HM17

LAS VEGAS – When the resident in the handoff training video approached another resident, she first vented about her “really crazy day” and how she’d been hoping to “get out of here on time for once.” Then, she tore through a case like an auctioneer, leaving out important details. At the end, she got a page and, of course, didn’t finish the handoff.

In Wednesday’s Quality Track session, “Strategies for Implementing a Successful Handoff” – with lessons from SHM’s I-PASS mentored implementation project – some attendees were eager to point out all of the flaws in the handoff. They were, however, slower to point to the good. For instance, the resident in the video made the effort to meet face-to-face and asked whether her colleague had any questions.

The audience had learned an important lesson about how to foster better handoffs, said Glenn Rosenbluth, MD, director of quality and safety programs at the University of California, San Francisco. He noted that it can be difficult to find the positives when the negatives are so glaring.

“This is one of the hard parts about doing feedback,” he said.

It was just one of many lessons taught in the session, also led by Amy Starmer, MD, MPH, a lecturer on pediatrics at Harvard Medical School, and Courtney Edgar-Zarate, MD, a pediatric hospitalist at Arkansas Children’s Hospital who was one of the I-PASS site leaders.

I-PASS was a nine-site study in the United States and Canada that found that using a bundle of interventions while doing handoffs resulted in a 30% reduction in preventable adverse events, meaning less harm to patients. The hallmark is the “I-PASS” mnemonic. It stands for:

• Illness severity – describing the stability level of a patient.
• Patient summary, including general information, such as the events leading to admission.
• Action list – essentially a to-do list for the patient.
• Situation awareness and contingency planning, which involves having a plan for what might happen.
• Synthesis by the receiver, in which the recipient of the information summarizes what was heard and asks questions.

Beyond that, the I-PASS system involves an introductory workshop, simulation exercises, structured observation and feedback, among other elements, Dr. Starmer said.

“This intervention was certainly not just a five-letter mnemonic,” she said.

The I-PASS Mentored Implementation Program, a collaboration with SHM that is funded by the Agency for Healthcare Research and Quality, is an effort to help implement a similar program in 32 hospitals in the United States.

Dr. Edgar-Zarate outlined the steps that worked at her site to make their I-PASS project successful. She said that project managers have to establish institutional support; assess a given center’s needs; gauge where to begin by identifying the most vulnerable transition points; find providers who will champion the project; establish good communication, in part by incorporating I-PASS into previously scheduled meetings; and collect data as time goes on.

Dr. Starmer directed attendees to www.ipassstudygroup.com, where anyone can download the material for free.

“This mentored implementation process,” she said, “has really been a helpful vehicle for disseminating the curriculum and implementation across different areas.”

LAS VEGAS – When the resident in the handoff training video approached another resident, she first vented about her “really crazy day” and how she’d been hoping to “get out of here on time for once.” Then, she tore through a case like an auctioneer, leaving out important details. At the end, she got a page and, of course, didn’t finish the handoff.

In Wednesday’s Quality Track session, “Strategies for Implementing a Successful Handoff” – with lessons from SHM’s I-PASS mentored implementation project – some attendees were eager to point out all of the flaws in the handoff. They were, however, slower to point to the good. For instance, the resident in the video made the effort to meet face-to-face and asked whether her colleague had any questions.

The audience had learned an important lesson about how to foster better handoffs, said Glenn Rosenbluth, MD, director of quality and safety programs at the University of California, San Francisco. He noted that it can be difficult to find the positives when the negatives are so glaring.

“This is one of the hard parts about doing feedback,” he said.

It was just one of many lessons taught in the session, also led by Amy Starmer, MD, MPH, a lecturer on pediatrics at Harvard Medical School, and Courtney Edgar-Zarate, MD, a pediatric hospitalist at Arkansas Children’s Hospital who was one of the I-PASS site leaders.

I-PASS was a nine-site study in the United States and Canada that found that using a bundle of interventions while doing handoffs resulted in a 30% reduction in preventable adverse events, meaning less harm to patients. The hallmark is the “I-PASS” mnemonic. It stands for:

• Illness severity – describing the stability level of a patient.
• Patient summary, including general information, such as the events leading to admission.
• Action list – essentially a to-do list for the patient.
• Situation awareness and contingency planning, which involves having a plan for what might happen.
• Synthesis by the receiver, in which the recipient of the information summarizes what was heard and asks questions.

Beyond that, the I-PASS system involves an introductory workshop, simulation exercises, structured observation and feedback, among other elements, Dr. Starmer said.

“This intervention was certainly not just a five-letter mnemonic,” she said.

The I-PASS Mentored Implementation Program, a collaboration with SHM that is funded by the Agency for Healthcare Research and Quality, is an effort to help implement a similar program in 32 hospitals in the United States.

Dr. Edgar-Zarate outlined the steps that worked at her site to make their I-PASS project successful. She said that project managers have to establish institutional support; assess a given center’s needs; gauge where to begin by identifying the most vulnerable transition points; find providers who will champion the project; establish good communication, in part by incorporating I-PASS into previously scheduled meetings; and collect data as time goes on.

Dr. Starmer directed attendees to www.ipassstudygroup.com, where anyone can download the material for free.

