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Hospitalist movers and shakers – Jan. 2018
Michael Rader, MD, has been named the chief medical officer of the Department of Veterans Affairs New York/New Jersey Health Care Network. The network serves upward of a half-million veterans in 76 counties in New York, New Jersey, and Pennsylvania. Dr. Rader’s appointment began on Oct. 15, 2017.
Previously, Dr. Rader was chief medical officer at Prospect East Orange (N.J.) General. In his new position, the 35-year veteran will be charged with overseeing care at VA facilities in Albany Stratton, Bath, Canandaigua, and Syracuse in New York, as well as the VA Western New York Health System, the New York Harbor Health System, the New Jersey Health Care System, Hudson Valley Healthcare System, the James J. Peters and Northport VA Medical Centers, as well as 66 community-based outpatient clinics.
The Rhode Island Medical Society has elected Bradley Collins, MD, as its new president. An internist and hospitalist, Dr. Collins practices at Miriam Hospital in Providence, R.I., where he started in 2006 as a staff hospitalist. He’s now the medical director of appeals for Lifespan at Miriam.
Dr. Collins is an assistant professor of clinical medicine at Brown University’s Alpert Medical School, while also serving as a fellow for the Society of Hospital Medicine.
Tracy Cardin, ACNP, SFHM, has been named associate director of clinical integration at Adfinitas Health, a private hospitalist company based in Maryland that serves more than 50 hospitals and post-acute care centers across the Mid-Atlantic region. Cardin is responsible for advancing the company’s training and onboarding infrastructure to support the full integration of physicians, nurse practitioners, and physician assistants into the Adfinitas care delivery model.
Jeffrey Millard, MD, has been named Patient Experience Provider of the Year by the employees and staff at Hardin Memorial Health (Elizabethtown, Ky.). Dr. Millard has been a hospitalist at Hardin Memorial Hospital since 2012.
The Patient Experience Provider of the Year award recognizes a provider who exceeds the company’s mission and vision with patients and their families, as well as with the hospital’s staff. Dr. Millard was chosen from a list of more than 800 nominations.
Benjamin Keidan, MD, has been appointed as chief medical officer for Boulder (Colo.) Community Health. Dr. Keidan advances from his previous role as medical director of quality and population health for outpatient primary care and specialty clinics.
Dr. Keidan is a former internist and hospitalist for BCH and has worked in Boulder County for the past 12 years. He is only the second CMO in BCH’s history.
Dinesh Bande, MD, has been selected as the new chair of the department of internal medicine at the University of North Dakota, Grand Forks. Dr. Bande is a clinical associate professor at the school and a hospitalist with Sanford Health.
Dr. Bande has been the clerkship director for third-year medical students at UND for the past 2 years. As chair of internal medicine, he will oversee education, research, clinical care, training, and service programs within the department.
Vicki Iannotti, MD, has been named chief medical officer at the Elizabeth Ann Seton Pediatric Center in Yonkers, N.Y. Dr. Iannotti joins Seton after spending 12 years as associate chief of pediatrics and pediatric hospital medicine at Maria Fareri Children’s Hospital in Valhalla, N.Y.
At Seton, Dr. Iannotti will oversee 100 medical professionals at the 201,000-square-foot facility, which is the largest provider of children’s acute care in the United States.
Business moves
Management Service Organization Continuum Health (Marlton, N.J.) has signed an agreement with the Mid-Atlantic region’s largest private hospitalist group, Adfinitas Health (Hanover, Md.), to be its revenue management cycle partner. Founded in 1999, Continuum Health now serves more than 1,500 providers in more than 400 locations.
Colquitt Regional Medical Center in Moultrie, Ga., has expanded its hospitalist program, adding 5 physicians to increase its total to 10 on-staff hospitalists. Colquitt Regional’s program began in 2012 with four hospitalists.
In the past, Colquitt Regional has shared hospitalists with surrounding hospitals to meet the demand for care. With the addition of the five new physicians, the hospital can provide full-time hospital medicine care with physicians employed by Colquitt Regional.
Michael Rader, MD, has been named the chief medical officer of the Department of Veterans Affairs New York/New Jersey Health Care Network. The network serves upward of a half-million veterans in 76 counties in New York, New Jersey, and Pennsylvania. Dr. Rader’s appointment began on Oct. 15, 2017.
Previously, Dr. Rader was chief medical officer at Prospect East Orange (N.J.) General. In his new position, the 35-year veteran will be charged with overseeing care at VA facilities in Albany Stratton, Bath, Canandaigua, and Syracuse in New York, as well as the VA Western New York Health System, the New York Harbor Health System, the New Jersey Health Care System, Hudson Valley Healthcare System, the James J. Peters and Northport VA Medical Centers, as well as 66 community-based outpatient clinics.
The Rhode Island Medical Society has elected Bradley Collins, MD, as its new president. An internist and hospitalist, Dr. Collins practices at Miriam Hospital in Providence, R.I., where he started in 2006 as a staff hospitalist. He’s now the medical director of appeals for Lifespan at Miriam.
Dr. Collins is an assistant professor of clinical medicine at Brown University’s Alpert Medical School, while also serving as a fellow for the Society of Hospital Medicine.
Tracy Cardin, ACNP, SFHM, has been named associate director of clinical integration at Adfinitas Health, a private hospitalist company based in Maryland that serves more than 50 hospitals and post-acute care centers across the Mid-Atlantic region. Cardin is responsible for advancing the company’s training and onboarding infrastructure to support the full integration of physicians, nurse practitioners, and physician assistants into the Adfinitas care delivery model.
Jeffrey Millard, MD, has been named Patient Experience Provider of the Year by the employees and staff at Hardin Memorial Health (Elizabethtown, Ky.). Dr. Millard has been a hospitalist at Hardin Memorial Hospital since 2012.
The Patient Experience Provider of the Year award recognizes a provider who exceeds the company’s mission and vision with patients and their families, as well as with the hospital’s staff. Dr. Millard was chosen from a list of more than 800 nominations.
Benjamin Keidan, MD, has been appointed as chief medical officer for Boulder (Colo.) Community Health. Dr. Keidan advances from his previous role as medical director of quality and population health for outpatient primary care and specialty clinics.
Dr. Keidan is a former internist and hospitalist for BCH and has worked in Boulder County for the past 12 years. He is only the second CMO in BCH’s history.
Dinesh Bande, MD, has been selected as the new chair of the department of internal medicine at the University of North Dakota, Grand Forks. Dr. Bande is a clinical associate professor at the school and a hospitalist with Sanford Health.
Dr. Bande has been the clerkship director for third-year medical students at UND for the past 2 years. As chair of internal medicine, he will oversee education, research, clinical care, training, and service programs within the department.
Vicki Iannotti, MD, has been named chief medical officer at the Elizabeth Ann Seton Pediatric Center in Yonkers, N.Y. Dr. Iannotti joins Seton after spending 12 years as associate chief of pediatrics and pediatric hospital medicine at Maria Fareri Children’s Hospital in Valhalla, N.Y.
At Seton, Dr. Iannotti will oversee 100 medical professionals at the 201,000-square-foot facility, which is the largest provider of children’s acute care in the United States.
Business moves
Management Service Organization Continuum Health (Marlton, N.J.) has signed an agreement with the Mid-Atlantic region’s largest private hospitalist group, Adfinitas Health (Hanover, Md.), to be its revenue management cycle partner. Founded in 1999, Continuum Health now serves more than 1,500 providers in more than 400 locations.
Colquitt Regional Medical Center in Moultrie, Ga., has expanded its hospitalist program, adding 5 physicians to increase its total to 10 on-staff hospitalists. Colquitt Regional’s program began in 2012 with four hospitalists.
In the past, Colquitt Regional has shared hospitalists with surrounding hospitals to meet the demand for care. With the addition of the five new physicians, the hospital can provide full-time hospital medicine care with physicians employed by Colquitt Regional.
Michael Rader, MD, has been named the chief medical officer of the Department of Veterans Affairs New York/New Jersey Health Care Network. The network serves upward of a half-million veterans in 76 counties in New York, New Jersey, and Pennsylvania. Dr. Rader’s appointment began on Oct. 15, 2017.
Previously, Dr. Rader was chief medical officer at Prospect East Orange (N.J.) General. In his new position, the 35-year veteran will be charged with overseeing care at VA facilities in Albany Stratton, Bath, Canandaigua, and Syracuse in New York, as well as the VA Western New York Health System, the New York Harbor Health System, the New Jersey Health Care System, Hudson Valley Healthcare System, the James J. Peters and Northport VA Medical Centers, as well as 66 community-based outpatient clinics.
