Quality

As a hospitalist, you typically have little, if any, contact with patients outside the hospital and, at most, you’ll only spend a couple of hours a year in front of any particular patient. The vast majority of the determinants of your patients’ health occur when you’re not there.

In a commentary in the New England Journal of Medicine entitled “Engineering Social Incentives for Health,” lead author David A. Asch, MD, MBA, addresses that issue.¹
 

“The motivation for the piece is that the people who are in a position to influence a patient’s health are their friends and family, and yet so much of how we have structured health care is between a clinician and a patient,” he says. “We often fail to engage the people in patients’ everyday lives, who can be quite willing partners in improving health care. There are all sorts of things they can do to help patients with hard-to-control diabetes or ... heart failure, or anything that might have put them in the hospital in the first place.”

The column describes a ladder of social engineering strategies, from very simple to complex. One example on the simple end might be to help a patient remember a daily medication by having him place the medication bottle where his partner can see him taking – or not taking – it. (The alternative is that medications are taken in a private place, such in the bathroom, where no one might be watching over the routine to keep the patient on track.)

Moving up the ladder, a hospitalist might help set up a network of other patients with heart failure, so that they can help each other in a kind of peer mentorship.

“These peer-to-peer connections might require Web-based platforms or social support groups, so that kind of activity is a lot more complicated, but the general theme is: Can hospitalists think about ways to constructively engage the social networks that already surround patients, so they don’t need to invoke the health system to do it?”

It’s long been known that people with more social support do better: People who are married do better; people who have more friends do better. “Up until now, it’s just been an observation,” Dr. Asch says. “I think we’re at a point where we could begin to prescribe social support in the way we might prescribe a diuretic. I’d like to try it out at least. I think that’s the call to action.”

Reference

1. Asch D, Rosin R. Engineering social incentives for health. NEJM. 2016;375:2511-2513.

As a hospitalist, you typically have little, if any, contact with patients outside the hospital and, at most, you’ll only spend a couple of hours a year in front of any particular patient. The vast majority of the determinants of your patients’ health occur when you’re not there.

In a commentary in the New England Journal of Medicine entitled “Engineering Social Incentives for Health,” lead author David A. Asch, MD, MBA, addresses that issue.¹
 

“The motivation for the piece is that the people who are in a position to influence a patient’s health are their friends and family, and yet so much of how we have structured health care is between a clinician and a patient,” he says. “We often fail to engage the people in patients’ everyday lives, who can be quite willing partners in improving health care. There are all sorts of things they can do to help patients with hard-to-control diabetes or ... heart failure, or anything that might have put them in the hospital in the first place.”

The column describes a ladder of social engineering strategies, from very simple to complex. One example on the simple end might be to help a patient remember a daily medication by having him place the medication bottle where his partner can see him taking – or not taking – it. (The alternative is that medications are taken in a private place, such in the bathroom, where no one might be watching over the routine to keep the patient on track.)

Moving up the ladder, a hospitalist might help set up a network of other patients with heart failure, so that they can help each other in a kind of peer mentorship.

“These peer-to-peer connections might require Web-based platforms or social support groups, so that kind of activity is a lot more complicated, but the general theme is: Can hospitalists think about ways to constructively engage the social networks that already surround patients, so they don’t need to invoke the health system to do it?”

It’s long been known that people with more social support do better: People who are married do better; people who have more friends do better. “Up until now, it’s just been an observation,” Dr. Asch says. “I think we’re at a point where we could begin to prescribe social support in the way we might prescribe a diuretic. I’d like to try it out at least. I think that’s the call to action.”

Reference

1. Asch D, Rosin R. Engineering social incentives for health. NEJM. 2016;375:2511-2513.

As a hospitalist, you typically have little, if any, contact with patients outside the hospital and, at most, you’ll only spend a couple of hours a year in front of any particular patient. The vast majority of the determinants of your patients’ health occur when you’re not there.

In a commentary in the New England Journal of Medicine entitled “Engineering Social Incentives for Health,” lead author David A. Asch, MD, MBA, addresses that issue.¹
 

“The motivation for the piece is that the people who are in a position to influence a patient’s health are their friends and family, and yet so much of how we have structured health care is between a clinician and a patient,” he says. “We often fail to engage the people in patients’ everyday lives, who can be quite willing partners in improving health care. There are all sorts of things they can do to help patients with hard-to-control diabetes or ... heart failure, or anything that might have put them in the hospital in the first place.”

The column describes a ladder of social engineering strategies, from very simple to complex. One example on the simple end might be to help a patient remember a daily medication by having him place the medication bottle where his partner can see him taking – or not taking – it. (The alternative is that medications are taken in a private place, such in the bathroom, where no one might be watching over the routine to keep the patient on track.)

Moving up the ladder, a hospitalist might help set up a network of other patients with heart failure, so that they can help each other in a kind of peer mentorship.

“These peer-to-peer connections might require Web-based platforms or social support groups, so that kind of activity is a lot more complicated, but the general theme is: Can hospitalists think about ways to constructively engage the social networks that already surround patients, so they don’t need to invoke the health system to do it?”

It’s long been known that people with more social support do better: People who are married do better; people who have more friends do better. “Up until now, it’s just been an observation,” Dr. Asch says. “I think we’re at a point where we could begin to prescribe social support in the way we might prescribe a diuretic. I’d like to try it out at least. I think that’s the call to action.”

Reference

1. Asch D, Rosin R. Engineering social incentives for health. NEJM. 2016;375:2511-2513.

Hospitalists can help enlist patients in the movement toward improved patient safety, and they can begin simply by sharing their notes.

OpenNotes offers a new platform to do that, according to a BMJ Quality & Safety article, “A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.”¹

Thinkstock

• Share their notes with patients and families (by printing the discharge summaries if they are not available on the portal and/or sharing notes from post-discharge follow-up visits).
• Emphasize for patients and families the important role they play as safety partners.
• Ask patients who receive care in other healthcare centers if they have OpenNotes, which can help hospitalists obtain medical records quickly and efficiently.
• Encourage patients to sign up for the patient portal and ask for their notes, for ambulatory visits to begin with and for in-patient notes when they become available.

Suzanne Bopp is a freelance medical writer in New York City.

Reference

1. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships [published online ahead of print, Dec. 13, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-006020.

Hospitalists can help enlist patients in the movement toward improved patient safety, and they can begin simply by sharing their notes.

OpenNotes offers a new platform to do that, according to a BMJ Quality & Safety article, “A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.”¹

Thinkstock

• Share their notes with patients and families (by printing the discharge summaries if they are not available on the portal and/or sharing notes from post-discharge follow-up visits).
• Emphasize for patients and families the important role they play as safety partners.
• Ask patients who receive care in other healthcare centers if they have OpenNotes, which can help hospitalists obtain medical records quickly and efficiently.
• Encourage patients to sign up for the patient portal and ask for their notes, for ambulatory visits to begin with and for in-patient notes when they become available.

Suzanne Bopp is a freelance medical writer in New York City.

Reference

1. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships [published online ahead of print, Dec. 13, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-006020.

Hospitalists can help enlist patients in the movement toward improved patient safety, and they can begin simply by sharing their notes.

OpenNotes offers a new platform to do that, according to a BMJ Quality & Safety article, “A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.”¹

Thinkstock

• Share their notes with patients and families (by printing the discharge summaries if they are not available on the portal and/or sharing notes from post-discharge follow-up visits).
• Emphasize for patients and families the important role they play as safety partners.
• Ask patients who receive care in other healthcare centers if they have OpenNotes, which can help hospitalists obtain medical records quickly and efficiently.
• Encourage patients to sign up for the patient portal and ask for their notes, for ambulatory visits to begin with and for in-patient notes when they become available.

Suzanne Bopp is a freelance medical writer in New York City.

Reference

1. Bell SK, Gerard M, Fossa A, et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships [published online ahead of print, Dec. 13, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-006020.

Background: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.

Objective: To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model.

Results: There was no difference in LOS (6.6 vs. 7.0 days, P = .17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs. 9.3%, P = .46). LOS was reduced for patients transferred to the study unit (10.4 vs. 14.0 days, P = .02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model.

Limitations: The trial was performed at a single hospital.

Conclusions:  Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.