“This mentored implementation process,” she said, “has really been a helpful vehicle for disseminating the curriculum and implementation across different areas.”

LAS VEGAS – When the resident in the handoff training video approached another resident, she first vented about her “really crazy day” and how she’d been hoping to “get out of here on time for once.” Then, she tore through a case like an auctioneer, leaving out important details. At the end, she got a page and, of course, didn’t finish the handoff.

In Wednesday’s Quality Track session, “Strategies for Implementing a Successful Handoff” – with lessons from SHM’s I-PASS mentored implementation project – some attendees were eager to point out all of the flaws in the handoff. They were, however, slower to point to the good. For instance, the resident in the video made the effort to meet face-to-face and asked whether her colleague had any questions.

The audience had learned an important lesson about how to foster better handoffs, said Glenn Rosenbluth, MD, director of quality and safety programs at the University of California, San Francisco. He noted that it can be difficult to find the positives when the negatives are so glaring.

“This is one of the hard parts about doing feedback,” he said.

It was just one of many lessons taught in the session, also led by Amy Starmer, MD, MPH, a lecturer on pediatrics at Harvard Medical School, and Courtney Edgar-Zarate, MD, a pediatric hospitalist at Arkansas Children’s Hospital who was one of the I-PASS site leaders.

I-PASS was a nine-site study in the United States and Canada that found that using a bundle of interventions while doing handoffs resulted in a 30% reduction in preventable adverse events, meaning less harm to patients. The hallmark is the “I-PASS” mnemonic. It stands for:

• Illness severity – describing the stability level of a patient.
• Patient summary, including general information, such as the events leading to admission.
• Action list – essentially a to-do list for the patient.
• Situation awareness and contingency planning, which involves having a plan for what might happen.
• Synthesis by the receiver, in which the recipient of the information summarizes what was heard and asks questions.

Beyond that, the I-PASS system involves an introductory workshop, simulation exercises, structured observation and feedback, among other elements, Dr. Starmer said.

“This intervention was certainly not just a five-letter mnemonic,” she said.

The I-PASS Mentored Implementation Program, a collaboration with SHM that is funded by the Agency for Healthcare Research and Quality, is an effort to help implement a similar program in 32 hospitals in the United States.

Dr. Edgar-Zarate outlined the steps that worked at her site to make their I-PASS project successful. She said that project managers have to establish institutional support; assess a given center’s needs; gauge where to begin by identifying the most vulnerable transition points; find providers who will champion the project; establish good communication, in part by incorporating I-PASS into previously scheduled meetings; and collect data as time goes on.

Dr. Starmer directed attendees to www.ipassstudygroup.com, where anyone can download the material for free.

“This mentored implementation process,” she said, “has really been a helpful vehicle for disseminating the curriculum and implementation across different areas.”

Practicing at the top of your license, billing and reimbursement, recruiting and orientation – Those were some of the hot topics discussed by more than 50 attendees of HM17’s Special Interest Forum for nurse practitioners (NPs) and physician assistants (PAs).

“Every year, we are seeing more and more HM groups integrating NPs and PAs into their practice,” said forum moderator Emilie Thornhill, PA-C, a certified PA, who works for Oschner Health in New Orleans, La.

Ms. Thornhill emphasized that a common issue among attendees is restrictive HM policies in dictating the scope of practice for NP/PAs in hospitalist groups.

“That seems to be the thing that is holding us back the most,” she said. “SHM is really going to be the home for these individuals to find the resources they need to address these issues.”

Practicing at the top of your license, billing and reimbursement, recruiting and orientation – Those were some of the hot topics discussed by more than 50 attendees of HM17’s Special Interest Forum for nurse practitioners (NPs) and physician assistants (PAs).

“Every year, we are seeing more and more HM groups integrating NPs and PAs into their practice,” said forum moderator Emilie Thornhill, PA-C, a certified PA, who works for Oschner Health in New Orleans, La.

Ms. Thornhill emphasized that a common issue among attendees is restrictive HM policies in dictating the scope of practice for NP/PAs in hospitalist groups.

“That seems to be the thing that is holding us back the most,” she said. “SHM is really going to be the home for these individuals to find the resources they need to address these issues.”

Practicing at the top of your license, billing and reimbursement, recruiting and orientation – Those were some of the hot topics discussed by more than 50 attendees of HM17’s Special Interest Forum for nurse practitioners (NPs) and physician assistants (PAs).

“Every year, we are seeing more and more HM groups integrating NPs and PAs into their practice,” said forum moderator Emilie Thornhill, PA-C, a certified PA, who works for Oschner Health in New Orleans, La.

Ms. Thornhill emphasized that a common issue among attendees is restrictive HM policies in dictating the scope of practice for NP/PAs in hospitalist groups.

“That seems to be the thing that is holding us back the most,” she said. “SHM is really going to be the home for these individuals to find the resources they need to address these issues.”

Coping with disjointed administrative goals, demonstrating value to hospital leadership, and strengthening support networks for one another were hot-button topics during the Special Interest Group for Community Hospitalists at this year’s HM17.

A mix of hospitalists from rural, urban, and suburban facilities with an average 200-500 beds joined in the discussion, moderated by Stephen Behnke, MD, an internist and president of MedOne in Columbus, Ohio, and Jason Robertson, MD, an internist with HealthPartners in Bloomington, Minn.