The Rhode Island Medical Society has elected Bradley Collins, MD, as its new president. An internist and hospitalist, Dr. Collins practices at Miriam Hospital in Providence, R.I., where he started in 2006 as a staff hospitalist. He’s now the medical director of appeals for Lifespan at Miriam.
Dr. Collins is an assistant professor of clinical medicine at Brown University’s Alpert Medical School, while also serving as a fellow for the Society of Hospital Medicine.
Tracy Cardin, ACNP, SFHM, has been named associate director of clinical integration at Adfinitas Health, a private hospitalist company based in Maryland that serves more than 50 hospitals and post-acute care centers across the Mid-Atlantic region. Cardin is responsible for advancing the company’s training and onboarding infrastructure to support the full integration of physicians, nurse practitioners, and physician assistants into the Adfinitas care delivery model.
Jeffrey Millard, MD, has been named Patient Experience Provider of the Year by the employees and staff at Hardin Memorial Health (Elizabethtown, Ky.). Dr. Millard has been a hospitalist at Hardin Memorial Hospital since 2012.
The Patient Experience Provider of the Year award recognizes a provider who exceeds the company’s mission and vision with patients and their families, as well as with the hospital’s staff. Dr. Millard was chosen from a list of more than 800 nominations.
Benjamin Keidan, MD, has been appointed as chief medical officer for Boulder (Colo.) Community Health. Dr. Keidan advances from his previous role as medical director of quality and population health for outpatient primary care and specialty clinics.
Dr. Keidan is a former internist and hospitalist for BCH and has worked in Boulder County for the past 12 years. He is only the second CMO in BCH’s history.
Dinesh Bande, MD, has been selected as the new chair of the department of internal medicine at the University of North Dakota, Grand Forks. Dr. Bande is a clinical associate professor at the school and a hospitalist with Sanford Health.
Dr. Bande has been the clerkship director for third-year medical students at UND for the past 2 years. As chair of internal medicine, he will oversee education, research, clinical care, training, and service programs within the department.
Vicki Iannotti, MD, has been named chief medical officer at the Elizabeth Ann Seton Pediatric Center in Yonkers, N.Y. Dr. Iannotti joins Seton after spending 12 years as associate chief of pediatrics and pediatric hospital medicine at Maria Fareri Children’s Hospital in Valhalla, N.Y.
At Seton, Dr. Iannotti will oversee 100 medical professionals at the 201,000-square-foot facility, which is the largest provider of children’s acute care in the United States.
Business moves
Management Service Organization Continuum Health (Marlton, N.J.) has signed an agreement with the Mid-Atlantic region’s largest private hospitalist group, Adfinitas Health (Hanover, Md.), to be its revenue management cycle partner. Founded in 1999, Continuum Health now serves more than 1,500 providers in more than 400 locations.
Colquitt Regional Medical Center in Moultrie, Ga., has expanded its hospitalist program, adding 5 physicians to increase its total to 10 on-staff hospitalists. Colquitt Regional’s program began in 2012 with four hospitalists.
In the past, Colquitt Regional has shared hospitalists with surrounding hospitals to meet the demand for care. With the addition of the five new physicians, the hospital can provide full-time hospital medicine care with physicians employed by Colquitt Regional.
Sneak Peek: The Hospital Leader blog – Dec. 2017
Cultivating women leaders in health care #WIMmonth #ThisIsWhatADoctorLooksLike
On my flight home from Scotland, I had a moment to watch a movie while my daughter was caught up in the encore adventures of Moana. I stumbled upon “Hidden Figures,” the story of the African American women at NASA who helped launch John Glenn into space, reviving the nation’s space program.
Turns out I wasn’t the only one who stumbled upon this. Harvard researcher Julie Silver, MD, raised the question about invisible women leaders when reviewing quotes in magazines like Modern Healthcare or Forbes. Moreover, her research demonstrates that, for many professional society awards, 0% are given to women! This is happening in specialties that had nearly even proportions of women and men in practice, such as dermatology and rehab medicine. Last month, I was dumbfounded when I saw a full-page New York Times ad of Top Surgeons by Castle Connolly featuring 16 surgeons, all male.
While Castle Connolly does name female top doctors and market ad opportunities to women and men, I learned that only men sign up for the ads. While this raises more questions, the optics remain problematic – women doctors are hidden. Regardless of the venue, we must do a better job profiling our female leaders. In addition, it is important to recognize that female leaders face well-documented and somewhat controversial challenges that require careful thought:
- Stereotype threat: Some of the original research on stereotype threat done in college students showed that, if women who are about to take a math test are told that the test will expose gender differences, such as men do better at math, women will perform worse AND men will do better. The threat of stereotypes is that women can internalize them and this may hamper their progress. The good news is that education on stereotype threat apparently helps.
- Impostor syndrome: Even highly successful people apparently suffer from impostor syndrome, the fear that they do not deserve their success, but it is much worse in women than in men. You are always trying to conquer the little voice in your head that tells you that you are not good enough.
Read the full post at hospitalleader.org.
Also on The Hospital Leader …
- If I were you, I would not be bullish on long-term care by Brad Flansbaum, DO, MPH, MHM
- Da Vinci wuz here by Jordan Messler, MD, SFHM
- Making the implicit explicit by Leslie Flores, MHA, SFHM
- Should we really focus on “patient-centered care”? by Tracy Cardin, ACNP-BC, SFHM
Cultivating women leaders in health care #WIMmonth #ThisIsWhatADoctorLooksLike
On my flight home from Scotland, I had a moment to watch a movie while my daughter was caught up in the encore adventures of Moana. I stumbled upon “Hidden Figures,” the story of the African American women at NASA who helped launch John Glenn into space, reviving the nation’s space program.
Turns out I wasn’t the only one who stumbled upon this. Harvard researcher Julie Silver, MD, raised the question about invisible women leaders when reviewing quotes in magazines like Modern Healthcare or Forbes. Moreover, her research demonstrates that, for many professional society awards, 0% are given to women! This is happening in specialties that had nearly even proportions of women and men in practice, such as dermatology and rehab medicine. Last month, I was dumbfounded when I saw a full-page New York Times ad of Top Surgeons by Castle Connolly featuring 16 surgeons, all male.
While Castle Connolly does name female top doctors and market ad opportunities to women and men, I learned that only men sign up for the ads. While this raises more questions, the optics remain problematic – women doctors are hidden. Regardless of the venue, we must do a better job profiling our female leaders. In addition, it is important to recognize that female leaders face well-documented and somewhat controversial challenges that require careful thought:
- Stereotype threat: Some of the original research on stereotype threat done in college students showed that, if women who are about to take a math test are told that the test will expose gender differences, such as men do better at math, women will perform worse AND men will do better. The threat of stereotypes is that women can internalize them and this may hamper their progress. The good news is that education on stereotype threat apparently helps.
- Impostor syndrome: Even highly successful people apparently suffer from impostor syndrome, the fear that they do not deserve their success, but it is much worse in women than in men. You are always trying to conquer the little voice in your head that tells you that you are not good enough.
Read the full post at hospitalleader.org.
Also on The Hospital Leader …
- If I were you, I would not be bullish on long-term care by Brad Flansbaum, DO, MPH, MHM
- Da Vinci wuz here by Jordan Messler, MD, SFHM
- Making the implicit explicit by Leslie Flores, MHA, SFHM
- Should we really focus on “patient-centered care”? by Tracy Cardin, ACNP-BC, SFHM
Cultivating women leaders in health care #WIMmonth #ThisIsWhatADoctorLooksLike
On my flight home from Scotland, I had a moment to watch a movie while my daughter was caught up in the encore adventures of Moana. I stumbled upon “Hidden Figures,” the story of the African American women at NASA who helped launch John Glenn into space, reviving the nation’s space program.
Turns out I wasn’t the only one who stumbled upon this. Harvard researcher Julie Silver, MD, raised the question about invisible women leaders when reviewing quotes in magazines like Modern Healthcare or Forbes. Moreover, her research demonstrates that, for many professional society awards, 0% are given to women! This is happening in specialties that had nearly even proportions of women and men in practice, such as dermatology and rehab medicine. Last month, I was dumbfounded when I saw a full-page New York Times ad of Top Surgeons by Castle Connolly featuring 16 surgeons, all male.