Also in the Journal of Hospital Medicine …

Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial

Authors: Bradley Monash, MD, Nader Najafi, MD, Michelle Mourad, MD, Alvin Rajkomar, MD, Sumant R. Ranji, MD, Margaret C. Fang, MD, MPH, FHM, Marcia Glass, MD, Dimiter Milev, MPH, Yile Ding, MD, Andy Shen, BA, Bradley A. Sharpe, MD, FACP, SFHM, James D Harrison, MPH, PhD

All Together Now: Impact of a Regionalization and Bedside Rounding Initiative on the Efficiency and Inclusiveness of Clinical Rounds

Authors: Kristin T. L. Huang, MD, Jacquelyn Minahan, Patricia Brita-Rossi, RN, MSN, MBA, Patricia Aylward, RN, MSN, Joel T. Katz, MD, SFHM, Christopher Roy, MD, Jeffrey L. Schnipper, MD, MPH, FHM, Robert Boxer, MD, PhD

Family Report Compared to Clinician-Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children

Authors: Stephanie K. Doupnik, MD, Chris Feudtner, MD, PhD, MPH, Steven C. Marcus, PhD

Perceived Safety and Value of Inpatient ‘Very Important Person’ Services

Authors: Joshua Allen-Dicker, MD, MPH, Andrew Auerbach, MD, MPH, SFHM, Shoshana J. Herzig, MD, MPH

A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories

Authors: Caroline B. Nguyen, PharmD, BCPS, Rita Shane, PharmD, FASHP, FCSHP, Douglas S. Bell, MD, PhD, Galen Cook-Wiens, MS, Joshua M. Pevnick, MD, MSHS

Background: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.

Objective: To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model.

Results: There was no difference in LOS (6.6 vs. 7.0 days, P = .17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs. 9.3%, P = .46). LOS was reduced for patients transferred to the study unit (10.4 vs. 14.0 days, P = .02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model.

Limitations: The trial was performed at a single hospital.

Conclusions:  Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.

Also in the Journal of Hospital Medicine …

Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial

Authors: Bradley Monash, MD, Nader Najafi, MD, Michelle Mourad, MD, Alvin Rajkomar, MD, Sumant R. Ranji, MD, Margaret C. Fang, MD, MPH, FHM, Marcia Glass, MD, Dimiter Milev, MPH, Yile Ding, MD, Andy Shen, BA, Bradley A. Sharpe, MD, FACP, SFHM, James D Harrison, MPH, PhD

All Together Now: Impact of a Regionalization and Bedside Rounding Initiative on the Efficiency and Inclusiveness of Clinical Rounds

Authors: Kristin T. L. Huang, MD, Jacquelyn Minahan, Patricia Brita-Rossi, RN, MSN, MBA, Patricia Aylward, RN, MSN, Joel T. Katz, MD, SFHM, Christopher Roy, MD, Jeffrey L. Schnipper, MD, MPH, FHM, Robert Boxer, MD, PhD

Family Report Compared to Clinician-Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children

Authors: Stephanie K. Doupnik, MD, Chris Feudtner, MD, PhD, MPH, Steven C. Marcus, PhD

Perceived Safety and Value of Inpatient ‘Very Important Person’ Services

Authors: Joshua Allen-Dicker, MD, MPH, Andrew Auerbach, MD, MPH, SFHM, Shoshana J. Herzig, MD, MPH

A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories

Authors: Caroline B. Nguyen, PharmD, BCPS, Rita Shane, PharmD, FASHP, FCSHP, Douglas S. Bell, MD, PhD, Galen Cook-Wiens, MS, Joshua M. Pevnick, MD, MSHS

Background: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.

Objective: To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model.

Results: There was no difference in LOS (6.6 vs. 7.0 days, P = .17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs. 9.3%, P = .46). LOS was reduced for patients transferred to the study unit (10.4 vs. 14.0 days, P = .02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model.

Limitations: The trial was performed at a single hospital.

Conclusions:  Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features.

Also in the Journal of Hospital Medicine …

Standardized Attending Rounds to Improve the Patient Experience: A Pragmatic Cluster Randomized Controlled Trial

Authors: Bradley Monash, MD, Nader Najafi, MD, Michelle Mourad, MD, Alvin Rajkomar, MD, Sumant R. Ranji, MD, Margaret C. Fang, MD, MPH, FHM, Marcia Glass, MD, Dimiter Milev, MPH, Yile Ding, MD, Andy Shen, BA, Bradley A. Sharpe, MD, FACP, SFHM, James D Harrison, MPH, PhD

All Together Now: Impact of a Regionalization and Bedside Rounding Initiative on the Efficiency and Inclusiveness of Clinical Rounds

Authors: Kristin T. L. Huang, MD, Jacquelyn Minahan, Patricia Brita-Rossi, RN, MSN, MBA, Patricia Aylward, RN, MSN, Joel T. Katz, MD, SFHM, Christopher Roy, MD, Jeffrey L. Schnipper, MD, MPH, FHM, Robert Boxer, MD, PhD

Family Report Compared to Clinician-Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children

Authors: Stephanie K. Doupnik, MD, Chris Feudtner, MD, PhD, MPH, Steven C. Marcus, PhD

Perceived Safety and Value of Inpatient ‘Very Important Person’ Services

Authors: Joshua Allen-Dicker, MD, MPH, Andrew Auerbach, MD, MPH, SFHM, Shoshana J. Herzig, MD, MPH

A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories

Authors: Caroline B. Nguyen, PharmD, BCPS, Rita Shane, PharmD, FASHP, FCSHP, Douglas S. Bell, MD, PhD, Galen Cook-Wiens, MS, Joshua M. Pevnick, MD, MSHS

Clinical question: Is there an association between time to completion of discharge summary and hospital readmission?

Background: Thirty-day hospital readmission is one of the quality indicators for inpatient care and a higher rate can result in monetary penalties. Several interventions aimed at reducing this occurrence have been studied in different settings with variable success. Timely completion of discharge summary can possibly affect readmissions by providing crucial information to outpatient providers caring for patients across the care continuum.

Study design: Retrospective cohort study.

Setting: Johns Hopkins University, Baltimore.

Dr. Rachoin is an assistant professor of clinical medicine and associate division head, Hospital Medicine, at Cooper Medical School at Rowan University. He works as a hospitalist at Cooper University Hospital in Camden, N.J.

Clinical question: Is there an association between time to completion of discharge summary and hospital readmission?

Background: Thirty-day hospital readmission is one of the quality indicators for inpatient care and a higher rate can result in monetary penalties. Several interventions aimed at reducing this occurrence have been studied in different settings with variable success. Timely completion of discharge summary can possibly affect readmissions by providing crucial information to outpatient providers caring for patients across the care continuum.

Study design: Retrospective cohort study.

Setting: Johns Hopkins University, Baltimore.

Dr. Rachoin is an assistant professor of clinical medicine and associate division head, Hospital Medicine, at Cooper Medical School at Rowan University. He works as a hospitalist at Cooper University Hospital in Camden, N.J.

Clinical question: Is there an association between time to completion of discharge summary and hospital readmission?

Background: Thirty-day hospital readmission is one of the quality indicators for inpatient care and a higher rate can result in monetary penalties. Several interventions aimed at reducing this occurrence have been studied in different settings with variable success. Timely completion of discharge summary can possibly affect readmissions by providing crucial information to outpatient providers caring for patients across the care continuum.

Study design: Retrospective cohort study.

Setting: Johns Hopkins University, Baltimore.

Dr. Rachoin is an assistant professor of clinical medicine and associate division head, Hospital Medicine, at Cooper Medical School at Rowan University. He works as a hospitalist at Cooper University Hospital in Camden, N.J.

Top 10 reasons to attend 2017 Quality and Safety Educators Academy

It’s your last chance to register for the 2017 Quality and Safety Educators Academy (QSEA), which will be held Feb. 26-28 in Tempe, Ariz. Looking for some reasons to attend? Here are the top 10:

• Education. Develop and refine your knowledge in quality and patient safety.
• Desert beauty. Enjoy sunny Tempe, or travel to nearby Phoenix or Scottsdale.
• Curriculum development. Return to your institution with a collection of new educational strategies and curriculum development tactics.
• Professional development. Hone your skills and be the best that you can be to meet the increasing demand for medical educators who are well versed in patient safety and quality.
• Relationships. Build your network with faculty mentors and colleagues who have similar career interests.
• Institutional backing. Engage your institutional leaders to support and implement a quality and patient safety curriculum to meet the Accreditation Council for Graduate Medical Education core competencies and improve patient care.
• Hands-on learning. Engage in an interactive learning environment, with a 10:1 student to faculty ratio, including facilitated large-group sessions, small-group exercises, and panel discussions.
• Variety. Each day has its own topic that breaks down into subtopics, covering the breadth of information you need to know to succeed.
• Faculty. All sessions are led by experienced physicians known for their ability to practice and teach quality improvement and patient safety, mentor junior faculty, and guide educators in curriculum development.
• Resources. Leave with a toolkit of educational resources and curricular tools for quality and safety education.

Reserve your spot today before the meeting sells out at www.shmqsea.org.