Burnout was seen by several in the crowd of about two dozen physicians as being related in part to poor staffing and scheduling decisions at the administrative level, and not allocating clerical work to other staff, often forcing hospitalists to perform tasks not at the top of their license. One solution offered was to amortize the cost of physicians doing paperwork according to their salaries, and to bring those numbers to the attention of hospital leadership.

The group called on the Society of Hospital Medicine to create and disseminate evidence-based resources to help demonstrate their value to hospital administration. Many in the group expressed interest in learning how to communicate their value effectively to their respective C-suites to underscore the essential nature HM has to the core business. In an interview directly after the session, Dr. Behnke explained that hospital leaders often underfund HM programs, only to find that the decision ends up costing them more in the long run.

Lots of upset was vented by session attendees over patient discharge protocols that often resulted in higher lengths of stay or increased readmissions, which then reflected poorly on the hospitalist. The group agreed that since there was no one-size-fits-all approach to this, it would be helpful to start a listserv of community hospitalists in the SHM that was organized by hospital size, location, and types of staffing, so it would be easier to find solutions by connecting with others with similar concerns.

Many in the group also shared how their respective facilities promoted wellness through togetherness activities: staff retreats, movie nights, book clubs, group family outings, and forming alliances with hospitalists at other local hospitals. The general consensus was that this helped improve staff morale.

Coping with disjointed administrative goals, demonstrating value to hospital leadership, and strengthening support networks for one another were hot-button topics during the Special Interest Group for Community Hospitalists at this year’s HM17.

A mix of hospitalists from rural, urban, and suburban facilities with an average 200-500 beds joined in the discussion, moderated by Stephen Behnke, MD, an internist and president of MedOne in Columbus, Ohio, and Jason Robertson, MD, an internist with HealthPartners in Bloomington, Minn.

Burnout was seen by several in the crowd of about two dozen physicians as being related in part to poor staffing and scheduling decisions at the administrative level, and not allocating clerical work to other staff, often forcing hospitalists to perform tasks not at the top of their license. One solution offered was to amortize the cost of physicians doing paperwork according to their salaries, and to bring those numbers to the attention of hospital leadership.

The group called on the Society of Hospital Medicine to create and disseminate evidence-based resources to help demonstrate their value to hospital administration. Many in the group expressed interest in learning how to communicate their value effectively to their respective C-suites to underscore the essential nature HM has to the core business. In an interview directly after the session, Dr. Behnke explained that hospital leaders often underfund HM programs, only to find that the decision ends up costing them more in the long run.

Lots of upset was vented by session attendees over patient discharge protocols that often resulted in higher lengths of stay or increased readmissions, which then reflected poorly on the hospitalist. The group agreed that since there was no one-size-fits-all approach to this, it would be helpful to start a listserv of community hospitalists in the SHM that was organized by hospital size, location, and types of staffing, so it would be easier to find solutions by connecting with others with similar concerns.

Many in the group also shared how their respective facilities promoted wellness through togetherness activities: staff retreats, movie nights, book clubs, group family outings, and forming alliances with hospitalists at other local hospitals. The general consensus was that this helped improve staff morale.

Coping with disjointed administrative goals, demonstrating value to hospital leadership, and strengthening support networks for one another were hot-button topics during the Special Interest Group for Community Hospitalists at this year’s HM17.

A mix of hospitalists from rural, urban, and suburban facilities with an average 200-500 beds joined in the discussion, moderated by Stephen Behnke, MD, an internist and president of MedOne in Columbus, Ohio, and Jason Robertson, MD, an internist with HealthPartners in Bloomington, Minn.

Burnout was seen by several in the crowd of about two dozen physicians as being related in part to poor staffing and scheduling decisions at the administrative level, and not allocating clerical work to other staff, often forcing hospitalists to perform tasks not at the top of their license. One solution offered was to amortize the cost of physicians doing paperwork according to their salaries, and to bring those numbers to the attention of hospital leadership.

The group called on the Society of Hospital Medicine to create and disseminate evidence-based resources to help demonstrate their value to hospital administration. Many in the group expressed interest in learning how to communicate their value effectively to their respective C-suites to underscore the essential nature HM has to the core business. In an interview directly after the session, Dr. Behnke explained that hospital leaders often underfund HM programs, only to find that the decision ends up costing them more in the long run.

Lots of upset was vented by session attendees over patient discharge protocols that often resulted in higher lengths of stay or increased readmissions, which then reflected poorly on the hospitalist. The group agreed that since there was no one-size-fits-all approach to this, it would be helpful to start a listserv of community hospitalists in the SHM that was organized by hospital size, location, and types of staffing, so it would be easier to find solutions by connecting with others with similar concerns.

Many in the group also shared how their respective facilities promoted wellness through togetherness activities: staff retreats, movie nights, book clubs, group family outings, and forming alliances with hospitalists at other local hospitals. The general consensus was that this helped improve staff morale.

Sometimes the final day of a convention is nothing more than the “getaway day.”

But not at HM17. Not this year.