While Castle Connolly does name female top doctors and market ad opportunities to women and men, I learned that only men sign up for the ads. While this raises more questions, the optics remain problematic – women doctors are hidden. Regardless of the venue, we must do a better job profiling our female leaders. In addition, it is important to recognize that female leaders face well-documented and somewhat controversial challenges that require careful thought:
- Stereotype threat: Some of the original research on stereotype threat done in college students showed that, if women who are about to take a math test are told that the test will expose gender differences, such as men do better at math, women will perform worse AND men will do better. The threat of stereotypes is that women can internalize them and this may hamper their progress. The good news is that education on stereotype threat apparently helps.
- Impostor syndrome: Even highly successful people apparently suffer from impostor syndrome, the fear that they do not deserve their success, but it is much worse in women than in men. You are always trying to conquer the little voice in your head that tells you that you are not good enough.
Read the full post at hospitalleader.org.
Also on The Hospital Leader …
- If I were you, I would not be bullish on long-term care by Brad Flansbaum, DO, MPH, MHM
- Da Vinci wuz here by Jordan Messler, MD, SFHM
- Making the implicit explicit by Leslie Flores, MHA, SFHM
- Should we really focus on “patient-centered care”? by Tracy Cardin, ACNP-BC, SFHM
Project improves noninvasive IUC alternatives
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It truly has been a rewarding experience participating in a quality improvement project and I am excited to see what the future holds. Our project, “Reducing CAUTI with Noninvasive UC Alternatives and Measure-vention,” aimed to combat catheter associated urinary tract infections, with a three-pronged approach: by reducing UC placement, performing proper maintenance of IUC, and ensuring prompt removal of unnecessary UC.
To date, our project has demonstrated qualitative success. Specifically, we have implemented a pipeline to perform “measure-vention,” or real-time monitoring and correction of defects. The surgical care intensive unit (SICU) was identified as an appropriate candidate for a pilot partnership due to its high utilization of UC. A daily report of patients with UC is generated and then checked against the EMR for UC necessity. Subsequently, we contact the unit RN for details and physicians for removal orders, when possible. Simultaneously, this enables us to reinforce our management bundle in real time. This protocol is being effectively implemented in the SICU and we are hoping to expand to other units as well. Quantitative data collection is still ongoing and hopefully forthcoming.
Previous CAUTI reduction efforts have had variable and partial success. We are very excited to have improved noninvasive IUC alternatives that address staff concerns about incontinence workload, urine output monitoring, and patient comfort. We hope to protect our patients from harm and eventually publicize our experience to help other health care facilities reduce IUC use and CAUTI.
It has been a rewarding experience to participate in a quality improvement project and I am enjoying the challenges of collaborating with a diverse team of medical professionals to improve the patient experience.
Victor Ekuta is a third-year medical student at UC San Diego.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It truly has been a rewarding experience participating in a quality improvement project and I am excited to see what the future holds. Our project, “Reducing CAUTI with Noninvasive UC Alternatives and Measure-vention,” aimed to combat catheter associated urinary tract infections, with a three-pronged approach: by reducing UC placement, performing proper maintenance of IUC, and ensuring prompt removal of unnecessary UC.
To date, our project has demonstrated qualitative success. Specifically, we have implemented a pipeline to perform “measure-vention,” or real-time monitoring and correction of defects. The surgical care intensive unit (SICU) was identified as an appropriate candidate for a pilot partnership due to its high utilization of UC. A daily report of patients with UC is generated and then checked against the EMR for UC necessity. Subsequently, we contact the unit RN for details and physicians for removal orders, when possible. Simultaneously, this enables us to reinforce our management bundle in real time. This protocol is being effectively implemented in the SICU and we are hoping to expand to other units as well. Quantitative data collection is still ongoing and hopefully forthcoming.
Previous CAUTI reduction efforts have had variable and partial success. We are very excited to have improved noninvasive IUC alternatives that address staff concerns about incontinence workload, urine output monitoring, and patient comfort. We hope to protect our patients from harm and eventually publicize our experience to help other health care facilities reduce IUC use and CAUTI.
It has been a rewarding experience to participate in a quality improvement project and I am enjoying the challenges of collaborating with a diverse team of medical professionals to improve the patient experience.
Victor Ekuta is a third-year medical student at UC San Diego.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It truly has been a rewarding experience participating in a quality improvement project and I am excited to see what the future holds. Our project, “Reducing CAUTI with Noninvasive UC Alternatives and Measure-vention,” aimed to combat catheter associated urinary tract infections, with a three-pronged approach: by reducing UC placement, performing proper maintenance of IUC, and ensuring prompt removal of unnecessary UC.
To date, our project has demonstrated qualitative success. Specifically, we have implemented a pipeline to perform “measure-vention,” or real-time monitoring and correction of defects. The surgical care intensive unit (SICU) was identified as an appropriate candidate for a pilot partnership due to its high utilization of UC. A daily report of patients with UC is generated and then checked against the EMR for UC necessity. Subsequently, we contact the unit RN for details and physicians for removal orders, when possible. Simultaneously, this enables us to reinforce our management bundle in real time. This protocol is being effectively implemented in the SICU and we are hoping to expand to other units as well. Quantitative data collection is still ongoing and hopefully forthcoming.
Previous CAUTI reduction efforts have had variable and partial success. We are very excited to have improved noninvasive IUC alternatives that address staff concerns about incontinence workload, urine output monitoring, and patient comfort. We hope to protect our patients from harm and eventually publicize our experience to help other health care facilities reduce IUC use and CAUTI.
It has been a rewarding experience to participate in a quality improvement project and I am enjoying the challenges of collaborating with a diverse team of medical professionals to improve the patient experience.
Victor Ekuta is a third-year medical student at UC San Diego.
Different perspectives on the care delivery process
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.
Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.
It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-time longer length of stay compared to the average. The social-psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.
When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.
My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.
My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.
Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.
It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-time longer length of stay compared to the average. The social-psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.
When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.
My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.
My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.
Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.
It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-time longer length of stay compared to the average. The social-psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.
When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.
My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.
My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Swarm and suspicion leadership
During your career, you serve as staff member and leader to many different professional groups. Some are collaborative, collegial, and supportive. Others are competitive, antagonistic, or even combative. What are the benefits and downsides of each of these cultures and what can you do, as a hospitalist leader, to influence the character of your workplace?
The field of “game theory” provides insights into the distinction. The first questions to ask are “What is the game you are playing?” and then “Who is the competition?” In a “winner-takes-all” scenario, such as a sporting event, each team seeks strategic advantage over the other team. In baseball terms, the winner gets more points when at bat and denies more points when on the field. However, when competing as a team, winning together requires collaboration to build strategy, execute plays, and reach victory. You compete against the other team and collaborate within your own team.
Scientists who study negotiation strategies and conflict resolution find that collaborative groups spend less time countering one another and, instead, investing that same effort into building constructive outcomes, a force multiplier.
In the winner-takes-all model, the baseball team that gets “outs,” makes plays, and advances team members to home plate, wins. If there is contest within the team, players invest that same effort into seeking their own gain at the expense of others. Benefits derived from shared effort are shunned in favor of benefits accrued to one player over the other. It is a distinction between “I won” versus “We won.”
Hospital medicine is not a win/lose sport, yet over the years, hospitalists have shared with me that their institution or group at times feels like a competitive field with winners and losers. If this distinction is placed on a continuum, what factors encourage a more collaborative environment and what factors do the opposite, toward the adversarial side of the continuum? It makes a substantive difference in the interactions and accomplishments that a group achieves.
My colleagues and I at Harvard study leaders in times of crisis. A crisis makes apparent what is often more subtle during routine times. Our study of leaders in the wake of the Boston Marathon bombings was among our most revealing.
During most crises, an operational leader is designated to oversee the whole of the response. This is an individual with organizational authority and subject-matter expertise appropriate to the situation at hand. In Boston, however, there were so many different jurisdictions – federal, state, and local – and so many different agencies, that no one leader stood above the others. They worked in a remarkably collaborative fashion. While the bombings themselves were tragic, the response itself was a success: All who survived the initial blasts lived, a function of remarkable emergency care, distribution to hospitals, and good medical care. The perpetrators were caught in 102 hours, and “Boston Strong” reflected a genuine city resilience.
