enzyme (ACE) inhibitors, providing discharge instructions to patients, and counseling on smoking cessation.
The study looked retrospectively at 6,000 CHF patients within a four-hospital healthcare system between 2001 and 2009, at a time when adherence to the performance measures rose to 99.9% from 95.8%. The hospital readmission rate for these patients averaged 19.6%.
Larry Beresford is a freelance writer in Oakland, Calif.
References
A study of the relationship between hospital adherence to congestive heart failure (CHF) quality performance measures and 30-day readmission rates found little association, except for the assessment of left ventricular function, which, if not performed according to guidelines, was associated with higher readmissions.1
Lead author Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, looked at adherence to the performance measures, which in recent years have been adopted by quality organizations and third-party payors as surrogate markers for quality of care. These include documented ordering of angiotensin-converting enzyme (ACE) inhibitors, providing discharge instructions to patients, and counseling on smoking cessation.
The study looked retrospectively at 6,000 CHF patients within a four-hospital healthcare system between 2001 and 2009, at a time when adherence to the performance measures rose to 99.9% from 95.8%. The hospital readmission rate for these patients averaged 19.6%.
Larry Beresford is a freelance writer in Oakland, Calif.
References
A study of the relationship between hospital adherence to congestive heart failure (CHF) quality performance measures and 30-day readmission rates found little association, except for the assessment of left ventricular function, which, if not performed according to guidelines, was associated with higher readmissions.1
Lead author Sula Mazimba, MD, MPH, and colleagues at Kettering Medical Center in Kettering, Ohio, looked at adherence to the performance measures, which in recent years have been adopted by quality organizations and third-party payors as surrogate markers for quality of care. These include documented ordering of angiotensin-converting enzyme (ACE) inhibitors, providing discharge instructions to patients, and counseling on smoking cessation.
The study looked retrospectively at 6,000 CHF patients within a four-hospital healthcare system between 2001 and 2009, at a time when adherence to the performance measures rose to 99.9% from 95.8%. The hospital readmission rate for these patients averaged 19.6%.
Larry Beresford is a freelance writer in Oakland, Calif.
References
Ready to be a Fellow in Hospital Medicine?
If you’re ready to demonstrate your commitment to HM and hospitalized patients, you still have time to submit your SHM fellowship application.
The deadline for 2013 applications is Jan. 18. To apply online or learn more, visit www.hospitalmedicine.org/fellows.
The class of 2013 Fellows will be inducted during a plenary session at SHM’s annual meeting in May in National Harbor, Md.
This year’s class will reach a milestone—not just for hospital medicine, but for all of healthcare. SHM has expanded eligibility in its Fellowship in Hospital Medicine program to include nurse practitioners (NPs), physician assistants (PAs), and HM practice administrators. By opening the designation to nonphysicians, SHM becomes the only medical society to offer a singular designation to the entire care team.
SHM members who meet eligibility criteria are recognized as Fellows each year at the annual meeting. Based on current membership, SHM estimates that more than 300 NPs, PAs, and administrators are eligible immediately; thousands more will be eligible after they meet the three-year membership requirement for fellow status.
“We are proud to be able to recognize excellence within the specialty and contributions to the field by nurse practitioners, physician assistants, and practice administrators,” says SHM President Shaun Frost, MD, SFHM. “The standards by which SHM fellows are measured promote the highest quality of patient care and systems efficiency. And they can be equally applied to physicians, NPs, PAs, and administrators within the hospital medicine specialty.”
SHM’s Fellows program is rooted in the society’s Core Competencies in Hospital Medicine, and those who earn the Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designation have demonstrated a commitment to hospital medicine, system change, and quality-improvement (QI) principles.
All candidates for the designation are required to submit applications that demonstrate experience, organizational teamwork and leadership, and a dedication to lifelong learning. Applicants must receive endorsement from practitioners in the field and are subject to committee review.
“Hospital medicine was built on the principle that caregivers must act as a team,” Dr. Frost says. “We are honored to recognize more members of that team today through our Fellows designation.”
