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Patient handoff
Patient handoff (or sign‐out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Effective and timely sign‐outs are essential to maintain high quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between health care providers.
KNOWLEDGE
Hospitalists should be able to:
Describe key elements involved in signing out a patient.
Explain important information that should be communicated during patient sign‐out, which may include administrative details, updated clinical status, tasks to be completed and relative priority, severity of illness assessment, code status, and contingency planning.
Explain the components and strategies that are critical for successful communication during sign‐outs.
Explain how the components, strategies and specific information provided at sign‐out might vary depending on complexity of the patient, familiarity of provider with the patient and the care environment, and timing of sign‐out.
Explain the strengths and limitations of various sign‐out communication strategies and procedures.
SKILLS
Hospitalists should be able to:
Communicate effectively and efficiently during patient sign‐out.
Demonstrate the use of read back when communicating tasks.
Utilize the most efficient and effective verbal and written communication modalities.
Construct patient summaries for oral and written delivery, incorporating the unique characteristics of the patient, provider and timing of the sign‐out.
Evaluate all medications for indication, dosing, and planned duration at the time of sign‐out.
Document updated clinical status, recent and pending test and study results, a complete problem list, and plans for continued care.
Explain the importance of using if‐then statements for critical tasks to be completed.
Anticipate what may go wrong with a patient after a transition in care and communicate this clearly to the receiving clinician.
Synthesize medical information received from Hospitalists signing out patients into care plans
ATTITUDES
Hospitalists should be able to:
Inform patients and families in advance of sign‐out.
Recognize the impact of effective and ineffective sign‐outs on patient safety.
Appreciate the value of real time interactive dialogue between hospitalists during sign‐out.
Review received sign‐out summaries and communications information carefully and request clarification when needed.
Engage stakeholders in hospital initiatives to continuously assess the quality of sign‐outs.
Lead, coordinate or participate in initiatives to develop and implement new protocols to improve and optimize sign‐outs.
Lead, coordinate or participate in evaluation of new strategies or information systems designed to improve sign‐outs.
Promote availability after sign‐outs should questions arise.
Patient handoff (or sign‐out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Effective and timely sign‐outs are essential to maintain high quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between health care providers.
KNOWLEDGE
Hospitalists should be able to:
Describe key elements involved in signing out a patient.
Explain important information that should be communicated during patient sign‐out, which may include administrative details, updated clinical status, tasks to be completed and relative priority, severity of illness assessment, code status, and contingency planning.
Explain the components and strategies that are critical for successful communication during sign‐outs.
Explain how the components, strategies and specific information provided at sign‐out might vary depending on complexity of the patient, familiarity of provider with the patient and the care environment, and timing of sign‐out.
Explain the strengths and limitations of various sign‐out communication strategies and procedures.
SKILLS
Hospitalists should be able to:
Communicate effectively and efficiently during patient sign‐out.
Demonstrate the use of read back when communicating tasks.
Utilize the most efficient and effective verbal and written communication modalities.
Construct patient summaries for oral and written delivery, incorporating the unique characteristics of the patient, provider and timing of the sign‐out.
Evaluate all medications for indication, dosing, and planned duration at the time of sign‐out.
Document updated clinical status, recent and pending test and study results, a complete problem list, and plans for continued care.
Explain the importance of using if‐then statements for critical tasks to be completed.
Anticipate what may go wrong with a patient after a transition in care and communicate this clearly to the receiving clinician.
Synthesize medical information received from Hospitalists signing out patients into care plans
ATTITUDES
Hospitalists should be able to:
Inform patients and families in advance of sign‐out.
Recognize the impact of effective and ineffective sign‐outs on patient safety.
Appreciate the value of real time interactive dialogue between hospitalists during sign‐out.
Review received sign‐out summaries and communications information carefully and request clarification when needed.
Engage stakeholders in hospital initiatives to continuously assess the quality of sign‐outs.
Lead, coordinate or participate in initiatives to develop and implement new protocols to improve and optimize sign‐outs.
Lead, coordinate or participate in evaluation of new strategies or information systems designed to improve sign‐outs.
Promote availability after sign‐outs should questions arise.
Patient handoff (or sign‐out) refers to the specific interaction, communication, and planning required to achieve seamless transitions of care from one clinician to another. Effective and timely sign‐outs are essential to maintain high quality medical care, reduce medical errors and redundancy, and prevent loss of information. Hospitalists are involved in the transfer of patient care on a daily basis and can lead institutional initiatives that promote optimal transfer of information between health care providers.
KNOWLEDGE
Hospitalists should be able to:
Describe key elements involved in signing out a patient.