The finale of the 2017 annual meeting is capped off, as has become tradition, by a speech from the dean of hospital medicine: Robert Wachter, MD, MHM. The last time Dr. Wachter gave his address from a Vegas stage, it ended with him in head-to-toe Elton John regalia. While there’s no guarantee of a wardrobe reprisal, the annual address from the man who helped name the specialty promises to entertain and inform, said HM17 course director Lenny Feldman, MD, SFHM.

Sometimes the final day of a convention is nothing more than the “getaway day.”

But not at HM17. Not this year.

The finale of the 2017 annual meeting is capped off, as has become tradition, by a speech from the dean of hospital medicine: Robert Wachter, MD, MHM. The last time Dr. Wachter gave his address from a Vegas stage, it ended with him in head-to-toe Elton John regalia. While there’s no guarantee of a wardrobe reprisal, the annual address from the man who helped name the specialty promises to entertain and inform, said HM17 course director Lenny Feldman, MD, SFHM.

Sometimes the final day of a convention is nothing more than the “getaway day.”

But not at HM17. Not this year.

The finale of the 2017 annual meeting is capped off, as has become tradition, by a speech from the dean of hospital medicine: Robert Wachter, MD, MHM. The last time Dr. Wachter gave his address from a Vegas stage, it ended with him in head-to-toe Elton John regalia. While there’s no guarantee of a wardrobe reprisal, the annual address from the man who helped name the specialty promises to entertain and inform, said HM17 course director Lenny Feldman, MD, SFHM.

Robert M. Wachter, MD, MHM, has given the last plenary address at every SHM annual meeting since 2007. The talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy. Then there was the time when he broke into an Elton John parody.

Where does that point of view come from? Well, as the dean of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli-sci major becomes an academic physician.”

That’s a needed perspective this year, as the level of political upheaval in the United States has added to the tumult in the health care field. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles that doctors face when using electronic health records (EHRs) are among the topics that he will address in his this final discussion.

The defeat of Republicans’ plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA) showed that the divide over health care extends even to intraparty discussions.

“The implosion of the AHCA shows how difficult health reform is and how quickly the ACA became the de facto standard,” Dr. Wachter said. “It is now that status quo that is so difficult to change.”

Dr. Wachter, who famously helped coined the term “hospitalist” in the 1996 New England Journal of Medicine paper that propelled the nascent specialty, said that one big challenge to HM is determining the future of how hospitals get paid – and how they pay their workers (335[7]:514-7).

“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or [if] their payments go way down,” he predicted.

What that means for the daily schedules of hospitalists remains to be seen, but Dr. Wachter doesn’t expect much in the short term.

“The job will be the same,” he said. “Take care of patients well, make them happy, satisfy your bosses and colleagues, and do it for less money. The biggest shift is likely to be that more and more people/systems – doing the same thing – will find that they don’t need as many hospital days, which means that we’ll have fewer patients and fewer hospitals. But we knew that.”

Dr. Wachter is more interested to see what will happen in postacute and other nonhospital facilities, how quickly technology continues to disrupt, and who hospitalists will work for (be it staffing companies, medical groups, or “something new”).

The veteran physician in him says not to get too distracted “by all of the zigs and zags,” he noted, while the political idealist in him says not to ever forget that the “core values and imperatives remain.”

If the past decade of wise words ending SHM’s annual meeting are any indication, Dr. Wachter’s message of trepidation and concern will end on a high note for attendees.

Robert M. Wachter, MD, MHM, has given the last plenary address at every SHM annual meeting since 2007. The talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy. Then there was the time when he broke into an Elton John parody.

Where does that point of view come from? Well, as the dean of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli-sci major becomes an academic physician.”

That’s a needed perspective this year, as the level of political upheaval in the United States has added to the tumult in the health care field. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles that doctors face when using electronic health records (EHRs) are among the topics that he will address in his this final discussion.

The defeat of Republicans’ plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA) showed that the divide over health care extends even to intraparty discussions.

“The implosion of the AHCA shows how difficult health reform is and how quickly the ACA became the de facto standard,” Dr. Wachter said. “It is now that status quo that is so difficult to change.”

Dr. Wachter, who famously helped coined the term “hospitalist” in the 1996 New England Journal of Medicine paper that propelled the nascent specialty, said that one big challenge to HM is determining the future of how hospitals get paid – and how they pay their workers (335[7]:514-7).

“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or [if] their payments go way down,” he predicted.

What that means for the daily schedules of hospitalists remains to be seen, but Dr. Wachter doesn’t expect much in the short term.

“The job will be the same,” he said. “Take care of patients well, make them happy, satisfy your bosses and colleagues, and do it for less money. The biggest shift is likely to be that more and more people/systems – doing the same thing – will find that they don’t need as many hospital days, which means that we’ll have fewer patients and fewer hospitals. But we knew that.”

Dr. Wachter is more interested to see what will happen in postacute and other nonhospital facilities, how quickly technology continues to disrupt, and who hospitalists will work for (be it staffing companies, medical groups, or “something new”).

The veteran physician in him says not to get too distracted “by all of the zigs and zags,” he noted, while the political idealist in him says not to ever forget that the “core values and imperatives remain.”

