For the Team | MDedge

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For the Team

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Brendon Shank

Many speakers at the recent SHM annual meeting in Dallas focused on the many ways hospitalists enhance quality of care. The teamwork necessary to effectively render inpatient services was an especially important topic.

Hospitalists have compiled a significant amount of descriptive material about their working environments and the composition and workloads of hospitalist teams. However, there is not much material available quantifying the ways that various disciplines impact the overall care-delivery metrics of multidisciplinary hospitalist teams.

The SHM Non-Physician Provider Committee is interested in collecting information on multidisciplinary programs, their component disciplines and individual providers to help identify and describe teams that have integrated nurse practitioners, physician assistants, clinical pharmacists and pharmacologists, nurse clinical care coordinators, and other related disciplines into their practices. Our goal is to develop descriptions of successful and unsuccessful implementation models.

Hospital Medicine Fast Facts — click for large version

We would also like to collect information measuring additional domains of interest to major stakeholders. Such domains might include the clinical utilization of non-physician providers in relationship to both scope-of-practice and delegation of authority, the influence of multidisciplinary integration on patient-centered care and patient satisfaction, process and outcomes quality metrics, throughput and efficiency measures, documentation practices, hospital privileges for non-physicians, medical education in the multidisciplinary environment, risk management and, of course, reimbursement.

One might ask why the collection and analysis of such data should be of interest to hospitalists and to SHM. There are several immediate answers:

The first reason involves manpower. Hospital medicine has become a growing discipline for physicians—one that did not exist on the radar screens of physician planners 10 years ago. However, given the growing demand for hospitalists there may be a significant shortage. To address this deficit, hospital medicine practices will need to attract new associates in the form of nurse practitioners and physician assistants. It is therefore imperative that hospitalists proactively identify barriers to the integration of non-physician providers into their practices and have successful implementation models to guide this effort.

The second reason centers on the fact that hospitalists will continue to lead efforts to enhance quality of care. Incorporating a multidisciplinary approach—whether through the pre-rounding and follow-up of nurse clinical care coordinators, the counsel of clinical pharmacists, or the hands-on care of other disciplines—will facilitate throughput and improve quality as well as enhance patient satisfaction and communication. Identifying best practices in these particular domains will provide information crucial to success in these areas.

The third reason is related to the cost of services. With declining reimbursements coupled with increasing costs, hospital medicine programs must identify and implement measures aimed at expense control and maximization of services. Used appropriately, non-physician providers provide a lower-cost alternative to a physician-only model. When one-to-one pairing occurs, physician/NPP team-care can be delivered in a parallel-versus-linear fashion, thus allowing for increased census as well as expedition of care.

The future of hospital medicine is one of continued growth with the demand for hospital medicine physicians far outstripping the available supply to meet the ever-increasing needs. SHM is committed to researching and sharing best practices, and views the use of multidisciplinary teams as an important model of care. Together, we can all achieve more.

If you are interested in being a part of this project or feel that this data would be of benefit to your practice, please contact the Non-Physician Provider Committee at nppcommittee@hospitalmedicine.org.

Hospitalists Stay in the Know

Education Committee strives to achieve relevancy

By Geri Barnes, MS, MT

According to the Oxford English Dictionary, “relevant” is an adjective that means closely connected or appropriate to the matter in hand. Because of their limited experience and vision, young students often fail to see the connection of what they are learning to real life.

For professionals, the demands of their careers make relevant education even more important. Organizations have the responsibility to make sure they are relevant to their members and provide relevant resources and tools. SHM understands this responsibility and strives to achieve relevancy.

SHM’s mission is focused on improving the care of patients and serving as an educational resource for hospitalists. The challenge for any organization is balancing a philosophical approach with the practical implementation. That is the charge of SHM’s Education Committee.

The Education Committee, chaired by Preetha Basaviah, MD, until May, has been successful in melding the two. During her tenure, an Education Summit was held to establish philosophical direction, the SHM Annual Meeting grew to include various educational sessions and pre-courses that fit the needs of the audience, and The Core Competencies in Hospital Medicine: A Framework for Curriculum Development were published to provide the practical framework. SHM is grateful for Dr. Basaviah’s direction and expertise in moving the organization’s efforts forward.