These leaders worked together in ways that we had rarely seen before. What we discovered was a phenomenon we call “swarm leadership,” inspired by the ways ants, bees, and termites engage in collective work and decision making. These creatures have clear lines of communication and structures for judgment calls, often about food sources, nesting locations, and threats.
There are five principles of swarm leadership:
- Unity of mission – In Boston, that was to “save lives,” and it motivated and activated the whole of the response.
- Generosity of spirit and action – Across the community, people were eager to assist in the response.
- Everyone stayed in their own lanes of responsibility and helped others succeed in theirs – There were law enforcement, medical, and resilience activities and the theme across the leaders was “how can I help make you a success?”
- No ego and no blame – There was a level of emotional intelligence and maturity among the leaders.
- A foundation of trusting relations – These leaders had known one another for years and, though the decisions were tough, they were confident in the motives and actions of the others.
While the discovery emerged from our crisis research, the findings equally apply to other, more routine work and interactions. Conduct your own assessment. Have you worked in groups in which these principles of swarm leadership characterized the experience? People were focused on a shared mission: They were available to assist one another; accomplished their work in ways that were respectful and supportive of their different responsibilities; did not claim undue credit or swipe at each another; and knew one another well enough to trust the others’ actions and motives.
The flip side of this continuum of collaboration and competition we term “suspicion leadership.” This is characterized by selfish ambitions; narcissistic actions; grabs for authority and resources; credit taking for the good and accusations for the bad; and an environment of mistrust and back stabbing.
Leaders influence the tone and tenor of their own group’s interactions as well as interactions among different working groups. As role models, if they articulate and demonstrate a mission that others can rally around, they forge that critical unity of mission. By contrast, suspicion leaders make it clear that “it is all about me and my priorities.” There is much work to be done, and swarm leaders ensure that people have the resources, autonomy, and support necessary to get the job done. On the other end, the work environment is burdened by the uncertainties about who does what and who is responsible. Swarm leaders are focused on “we” and suspicion leaders are caught up on “me.” There is no trust when people are suspicious of one another. Much can be accomplished when people believe in themselves, their colleagues, and the reasons that bring them together.
As a hospitalist leader, you influence where on this continuum your group will lie. It is your choice to be a role model for the principles of swarm, encouraging the same among others. When those principles become the beacons by which you work and relate, you will find an environment that inspires people to be and to do their best.
In the next column, how to build trust within your teams.
Dr. Marcus is director, Program on Health Care Negotiation and Conflict Resolution, at the Harvard T.H. Chan School of Public Health, in Boston.
During your career, you serve as staff member and leader to many different professional groups. Some are collaborative, collegial, and supportive. Others are competitive, antagonistic, or even combative. What are the benefits and downsides of each of these cultures and what can you do, as a hospitalist leader, to influence the character of your workplace?
The field of “game theory” provides insights into the distinction. The first questions to ask are “What is the game you are playing?” and then “Who is the competition?” In a “winner-takes-all” scenario, such as a sporting event, each team seeks strategic advantage over the other team. In baseball terms, the winner gets more points when at bat and denies more points when on the field. However, when competing as a team, winning together requires collaboration to build strategy, execute plays, and reach victory. You compete against the other team and collaborate within your own team.
Scientists who study negotiation strategies and conflict resolution find that collaborative groups spend less time countering one another and, instead, investing that same effort into building constructive outcomes, a force multiplier.
In the winner-takes-all model, the baseball team that gets “outs,” makes plays, and advances team members to home plate, wins. If there is contest within the team, players invest that same effort into seeking their own gain at the expense of others. Benefits derived from shared effort are shunned in favor of benefits accrued to one player over the other. It is a distinction between “I won” versus “We won.”
Hospital medicine is not a win/lose sport, yet over the years, hospitalists have shared with me that their institution or group at times feels like a competitive field with winners and losers. If this distinction is placed on a continuum, what factors encourage a more collaborative environment and what factors do the opposite, toward the adversarial side of the continuum? It makes a substantive difference in the interactions and accomplishments that a group achieves.
My colleagues and I at Harvard study leaders in times of crisis. A crisis makes apparent what is often more subtle during routine times. Our study of leaders in the wake of the Boston Marathon bombings was among our most revealing.
During most crises, an operational leader is designated to oversee the whole of the response. This is an individual with organizational authority and subject-matter expertise appropriate to the situation at hand. In Boston, however, there were so many different jurisdictions – federal, state, and local – and so many different agencies, that no one leader stood above the others. They worked in a remarkably collaborative fashion. While the bombings themselves were tragic, the response itself was a success: All who survived the initial blasts lived, a function of remarkable emergency care, distribution to hospitals, and good medical care. The perpetrators were caught in 102 hours, and “Boston Strong” reflected a genuine city resilience.
These leaders worked together in ways that we had rarely seen before. What we discovered was a phenomenon we call “swarm leadership,” inspired by the ways ants, bees, and termites engage in collective work and decision making. These creatures have clear lines of communication and structures for judgment calls, often about food sources, nesting locations, and threats.
There are five principles of swarm leadership:
- Unity of mission – In Boston, that was to “save lives,” and it motivated and activated the whole of the response.
- Generosity of spirit and action – Across the community, people were eager to assist in the response.
- Everyone stayed in their own lanes of responsibility and helped others succeed in theirs – There were law enforcement, medical, and resilience activities and the theme across the leaders was “how can I help make you a success?”
- No ego and no blame – There was a level of emotional intelligence and maturity among the leaders.
- A foundation of trusting relations – These leaders had known one another for years and, though the decisions were tough, they were confident in the motives and actions of the others.
While the discovery emerged from our crisis research, the findings equally apply to other, more routine work and interactions. Conduct your own assessment. Have you worked in groups in which these principles of swarm leadership characterized the experience? People were focused on a shared mission: They were available to assist one another; accomplished their work in ways that were respectful and supportive of their different responsibilities; did not claim undue credit or swipe at each another; and knew one another well enough to trust the others’ actions and motives.
The flip side of this continuum of collaboration and competition we term “suspicion leadership.” This is characterized by selfish ambitions; narcissistic actions; grabs for authority and resources; credit taking for the good and accusations for the bad; and an environment of mistrust and back stabbing.
Leaders influence the tone and tenor of their own group’s interactions as well as interactions among different working groups. As role models, if they articulate and demonstrate a mission that others can rally around, they forge that critical unity of mission. By contrast, suspicion leaders make it clear that “it is all about me and my priorities.” There is much work to be done, and swarm leaders ensure that people have the resources, autonomy, and support necessary to get the job done. On the other end, the work environment is burdened by the uncertainties about who does what and who is responsible. Swarm leaders are focused on “we” and suspicion leaders are caught up on “me.” There is no trust when people are suspicious of one another. Much can be accomplished when people believe in themselves, their colleagues, and the reasons that bring them together.
As a hospitalist leader, you influence where on this continuum your group will lie. It is your choice to be a role model for the principles of swarm, encouraging the same among others. When those principles become the beacons by which you work and relate, you will find an environment that inspires people to be and to do their best.
In the next column, how to build trust within your teams.
Dr. Marcus is director, Program on Health Care Negotiation and Conflict Resolution, at the Harvard T.H. Chan School of Public Health, in Boston.
During your career, you serve as staff member and leader to many different professional groups. Some are collaborative, collegial, and supportive. Others are competitive, antagonistic, or even combative. What are the benefits and downsides of each of these cultures and what can you do, as a hospitalist leader, to influence the character of your workplace?
The field of “game theory” provides insights into the distinction. The first questions to ask are “What is the game you are playing?” and then “Who is the competition?” In a “winner-takes-all” scenario, such as a sporting event, each team seeks strategic advantage over the other team. In baseball terms, the winner gets more points when at bat and denies more points when on the field. However, when competing as a team, winning together requires collaboration to build strategy, execute plays, and reach victory. You compete against the other team and collaborate within your own team.
Scientists who study negotiation strategies and conflict resolution find that collaborative groups spend less time countering one another and, instead, investing that same effort into building constructive outcomes, a force multiplier.
In the winner-takes-all model, the baseball team that gets “outs,” makes plays, and advances team members to home plate, wins. If there is contest within the team, players invest that same effort into seeking their own gain at the expense of others. Benefits derived from shared effort are shunned in favor of benefits accrued to one player over the other. It is a distinction between “I won” versus “We won.”