If the past decade of wise words ending SHM’s annual meeting are any indication, Dr. Wachter’s message of trepidation and concern will end on a high note for attendees.

Robert M. Wachter, MD, MHM, has given the last plenary address at every SHM annual meeting since 2007. The talks are peppered with his one-of-a-kind take on the confluence of medicine, politics, and policy. Then there was the time when he broke into an Elton John parody.

Where does that point of view come from? Well, as the dean of hospital medicine says in his ever-popular Twitter bio, he is “what happens when a poli-sci major becomes an academic physician.”

That’s a needed perspective this year, as the level of political upheaval in the United States has added to the tumult in the health care field. Questions surrounding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the continued struggles that doctors face when using electronic health records (EHRs) are among the topics that he will address in his this final discussion.

The defeat of Republicans’ plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA) showed that the divide over health care extends even to intraparty discussions.

“The implosion of the AHCA shows how difficult health reform is and how quickly the ACA became the de facto standard,” Dr. Wachter said. “It is now that status quo that is so difficult to change.”

Dr. Wachter, who famously helped coined the term “hospitalist” in the 1996 New England Journal of Medicine paper that propelled the nascent specialty, said that one big challenge to HM is determining the future of how hospitals get paid – and how they pay their workers (335[7]:514-7).

“The business model for hospitals will be massively challenged, and it could get worse if a lot of your patients lose insurance or [if] their payments go way down,” he predicted.

What that means for the daily schedules of hospitalists remains to be seen, but Dr. Wachter doesn’t expect much in the short term.

“The job will be the same,” he said. “Take care of patients well, make them happy, satisfy your bosses and colleagues, and do it for less money. The biggest shift is likely to be that more and more people/systems – doing the same thing – will find that they don’t need as many hospital days, which means that we’ll have fewer patients and fewer hospitals. But we knew that.”

Dr. Wachter is more interested to see what will happen in postacute and other nonhospital facilities, how quickly technology continues to disrupt, and who hospitalists will work for (be it staffing companies, medical groups, or “something new”).

The veteran physician in him says not to get too distracted “by all of the zigs and zags,” he noted, while the political idealist in him says not to ever forget that the “core values and imperatives remain.”

If the past decade of wise words ending SHM’s annual meeting are any indication, Dr. Wachter’s message of trepidation and concern will end on a high note for attendees.

Welcome to the third and final day of HM17!

Although it is the shortest day of the conference, day 3 is full of quality content, starting at 7:40 a.m. with a mini-track.

If you are interested in hearing about the impact of November’s election on health care reform, join me at the Health Policy Mini-Track starting first thing in the morning. The mini-track will begin with a session called “Hot Topics in Health Policy for Hospitalists” and will be followed by a panel of visitors from our nation’s capital who will weigh in on events in D.C. that will have an impact on our careers.

Welcome to the third and final day of HM17!

Although it is the shortest day of the conference, day 3 is full of quality content, starting at 7:40 a.m. with a mini-track.

If you are interested in hearing about the impact of November’s election on health care reform, join me at the Health Policy Mini-Track starting first thing in the morning. The mini-track will begin with a session called “Hot Topics in Health Policy for Hospitalists” and will be followed by a panel of visitors from our nation’s capital who will weigh in on events in D.C. that will have an impact on our careers.

Welcome to the third and final day of HM17!

Although it is the shortest day of the conference, day 3 is full of quality content, starting at 7:40 a.m. with a mini-track.

If you are interested in hearing about the impact of November’s election on health care reform, join me at the Health Policy Mini-Track starting first thing in the morning. The mini-track will begin with a session called “Hot Topics in Health Policy for Hospitalists” and will be followed by a panel of visitors from our nation’s capital who will weigh in on events in D.C. that will have an impact on our careers.

Gurpreet Dhaliwal, MD, professor of medicine at the University of California, San Francisco, joked that participating in a “Stump the Professor” event is “like taking an oral exam in front of 300 or 400 people.”

Dr. Dhaliwal passed his “exam” with flying colors on Wednesday at HM17, correctly making a diagnosis of a case of leptospirosis described by his co-presenter Daniel Brotman, MD, SFHM, professor of medicine and director of the hospitalist program at Johns Hopkins University, Baltimore.

Darnell Scott

Gurpreet Dhaliwal, MD, professor of medicine at the University of California, San Francisco, joked that participating in a “Stump the Professor” event is “like taking an oral exam in front of 300 or 400 people.”

Dr. Dhaliwal passed his “exam” with flying colors on Wednesday at HM17, correctly making a diagnosis of a case of leptospirosis described by his co-presenter Daniel Brotman, MD, SFHM, professor of medicine and director of the hospitalist program at Johns Hopkins University, Baltimore.

Darnell Scott

Gurpreet Dhaliwal, MD, professor of medicine at the University of California, San Francisco, joked that participating in a “Stump the Professor” event is “like taking an oral exam in front of 300 or 400 people.”

Dr. Dhaliwal passed his “exam” with flying colors on Wednesday at HM17, correctly making a diagnosis of a case of leptospirosis described by his co-presenter Daniel Brotman, MD, SFHM, professor of medicine and director of the hospitalist program at Johns Hopkins University, Baltimore.