In May, William Rifkin, MD, took over as chair of the committee. He acknowledges that this is a daunting but exciting opportunity. Joining Dr. Rifkin on the committee are Sam Bagchi, MD, Allison Ballantine, MD, Preetha Basaviah, MD, Daniel Dressler, MD, MSc, Ian Jenkins, MD, Valerie Lang, MD, Kevin Larsen, MD, Efren Manjarrez, MD, Susanne M. Mierendorf, MD, Mary Ottolini, MD, James Pile, MD, Michael Pistoria, DO, Keith Posley, MD, Vijay Rajput, MD, Bradley Sharpe, MD, Lisa Shieh, MD, Jerome Siy, MD, Daniel I. Steinberg, MD, Anjala Tess, MD, and David Wesorick, MD.

The real key to the success of the Education Committee will be ensuring that the committee’s output and products are relevant to SHM members and the hospitalist community at large. As the expected roles of hospitalists expand to clinician expert, academician, quality improvement leader, guardian of patient safety, and researcher, among others, so do the responsibilities and necessary knowledge base. SHM’s Education Committee is poised to meet this challenge.

The starting point for the committee is the Core Competencies, a first attempt to define the specialty of hospital medicine. It comprises three sections: “Clinical Conditions,” “Procedures,” and “Healthcare Systems.” It offers a wealth of guidance in framing the context and content of needed education that matches the hospitalist’s role now and in the ever-changing future. The SHM Education Committee is using this roadmap for prioritizing its activities and to aid in the planning process.

The focus of the SHM Education Committee during the coming year will be to:

Provide training for hospitalists early in their career as clinician educators;

Identify resources such as self-evaluation process and self-improvement modules that support hospitalists to obtain recognition of focused practice in hospital medicine;

Prioritize procedural skills training and identify partners to bring the training to members; and

Explore and, if appropriate, implement the use of new modalities such as podcasting and blogging to deliver educational products and resources

Achieving relevancy is based upon understanding needs. SHM’s Education Committee plans to employ member surveys and focus groups to best concentrate attention on educational resources such as conferences, training opportunities, quality improvement resource rooms, and toolkits that will best service the needs of membership.

Chapter Reports

Nashville

Quite a bit of networking took place before the Medtronic-sponsored presentation at Ruth’s Chris in Nashville on April 26. The SHM Nashville Chapter has re-energized itself under the co-direction of Steven Embry, MD, and Kimberly Bell, MD. Eleven Nashville-area healthcare organizations were represented by more than 28 attendees. The attendees were a multidisciplinary mix of physicians, nurses, and administrators. Shashank Desai, MD, engaged the audience with his presentation “Simple to Complex: Advances in the Management of CHF.” Dr. Desai is the medical director of the Heart Failure and Transplant Program at Inova Fairfax Hospital.

Pacific Northwest

The latest Pacific Northwest Chapter meeting of SHM was held in Seattle on May 15. A change of venue and a new focus on speakers provided local hospitalists with information they won’t find elsewhere. Joseph Bennet, MD, former president of the local chapter, gave a presentation detailing his 15 months practicing hospitalist medicine in Dunedin, New Zealand. In addition to stunning photos of the terrain, Dr. Bennet delivered a thought-provoking presentation comparing New Zealand with the United States regarding culture, medical system financing, drug and care delivery, physician training, end-of-life issues, and many more aspects.

Pittsburgh

The Pittsburgh Chapter had a meeting May 10 at Morton’s Steakhouse. The speaker for the event was Rene Alvarez, MD, director of the Critical Care Unit at University of Pittsburgh Medical Center. Dr. Alvarez discussed “Strategies for Optimal Management of Patients with Heart Failure,” which generated an excellent discussion. Various hospital medicine topics including incentives, program structures, and 24/7 programs were also discussed. Attendees included hospitalists from six local hospitals. The next meeting will be held Oct. 30. For more information on the Pittsburgh Chapter, contact Michael Cratty, MD, PhD, at mcratty@wpahs.org.