Hospital medicine is not a win/lose sport, yet over the years, hospitalists have shared with me that their institution or group at times feels like a competitive field with winners and losers. If this distinction is placed on a continuum, what factors encourage a more collaborative environment and what factors do the opposite, toward the adversarial side of the continuum? It makes a substantive difference in the interactions and accomplishments that a group achieves.
My colleagues and I at Harvard study leaders in times of crisis. A crisis makes apparent what is often more subtle during routine times. Our study of leaders in the wake of the Boston Marathon bombings was among our most revealing.
During most crises, an operational leader is designated to oversee the whole of the response. This is an individual with organizational authority and subject-matter expertise appropriate to the situation at hand. In Boston, however, there were so many different jurisdictions – federal, state, and local – and so many different agencies, that no one leader stood above the others. They worked in a remarkably collaborative fashion. While the bombings themselves were tragic, the response itself was a success: All who survived the initial blasts lived, a function of remarkable emergency care, distribution to hospitals, and good medical care. The perpetrators were caught in 102 hours, and “Boston Strong” reflected a genuine city resilience.
These leaders worked together in ways that we had rarely seen before. What we discovered was a phenomenon we call “swarm leadership,” inspired by the ways ants, bees, and termites engage in collective work and decision making. These creatures have clear lines of communication and structures for judgment calls, often about food sources, nesting locations, and threats.
There are five principles of swarm leadership:
- Unity of mission – In Boston, that was to “save lives,” and it motivated and activated the whole of the response.
- Generosity of spirit and action – Across the community, people were eager to assist in the response.
- Everyone stayed in their own lanes of responsibility and helped others succeed in theirs – There were law enforcement, medical, and resilience activities and the theme across the leaders was “how can I help make you a success?”
- No ego and no blame – There was a level of emotional intelligence and maturity among the leaders.
- A foundation of trusting relations – These leaders had known one another for years and, though the decisions were tough, they were confident in the motives and actions of the others.
While the discovery emerged from our crisis research, the findings equally apply to other, more routine work and interactions. Conduct your own assessment. Have you worked in groups in which these principles of swarm leadership characterized the experience? People were focused on a shared mission: They were available to assist one another; accomplished their work in ways that were respectful and supportive of their different responsibilities; did not claim undue credit or swipe at each another; and knew one another well enough to trust the others’ actions and motives.
The flip side of this continuum of collaboration and competition we term “suspicion leadership.” This is characterized by selfish ambitions; narcissistic actions; grabs for authority and resources; credit taking for the good and accusations for the bad; and an environment of mistrust and back stabbing.
Leaders influence the tone and tenor of their own group’s interactions as well as interactions among different working groups. As role models, if they articulate and demonstrate a mission that others can rally around, they forge that critical unity of mission. By contrast, suspicion leaders make it clear that “it is all about me and my priorities.” There is much work to be done, and swarm leaders ensure that people have the resources, autonomy, and support necessary to get the job done. On the other end, the work environment is burdened by the uncertainties about who does what and who is responsible. Swarm leaders are focused on “we” and suspicion leaders are caught up on “me.” There is no trust when people are suspicious of one another. Much can be accomplished when people believe in themselves, their colleagues, and the reasons that bring them together.
As a hospitalist leader, you influence where on this continuum your group will lie. It is your choice to be a role model for the principles of swarm, encouraging the same among others. When those principles become the beacons by which you work and relate, you will find an environment that inspires people to be and to do their best.
In the next column, how to build trust within your teams.
Dr. Marcus is director, Program on Health Care Negotiation and Conflict Resolution, at the Harvard T.H. Chan School of Public Health, in Boston.
Ensuring a smooth data collection process
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Piloting of data collection is finally underway! My mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, and I are currently collaborating with the Surgical Intensive Care Unit at UC San Diego to conduct a daily review of urinary catheter (UC) necessity for patients on the unit, and subsequently coordinating with nursing staff on the unit to look for opportunities to implement UC alternatives.
As far as timeline, we are past the halfway point. One thing that has surprised me is how long it has taken to get piloting phase underway. To that end, I think that our initial project timeline was ambitious, especially because we were unclear on how well initial project enthusiasm would translate into subsequent project participation. Up until this point, our research approach has largely been to fine tune each process prospectively. For instance, we decided a pilot run of data collection prior to final project data collection would allow us to ensure a smoother data collection process. While this has slowed things initially, we are optimistic that this will allow us to progress more quickly and smoothly in the latter stages of the project. We are not currently planning to change this research approach for the time being, but we are open to the idea depending on how well the data piloting phase progresses.
Outside of data collection, the project has provided an excellent opportunity to learn and improve clinical skills. Specifically, the project has improved my understanding of the indications for urinary catheter use, as well as helped me to develop a more critical mindset regarding medical indications in general. The project has made me more aware of the importance of really asking and thinking about why a patient is on a specific medication or using a specific medical device, which is something that is very helpful for anticipating and avoiding errors in the clinical setting.
Overall, I have enjoyed my participation in the project to date and it has increased my enthusiasm for participating in a quality improvement project.
Victor Ekuta is a third-year medical student at UC San Diego.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Piloting of data collection is finally underway! My mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, and I are currently collaborating with the Surgical Intensive Care Unit at UC San Diego to conduct a daily review of urinary catheter (UC) necessity for patients on the unit, and subsequently coordinating with nursing staff on the unit to look for opportunities to implement UC alternatives.
As far as timeline, we are past the halfway point. One thing that has surprised me is how long it has taken to get piloting phase underway. To that end, I think that our initial project timeline was ambitious, especially because we were unclear on how well initial project enthusiasm would translate into subsequent project participation. Up until this point, our research approach has largely been to fine tune each process prospectively. For instance, we decided a pilot run of data collection prior to final project data collection would allow us to ensure a smoother data collection process. While this has slowed things initially, we are optimistic that this will allow us to progress more quickly and smoothly in the latter stages of the project. We are not currently planning to change this research approach for the time being, but we are open to the idea depending on how well the data piloting phase progresses.
Outside of data collection, the project has provided an excellent opportunity to learn and improve clinical skills. Specifically, the project has improved my understanding of the indications for urinary catheter use, as well as helped me to develop a more critical mindset regarding medical indications in general. The project has made me more aware of the importance of really asking and thinking about why a patient is on a specific medication or using a specific medical device, which is something that is very helpful for anticipating and avoiding errors in the clinical setting.
Overall, I have enjoyed my participation in the project to date and it has increased my enthusiasm for participating in a quality improvement project.
Victor Ekuta is a third-year medical student at UC San Diego.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Piloting of data collection is finally underway! My mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, and I are currently collaborating with the Surgical Intensive Care Unit at UC San Diego to conduct a daily review of urinary catheter (UC) necessity for patients on the unit, and subsequently coordinating with nursing staff on the unit to look for opportunities to implement UC alternatives.
As far as timeline, we are past the halfway point. One thing that has surprised me is how long it has taken to get piloting phase underway. To that end, I think that our initial project timeline was ambitious, especially because we were unclear on how well initial project enthusiasm would translate into subsequent project participation. Up until this point, our research approach has largely been to fine tune each process prospectively. For instance, we decided a pilot run of data collection prior to final project data collection would allow us to ensure a smoother data collection process. While this has slowed things initially, we are optimistic that this will allow us to progress more quickly and smoothly in the latter stages of the project. We are not currently planning to change this research approach for the time being, but we are open to the idea depending on how well the data piloting phase progresses.
Outside of data collection, the project has provided an excellent opportunity to learn and improve clinical skills. Specifically, the project has improved my understanding of the indications for urinary catheter use, as well as helped me to develop a more critical mindset regarding medical indications in general. The project has made me more aware of the importance of really asking and thinking about why a patient is on a specific medication or using a specific medical device, which is something that is very helpful for anticipating and avoiding errors in the clinical setting.
Overall, I have enjoyed my participation in the project to date and it has increased my enthusiasm for participating in a quality improvement project.
Victor Ekuta is a third-year medical student at UC San Diego.
Hospitalist movers and shakers – Nov. 2017
Pediatric hospitalist Patrick Conway, MD, has been named president and chief executive officer of Blue Cross and Blue Shield of North Carolina. Dr. Conway will take over for the retiring Brad Wilson on Oct. 1.
Dr. Conway is currently the deputy administrator for Innovation and Quality, and the director of the Center for Medicare and Medicaid Innovation for the Centers for Medicare and Medicaid Services (CMS). Previously, he was CMO at CMS, having served both the Obama and Trump administrations.