Explain important information that should be communicated during patient sign‐out, which may include administrative details, updated clinical status, tasks to be completed and relative priority, severity of illness assessment, code status, and contingency planning.
Explain the components and strategies that are critical for successful communication during sign‐outs.
Explain how the components, strategies and specific information provided at sign‐out might vary depending on complexity of the patient, familiarity of provider with the patient and the care environment, and timing of sign‐out.
Explain the strengths and limitations of various sign‐out communication strategies and procedures.
SKILLS
Hospitalists should be able to:
Communicate effectively and efficiently during patient sign‐out.
Demonstrate the use of read back when communicating tasks.
Utilize the most efficient and effective verbal and written communication modalities.
Construct patient summaries for oral and written delivery, incorporating the unique characteristics of the patient, provider and timing of the sign‐out.
Evaluate all medications for indication, dosing, and planned duration at the time of sign‐out.
Document updated clinical status, recent and pending test and study results, a complete problem list, and plans for continued care.
Explain the importance of using if‐then statements for critical tasks to be completed.
Anticipate what may go wrong with a patient after a transition in care and communicate this clearly to the receiving clinician.
Synthesize medical information received from Hospitalists signing out patients into care plans
ATTITUDES
Hospitalists should be able to:
Inform patients and families in advance of sign‐out.
Recognize the impact of effective and ineffective sign‐outs on patient safety.
Appreciate the value of real time interactive dialogue between hospitalists during sign‐out.
Review received sign‐out summaries and communications information carefully and request clarification when needed.
Engage stakeholders in hospital initiatives to continuously assess the quality of sign‐outs.
Lead, coordinate or participate in initiatives to develop and implement new protocols to improve and optimize sign‐outs.
Lead, coordinate or participate in evaluation of new strategies or information systems designed to improve sign‐outs.
Promote availability after sign‐outs should questions arise.
Copyright © 2006 Society of Hospital Medicine
Congestive heart failure syndrome
Congestive heart failure syndrome (chf) is characterized by impaired function of the heart resulting in a constellation of symptoms and signs, which may include fatigue, weakness and shortness of breath. the american heart association (aha) reports that chf affects nearly 5 million people in the united states. chf accounted for 970,000 hospital discharges in 2002. medicare paid $3.6 billion for the care of patients with chf in 1999, or $5,456 per discharge. the estimated direct and indirect cost of chf in 2005 is $27.9 billion. despite published guidelines for chf management, there is significant variation in treatment for hospitalized patients. this variability significantly impacts individual patients, families and hospital systems, and accounts for billions of dollars of the medicare budget. hospitalists can lead their institutions in early diagnosis, initiation of evidence based medical therapy, and incorporation of a multidisciplinary approach to heart failure. hospitalists can also develop strategies to operationalize cost‐effective interventions that reduce morbidity, mortality and readmission rates.
KNOWLEDGE
Hospitalists should be able to:
Explain underlying causes of chf and precipitating factors leading to exacerbation.
Differentiate features of systolic and diastolic dysfunction, and explain the common etiologies of each.
Describe the indicated tests required to evaluate chf, including assessment of left ventricular function.
Describe risk factors for the development of chf in the hospital setting.
Risk stratify patients admitted with chf and determine the appropriate level of care.
Describe goals of inpatient therapy for acute decompensated heart failure including pre‐load and after‐load reduction, hemodynamic stabilization, and optimization of volume status.
Describe the role of invasive and noninvasive ventilatory support.
Explain evidence based therapeutic options for management of acute and chronic chf and describe contraindications to these therapies.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat chf.
Identify medications and interventions contraindicated in chf.
Explain markers of severity of the disease and factors that influence prognosis.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history and review the medical record to identify symptoms, co‐morbidities, medications, and/or social influences contributing to chf or its exacerbation.
Review inpatient records to determine iatrogenic influences of chf.
Recognize the clinical presentation of heart failure, including features of exacerbation and reliability of signs and symptoms.
Identify physical findings consistent with chf.
Identify signs of low perfusion states and cardiogenic shock.
Order indicated diagnostic testing to identify precipitating factors of chf and assess cardiac function.
Formulate an evidence based treatment plan, tailored to the individual patient, which may include pharmacologic agents and dosing, nutritional recommendations, and patient compliance.
Recognize symptoms and signs of acute decompensation and initiate immediate indicated therapies.
Assess patients with suspected heart failure in a timely manner, identify the level of care required, and manage or co‐manage the patient with the primary requesting service.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the history and prognosis of chf.