Brendon Shank is associate vice president of communications for SHM.
If you’re ready to demonstrate your commitment to HM and hospitalized patients, you still have time to submit your SHM fellowship application.
The deadline for 2013 applications is Jan. 18. To apply online or learn more, visit www.hospitalmedicine.org/fellows.
The class of 2013 Fellows will be inducted during a plenary session at SHM’s annual meeting in May in National Harbor, Md.
This year’s class will reach a milestone—not just for hospital medicine, but for all of healthcare. SHM has expanded eligibility in its Fellowship in Hospital Medicine program to include nurse practitioners (NPs), physician assistants (PAs), and HM practice administrators. By opening the designation to nonphysicians, SHM becomes the only medical society to offer a singular designation to the entire care team.
SHM members who meet eligibility criteria are recognized as Fellows each year at the annual meeting. Based on current membership, SHM estimates that more than 300 NPs, PAs, and administrators are eligible immediately; thousands more will be eligible after they meet the three-year membership requirement for fellow status.
“We are proud to be able to recognize excellence within the specialty and contributions to the field by nurse practitioners, physician assistants, and practice administrators,” says SHM President Shaun Frost, MD, SFHM. “The standards by which SHM fellows are measured promote the highest quality of patient care and systems efficiency. And they can be equally applied to physicians, NPs, PAs, and administrators within the hospital medicine specialty.”
SHM’s Fellows program is rooted in the society’s Core Competencies in Hospital Medicine, and those who earn the Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designation have demonstrated a commitment to hospital medicine, system change, and quality-improvement (QI) principles.
All candidates for the designation are required to submit applications that demonstrate experience, organizational teamwork and leadership, and a dedication to lifelong learning. Applicants must receive endorsement from practitioners in the field and are subject to committee review.
“Hospital medicine was built on the principle that caregivers must act as a team,” Dr. Frost says. “We are honored to recognize more members of that team today through our Fellows designation.”
Brendon Shank is associate vice president of communications for SHM.
If you’re ready to demonstrate your commitment to HM and hospitalized patients, you still have time to submit your SHM fellowship application.
The deadline for 2013 applications is Jan. 18. To apply online or learn more, visit www.hospitalmedicine.org/fellows.
The class of 2013 Fellows will be inducted during a plenary session at SHM’s annual meeting in May in National Harbor, Md.
This year’s class will reach a milestone—not just for hospital medicine, but for all of healthcare. SHM has expanded eligibility in its Fellowship in Hospital Medicine program to include nurse practitioners (NPs), physician assistants (PAs), and HM practice administrators. By opening the designation to nonphysicians, SHM becomes the only medical society to offer a singular designation to the entire care team.
SHM members who meet eligibility criteria are recognized as Fellows each year at the annual meeting. Based on current membership, SHM estimates that more than 300 NPs, PAs, and administrators are eligible immediately; thousands more will be eligible after they meet the three-year membership requirement for fellow status.
“We are proud to be able to recognize excellence within the specialty and contributions to the field by nurse practitioners, physician assistants, and practice administrators,” says SHM President Shaun Frost, MD, SFHM. “The standards by which SHM fellows are measured promote the highest quality of patient care and systems efficiency. And they can be equally applied to physicians, NPs, PAs, and administrators within the hospital medicine specialty.”
SHM’s Fellows program is rooted in the society’s Core Competencies in Hospital Medicine, and those who earn the Fellow in Hospital Medicine (FHM) or Senior Fellow in Hospital Medicine (SFHM) designation have demonstrated a commitment to hospital medicine, system change, and quality-improvement (QI) principles.
All candidates for the designation are required to submit applications that demonstrate experience, organizational teamwork and leadership, and a dedication to lifelong learning. Applicants must receive endorsement from practitioners in the field and are subject to committee review.
“Hospital medicine was built on the principle that caregivers must act as a team,” Dr. Frost says. “We are honored to recognize more members of that team today through our Fellows designation.”
Brendon Shank is associate vice president of communications for SHM.