Hossam Hafez, MD, recently claimed the role of chief of Hospitalist Service with Health Quest Medical Practice (LaGrangeville, N.Y.). Dr. Hafez will be based out of Health Quest’s Vassar Brothers Medical Center in Poughkeepsie, N.Y., coordinating care in that hospital and throughout the Health Quest system.
Dr. Hafez has served full-time hospitalist stints with MidMichigan Health’s Physician Hospitalist Group, as well as with RiteMed Urgent Care. A native of Egypt, Dr. Hafez is fluent in both English and Arabic.
Caldwell UNC Healthcare (Lenoir, N.C.) has promoted David Lowry, MD, to chief medical officer as of Aug. 1, 2017.
Dr. Lowry, a longtime hospitalist and veteran in hospital medicine in general, will lead the building’s hospitalist program, support the chief of staff, and provide direct patient care, as well. He will serve as physician advisor for Caldwell’s Clinical Documentation, Utilization Review, Respiratory Care, and Rehabilitation departments.
Dr. Lowry boasts more than 25 years experience in hospital medicine and led in the creation of Caldwell’s hospitalist program. Since joining Caldwell, he has held leadership positions including chief of medicine. He received the hospital’s Donald D. McNeill Jr. Award for Outstanding Physician Leadership in 2014, as voted by his peers.
Joahd Toure, MD, recently was hired by Adirondack Health (Saranac Lake, N.Y.) as its new chief medical officer. He started his new position in late June 2017.
A Massachusetts native, Dr. Toure most recently worked as chief of hospitalist medicine with AdvantageCare Physicians in New York City. There, he helped manage care for patients in that system’s 16 hospitals in the New York metro area. Previously, he was regional medical director for Essex Inpatient Physicians (Boxford, Mass.) and a staff hospitalist at South Shore Hospital (South Weymouth, Mass.).
Longtime employee Emily Chapman, MD, has been promoted to chief medical officer and vice president of medical affairs at Children’s Minnesota Hospital (Minneapolis). The former vice CMO took on her new role on July 5, 2017.
Previously, Dr. Chapman served Children’s as its hospitalist program director, and as director of graduate medical education. She is an American Academy of Pediatrics Fellow.
Mark Sockell, MD, is the new chief medical officer at Meritage Medical Network in Novato, Calif. Meritage is a physician-run network that includes more than 700 board-certified physicians in both primary care and specialist fields.
Dr. Sockell has been a member of Meritage’s Board of Directors since 2014, and he specializes in risk adjustment and quality measures. His career has focused on medical education, headed by a stint as director of medical education at St. Mary’s Medical Center (San Francisco). There, he created and ran the inpatient hospitalist program.
Business Moves
Hammond-Henry Hospital (Geneseo, Ill.) recently announced the creation of a hospitalist program, utilizing the facility’s own emergency room physicians. Hammond-Henry will staff one emergency room doctor available for rounds outside of their ER work throughout the day.
The center’s hospitalist program will be led by medical director Kevin Jeffries, MD, who also will serve as one of the hospital’s ER physicians/hospitalists.
Avera Queen of Peace Hospital (Mitchell, S.D.) started its own hospitalist program on Aug. 1, 2017, launching with the goal of improving patient experience within the building. Avera’s hospitalists will be on-site for 12 hours each day, assisting specialists and working with patients who do not have a local primary care physician.
Queen of Peace is the regional referral center for an 11-county area, part of Avera Health System’s 330 facilities across North and South Dakota, Minnesota, Iowa, and Nebraska.
Pediatric hospitalist Patrick Conway, MD, has been named president and chief executive officer of Blue Cross and Blue Shield of North Carolina. Dr. Conway will take over for the retiring Brad Wilson on Oct. 1.
Dr. Conway is currently the deputy administrator for Innovation and Quality, and the director of the Center for Medicare and Medicaid Innovation for the Centers for Medicare and Medicaid Services (CMS). Previously, he was CMO at CMS, having served both the Obama and Trump administrations.
Hossam Hafez, MD, recently claimed the role of chief of Hospitalist Service with Health Quest Medical Practice (LaGrangeville, N.Y.). Dr. Hafez will be based out of Health Quest’s Vassar Brothers Medical Center in Poughkeepsie, N.Y., coordinating care in that hospital and throughout the Health Quest system.
Dr. Hafez has served full-time hospitalist stints with MidMichigan Health’s Physician Hospitalist Group, as well as with RiteMed Urgent Care. A native of Egypt, Dr. Hafez is fluent in both English and Arabic.
Caldwell UNC Healthcare (Lenoir, N.C.) has promoted David Lowry, MD, to chief medical officer as of Aug. 1, 2017.
Dr. Lowry, a longtime hospitalist and veteran in hospital medicine in general, will lead the building’s hospitalist program, support the chief of staff, and provide direct patient care, as well. He will serve as physician advisor for Caldwell’s Clinical Documentation, Utilization Review, Respiratory Care, and Rehabilitation departments.
Dr. Lowry boasts more than 25 years experience in hospital medicine and led in the creation of Caldwell’s hospitalist program. Since joining Caldwell, he has held leadership positions including chief of medicine. He received the hospital’s Donald D. McNeill Jr. Award for Outstanding Physician Leadership in 2014, as voted by his peers.
Joahd Toure, MD, recently was hired by Adirondack Health (Saranac Lake, N.Y.) as its new chief medical officer. He started his new position in late June 2017.
A Massachusetts native, Dr. Toure most recently worked as chief of hospitalist medicine with AdvantageCare Physicians in New York City. There, he helped manage care for patients in that system’s 16 hospitals in the New York metro area. Previously, he was regional medical director for Essex Inpatient Physicians (Boxford, Mass.) and a staff hospitalist at South Shore Hospital (South Weymouth, Mass.).
Longtime employee Emily Chapman, MD, has been promoted to chief medical officer and vice president of medical affairs at Children’s Minnesota Hospital (Minneapolis). The former vice CMO took on her new role on July 5, 2017.
Previously, Dr. Chapman served Children’s as its hospitalist program director, and as director of graduate medical education. She is an American Academy of Pediatrics Fellow.
Mark Sockell, MD, is the new chief medical officer at Meritage Medical Network in Novato, Calif. Meritage is a physician-run network that includes more than 700 board-certified physicians in both primary care and specialist fields.
Dr. Sockell has been a member of Meritage’s Board of Directors since 2014, and he specializes in risk adjustment and quality measures. His career has focused on medical education, headed by a stint as director of medical education at St. Mary’s Medical Center (San Francisco). There, he created and ran the inpatient hospitalist program.
Business Moves
Hammond-Henry Hospital (Geneseo, Ill.) recently announced the creation of a hospitalist program, utilizing the facility’s own emergency room physicians. Hammond-Henry will staff one emergency room doctor available for rounds outside of their ER work throughout the day.
The center’s hospitalist program will be led by medical director Kevin Jeffries, MD, who also will serve as one of the hospital’s ER physicians/hospitalists.
Avera Queen of Peace Hospital (Mitchell, S.D.) started its own hospitalist program on Aug. 1, 2017, launching with the goal of improving patient experience within the building. Avera’s hospitalists will be on-site for 12 hours each day, assisting specialists and working with patients who do not have a local primary care physician.
Queen of Peace is the regional referral center for an 11-county area, part of Avera Health System’s 330 facilities across North and South Dakota, Minnesota, Iowa, and Nebraska.
Pediatric hospitalist Patrick Conway, MD, has been named president and chief executive officer of Blue Cross and Blue Shield of North Carolina. Dr. Conway will take over for the retiring Brad Wilson on Oct. 1.
Dr. Conway is currently the deputy administrator for Innovation and Quality, and the director of the Center for Medicare and Medicaid Innovation for the Centers for Medicare and Medicaid Services (CMS). Previously, he was CMO at CMS, having served both the Obama and Trump administrations.
Hossam Hafez, MD, recently claimed the role of chief of Hospitalist Service with Health Quest Medical Practice (LaGrangeville, N.Y.). Dr. Hafez will be based out of Health Quest’s Vassar Brothers Medical Center in Poughkeepsie, N.Y., coordinating care in that hospital and throughout the Health Quest system.
Dr. Hafez has served full-time hospitalist stints with MidMichigan Health’s Physician Hospitalist Group, as well as with RiteMed Urgent Care. A native of Egypt, Dr. Hafez is fluent in both English and Arabic.