SHM committees address practice management topics

SHM’s Practice Management Committee has been researching, deliberating case studies, and authoring timely content to further define HM’s role in key health care innovations. As the specialty has grown and evolved, so have hospitalists’ involvement in comanagement relationships.

The committee recently released a white paper addressing the evolution of comanagement in hospital medicine. Be on the lookout for that in early 2017. 

Similarly, telemedicine is rapidly expanding, and the committee found it imperative to clarify the who, what, when, where, why, and how of telemedicine programs in hospital medicine. You can also expect this white paper in early 2017.

The committee also has created guidelines on how to raise awareness of cultural humility in your HM group. Deemed the “5 R’s of Cultural Humility,” look for a campaign around the guidelines to launch at HM17 in May in Las Vegas.

SHM’s Health Information Technology Committee has been diligently analyzing and reporting on survey results that captured hospitalists’ attitudes toward electronic health records. The purpose of this white paper is to effect change on EHR systems by informing conversations with decision makers, and to provide HM a definitive voice in the landscape of the tumultuous world of EHRs. More information is coming soon.

Make a difference with SHM 

Grow professionally, expand your curriculum vitae, and get involved in work you are passionate about with colleagues across the country with SHM’s volunteer experiences. New opportunities are constantly being added that will bolster your strengths, sharpen your professional acumen and enhance your profile in the hospital medicine community at www.hospitalmedicine.org/getinvolved.
 

Leadership Academy 2017 has a new look

Don’t miss out on the only leadership program designed specifically for hospitalists. SHM Leadership Academy 2017 will be at the JW Marriott Camelback Inn in Scottsdale, Ariz., on Oct. 23-26.

For the first time, the Leadership Academy prerequisite of attendance in the first-level, Foundations course has been removed. Essential Strategies (formerly Leadership Foundations), Influential Management, and Mastering Teamwork courses are available to all attendees, regardless of previous attendance. Prior participants have made recommendations to help interested registrants determine which course fits them best in their leadership journey. 

All three courses run concurrently over the span of 4 days. This expanded meeting will provide attendees with world-class networking opportunities, creating opportunities for a more engaging, impactful educational experience.

Learn more about SHM’s Leadership Academy at www.shmleadershipacademy.org.

Earn dues credits with the Membership Ambassador Program

Help SHM grow its network of hospitalists and continue to provide education, networking, and career advancement for its members. Visit www.hospitalmedicine.org/refer today.

Brett Radler is SHM's communications specialist.

Top 10 reasons to attend 2017 Quality and Safety Educators Academy

It’s your last chance to register for the 2017 Quality and Safety Educators Academy (QSEA), which will be held Feb. 26-28 in Tempe, Ariz. Looking for some reasons to attend? Here are the top 10:

• Education. Develop and refine your knowledge in quality and patient safety.
• Desert beauty. Enjoy sunny Tempe, or travel to nearby Phoenix or Scottsdale.
• Curriculum development. Return to your institution with a collection of new educational strategies and curriculum development tactics.
• Professional development. Hone your skills and be the best that you can be to meet the increasing demand for medical educators who are well versed in patient safety and quality.
• Relationships. Build your network with faculty mentors and colleagues who have similar career interests.
• Institutional backing. Engage your institutional leaders to support and implement a quality and patient safety curriculum to meet the Accreditation Council for Graduate Medical Education core competencies and improve patient care.
• Hands-on learning. Engage in an interactive learning environment, with a 10:1 student to faculty ratio, including facilitated large-group sessions, small-group exercises, and panel discussions.
• Variety. Each day has its own topic that breaks down into subtopics, covering the breadth of information you need to know to succeed.
• Faculty. All sessions are led by experienced physicians known for their ability to practice and teach quality improvement and patient safety, mentor junior faculty, and guide educators in curriculum development.
• Resources. Leave with a toolkit of educational resources and curricular tools for quality and safety education.

Reserve your spot today before the meeting sells out at www.shmqsea.org.

SHM committees address practice management topics

SHM’s Practice Management Committee has been researching, deliberating case studies, and authoring timely content to further define HM’s role in key health care innovations. As the specialty has grown and evolved, so have hospitalists’ involvement in comanagement relationships.

The committee recently released a white paper addressing the evolution of comanagement in hospital medicine. Be on the lookout for that in early 2017. 

Similarly, telemedicine is rapidly expanding, and the committee found it imperative to clarify the who, what, when, where, why, and how of telemedicine programs in hospital medicine. You can also expect this white paper in early 2017.

The committee also has created guidelines on how to raise awareness of cultural humility in your HM group. Deemed the “5 R’s of Cultural Humility,” look for a campaign around the guidelines to launch at HM17 in May in Las Vegas.

SHM’s Health Information Technology Committee has been diligently analyzing and reporting on survey results that captured hospitalists’ attitudes toward electronic health records. The purpose of this white paper is to effect change on EHR systems by informing conversations with decision makers, and to provide HM a definitive voice in the landscape of the tumultuous world of EHRs. More information is coming soon.

Make a difference with SHM 

Grow professionally, expand your curriculum vitae, and get involved in work you are passionate about with colleagues across the country with SHM’s volunteer experiences. New opportunities are constantly being added that will bolster your strengths, sharpen your professional acumen and enhance your profile in the hospital medicine community at www.hospitalmedicine.org/getinvolved.
 

Leadership Academy 2017 has a new look

Don’t miss out on the only leadership program designed specifically for hospitalists. SHM Leadership Academy 2017 will be at the JW Marriott Camelback Inn in Scottsdale, Ariz., on Oct. 23-26.

For the first time, the Leadership Academy prerequisite of attendance in the first-level, Foundations course has been removed. Essential Strategies (formerly Leadership Foundations), Influential Management, and Mastering Teamwork courses are available to all attendees, regardless of previous attendance. Prior participants have made recommendations to help interested registrants determine which course fits them best in their leadership journey. 

All three courses run concurrently over the span of 4 days. This expanded meeting will provide attendees with world-class networking opportunities, creating opportunities for a more engaging, impactful educational experience.

Learn more about SHM’s Leadership Academy at www.shmleadershipacademy.org.

Earn dues credits with the Membership Ambassador Program

Help SHM grow its network of hospitalists and continue to provide education, networking, and career advancement for its members. Visit www.hospitalmedicine.org/refer today.

Brett Radler is SHM's communications specialist.

Top 10 reasons to attend 2017 Quality and Safety Educators Academy

It’s your last chance to register for the 2017 Quality and Safety Educators Academy (QSEA), which will be held Feb. 26-28 in Tempe, Ariz. Looking for some reasons to attend? Here are the top 10:

• Education. Develop and refine your knowledge in quality and patient safety.
• Desert beauty. Enjoy sunny Tempe, or travel to nearby Phoenix or Scottsdale.
• Curriculum development. Return to your institution with a collection of new educational strategies and curriculum development tactics.
• Professional development. Hone your skills and be the best that you can be to meet the increasing demand for medical educators who are well versed in patient safety and quality.
• Relationships. Build your network with faculty mentors and colleagues who have similar career interests.
• Institutional backing. Engage your institutional leaders to support and implement a quality and patient safety curriculum to meet the Accreditation Council for Graduate Medical Education core competencies and improve patient care.
• Hands-on learning. Engage in an interactive learning environment, with a 10:1 student to faculty ratio, including facilitated large-group sessions, small-group exercises, and panel discussions.
• Variety. Each day has its own topic that breaks down into subtopics, covering the breadth of information you need to know to succeed.
• Faculty. All sessions are led by experienced physicians known for their ability to practice and teach quality improvement and patient safety, mentor junior faculty, and guide educators in curriculum development.
• Resources. Leave with a toolkit of educational resources and curricular tools for quality and safety education.

Reserve your spot today before the meeting sells out at www.shmqsea.org.

SHM committees address practice management topics

SHM’s Practice Management Committee has been researching, deliberating case studies, and authoring timely content to further define HM’s role in key health care innovations. As the specialty has grown and evolved, so have hospitalists’ involvement in comanagement relationships.

The committee recently released a white paper addressing the evolution of comanagement in hospital medicine. Be on the lookout for that in early 2017. 

Similarly, telemedicine is rapidly expanding, and the committee found it imperative to clarify the who, what, when, where, why, and how of telemedicine programs in hospital medicine. You can also expect this white paper in early 2017.

The committee also has created guidelines on how to raise awareness of cultural humility in your HM group. Deemed the “5 R’s of Cultural Humility,” look for a campaign around the guidelines to launch at HM17 in May in Las Vegas.

SHM’s Health Information Technology Committee has been diligently analyzing and reporting on survey results that captured hospitalists’ attitudes toward electronic health records. The purpose of this white paper is to effect change on EHR systems by informing conversations with decision makers, and to provide HM a definitive voice in the landscape of the tumultuous world of EHRs. More information is coming soon.