Darnell Scott

This year’s RIV innovation winners reflect a nascent trend of applying informatics to quality improvement and patient safety initiatives.

“One striking thing is that all three winners used either EHR or Big Data and large collaboratives to achieve their goals,” Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, and moderator of the winners’ panel, said in an interview. This year’s winners included a sleep-promoting “nudge” system that Dr. Fang said she expects will help improve sleep and lower rates of delirium and a source code that connects disparate data systems for daily updates on where quality can be improved. The third winner used what Dr. Fang, a hospitalist and the medical director of the anticoagulation clinic at the University of California, San Francisco, called a “classic quality improvement collaborative,” which simplifies the decision tree around venous thromboembolism (VTE) prophylaxis for better patient outcomes.

Calling uninterrupted sleep the “sine qua non” of patient care, RIV award recipient Vineet Arora, MD, an associate professor of medicine at the University of Chicago, described the rationale for her RIV award-winning SIESTA (Sleep for Inpatients: Empowering Staff to Act) program. She and her colleagues surveyed hospitalists, nurses, residents, and patients to determine the most common sleep disrupters in their institution and devised “nudges” to alter how staff performed various tasks that otherwise might interfere with patient sleep. Rather than use overt incentives, nudges are changes in what Dr. Arora called the “choice architecture” of people’s behavior.

Based on survey feedback, Dr. Arora and her colleagues worked with their electronic health record (EHR) vendor to consolidate the performance of certain tasks that were affecting patient sleep. Reminders were added to daily nursing huddles to prompt them to look for ways they could decrease patient interruptions, and empowerment coaching was offered to nurses to encourage patient advocacy when physicians had given orders that would interfere with patients’ sleep.

When tested and measured over the course of a year, SIESTA’s EHR innovations resulted in six fewer nighttime disruptions than before the intervention, compared with controls, a statistically significant difference. The nursing-based interventions resulted in one less nocturnal interruption on average, also a significant change.

“If every patient were admitted into a SIESTA unit, 84% would say they were not disrupted by medications, compared to 57%. For interruptions for vitals, it would be 17% vs. 41%,” Dr. Arora said. In terms of the Hospital Consumer Assessment of Healthcare Providers and Systems) data, this translates into as much as a 25th-percentile performance improvement for hospitals in related domains, according to Dr. Arora.

Nader Najafi, MD, an assistant clinical professor of medicine at UCSF, and his colleagues created Murmur, an open-source code data aggregator, which can be customized to solve a variety of quality improvement issues. RIV award winner Dr. Najafi applied the code to determine how systems failures in their institution were contributing to avoidable inpatient days, for example. At a daily appointed time, Murmur would determine which staff members were scheduled to work that day. Each provider would then receive a brief, customized survey about patients for that day on their cell phone. The data were then collected to create instant reports of where the delays in discharge were occurring.

Testing by gastroenterologists was pinpointed as a “huge source of delays, something we had never been able to quantify before, “ Dr. Najafi said. This led to brainstorming sessions with the department for solutions.

To reduce rates of hospital-associated VTE, 35 California hospitals with varying numbers of beds and locations collaborated on a project led by RIV award recipient Ian Jenkins, MD, SFHM, a health sciences clinical professor at the University of California, San Diego. Key components of the intervention were mentoring at the sites by VTE prophylaxis experts, group webinars in best practices, and a “measure-vention.” Teams were taught how to rate patient risk for VTE and apply specific protocols according to risk rating using the SHM-mentored implementation model. Real-time monitoring of the intervention was used to make any necessary adjustments. When before-and-after data were compared, following the 18-month period during which the intervention was measured, Dr. Jenkins said an average of 330 VTEs were averted annually. “We found the results very gratifying,” said Dr. Jenkins.

“These projects all reflect a broader trend in hospital medicine where we are using the wealth of data we have now for quality improvement and for outcomes research,” Dr. Fang said in the interview.

There were no relevant disclosures.
 

This year’s RIV innovation winners reflect a nascent trend of applying informatics to quality improvement and patient safety initiatives.

“One striking thing is that all three winners used either EHR or Big Data and large collaboratives to achieve their goals,” Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, and moderator of the winners’ panel, said in an interview. This year’s winners included a sleep-promoting “nudge” system that Dr. Fang said she expects will help improve sleep and lower rates of delirium and a source code that connects disparate data systems for daily updates on where quality can be improved. The third winner used what Dr. Fang, a hospitalist and the medical director of the anticoagulation clinic at the University of California, San Francisco, called a “classic quality improvement collaborative,” which simplifies the decision tree around venous thromboembolism (VTE) prophylaxis for better patient outcomes.

Calling uninterrupted sleep the “sine qua non” of patient care, RIV award recipient Vineet Arora, MD, an associate professor of medicine at the University of Chicago, described the rationale for her RIV award-winning SIESTA (Sleep for Inpatients: Empowering Staff to Act) program. She and her colleagues surveyed hospitalists, nurses, residents, and patients to determine the most common sleep disrupters in their institution and devised “nudges” to alter how staff performed various tasks that otherwise might interfere with patient sleep. Rather than use overt incentives, nudges are changes in what Dr. Arora called the “choice architecture” of people’s behavior.