Communicate with patients and families to explain the importance of home self‐monitoring and adherence to medication regimens, nutritional recommendations, and physical rehabilitation.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain tests and procedures, and the use and potential side effects of pharmacologic agents.
Recognize indications for early cardiology consultation.
Recognize indications and qualifications for cardiac transplant evaluation.
Advocate the importance of behavioral modification to delay the progression of disease and improve quality of life.
Employ a multidisciplinary approach to the care of patients with chf that begins at admission and continues through all care transitions.
Recognize the importance of palliative care in the treatment of patients with chronic chf.
Responsibly address and respect end of life care wishes for patients with end‐stage chf.
Communicate to outpatient providers the relevant events of the hospitalization and post‐discharge needs, including pending tests, and determine who is responsible for checking the results.
Document treatment plan and provide clear discharge instructions for receiving primary care physician.
Utilize evidence based recommendations to guide diagnosis, monitoring and treatment of chf.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Advocate to hospital administrators to establish and support outpatient chf teams, which have been shown to reduce readmission rates and possibly morbidity and mortality through outreach to chf patients.
Lead, coordinate or participate in multidisciplinary teams, which may include nursing and social services, nutrition, pharmacy, and physical therapy, early in the hospital course to facilitate patient education and discharge planning; improve patient function and outcomes; and advocate patient outreach post‐discharge.
Implement systems to ensure hospital wide adherence to national standards and document those measures as specified by recognized organizations (jcaho, aha, acc, ahrq or others).
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead efforts to educate staff on the importance of smoking cessation counseling and other prevention measures.
Integrate outcomes research, institution‐specific laboratory policies, and hospital formulary to create indicated and cost‐effective diagnostic and management strategies for patients with chf.
Congestive heart failure syndrome (chf) is characterized by impaired function of the heart resulting in a constellation of symptoms and signs, which may include fatigue, weakness and shortness of breath. the american heart association (aha) reports that chf affects nearly 5 million people in the united states. chf accounted for 970,000 hospital discharges in 2002. medicare paid $3.6 billion for the care of patients with chf in 1999, or $5,456 per discharge. the estimated direct and indirect cost of chf in 2005 is $27.9 billion. despite published guidelines for chf management, there is significant variation in treatment for hospitalized patients. this variability significantly impacts individual patients, families and hospital systems, and accounts for billions of dollars of the medicare budget. hospitalists can lead their institutions in early diagnosis, initiation of evidence based medical therapy, and incorporation of a multidisciplinary approach to heart failure. hospitalists can also develop strategies to operationalize cost‐effective interventions that reduce morbidity, mortality and readmission rates.
KNOWLEDGE
Hospitalists should be able to:
Explain underlying causes of chf and precipitating factors leading to exacerbation.
Differentiate features of systolic and diastolic dysfunction, and explain the common etiologies of each.
Describe the indicated tests required to evaluate chf, including assessment of left ventricular function.
Describe risk factors for the development of chf in the hospital setting.
Risk stratify patients admitted with chf and determine the appropriate level of care.
Describe goals of inpatient therapy for acute decompensated heart failure including pre‐load and after‐load reduction, hemodynamic stabilization, and optimization of volume status.
Describe the role of invasive and noninvasive ventilatory support.
Explain evidence based therapeutic options for management of acute and chronic chf and describe contraindications to these therapies.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat chf.
Identify medications and interventions contraindicated in chf.
Explain markers of severity of the disease and factors that influence prognosis.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history and review the medical record to identify symptoms, co‐morbidities, medications, and/or social influences contributing to chf or its exacerbation.
Review inpatient records to determine iatrogenic influences of chf.
Recognize the clinical presentation of heart failure, including features of exacerbation and reliability of signs and symptoms.
Identify physical findings consistent with chf.
Identify signs of low perfusion states and cardiogenic shock.
Order indicated diagnostic testing to identify precipitating factors of chf and assess cardiac function.
Formulate an evidence based treatment plan, tailored to the individual patient, which may include pharmacologic agents and dosing, nutritional recommendations, and patient compliance.
Recognize symptoms and signs of acute decompensation and initiate immediate indicated therapies.
Assess patients with suspected heart failure in a timely manner, identify the level of care required, and manage or co‐manage the patient with the primary requesting service.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the history and prognosis of chf.
Communicate with patients and families to explain the importance of home self‐monitoring and adherence to medication regimens, nutritional recommendations, and physical rehabilitation.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain tests and procedures, and the use and potential side effects of pharmacologic agents.
Recognize indications for early cardiology consultation.
Recognize indications and qualifications for cardiac transplant evaluation.