Make a difference with SHM 

Grow professionally, expand your curriculum vitae, and get involved in work you are passionate about with colleagues across the country with SHM’s volunteer experiences. New opportunities are constantly being added that will bolster your strengths, sharpen your professional acumen and enhance your profile in the hospital medicine community at www.hospitalmedicine.org/getinvolved.
 

Leadership Academy 2017 has a new look

Don’t miss out on the only leadership program designed specifically for hospitalists. SHM Leadership Academy 2017 will be at the JW Marriott Camelback Inn in Scottsdale, Ariz., on Oct. 23-26.

For the first time, the Leadership Academy prerequisite of attendance in the first-level, Foundations course has been removed. Essential Strategies (formerly Leadership Foundations), Influential Management, and Mastering Teamwork courses are available to all attendees, regardless of previous attendance. Prior participants have made recommendations to help interested registrants determine which course fits them best in their leadership journey. 

All three courses run concurrently over the span of 4 days. This expanded meeting will provide attendees with world-class networking opportunities, creating opportunities for a more engaging, impactful educational experience.

Learn more about SHM’s Leadership Academy at www.shmleadershipacademy.org.

Earn dues credits with the Membership Ambassador Program

Help SHM grow its network of hospitalists and continue to provide education, networking, and career advancement for its members. Visit www.hospitalmedicine.org/refer today.

Brett Radler is SHM's communications specialist.

Hospitalists have been paying close attention to 30-day readmission figures since public reporting and payment programs embraced that number as an indicator of the quality of hospital care. But there is limited evidence to demonstrate 30-day readmission is really a meaningful interval of time, according to a recent study, “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators of Quality of Care.”

“I began to dig through the literature to find some sort of evidence to support this figure – I couldn’t find anything. In talking with quality experts, they all, more or less, believe that things that happen outside of 7 or 10 days are really out of the control of the clinician,” says lead author David L. Chin, PhD, of the Center for Healthcare Policy and Research at the University of California, Davis.

Dr. Chin and his team examined the 30-day risk of unplanned inpatient readmission at the hospital level for Medicare patients aged 65 and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. Across states and diagnoses, the hospital-level quality signal captured in readmission risk was highest on the first day after discharge, and it declined quickly to its lowest level at day 7.

“The rapid decay in the quality signal suggests that most readmissions after the seventh-day postdischarge were explained by community- and household-level factors beyond hospitals’ control,” the authors concluded.

Dr. Chin said the study results show the 30-day measure is “a blunt instrument.”

“It isn’t really measuring anything that we’re supposed to be measuring,” he explains. “Essentially, 97% of the reasons a person comes back to the hospital is due to some other, non-hospital thing.”

He does not advocate for 7 days as the new standard, however.

“This is more intended to be a message that this is really not the right way of approaching [readmissions] to begin with,” he says. “I think we convincingly showed that it shouldn’t be 30 days, but we don’t really have a very good picture of what is driving readmission. Hospitals are getting dinged on these things that have happened that, really, they don’t have direct influence on.”

Reference

1. Chin DL, Bang H, Manickam RN, Romano PS. Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Aff (Millwood). 2016;35(10):1867-75.

Quality Improvement: Overuse as medical error

Hospitalists may recognize a culture of overuse at their hospitals, but how can they address it? That’s the question behind an HM16 abstract, “Occam’s Conference: Overuse as a Medical Error.”

“We wanted to change the culture of overuse here among the hospitalists and the house staff,” said lead author Hyung Cho, MD, director of quality and patient safety at the Icahn School of Medicine at Mount Sinai in New York City. “We wanted to frame it in a way that people can recognize and feel free to talk about and also give it the weight that it deserves. It’s a common thing that we all do: the chest x-ray or the EKG before a surgery, things like that.”

Seeing overuse as a medical error is a place to start.

“A framework in which overuse is considered a medical error would facilitate understanding of the drivers of overuse and systems factors that lead to it,” the authors wrote.

Dr. Cho and colleagues chose a monthly inpatient conference format, with all the relevant players gathered together.

“We also wanted to use the formula that Brandon Combs had with the ‘Do No Harm’ project, which is taking cases of overuse that actually lead to harm or a near miss. I think people respond to that as opposed to just talking about the cost, which people have a hard time actually figuring out,” Dr. Cho said.

The resulting Occam’s Conference provides a process to identify and discuss overuse as a medical error. It uses a fish-bone diagram to help analyze each case.

“That conversation needs to happen,” Dr. Cho said. “You realize that people are all on the same page, and if they’re not, they need to get on the same page and have an open dialogue.”
 

Reference

1. Cho HJ, Lutz C, Truong TTN, et al. Occam’s Conference: overuse as a medical error [abstract]. J Hosp Med. 2016;11(suppl1).

Practice Management: There’s an app for … end-of-life communications

Hospitalists wanting to help patients navigate end-of-life decisions or assist bereaved families in dealing with the death of a loved one have some new tools, according to The New York Times article, “Start-Ups for the End of Life.”

Thinkstock

Reference

1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.

Quality Improvement: How to create a high-value culture

Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.

“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”

Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.

Four factors emerged with strong reliability:

• Leadership and health system messaging.

• Data transparency and access.

• Comfort with cost conversations.

• Blame-free environment.

The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.

Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.

“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
 

Reference

Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.

Quick Byte: Cleaning robotic surgical instruments

Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.

Reference

1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.

Suzanne Bopp is a freelance writer in New Jersey.

Hospitalists have been paying close attention to 30-day readmission figures since public reporting and payment programs embraced that number as an indicator of the quality of hospital care. But there is limited evidence to demonstrate 30-day readmission is really a meaningful interval of time, according to a recent study, “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators of Quality of Care.”

“I began to dig through the literature to find some sort of evidence to support this figure – I couldn’t find anything. In talking with quality experts, they all, more or less, believe that things that happen outside of 7 or 10 days are really out of the control of the clinician,” says lead author David L. Chin, PhD, of the Center for Healthcare Policy and Research at the University of California, Davis.

Dr. Chin and his team examined the 30-day risk of unplanned inpatient readmission at the hospital level for Medicare patients aged 65 and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. Across states and diagnoses, the hospital-level quality signal captured in readmission risk was highest on the first day after discharge, and it declined quickly to its lowest level at day 7.

“The rapid decay in the quality signal suggests that most readmissions after the seventh-day postdischarge were explained by community- and household-level factors beyond hospitals’ control,” the authors concluded.

Dr. Chin said the study results show the 30-day measure is “a blunt instrument.”

“It isn’t really measuring anything that we’re supposed to be measuring,” he explains. “Essentially, 97% of the reasons a person comes back to the hospital is due to some other, non-hospital thing.”

He does not advocate for 7 days as the new standard, however.

“This is more intended to be a message that this is really not the right way of approaching [readmissions] to begin with,” he says. “I think we convincingly showed that it shouldn’t be 30 days, but we don’t really have a very good picture of what is driving readmission. Hospitals are getting dinged on these things that have happened that, really, they don’t have direct influence on.”

Reference

1. Chin DL, Bang H, Manickam RN, Romano PS. Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Aff (Millwood). 2016;35(10):1867-75.

Quality Improvement: Overuse as medical error

Hospitalists may recognize a culture of overuse at their hospitals, but how can they address it? That’s the question behind an HM16 abstract, “Occam’s Conference: Overuse as a Medical Error.”

“We wanted to change the culture of overuse here among the hospitalists and the house staff,” said lead author Hyung Cho, MD, director of quality and patient safety at the Icahn School of Medicine at Mount Sinai in New York City. “We wanted to frame it in a way that people can recognize and feel free to talk about and also give it the weight that it deserves. It’s a common thing that we all do: the chest x-ray or the EKG before a surgery, things like that.”

Seeing overuse as a medical error is a place to start.

“A framework in which overuse is considered a medical error would facilitate understanding of the drivers of overuse and systems factors that lead to it,” the authors wrote.

Dr. Cho and colleagues chose a monthly inpatient conference format, with all the relevant players gathered together.

“We also wanted to use the formula that Brandon Combs had with the ‘Do No Harm’ project, which is taking cases of overuse that actually lead to harm or a near miss. I think people respond to that as opposed to just talking about the cost, which people have a hard time actually figuring out,” Dr. Cho said.

The resulting Occam’s Conference provides a process to identify and discuss overuse as a medical error. It uses a fish-bone diagram to help analyze each case.

“That conversation needs to happen,” Dr. Cho said. “You realize that people are all on the same page, and if they’re not, they need to get on the same page and have an open dialogue.”
 

Reference

1. Cho HJ, Lutz C, Truong TTN, et al. Occam’s Conference: overuse as a medical error [abstract]. J Hosp Med. 2016;11(suppl1).