Caldwell UNC Healthcare (Lenoir, N.C.) has promoted David Lowry, MD, to chief medical officer as of Aug. 1, 2017.
Dr. Lowry, a longtime hospitalist and veteran in hospital medicine in general, will lead the building’s hospitalist program, support the chief of staff, and provide direct patient care, as well. He will serve as physician advisor for Caldwell’s Clinical Documentation, Utilization Review, Respiratory Care, and Rehabilitation departments.
Dr. Lowry boasts more than 25 years experience in hospital medicine and led in the creation of Caldwell’s hospitalist program. Since joining Caldwell, he has held leadership positions including chief of medicine. He received the hospital’s Donald D. McNeill Jr. Award for Outstanding Physician Leadership in 2014, as voted by his peers.
Joahd Toure, MD, recently was hired by Adirondack Health (Saranac Lake, N.Y.) as its new chief medical officer. He started his new position in late June 2017.
A Massachusetts native, Dr. Toure most recently worked as chief of hospitalist medicine with AdvantageCare Physicians in New York City. There, he helped manage care for patients in that system’s 16 hospitals in the New York metro area. Previously, he was regional medical director for Essex Inpatient Physicians (Boxford, Mass.) and a staff hospitalist at South Shore Hospital (South Weymouth, Mass.).
Longtime employee Emily Chapman, MD, has been promoted to chief medical officer and vice president of medical affairs at Children’s Minnesota Hospital (Minneapolis). The former vice CMO took on her new role on July 5, 2017.
Previously, Dr. Chapman served Children’s as its hospitalist program director, and as director of graduate medical education. She is an American Academy of Pediatrics Fellow.
Mark Sockell, MD, is the new chief medical officer at Meritage Medical Network in Novato, Calif. Meritage is a physician-run network that includes more than 700 board-certified physicians in both primary care and specialist fields.
Dr. Sockell has been a member of Meritage’s Board of Directors since 2014, and he specializes in risk adjustment and quality measures. His career has focused on medical education, headed by a stint as director of medical education at St. Mary’s Medical Center (San Francisco). There, he created and ran the inpatient hospitalist program.
Business Moves
Hammond-Henry Hospital (Geneseo, Ill.) recently announced the creation of a hospitalist program, utilizing the facility’s own emergency room physicians. Hammond-Henry will staff one emergency room doctor available for rounds outside of their ER work throughout the day.
The center’s hospitalist program will be led by medical director Kevin Jeffries, MD, who also will serve as one of the hospital’s ER physicians/hospitalists.
Avera Queen of Peace Hospital (Mitchell, S.D.) started its own hospitalist program on Aug. 1, 2017, launching with the goal of improving patient experience within the building. Avera’s hospitalists will be on-site for 12 hours each day, assisting specialists and working with patients who do not have a local primary care physician.
Queen of Peace is the regional referral center for an 11-county area, part of Avera Health System’s 330 facilities across North and South Dakota, Minnesota, Iowa, and Nebraska.
Physicians do not trust bone biopsy culture data
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As I approach the end of my summer research project, my team and I have reflected on what we’ve learned from both the research itself and the experience of working on the project.
As work-life balance is important to me, I would usually I would balk at the idea of sacrificing my personal time, but in this case, I am driven by a sense of ownership and pride over the project that I haven’t felt with past projects. I truly believe the results of this research have the potential to change the way physicians think about and manage patients with osteomyelitis, and I am eager to publish our results and attend conferences where I can present and discuss the findings with the medical community.
We hypothesized that the use of image-guided bone biopsies in patients with non-vertebral osteomyelitis would not have a significant impact on antibiotic management. Our results showed that physicians usually do not trust culture data provided by bone biopsy results. Negative bone cultures almost never lead physicians to discontinue antibiotics due to the low yield and reliability of bone biopsy culture data. Similarly, positive cultures almost never lead physicians to prescribe targeted antibiotics. 75% of the patients in our study had contiguous osteomyelitis caused by an overlying ulcer (e.g., diabetic foot ulcers or sacral decubitus ulcers). Exposure of the wound to the outside world often results in polymicrobial infections, and as such physicians rarely narrowed antibiotic coverage when a single organism was cultured. We also found that empiric antibiotic therapy adequately treated cultured micro-organisms in 95% of cases.
While many questions remained unanswered by this study, our results are an important contribution to the body of evidence that image-guided bone biopsies have low utility in the management of contiguous non-vertebral osteomyelitis. I look forward to seeing how the results of future research will compare with our findings. I am grateful to have had the opportunity to work in such an exciting area of research and I hope to continue participating in research projects throughout my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As I approach the end of my summer research project, my team and I have reflected on what we’ve learned from both the research itself and the experience of working on the project.
As work-life balance is important to me, I would usually I would balk at the idea of sacrificing my personal time, but in this case, I am driven by a sense of ownership and pride over the project that I haven’t felt with past projects. I truly believe the results of this research have the potential to change the way physicians think about and manage patients with osteomyelitis, and I am eager to publish our results and attend conferences where I can present and discuss the findings with the medical community.
We hypothesized that the use of image-guided bone biopsies in patients with non-vertebral osteomyelitis would not have a significant impact on antibiotic management. Our results showed that physicians usually do not trust culture data provided by bone biopsy results. Negative bone cultures almost never lead physicians to discontinue antibiotics due to the low yield and reliability of bone biopsy culture data. Similarly, positive cultures almost never lead physicians to prescribe targeted antibiotics. 75% of the patients in our study had contiguous osteomyelitis caused by an overlying ulcer (e.g., diabetic foot ulcers or sacral decubitus ulcers). Exposure of the wound to the outside world often results in polymicrobial infections, and as such physicians rarely narrowed antibiotic coverage when a single organism was cultured. We also found that empiric antibiotic therapy adequately treated cultured micro-organisms in 95% of cases.
While many questions remained unanswered by this study, our results are an important contribution to the body of evidence that image-guided bone biopsies have low utility in the management of contiguous non-vertebral osteomyelitis. I look forward to seeing how the results of future research will compare with our findings. I am grateful to have had the opportunity to work in such an exciting area of research and I hope to continue participating in research projects throughout my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their 1st, 2nd, and 3rd years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
As I approach the end of my summer research project, my team and I have reflected on what we’ve learned from both the research itself and the experience of working on the project.
As work-life balance is important to me, I would usually I would balk at the idea of sacrificing my personal time, but in this case, I am driven by a sense of ownership and pride over the project that I haven’t felt with past projects. I truly believe the results of this research have the potential to change the way physicians think about and manage patients with osteomyelitis, and I am eager to publish our results and attend conferences where I can present and discuss the findings with the medical community.
We hypothesized that the use of image-guided bone biopsies in patients with non-vertebral osteomyelitis would not have a significant impact on antibiotic management. Our results showed that physicians usually do not trust culture data provided by bone biopsy results. Negative bone cultures almost never lead physicians to discontinue antibiotics due to the low yield and reliability of bone biopsy culture data. Similarly, positive cultures almost never lead physicians to prescribe targeted antibiotics. 75% of the patients in our study had contiguous osteomyelitis caused by an overlying ulcer (e.g., diabetic foot ulcers or sacral decubitus ulcers). Exposure of the wound to the outside world often results in polymicrobial infections, and as such physicians rarely narrowed antibiotic coverage when a single organism was cultured. We also found that empiric antibiotic therapy adequately treated cultured micro-organisms in 95% of cases.
While many questions remained unanswered by this study, our results are an important contribution to the body of evidence that image-guided bone biopsies have low utility in the management of contiguous non-vertebral osteomyelitis. I look forward to seeing how the results of future research will compare with our findings. I am grateful to have had the opportunity to work in such an exciting area of research and I hope to continue participating in research projects throughout my medical career.
Cole Hirschfeld is originally from Phoenix. He received undergraduate degrees in finance and entrepreneurship from the University of Arizona and went on to work in the finance industry for 2 years before deciding to change careers and attend medical school. He is now a 4th year medical student at Cornell University, New York, and plans to apply for residency in internal medicine.
Higher hospital mortality in pediatric emergency transfer patients
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
I’ve learned so much this summer from working with Dr. Patrick Brady to better understand characteristics of pediatric patients who undergo clinical deterioration and unplanned transfers to the ICU. I’m very grateful to have spent my summer with a mentor who really cared about my growth as a student, and a fantastic group of physicians in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center.