Rocky Mountain

The Rocky Mountain Chapter held its spring meeting May 3 at the Denver Colorado Downtown Aquarium. Chapter President Eugene Chu, MD, welcomed attendees and was followed by an update from the Rocky Mountain Chapter Public Policy Committee presented by Bob Brockmann, MD, MSc. Guest speakers for the night were Edward Maa, MD, who spoke about “Seizure Management in Hospitalized Patients” and Daniel Mogyoros, MD, whose presentation was titled “Updates in Infectious Disease for Hospital Medicine.” Attendees received two AMA PRA [Physician’s Recognition Award] Category 1 credits.

San Diego

At its June 5 meeting, San Diego’s chapter discussed real-time, evidence-based practice as a means to improve patient care and share new clinical evidence with colleagues. Online access during the presentation allowed the group to review several evidence resources: PubMed, the Physician’s Information and Education Resource, the American College of Physicians Journal Club, and National Guideline Clearing House using real patient cases. Dinner was served by Blue Coral Seafood and Spirits, and Novartis sponsored the event.

Upstate South Carolina

The second meeting of the Upstate S.C. Chapter was held May 15, with close to 20 physicians representing five hospitals in upstate South Carolina. Kenneth Leeper, MD, pulmonologist, presented information on ventilator-associated pneumonia. Following the presentation, the business meeting was opened by outgoing President Raja Paladugu, MD.

The following officers were elected for 2007:

President: Zafar Hossain, MD;

Vice President: Imran Shaikh, MD; and

Secretary: Shawn Morrow, MD.

The group decided to meet on a quarterly basis, with the next meeting to be held in September. TH

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Many speakers at the recent SHM annual meeting in Dallas focused on the many ways hospitalists enhance quality of care. The teamwork necessary to effectively render inpatient services was an especially important topic.

Hospitalists have compiled a significant amount of descriptive material about their working environments and the composition and workloads of hospitalist teams. However, there is not much material available quantifying the ways that various disciplines impact the overall care-delivery metrics of multidisciplinary hospitalist teams.

The SHM Non-Physician Provider Committee is interested in collecting information on multidisciplinary programs, their component disciplines and individual providers to help identify and describe teams that have integrated nurse practitioners, physician assistants, clinical pharmacists and pharmacologists, nurse clinical care coordinators, and other related disciplines into their practices. Our goal is to develop descriptions of successful and unsuccessful implementation models.

We would also like to collect information measuring additional domains of interest to major stakeholders. Such domains might include the clinical utilization of non-physician providers in relationship to both scope-of-practice and delegation of authority, the influence of multidisciplinary integration on patient-centered care and patient satisfaction, process and outcomes quality metrics, throughput and efficiency measures, documentation practices, hospital privileges for non-physicians, medical education in the multidisciplinary environment, risk management and, of course, reimbursement.

One might ask why the collection and analysis of such data should be of interest to hospitalists and to SHM. There are several immediate answers:

The first reason involves manpower. Hospital medicine has become a growing discipline for physicians—one that did not exist on the radar screens of physician planners 10 years ago. However, given the growing demand for hospitalists there may be a significant shortage. To address this deficit, hospital medicine practices will need to attract new associates in the form of nurse practitioners and physician assistants. It is therefore imperative that hospitalists proactively identify barriers to the integration of non-physician providers into their practices and have successful implementation models to guide this effort.

The second reason centers on the fact that hospitalists will continue to lead efforts to enhance quality of care. Incorporating a multidisciplinary approach—whether through the pre-rounding and follow-up of nurse clinical care coordinators, the counsel of clinical pharmacists, or the hands-on care of other disciplines—will facilitate throughput and improve quality as well as enhance patient satisfaction and communication. Identifying best practices in these particular domains will provide information crucial to success in these areas.

The third reason is related to the cost of services. With declining reimbursements coupled with increasing costs, hospital medicine programs must identify and implement measures aimed at expense control and maximization of services. Used appropriately, non-physician providers provide a lower-cost alternative to a physician-only model. When one-to-one pairing occurs, physician/NPP team-care can be delivered in a parallel-versus-linear fashion, thus allowing for increased census as well as expedition of care.