Practice Management: There’s an app for … end-of-life communications

Hospitalists wanting to help patients navigate end-of-life decisions or assist bereaved families in dealing with the death of a loved one have some new tools, according to The New York Times article, “Start-Ups for the End of Life.”

Thinkstock

Reference

1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.

Quality Improvement: How to create a high-value culture

Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.

“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”

Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.

Four factors emerged with strong reliability:

• Leadership and health system messaging.

• Data transparency and access.

• Comfort with cost conversations.

• Blame-free environment.

The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.

Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.

“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
 

Reference

Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.

Quick Byte: Cleaning robotic surgical instruments

Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.

Reference

1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.

Suzanne Bopp is a freelance writer in New Jersey.

Hospitalists have been paying close attention to 30-day readmission figures since public reporting and payment programs embraced that number as an indicator of the quality of hospital care. But there is limited evidence to demonstrate 30-day readmission is really a meaningful interval of time, according to a recent study, “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators of Quality of Care.”

“I began to dig through the literature to find some sort of evidence to support this figure – I couldn’t find anything. In talking with quality experts, they all, more or less, believe that things that happen outside of 7 or 10 days are really out of the control of the clinician,” says lead author David L. Chin, PhD, of the Center for Healthcare Policy and Research at the University of California, Davis.

Dr. Chin and his team examined the 30-day risk of unplanned inpatient readmission at the hospital level for Medicare patients aged 65 and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. Across states and diagnoses, the hospital-level quality signal captured in readmission risk was highest on the first day after discharge, and it declined quickly to its lowest level at day 7.

“The rapid decay in the quality signal suggests that most readmissions after the seventh-day postdischarge were explained by community- and household-level factors beyond hospitals’ control,” the authors concluded.

Dr. Chin said the study results show the 30-day measure is “a blunt instrument.”

“It isn’t really measuring anything that we’re supposed to be measuring,” he explains. “Essentially, 97% of the reasons a person comes back to the hospital is due to some other, non-hospital thing.”

He does not advocate for 7 days as the new standard, however.

“This is more intended to be a message that this is really not the right way of approaching [readmissions] to begin with,” he says. “I think we convincingly showed that it shouldn’t be 30 days, but we don’t really have a very good picture of what is driving readmission. Hospitals are getting dinged on these things that have happened that, really, they don’t have direct influence on.”

Reference

1. Chin DL, Bang H, Manickam RN, Romano PS. Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care. Health Aff (Millwood). 2016;35(10):1867-75.

Quality Improvement: Overuse as medical error

Hospitalists may recognize a culture of overuse at their hospitals, but how can they address it? That’s the question behind an HM16 abstract, “Occam’s Conference: Overuse as a Medical Error.”

“We wanted to change the culture of overuse here among the hospitalists and the house staff,” said lead author Hyung Cho, MD, director of quality and patient safety at the Icahn School of Medicine at Mount Sinai in New York City. “We wanted to frame it in a way that people can recognize and feel free to talk about and also give it the weight that it deserves. It’s a common thing that we all do: the chest x-ray or the EKG before a surgery, things like that.”

Seeing overuse as a medical error is a place to start.

“A framework in which overuse is considered a medical error would facilitate understanding of the drivers of overuse and systems factors that lead to it,” the authors wrote.

Dr. Cho and colleagues chose a monthly inpatient conference format, with all the relevant players gathered together.

“We also wanted to use the formula that Brandon Combs had with the ‘Do No Harm’ project, which is taking cases of overuse that actually lead to harm or a near miss. I think people respond to that as opposed to just talking about the cost, which people have a hard time actually figuring out,” Dr. Cho said.

The resulting Occam’s Conference provides a process to identify and discuss overuse as a medical error. It uses a fish-bone diagram to help analyze each case.

“That conversation needs to happen,” Dr. Cho said. “You realize that people are all on the same page, and if they’re not, they need to get on the same page and have an open dialogue.”
 

Reference

1. Cho HJ, Lutz C, Truong TTN, et al. Occam’s Conference: overuse as a medical error [abstract]. J Hosp Med. 2016;11(suppl1).

Practice Management: There’s an app for … end-of-life communications

Hospitalists wanting to help patients navigate end-of-life decisions or assist bereaved families in dealing with the death of a loved one have some new tools, according to The New York Times article, “Start-Ups for the End of Life.”

Thinkstock

Reference

1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.

Quality Improvement: How to create a high-value culture

Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.

“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”

Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.

Four factors emerged with strong reliability:

• Leadership and health system messaging.

• Data transparency and access.

• Comfort with cost conversations.

• Blame-free environment.

The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.

Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.

“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
 

Reference

Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.

Quick Byte: Cleaning robotic surgical instruments

Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.

Reference

1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.

Suzanne Bopp is a freelance writer in New Jersey.

Editor’s note: First published on The Hospital Leader blog under the title, “How I Realized QI Could Be a Dirty Word.”
 

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?”

Also on The Hospital Leader…

• THIS Is What Teamwork Looks Like, by Danielle Scheurer, MD, MSCR, SFHM
• The Medicaid Overhaul and How Hospitals and Their Providers Could Be Hardest Hit, by Brad Flansbaum, DO, MPH, MHM
• Count Me – and My Intuition – In, by Tracy Cardin, ACNP-BC, SFHM

Editor’s note: First published on The Hospital Leader blog under the title, “How I Realized QI Could Be a Dirty Word.”
 

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?”

Also on The Hospital Leader…

• THIS Is What Teamwork Looks Like, by Danielle Scheurer, MD, MSCR, SFHM
• The Medicaid Overhaul and How Hospitals and Their Providers Could Be Hardest Hit, by Brad Flansbaum, DO, MPH, MHM
• Count Me – and My Intuition – In, by Tracy Cardin, ACNP-BC, SFHM

Editor’s note: First published on The Hospital Leader blog under the title, “How I Realized QI Could Be a Dirty Word.”
 

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?”

Also on The Hospital Leader…

• THIS Is What Teamwork Looks Like, by Danielle Scheurer, MD, MSCR, SFHM
• The Medicaid Overhaul and How Hospitals and Their Providers Could Be Hardest Hit, by Brad Flansbaum, DO, MPH, MHM
• Count Me – and My Intuition – In, by Tracy Cardin, ACNP-BC, SFHM

It took my hospital medicine group (HMG) 20 years to implement a formal backup system. Of all the reasons we resisted creating a backup system, foremost was that we did not want to mandate additional work. Because our compensation model did not have a mechanism to financially reward hospitalists for unexpectedly having to come in on unscheduled work days (other than the work relative value units generated by seeing patients), there was not enough motivational energy to get a system started.

It turns out our group is not unlike many other HMGs across the nation. According to the 2016 State of Hospital Medicine report (SoHM), 58.3% of adult-only HMGs, 72.2% of pediatric-only HMGs, and 52.6% of HMGs serving both adults and children did not have staffing backup systems. Interestingly, the report also showed that for groups serving adults only, academic HMGs were more likely to have formal backup systems in place (62.6%, compared with 37.3% in nonacademic HMGs).

The reason most HMGs create backup systems is to have a consistent and fair approach for dealing with unanticipated absences and/or high-volume census. In addition to creating a safety net, implementing a backup system addresses the common problem of the same hospitalists disproportionately filling in during times of crisis.

Although our group created a formal backup system starting January 2015, it is not comprehensive and deals only with high patient volumes occurring during the late evening and night hours. Hospitalists rotate through a schedule, taking a week of backup call for which no additional compensation is offered. Then, if they are actually called to come in, an hourly stipend is paid in addition to work RVUs generated. Implementing a backup system was not necessarily a popular idea. Nevertheless, the system has successfully remained in place. Triggering the system infrequently, having a clear set of criteria for when to activate backup, and providing additional compensation for the additional work are key factors in our system’s success.

Dr. Stephan is a hospitalist at Abbott Northwestern Hospital in Minneapolis and a member of SHM’s Practice Analysis Committee.

It took my hospital medicine group (HMG) 20 years to implement a formal backup system. Of all the reasons we resisted creating a backup system, foremost was that we did not want to mandate additional work. Because our compensation model did not have a mechanism to financially reward hospitalists for unexpectedly having to come in on unscheduled work days (other than the work relative value units generated by seeing patients), there was not enough motivational energy to get a system started.

It turns out our group is not unlike many other HMGs across the nation. According to the 2016 State of Hospital Medicine report (SoHM), 58.3% of adult-only HMGs, 72.2% of pediatric-only HMGs, and 52.6% of HMGs serving both adults and children did not have staffing backup systems. Interestingly, the report also showed that for groups serving adults only, academic HMGs were more likely to have formal backup systems in place (62.6%, compared with 37.3% in nonacademic HMGs).