Advocate the importance of behavioral modification to delay the progression of disease and improve quality of life.
Employ a multidisciplinary approach to the care of patients with chf that begins at admission and continues through all care transitions.
Recognize the importance of palliative care in the treatment of patients with chronic chf.
Responsibly address and respect end of life care wishes for patients with end‐stage chf.
Communicate to outpatient providers the relevant events of the hospitalization and post‐discharge needs, including pending tests, and determine who is responsible for checking the results.
Document treatment plan and provide clear discharge instructions for receiving primary care physician.
Utilize evidence based recommendations to guide diagnosis, monitoring and treatment of chf.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Advocate to hospital administrators to establish and support outpatient chf teams, which have been shown to reduce readmission rates and possibly morbidity and mortality through outreach to chf patients.
Lead, coordinate or participate in multidisciplinary teams, which may include nursing and social services, nutrition, pharmacy, and physical therapy, early in the hospital course to facilitate patient education and discharge planning; improve patient function and outcomes; and advocate patient outreach post‐discharge.
Implement systems to ensure hospital wide adherence to national standards and document those measures as specified by recognized organizations (jcaho, aha, acc, ahrq or others).
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead efforts to educate staff on the importance of smoking cessation counseling and other prevention measures.
Integrate outcomes research, institution‐specific laboratory policies, and hospital formulary to create indicated and cost‐effective diagnostic and management strategies for patients with chf.
Congestive heart failure syndrome (chf) is characterized by impaired function of the heart resulting in a constellation of symptoms and signs, which may include fatigue, weakness and shortness of breath. the american heart association (aha) reports that chf affects nearly 5 million people in the united states. chf accounted for 970,000 hospital discharges in 2002. medicare paid $3.6 billion for the care of patients with chf in 1999, or $5,456 per discharge. the estimated direct and indirect cost of chf in 2005 is $27.9 billion. despite published guidelines for chf management, there is significant variation in treatment for hospitalized patients. this variability significantly impacts individual patients, families and hospital systems, and accounts for billions of dollars of the medicare budget. hospitalists can lead their institutions in early diagnosis, initiation of evidence based medical therapy, and incorporation of a multidisciplinary approach to heart failure. hospitalists can also develop strategies to operationalize cost‐effective interventions that reduce morbidity, mortality and readmission rates.
KNOWLEDGE
Hospitalists should be able to:
Explain underlying causes of chf and precipitating factors leading to exacerbation.
Differentiate features of systolic and diastolic dysfunction, and explain the common etiologies of each.
Describe the indicated tests required to evaluate chf, including assessment of left ventricular function.
Describe risk factors for the development of chf in the hospital setting.
Risk stratify patients admitted with chf and determine the appropriate level of care.
Describe goals of inpatient therapy for acute decompensated heart failure including pre‐load and after‐load reduction, hemodynamic stabilization, and optimization of volume status.
Describe the role of invasive and noninvasive ventilatory support.
Explain evidence based therapeutic options for management of acute and chronic chf and describe contraindications to these therapies.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat chf.
Identify medications and interventions contraindicated in chf.
Explain markers of severity of the disease and factors that influence prognosis.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history and review the medical record to identify symptoms, co‐morbidities, medications, and/or social influences contributing to chf or its exacerbation.
Review inpatient records to determine iatrogenic influences of chf.
Recognize the clinical presentation of heart failure, including features of exacerbation and reliability of signs and symptoms.
Identify physical findings consistent with chf.
Identify signs of low perfusion states and cardiogenic shock.
Order indicated diagnostic testing to identify precipitating factors of chf and assess cardiac function.
Formulate an evidence based treatment plan, tailored to the individual patient, which may include pharmacologic agents and dosing, nutritional recommendations, and patient compliance.
Recognize symptoms and signs of acute decompensation and initiate immediate indicated therapies.
Assess patients with suspected heart failure in a timely manner, identify the level of care required, and manage or co‐manage the patient with the primary requesting service.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the history and prognosis of chf.
Communicate with patients and families to explain the importance of home self‐monitoring and adherence to medication regimens, nutritional recommendations, and physical rehabilitation.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain tests and procedures, and the use and potential side effects of pharmacologic agents.
Recognize indications for early cardiology consultation.
Recognize indications and qualifications for cardiac transplant evaluation.
Advocate the importance of behavioral modification to delay the progression of disease and improve quality of life.
Employ a multidisciplinary approach to the care of patients with chf that begins at admission and continues through all care transitions.
Recognize the importance of palliative care in the treatment of patients with chronic chf.
Responsibly address and respect end of life care wishes for patients with end‐stage chf.