Based on survey feedback, Dr. Arora and her colleagues worked with their electronic health record (EHR) vendor to consolidate the performance of certain tasks that were affecting patient sleep. Reminders were added to daily nursing huddles to prompt them to look for ways they could decrease patient interruptions, and empowerment coaching was offered to nurses to encourage patient advocacy when physicians had given orders that would interfere with patients’ sleep.

When tested and measured over the course of a year, SIESTA’s EHR innovations resulted in six fewer nighttime disruptions than before the intervention, compared with controls, a statistically significant difference. The nursing-based interventions resulted in one less nocturnal interruption on average, also a significant change.

“If every patient were admitted into a SIESTA unit, 84% would say they were not disrupted by medications, compared to 57%. For interruptions for vitals, it would be 17% vs. 41%,” Dr. Arora said. In terms of the Hospital Consumer Assessment of Healthcare Providers and Systems) data, this translates into as much as a 25th-percentile performance improvement for hospitals in related domains, according to Dr. Arora.

Nader Najafi, MD, an assistant clinical professor of medicine at UCSF, and his colleagues created Murmur, an open-source code data aggregator, which can be customized to solve a variety of quality improvement issues. RIV award winner Dr. Najafi applied the code to determine how systems failures in their institution were contributing to avoidable inpatient days, for example. At a daily appointed time, Murmur would determine which staff members were scheduled to work that day. Each provider would then receive a brief, customized survey about patients for that day on their cell phone. The data were then collected to create instant reports of where the delays in discharge were occurring.

Testing by gastroenterologists was pinpointed as a “huge source of delays, something we had never been able to quantify before, “ Dr. Najafi said. This led to brainstorming sessions with the department for solutions.

To reduce rates of hospital-associated VTE, 35 California hospitals with varying numbers of beds and locations collaborated on a project led by RIV award recipient Ian Jenkins, MD, SFHM, a health sciences clinical professor at the University of California, San Diego. Key components of the intervention were mentoring at the sites by VTE prophylaxis experts, group webinars in best practices, and a “measure-vention.” Teams were taught how to rate patient risk for VTE and apply specific protocols according to risk rating using the SHM-mentored implementation model. Real-time monitoring of the intervention was used to make any necessary adjustments. When before-and-after data were compared, following the 18-month period during which the intervention was measured, Dr. Jenkins said an average of 330 VTEs were averted annually. “We found the results very gratifying,” said Dr. Jenkins.

“These projects all reflect a broader trend in hospital medicine where we are using the wealth of data we have now for quality improvement and for outcomes research,” Dr. Fang said in the interview.

There were no relevant disclosures.
 

This year’s RIV innovation winners reflect a nascent trend of applying informatics to quality improvement and patient safety initiatives.

“One striking thing is that all three winners used either EHR or Big Data and large collaboratives to achieve their goals,” Margaret Fang, MD, MPH, FHM, program chair for HM17’s scientific abstracts competition, and moderator of the winners’ panel, said in an interview. This year’s winners included a sleep-promoting “nudge” system that Dr. Fang said she expects will help improve sleep and lower rates of delirium and a source code that connects disparate data systems for daily updates on where quality can be improved. The third winner used what Dr. Fang, a hospitalist and the medical director of the anticoagulation clinic at the University of California, San Francisco, called a “classic quality improvement collaborative,” which simplifies the decision tree around venous thromboembolism (VTE) prophylaxis for better patient outcomes.

Calling uninterrupted sleep the “sine qua non” of patient care, RIV award recipient Vineet Arora, MD, an associate professor of medicine at the University of Chicago, described the rationale for her RIV award-winning SIESTA (Sleep for Inpatients: Empowering Staff to Act) program. She and her colleagues surveyed hospitalists, nurses, residents, and patients to determine the most common sleep disrupters in their institution and devised “nudges” to alter how staff performed various tasks that otherwise might interfere with patient sleep. Rather than use overt incentives, nudges are changes in what Dr. Arora called the “choice architecture” of people’s behavior.

Based on survey feedback, Dr. Arora and her colleagues worked with their electronic health record (EHR) vendor to consolidate the performance of certain tasks that were affecting patient sleep. Reminders were added to daily nursing huddles to prompt them to look for ways they could decrease patient interruptions, and empowerment coaching was offered to nurses to encourage patient advocacy when physicians had given orders that would interfere with patients’ sleep.

When tested and measured over the course of a year, SIESTA’s EHR innovations resulted in six fewer nighttime disruptions than before the intervention, compared with controls, a statistically significant difference. The nursing-based interventions resulted in one less nocturnal interruption on average, also a significant change.

“If every patient were admitted into a SIESTA unit, 84% would say they were not disrupted by medications, compared to 57%. For interruptions for vitals, it would be 17% vs. 41%,” Dr. Arora said. In terms of the Hospital Consumer Assessment of Healthcare Providers and Systems) data, this translates into as much as a 25th-percentile performance improvement for hospitals in related domains, according to Dr. Arora.

Nader Najafi, MD, an assistant clinical professor of medicine at UCSF, and his colleagues created Murmur, an open-source code data aggregator, which can be customized to solve a variety of quality improvement issues. RIV award winner Dr. Najafi applied the code to determine how systems failures in their institution were contributing to avoidable inpatient days, for example. At a daily appointed time, Murmur would determine which staff members were scheduled to work that day. Each provider would then receive a brief, customized survey about patients for that day on their cell phone. The data were then collected to create instant reports of where the delays in discharge were occurring.