The reason most HMGs create backup systems is to have a consistent and fair approach for dealing with unanticipated absences and/or high-volume census. In addition to creating a safety net, implementing a backup system addresses the common problem of the same hospitalists disproportionately filling in during times of crisis.

Although our group created a formal backup system starting January 2015, it is not comprehensive and deals only with high patient volumes occurring during the late evening and night hours. Hospitalists rotate through a schedule, taking a week of backup call for which no additional compensation is offered. Then, if they are actually called to come in, an hourly stipend is paid in addition to work RVUs generated. Implementing a backup system was not necessarily a popular idea. Nevertheless, the system has successfully remained in place. Triggering the system infrequently, having a clear set of criteria for when to activate backup, and providing additional compensation for the additional work are key factors in our system’s success.

Dr. Stephan is a hospitalist at Abbott Northwestern Hospital in Minneapolis and a member of SHM’s Practice Analysis Committee.

It took my hospital medicine group (HMG) 20 years to implement a formal backup system. Of all the reasons we resisted creating a backup system, foremost was that we did not want to mandate additional work. Because our compensation model did not have a mechanism to financially reward hospitalists for unexpectedly having to come in on unscheduled work days (other than the work relative value units generated by seeing patients), there was not enough motivational energy to get a system started.

It turns out our group is not unlike many other HMGs across the nation. According to the 2016 State of Hospital Medicine report (SoHM), 58.3% of adult-only HMGs, 72.2% of pediatric-only HMGs, and 52.6% of HMGs serving both adults and children did not have staffing backup systems. Interestingly, the report also showed that for groups serving adults only, academic HMGs were more likely to have formal backup systems in place (62.6%, compared with 37.3% in nonacademic HMGs).

The reason most HMGs create backup systems is to have a consistent and fair approach for dealing with unanticipated absences and/or high-volume census. In addition to creating a safety net, implementing a backup system addresses the common problem of the same hospitalists disproportionately filling in during times of crisis.

Although our group created a formal backup system starting January 2015, it is not comprehensive and deals only with high patient volumes occurring during the late evening and night hours. Hospitalists rotate through a schedule, taking a week of backup call for which no additional compensation is offered. Then, if they are actually called to come in, an hourly stipend is paid in addition to work RVUs generated. Implementing a backup system was not necessarily a popular idea. Nevertheless, the system has successfully remained in place. Triggering the system infrequently, having a clear set of criteria for when to activate backup, and providing additional compensation for the additional work are key factors in our system’s success.

Dr. Stephan is a hospitalist at Abbott Northwestern Hospital in Minneapolis and a member of SHM’s Practice Analysis Committee.

Whether you’re a hospitalist who works only in a hospital, a hospitalist who works only in a post-acute care (PAC) setting, or a hospitalist who works in both types of facilities, knowing about current trends at PAC facilities and what the future may hold can help you excel in your current capacity and, ultimately, improve patient care.

The Hospitalist tapped experts in the post-acute space to tell us what they thought HM should know about working in PAC – which, in many ways, is quite different from the hospital setting. Here’s a compilation of their top eight must-knows.

1. PAC settings rely more on mid-level medical staff than hospitals do.

PAC facilities employ more mid-level providers, such as nurse practitioners and physician assistants, because they can support the level of medical complexity and decision making 95% of the time, says James D. Tollman, MD, FHM, president of Essex Inpatient Physicians in Boxford, Mass. Further, they are more heavily staffed by licensed practical nurses than are acute-care settings.

2. Testing takes longer, and options are limited.

Access to some acute urgent resources such as laboratory testing, imaging tests, and pharmacy products is more challenging at PAC facilities because most of these resources are not on-site. Consequently, there is a time lag between ordering tests and new medications and implementing these orders.

“If a patient needs something performed diagnostically immediately, they usually have to be transported to the emergency room or a facility with the necessary testing equipment,” Dr. Tollman says.

3. Patient populations mainly include rehab and terminally ill patients.

Patients are typically sent to a PAC facility either to recover from an illness or injury or because they are chronically ill and have exhausted treatment options. Regarding the latter, “They are mostly there for palliation; we don’t perform daily tests or prescribe aggressive medications on these patients,” Dr. Nazir says.

Dr. Cummings explains that PAC clinicians go through “the dying process with the patient.”

“They may or may not have assistance from hospice organizations,” she says, “and when they don’t, [hospitalists] take on the role of palliative-care providers.”

Dr. Cummings has seen an increase in psychiatric patients entering PAC facilities.

“Many patients with chronic psychological problems are aging, and there are fewer inpatient psychiatric beds available to those with concurrent medical and psychiatric problems,” she says. Much of this work is now being done in PAC settings.

4. You can build a relationship with your patient.

Because the pace of a PAC facility is slower and a patient typically stays in a PAC facility longer than at a hospital, there’s time for a hospitalist to have more in-depth conversations with patients and their families.

“Building a deeper relationship with a patient may give the hospitalist an opportunity to discover the cause of an acute problem,” Dr. Nazir says. “They can go in-depth into the psychosocial aspect of medicine and may be able to find out what led to the initial problem and the real root cause, which can help prevent future recurrences, such as repeat falls or forgetting to take a medication.”
 

5. Using EHRs can improve transitions.

Care transitions between a hospital and PAC facility can be compromised by a lack of information sharing, and they can affect the quality and safety of patient care, says Dori Cross, a doctoral candidate in health services organization and policy at the University of Michigan School of Public Health in Ann Arbor. Handoffs between providers require information continuity – information that is complete, timely, and in a usable format – to ensure appropriate medical decisions and to provide high-quality care during and after transition.

Electronic health records (EHRs) as well as health information exchanges (HIEs) allow providers to communicate and share patient information. For example, hospitals can send information electronically to PAC facilities (“push” exchange) or make information available online securely for PAC providers to log in and access (“pull” exchange). According to a 2014 survey data by the American Hospital Association, more than 50% of hospitals report sending structured summary-of-care records electronically to long-term care settings; a little less than half of those hospitals (23% of the total sample of hospitals) were also receiving information electronically from long-term care sites.¹

“This bidirectional exchange, in particular, can make it easier to share information across provider organizations electronically and, in turn, improve care delivery,” says Ms. Cross, who authored an accepted paper on the subject in the Journal of Post-Acute and Long-Term Medicine.

6. Hospitalists can work with providers in PAC settings to improve transitions.

Despite improvements in the electronic transfer of medical information, gaps still exist and can cause problems. One chasm when discharging patients to a PAC facility, is when a hospital IT system is incapable of communicating with the PAC facility system. In this instance, Dr. Nazir says, the hospitalist “can help bridge the gap.”

“[We] can verbally relay relevant information to physicians at PAC facilities so they understand the patient’s status, needs, and expectations,” he says. “Furthermore, hospitalists and a PAC facility’s administration can brainstorm methods to improve the systems of care so the patient receives more effective and timely care.”
 

7. Hospitalists switching to the PAC setting should have formal training.

The two main obstacles for hospitalists who change from working in a hospital to a PAC facility are the lack of exposure to PAC work in training and the assumption that it requires the same skills sets of a typical hospitalist, according to Manoj K. Mathew, MD, SFHM, national medical director of Los Angeles–based Agilon Health. The PAC setting has quite a number of differences compared with a hospital setting. For example, some regulations apply specifically to PAC facilities. In addition to formal training, hospitalists can benefit from using SHM’s Post-Acute Care Transitions Toolkit, having a mentor, or using resources from other organizations that function in this space such as The Society for Post-Acute and Long-Term Care Medicine, Dr. Nazir says.

Dr. Manoj K. Mathew

8. A variety of payors and payment models are in play.

Commercial insurers continue to be major payors for PAC, especially for individuals younger than 65 years. Medicare and Medicaid, administered by the Centers for Medicare & Medicaid Services, are the primary payors for patients aged 65 years and older.

Reference

Cross DA, Adler-Milstein J. Investing in post-acute care transitions: electronic information exchange between hospitals and long-term care facilities [published online ahead of print Sept. 14, 2016]. JAMDA. doi: http://dx.doi.org/10.1016/j.jamda.2016.07.024.

Whether you’re a hospitalist who works only in a hospital, a hospitalist who works only in a post-acute care (PAC) setting, or a hospitalist who works in both types of facilities, knowing about current trends at PAC facilities and what the future may hold can help you excel in your current capacity and, ultimately, improve patient care.

The Hospitalist tapped experts in the post-acute space to tell us what they thought HM should know about working in PAC – which, in many ways, is quite different from the hospital setting. Here’s a compilation of their top eight must-knows.