After data analysis, we discovered that children who have had an emergency transfer event spend a longer time in the ICU and in the hospital. After comparing hospital mortality, we can conclude that emergency transfer patients have a higher likelihood of hospital mortality.
From this preliminary research, the emergency transfer metric in children’s hospitals has the potential to enable more rapid learning and systems improvement. We have a few next steps to investigate these next couple months as well. We want to compare medical diagnoses and complex chronic conditions between the emergency transfer cases and controls. We also hope to describe the incidence using a patient-days denominator. Finally, our long term goals are to identify predictors for an emergency transfer event in children.
Farah Hussain is a 2nd-year medical student at University of Cincinnati College of Medicine and student researcher at Cincinnati Children’s Hospital Medical Center. Her research interests involve bettering patient care to vulnerable populations.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
I’ve learned so much this summer from working with Dr. Patrick Brady to better understand characteristics of pediatric patients who undergo clinical deterioration and unplanned transfers to the ICU. I’m very grateful to have spent my summer with a mentor who really cared about my growth as a student, and a fantastic group of physicians in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center.
After data analysis, we discovered that children who have had an emergency transfer event spend a longer time in the ICU and in the hospital. After comparing hospital mortality, we can conclude that emergency transfer patients have a higher likelihood of hospital mortality.
From this preliminary research, the emergency transfer metric in children’s hospitals has the potential to enable more rapid learning and systems improvement. We have a few next steps to investigate these next couple months as well. We want to compare medical diagnoses and complex chronic conditions between the emergency transfer cases and controls. We also hope to describe the incidence using a patient-days denominator. Finally, our long term goals are to identify predictors for an emergency transfer event in children.
Farah Hussain is a 2nd-year medical student at University of Cincinnati College of Medicine and student researcher at Cincinnati Children’s Hospital Medical Center. Her research interests involve bettering patient care to vulnerable populations.
Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-2018 year, offering two options for students to receive funding and engage in scholarly work during their first, second, and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.
I’ve learned so much this summer from working with Dr. Patrick Brady to better understand characteristics of pediatric patients who undergo clinical deterioration and unplanned transfers to the ICU. I’m very grateful to have spent my summer with a mentor who really cared about my growth as a student, and a fantastic group of physicians in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center.
After data analysis, we discovered that children who have had an emergency transfer event spend a longer time in the ICU and in the hospital. After comparing hospital mortality, we can conclude that emergency transfer patients have a higher likelihood of hospital mortality.
From this preliminary research, the emergency transfer metric in children’s hospitals has the potential to enable more rapid learning and systems improvement. We have a few next steps to investigate these next couple months as well. We want to compare medical diagnoses and complex chronic conditions between the emergency transfer cases and controls. We also hope to describe the incidence using a patient-days denominator. Finally, our long term goals are to identify predictors for an emergency transfer event in children.
Farah Hussain is a 2nd-year medical student at University of Cincinnati College of Medicine and student researcher at Cincinnati Children’s Hospital Medical Center. Her research interests involve bettering patient care to vulnerable populations.
Understanding patient process flow
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
This phase of the QI project aims at a thorough understanding of the process flow of a patient, from being transferred from outside the hospital, receiving tertiary care services at Dartmouth-Hitchcock Medical Center, to being discharged to a rehabilitation facility/skilled nursing facility.
I am conducting interviews with key stakeholders to understand the current processes and needs for improvement. The key stakeholders include but are not limited to infectious disease, hospital medicine, nursing, case management, and psychiatry services.
I have developed an interview guide to facilitate the interviews. Based on a framework similar to SWOT analysis, the key questions include: (1) what makes this patient population particularly difficult to receive appropriate care/support? (2) What makes them difficult to be discharged when tertiary service is completed? (3) What can help them stay longer in the community and delay/prevent readmission?
I am working on retrieving clinical data from medical records and an infectious disease service database, and am going to analyze current patient status. Key metrics will include but not limited to length of stay, 30‐day readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost.
A challenge I foresee I will encounter is deciding on a focused area for the improvement project. The constraints may be coming from clinical data availability or the willingness for the stakeholder to participate. For this purpose, I am going to ask each stakeholder about their priorities, and what they view as the most urgent or important aspects to improve. I also hope to identify stakeholders who might already have been thinking or working on improving care for this patient population.
I will address the data availability issue by following up closely with the infectious disease service. After I develop a general sense of the data, I will work with the interdisciplinary team to decide on a focused area for improvement.
One unexpected thing I learned during the last month was project planning. Initially, I was struggling with putting the details of the project together. I recalled later that at business school we often use timelines to facilitate project planning. I carved out two hours of my time. On a piece of paper, I wrote down one-by-one the tasks I need to accomplish for each phase of the study. I also set up an internal deadline for communications and deliverables with my advisor. Now I can track my progress much better and am confident that the project will move towards its landmarks.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
This phase of the QI project aims at a thorough understanding of the process flow of a patient, from being transferred from outside the hospital, receiving tertiary care services at Dartmouth-Hitchcock Medical Center, to being discharged to a rehabilitation facility/skilled nursing facility.
I am conducting interviews with key stakeholders to understand the current processes and needs for improvement. The key stakeholders include but are not limited to infectious disease, hospital medicine, nursing, case management, and psychiatry services.
I have developed an interview guide to facilitate the interviews. Based on a framework similar to SWOT analysis, the key questions include: (1) what makes this patient population particularly difficult to receive appropriate care/support? (2) What makes them difficult to be discharged when tertiary service is completed? (3) What can help them stay longer in the community and delay/prevent readmission?
I am working on retrieving clinical data from medical records and an infectious disease service database, and am going to analyze current patient status. Key metrics will include but not limited to length of stay, 30‐day readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost.
A challenge I foresee I will encounter is deciding on a focused area for the improvement project. The constraints may be coming from clinical data availability or the willingness for the stakeholder to participate. For this purpose, I am going to ask each stakeholder about their priorities, and what they view as the most urgent or important aspects to improve. I also hope to identify stakeholders who might already have been thinking or working on improving care for this patient population.
I will address the data availability issue by following up closely with the infectious disease service. After I develop a general sense of the data, I will work with the interdisciplinary team to decide on a focused area for improvement.
One unexpected thing I learned during the last month was project planning. Initially, I was struggling with putting the details of the project together. I recalled later that at business school we often use timelines to facilitate project planning. I carved out two hours of my time. On a piece of paper, I wrote down one-by-one the tasks I need to accomplish for each phase of the study. I also set up an internal deadline for communications and deliverables with my advisor. Now I can track my progress much better and am confident that the project will move towards its landmarks.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.
Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
This phase of the QI project aims at a thorough understanding of the process flow of a patient, from being transferred from outside the hospital, receiving tertiary care services at Dartmouth-Hitchcock Medical Center, to being discharged to a rehabilitation facility/skilled nursing facility.
I am conducting interviews with key stakeholders to understand the current processes and needs for improvement. The key stakeholders include but are not limited to infectious disease, hospital medicine, nursing, case management, and psychiatry services.
I have developed an interview guide to facilitate the interviews. Based on a framework similar to SWOT analysis, the key questions include: (1) what makes this patient population particularly difficult to receive appropriate care/support? (2) What makes them difficult to be discharged when tertiary service is completed? (3) What can help them stay longer in the community and delay/prevent readmission?
I am working on retrieving clinical data from medical records and an infectious disease service database, and am going to analyze current patient status. Key metrics will include but not limited to length of stay, 30‐day readmission rate, patient satisfaction rating, infectious disease provider follow-up rate, and hospitalization cost.
A challenge I foresee I will encounter is deciding on a focused area for the improvement project. The constraints may be coming from clinical data availability or the willingness for the stakeholder to participate. For this purpose, I am going to ask each stakeholder about their priorities, and what they view as the most urgent or important aspects to improve. I also hope to identify stakeholders who might already have been thinking or working on improving care for this patient population.
I will address the data availability issue by following up closely with the infectious disease service. After I develop a general sense of the data, I will work with the interdisciplinary team to decide on a focused area for improvement.
One unexpected thing I learned during the last month was project planning. Initially, I was struggling with putting the details of the project together. I recalled later that at business school we often use timelines to facilitate project planning. I carved out two hours of my time. On a piece of paper, I wrote down one-by-one the tasks I need to accomplish for each phase of the study. I also set up an internal deadline for communications and deliverables with my advisor. Now I can track my progress much better and am confident that the project will move towards its landmarks.
Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.