Testing by gastroenterologists was pinpointed as a “huge source of delays, something we had never been able to quantify before, “ Dr. Najafi said. This led to brainstorming sessions with the department for solutions.

To reduce rates of hospital-associated VTE, 35 California hospitals with varying numbers of beds and locations collaborated on a project led by RIV award recipient Ian Jenkins, MD, SFHM, a health sciences clinical professor at the University of California, San Diego. Key components of the intervention were mentoring at the sites by VTE prophylaxis experts, group webinars in best practices, and a “measure-vention.” Teams were taught how to rate patient risk for VTE and apply specific protocols according to risk rating using the SHM-mentored implementation model. Real-time monitoring of the intervention was used to make any necessary adjustments. When before-and-after data were compared, following the 18-month period during which the intervention was measured, Dr. Jenkins said an average of 330 VTEs were averted annually. “We found the results very gratifying,” said Dr. Jenkins.

“These projects all reflect a broader trend in hospital medicine where we are using the wealth of data we have now for quality improvement and for outcomes research,” Dr. Fang said in the interview.

There were no relevant disclosures.
 

Hospitalists can – and should – help curb unnecessary antibiotic use, according to an expert who spoke at HM17.

Nearly three-quarters of patients who have been diagnosed with community acquired pneumonia are receiving antibiotics for longer periods than necessary, either because the severity of their illness doesn’t warrant them or because they do not have pneumonia, according to Valerie M. Vaughn, MD, a research scientist in the division of hospital medicine and the Patient Safety Enhancement Program at Michigan Medicine, Ann Arbor.

“As hospitalists, we have a role to play in antibiotic stewardship,” Dr. Vaughn said in this interview recorded at the meeting.

Hospitalists can – and should – help curb unnecessary antibiotic use, according to an expert who spoke at HM17.

Nearly three-quarters of patients who have been diagnosed with community acquired pneumonia are receiving antibiotics for longer periods than necessary, either because the severity of their illness doesn’t warrant them or because they do not have pneumonia, according to Valerie M. Vaughn, MD, a research scientist in the division of hospital medicine and the Patient Safety Enhancement Program at Michigan Medicine, Ann Arbor.

“As hospitalists, we have a role to play in antibiotic stewardship,” Dr. Vaughn said in this interview recorded at the meeting.

Hospitalists can – and should – help curb unnecessary antibiotic use, according to an expert who spoke at HM17.

Nearly three-quarters of patients who have been diagnosed with community acquired pneumonia are receiving antibiotics for longer periods than necessary, either because the severity of their illness doesn’t warrant them or because they do not have pneumonia, according to Valerie M. Vaughn, MD, a research scientist in the division of hospital medicine and the Patient Safety Enhancement Program at Michigan Medicine, Ann Arbor.

“As hospitalists, we have a role to play in antibiotic stewardship,” Dr. Vaughn said in this interview recorded at the meeting.

Hospitalists have a powerful tool to help them fight outbreaks of Clostridium difficile and other infectious agents: electronic health record data.

Sara Murray, MD, an assistant professor of medicine at the University of California, San Francisco, and her colleagues, used EHR data to map temporal and spatial coordinates to determine where patients in their hospital were at highest risk for C. difficile. Patients who’d had a CT scan on a particular machine in the emergency department within 24 hours of an infected person having been scanned there had a threefold higher risk of infection, they found. This information helped the hospital’s infection control team to create a more effective sterilization plan for that specific machine.

“The takeaway is that we should be leveraging our EHR data to inform our quality improvement efforts,” Dr. Murray said in this video interview, recorded during HM17.

Hospitalists have a powerful tool to help them fight outbreaks of Clostridium difficile and other infectious agents: electronic health record data.

Sara Murray, MD, an assistant professor of medicine at the University of California, San Francisco, and her colleagues, used EHR data to map temporal and spatial coordinates to determine where patients in their hospital were at highest risk for C. difficile. Patients who’d had a CT scan on a particular machine in the emergency department within 24 hours of an infected person having been scanned there had a threefold higher risk of infection, they found. This information helped the hospital’s infection control team to create a more effective sterilization plan for that specific machine.

“The takeaway is that we should be leveraging our EHR data to inform our quality improvement efforts,” Dr. Murray said in this video interview, recorded during HM17.

Hospitalists have a powerful tool to help them fight outbreaks of Clostridium difficile and other infectious agents: electronic health record data.

Sara Murray, MD, an assistant professor of medicine at the University of California, San Francisco, and her colleagues, used EHR data to map temporal and spatial coordinates to determine where patients in their hospital were at highest risk for C. difficile. Patients who’d had a CT scan on a particular machine in the emergency department within 24 hours of an infected person having been scanned there had a threefold higher risk of infection, they found. This information helped the hospital’s infection control team to create a more effective sterilization plan for that specific machine.

“The takeaway is that we should be leveraging our EHR data to inform our quality improvement efforts,” Dr. Murray said in this video interview, recorded during HM17.