1. PAC settings rely more on mid-level medical staff than hospitals do.

PAC facilities employ more mid-level providers, such as nurse practitioners and physician assistants, because they can support the level of medical complexity and decision making 95% of the time, says James D. Tollman, MD, FHM, president of Essex Inpatient Physicians in Boxford, Mass. Further, they are more heavily staffed by licensed practical nurses than are acute-care settings.

2. Testing takes longer, and options are limited.

Access to some acute urgent resources such as laboratory testing, imaging tests, and pharmacy products is more challenging at PAC facilities because most of these resources are not on-site. Consequently, there is a time lag between ordering tests and new medications and implementing these orders.

“If a patient needs something performed diagnostically immediately, they usually have to be transported to the emergency room or a facility with the necessary testing equipment,” Dr. Tollman says.

3. Patient populations mainly include rehab and terminally ill patients.

Patients are typically sent to a PAC facility either to recover from an illness or injury or because they are chronically ill and have exhausted treatment options. Regarding the latter, “They are mostly there for palliation; we don’t perform daily tests or prescribe aggressive medications on these patients,” Dr. Nazir says.

Dr. Cummings explains that PAC clinicians go through “the dying process with the patient.”

“They may or may not have assistance from hospice organizations,” she says, “and when they don’t, [hospitalists] take on the role of palliative-care providers.”

Dr. Cummings has seen an increase in psychiatric patients entering PAC facilities.

“Many patients with chronic psychological problems are aging, and there are fewer inpatient psychiatric beds available to those with concurrent medical and psychiatric problems,” she says. Much of this work is now being done in PAC settings.

4. You can build a relationship with your patient.

Because the pace of a PAC facility is slower and a patient typically stays in a PAC facility longer than at a hospital, there’s time for a hospitalist to have more in-depth conversations with patients and their families.

“Building a deeper relationship with a patient may give the hospitalist an opportunity to discover the cause of an acute problem,” Dr. Nazir says. “They can go in-depth into the psychosocial aspect of medicine and may be able to find out what led to the initial problem and the real root cause, which can help prevent future recurrences, such as repeat falls or forgetting to take a medication.”
 

5. Using EHRs can improve transitions.

Care transitions between a hospital and PAC facility can be compromised by a lack of information sharing, and they can affect the quality and safety of patient care, says Dori Cross, a doctoral candidate in health services organization and policy at the University of Michigan School of Public Health in Ann Arbor. Handoffs between providers require information continuity – information that is complete, timely, and in a usable format – to ensure appropriate medical decisions and to provide high-quality care during and after transition.

Electronic health records (EHRs) as well as health information exchanges (HIEs) allow providers to communicate and share patient information. For example, hospitals can send information electronically to PAC facilities (“push” exchange) or make information available online securely for PAC providers to log in and access (“pull” exchange). According to a 2014 survey data by the American Hospital Association, more than 50% of hospitals report sending structured summary-of-care records electronically to long-term care settings; a little less than half of those hospitals (23% of the total sample of hospitals) were also receiving information electronically from long-term care sites.¹

“This bidirectional exchange, in particular, can make it easier to share information across provider organizations electronically and, in turn, improve care delivery,” says Ms. Cross, who authored an accepted paper on the subject in the Journal of Post-Acute and Long-Term Medicine.

6. Hospitalists can work with providers in PAC settings to improve transitions.

Despite improvements in the electronic transfer of medical information, gaps still exist and can cause problems. One chasm when discharging patients to a PAC facility, is when a hospital IT system is incapable of communicating with the PAC facility system. In this instance, Dr. Nazir says, the hospitalist “can help bridge the gap.”

“[We] can verbally relay relevant information to physicians at PAC facilities so they understand the patient’s status, needs, and expectations,” he says. “Furthermore, hospitalists and a PAC facility’s administration can brainstorm methods to improve the systems of care so the patient receives more effective and timely care.”
 

7. Hospitalists switching to the PAC setting should have formal training.

The two main obstacles for hospitalists who change from working in a hospital to a PAC facility are the lack of exposure to PAC work in training and the assumption that it requires the same skills sets of a typical hospitalist, according to Manoj K. Mathew, MD, SFHM, national medical director of Los Angeles–based Agilon Health. The PAC setting has quite a number of differences compared with a hospital setting. For example, some regulations apply specifically to PAC facilities. In addition to formal training, hospitalists can benefit from using SHM’s Post-Acute Care Transitions Toolkit, having a mentor, or using resources from other organizations that function in this space such as The Society for Post-Acute and Long-Term Care Medicine, Dr. Nazir says.

Dr. Manoj K. Mathew

8. A variety of payors and payment models are in play.

Commercial insurers continue to be major payors for PAC, especially for individuals younger than 65 years. Medicare and Medicaid, administered by the Centers for Medicare & Medicaid Services, are the primary payors for patients aged 65 years and older.

Reference

Cross DA, Adler-Milstein J. Investing in post-acute care transitions: electronic information exchange between hospitals and long-term care facilities [published online ahead of print Sept. 14, 2016]. JAMDA. doi: http://dx.doi.org/10.1016/j.jamda.2016.07.024.

Whether you’re a hospitalist who works only in a hospital, a hospitalist who works only in a post-acute care (PAC) setting, or a hospitalist who works in both types of facilities, knowing about current trends at PAC facilities and what the future may hold can help you excel in your current capacity and, ultimately, improve patient care.

The Hospitalist tapped experts in the post-acute space to tell us what they thought HM should know about working in PAC – which, in many ways, is quite different from the hospital setting. Here’s a compilation of their top eight must-knows.

1. PAC settings rely more on mid-level medical staff than hospitals do.

PAC facilities employ more mid-level providers, such as nurse practitioners and physician assistants, because they can support the level of medical complexity and decision making 95% of the time, says James D. Tollman, MD, FHM, president of Essex Inpatient Physicians in Boxford, Mass. Further, they are more heavily staffed by licensed practical nurses than are acute-care settings.

2. Testing takes longer, and options are limited.

Access to some acute urgent resources such as laboratory testing, imaging tests, and pharmacy products is more challenging at PAC facilities because most of these resources are not on-site. Consequently, there is a time lag between ordering tests and new medications and implementing these orders.

“If a patient needs something performed diagnostically immediately, they usually have to be transported to the emergency room or a facility with the necessary testing equipment,” Dr. Tollman says.

3. Patient populations mainly include rehab and terminally ill patients.

Patients are typically sent to a PAC facility either to recover from an illness or injury or because they are chronically ill and have exhausted treatment options. Regarding the latter, “They are mostly there for palliation; we don’t perform daily tests or prescribe aggressive medications on these patients,” Dr. Nazir says.

Dr. Cummings explains that PAC clinicians go through “the dying process with the patient.”

“They may or may not have assistance from hospice organizations,” she says, “and when they don’t, [hospitalists] take on the role of palliative-care providers.”

Dr. Cummings has seen an increase in psychiatric patients entering PAC facilities.

“Many patients with chronic psychological problems are aging, and there are fewer inpatient psychiatric beds available to those with concurrent medical and psychiatric problems,” she says. Much of this work is now being done in PAC settings.

4. You can build a relationship with your patient.

Because the pace of a PAC facility is slower and a patient typically stays in a PAC facility longer than at a hospital, there’s time for a hospitalist to have more in-depth conversations with patients and their families.

“Building a deeper relationship with a patient may give the hospitalist an opportunity to discover the cause of an acute problem,” Dr. Nazir says. “They can go in-depth into the psychosocial aspect of medicine and may be able to find out what led to the initial problem and the real root cause, which can help prevent future recurrences, such as repeat falls or forgetting to take a medication.”
 

5. Using EHRs can improve transitions.

Care transitions between a hospital and PAC facility can be compromised by a lack of information sharing, and they can affect the quality and safety of patient care, says Dori Cross, a doctoral candidate in health services organization and policy at the University of Michigan School of Public Health in Ann Arbor. Handoffs between providers require information continuity – information that is complete, timely, and in a usable format – to ensure appropriate medical decisions and to provide high-quality care during and after transition.

Electronic health records (EHRs) as well as health information exchanges (HIEs) allow providers to communicate and share patient information. For example, hospitals can send information electronically to PAC facilities (“push” exchange) or make information available online securely for PAC providers to log in and access (“pull” exchange). According to a 2014 survey data by the American Hospital Association, more than 50% of hospitals report sending structured summary-of-care records electronically to long-term care settings; a little less than half of those hospitals (23% of the total sample of hospitals) were also receiving information electronically from long-term care sites.¹

“This bidirectional exchange, in particular, can make it easier to share information across provider organizations electronically and, in turn, improve care delivery,” says Ms. Cross, who authored an accepted paper on the subject in the Journal of Post-Acute and Long-Term Medicine.

6. Hospitalists can work with providers in PAC settings to improve transitions.

Despite improvements in the electronic transfer of medical information, gaps still exist and can cause problems. One chasm when discharging patients to a PAC facility, is when a hospital IT system is incapable of communicating with the PAC facility system. In this instance, Dr. Nazir says, the hospitalist “can help bridge the gap.”

“[We] can verbally relay relevant information to physicians at PAC facilities so they understand the patient’s status, needs, and expectations,” he says. “Furthermore, hospitalists and a PAC facility’s administration can brainstorm methods to improve the systems of care so the patient receives more effective and timely care.”
 

7. Hospitalists switching to the PAC setting should have formal training.

The two main obstacles for hospitalists who change from working in a hospital to a PAC facility are the lack of exposure to PAC work in training and the assumption that it requires the same skills sets of a typical hospitalist, according to Manoj K. Mathew, MD, SFHM, national medical director of Los Angeles–based Agilon Health. The PAC setting has quite a number of differences compared with a hospital setting. For example, some regulations apply specifically to PAC facilities. In addition to formal training, hospitalists can benefit from using SHM’s Post-Acute Care Transitions Toolkit, having a mentor, or using resources from other organizations that function in this space such as The Society for Post-Acute and Long-Term Care Medicine, Dr. Nazir says.

Dr. Manoj K. Mathew

8. A variety of payors and payment models are in play.

Commercial insurers continue to be major payors for PAC, especially for individuals younger than 65 years. Medicare and Medicaid, administered by the Centers for Medicare & Medicaid Services, are the primary payors for patients aged 65 years and older.

Reference

Cross DA, Adler-Milstein J. Investing in post-acute care transitions: electronic information exchange between hospitals and long-term care facilities [published online ahead of print Sept. 14, 2016]. JAMDA. doi: http://dx.doi.org/10.1016/j.jamda.2016.07.024.

Week in, week out for the past 25 years, I have had a front-row seat to the medical practice of a certain female physician: my wife, Heather. We met when we worked together on the wards during residency in 1991; spent a year in rural Montana working together in clinics, ERs, and hospitals; shared the care of one another’s patients as our practices grew in parallel – hers in skilled nursing facilities, mine in the hospital; and reunited in recent years to work together as part of the same practice.

She spends more time considering her approach to a challenging case.

She has less urgency in deciding on a definitive course of action and more patience in sorting things out before proceeding with a diagnostic and therapeutic plan. She is more likely to leave open the possibility of changing her mind; she has less of a tendency to anchor on a particular diagnosis and treatment. Put another way, she is more willing to continue with ambiguous findings without lateralizing to one particular approach.

She brings more work-life balance to her professional responsibilities.

Despite being highly productive at work (and at home), she has worked less than full time throughout her career. This means that, during any given patient encounter, she is more likely to be unburdened by overwork and its negative consequences. It is my sense that many full-time physicians would be happier (and more effective) if they simply worked less. Heather has had the self-knowledge to take on a more manageable workload; the result is that she has remained joyous in practice for more than two decades.

She is less dogmatic and more willing to customize care based on the needs of the individual patient.

Although a good fund of knowledge is essential, if such knowledge obscures the physician’s ability to read the patient, then it is best abandoned, at least temporarily. Heather refers to the body of scientific evidence frequently, but she reserves an equal or greater portion of her cognitive bandwidth for the patient she is caring for at a particular moment.

How might the observations of this case study help to derive meaning from the study by Dr. Tsugawa and his associates, so that all patients may benefit from whatever it is that female physicians do to achieve better outcomes?

First, if physicians – regardless of gender – simply have an awareness of anchoring bias or rushing to land on a diagnosis or treatment, they will be less likely to do so in the future.

Next, we can learn that avoiding overwork can make for more joy in work, and if this is so, our patients may fare better. When I say “avoiding overwork,” that might mean rethinking our assumptions underlying the amount of work we take on.

Finally, while amassing a large fund of knowledge is a good thing, balancing medical knowledge with knowledge of the individual patient is crucial to good medical practice.
 

Dr. Whitcomb is Chief Medical Officer at Remedy Partners in Darien, CT. He is a cofounder and past president of SHM. Email him at [email protected].

Week in, week out for the past 25 years, I have had a front-row seat to the medical practice of a certain female physician: my wife, Heather. We met when we worked together on the wards during residency in 1991; spent a year in rural Montana working together in clinics, ERs, and hospitals; shared the care of one another’s patients as our practices grew in parallel – hers in skilled nursing facilities, mine in the hospital; and reunited in recent years to work together as part of the same practice.

She spends more time considering her approach to a challenging case.

She has less urgency in deciding on a definitive course of action and more patience in sorting things out before proceeding with a diagnostic and therapeutic plan. She is more likely to leave open the possibility of changing her mind; she has less of a tendency to anchor on a particular diagnosis and treatment. Put another way, she is more willing to continue with ambiguous findings without lateralizing to one particular approach.

She brings more work-life balance to her professional responsibilities.

Despite being highly productive at work (and at home), she has worked less than full time throughout her career. This means that, during any given patient encounter, she is more likely to be unburdened by overwork and its negative consequences. It is my sense that many full-time physicians would be happier (and more effective) if they simply worked less. Heather has had the self-knowledge to take on a more manageable workload; the result is that she has remained joyous in practice for more than two decades.

She is less dogmatic and more willing to customize care based on the needs of the individual patient.

Although a good fund of knowledge is essential, if such knowledge obscures the physician’s ability to read the patient, then it is best abandoned, at least temporarily. Heather refers to the body of scientific evidence frequently, but she reserves an equal or greater portion of her cognitive bandwidth for the patient she is caring for at a particular moment.

How might the observations of this case study help to derive meaning from the study by Dr. Tsugawa and his associates, so that all patients may benefit from whatever it is that female physicians do to achieve better outcomes?

First, if physicians – regardless of gender – simply have an awareness of anchoring bias or rushing to land on a diagnosis or treatment, they will be less likely to do so in the future.

Next, we can learn that avoiding overwork can make for more joy in work, and if this is so, our patients may fare better. When I say “avoiding overwork,” that might mean rethinking our assumptions underlying the amount of work we take on.

Finally, while amassing a large fund of knowledge is a good thing, balancing medical knowledge with knowledge of the individual patient is crucial to good medical practice.
 

Dr. Whitcomb is Chief Medical Officer at Remedy Partners in Darien, CT. He is a cofounder and past president of SHM. Email him at [email protected].

Week in, week out for the past 25 years, I have had a front-row seat to the medical practice of a certain female physician: my wife, Heather. We met when we worked together on the wards during residency in 1991; spent a year in rural Montana working together in clinics, ERs, and hospitals; shared the care of one another’s patients as our practices grew in parallel – hers in skilled nursing facilities, mine in the hospital; and reunited in recent years to work together as part of the same practice.

She spends more time considering her approach to a challenging case.

She has less urgency in deciding on a definitive course of action and more patience in sorting things out before proceeding with a diagnostic and therapeutic plan. She is more likely to leave open the possibility of changing her mind; she has less of a tendency to anchor on a particular diagnosis and treatment. Put another way, she is more willing to continue with ambiguous findings without lateralizing to one particular approach.

She brings more work-life balance to her professional responsibilities.

Despite being highly productive at work (and at home), she has worked less than full time throughout her career. This means that, during any given patient encounter, she is more likely to be unburdened by overwork and its negative consequences. It is my sense that many full-time physicians would be happier (and more effective) if they simply worked less. Heather has had the self-knowledge to take on a more manageable workload; the result is that she has remained joyous in practice for more than two decades.

She is less dogmatic and more willing to customize care based on the needs of the individual patient.

Although a good fund of knowledge is essential, if such knowledge obscures the physician’s ability to read the patient, then it is best abandoned, at least temporarily. Heather refers to the body of scientific evidence frequently, but she reserves an equal or greater portion of her cognitive bandwidth for the patient she is caring for at a particular moment.

How might the observations of this case study help to derive meaning from the study by Dr. Tsugawa and his associates, so that all patients may benefit from whatever it is that female physicians do to achieve better outcomes?

First, if physicians – regardless of gender – simply have an awareness of anchoring bias or rushing to land on a diagnosis or treatment, they will be less likely to do so in the future.

Next, we can learn that avoiding overwork can make for more joy in work, and if this is so, our patients may fare better. When I say “avoiding overwork,” that might mean rethinking our assumptions underlying the amount of work we take on.

Finally, while amassing a large fund of knowledge is a good thing, balancing medical knowledge with knowledge of the individual patient is crucial to good medical practice.
 

Dr. Whitcomb is Chief Medical Officer at Remedy Partners in Darien, CT. He is a cofounder and past president of SHM. Email him at [email protected].