Communicate to outpatient providers the relevant events of the hospitalization and post‐discharge needs, including pending tests, and determine who is responsible for checking the results.
Document treatment plan and provide clear discharge instructions for receiving primary care physician.
Utilize evidence based recommendations to guide diagnosis, monitoring and treatment of chf.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Advocate to hospital administrators to establish and support outpatient chf teams, which have been shown to reduce readmission rates and possibly morbidity and mortality through outreach to chf patients.
Lead, coordinate or participate in multidisciplinary teams, which may include nursing and social services, nutrition, pharmacy, and physical therapy, early in the hospital course to facilitate patient education and discharge planning; improve patient function and outcomes; and advocate patient outreach post‐discharge.
Implement systems to ensure hospital wide adherence to national standards and document those measures as specified by recognized organizations (jcaho, aha, acc, ahrq or others).
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead efforts to educate staff on the importance of smoking cessation counseling and other prevention measures.
Integrate outcomes research, institution‐specific laboratory policies, and hospital formulary to create indicated and cost‐effective diagnostic and management strategies for patients with chf.
Copyright © 2006 Society of Hospital Medicine
Thoracentesis
Thoracentesis is a bedside procedure involving the withdrawal of fluid from the pleural cavity. Pleural effusions are associated with several disease processes in hospitalized patients and may be evaluated using thoracentesis. The Healthcare Cost and Utilization Project (HCUP) estimates almost 189,000 thoracenteses were performed in hospitalized patients in 2002, although this total includes chest tube placement as well. Using the history, physical examination and radiographic findings, hospitalists identify those patients who would benefit from diagnostic or therapeutic thoracentesis.
KNOWLEDGE
Hospitalists should be able to:
Describe the normal anatomy of the chest wall, thorax and lung.
Define and differentiate the disease processes that may lead to the development of pleural effusion.
Define and differentiate transudative and exudative pleural effusions and their causes.
Explain indications and contraindications of thoracentesis and its potential risks and complications.
Explain the role of chest imaging in the evaluation of pleural effusion.
Explain the appropriate diagnostic testing for pleural fluid.
Describe indications for use of ultrasonography or computed tomography to assess the quantity of pleural fluid and/or guide thoracentesis.
Select the necessary equipment to perform a thoracentesis at the bedside, and differentiate what is needed for diagnostic versus therapeutic thoracentesis.
Define the criteria that distinguish transudative and exudative effusions.
Describe the effects of various disease processes on pleural fluid results.
SKILLS
Hospitalists should be able to:
Elicit a thorough history, identifying potential disease processes and risk factors for the development of pleural effusions.
Perform a chest examination, including specific maneuvers to assess for the presence of pleural effusion.
Properly position the patient and identify anatomic landmarks to perform a thoracentesis.
Use sterile techniques during preparation for and performance of thoracentesis.
Maintain clinician safety with appropriate protective wear.
Recognize and manage complications associated with thoracentesis, especially pneumothorax and re‐expansion pulmonary edema.
Order and interpret the results of pleural fluid analysis.
Order and interpret platelet and coagulation studies when indicated.
Determine need for chest tube placement based on thoracentesis results.
Synthesize a management plan based on history, physical examination, radiographic imaging and results of pleural fluid analysis.
Identify patients with pleural effusions who may benefit from therapeutic thoracentesis, chest tube placement and/or pleurodesis.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, and potential complications; and to obtain informed consent.
Order and promptly review the results of routine post‐procedure chest radiographs.
Manage patient discomfort or pain during and after the procedure.
Recognize indications for specialty consultations, which may include interventional radiology, pulmonary medicine, infectious disease, or cardiothoracic surgery.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Collaborate with radiologists to standardize identification of patients who would benefit from ultrasound‐guided thoracentesis.
Lead, coordinate or participate in efforts to develop strategies to minimize institution complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of thoracentesis.
Lead, coordinate or participate in efforts to organize and consolidate thoracentesis equipment in an identifiable location in the hospital, easily accessible to clinicians who perform the procedure.
Thoracentesis is a bedside procedure involving the withdrawal of fluid from the pleural cavity. Pleural effusions are associated with several disease processes in hospitalized patients and may be evaluated using thoracentesis. The Healthcare Cost and Utilization Project (HCUP) estimates almost 189,000 thoracenteses were performed in hospitalized patients in 2002, although this total includes chest tube placement as well. Using the history, physical examination and radiographic findings, hospitalists identify those patients who would benefit from diagnostic or therapeutic thoracentesis.
KNOWLEDGE
Hospitalists should be able to:
Describe the normal anatomy of the chest wall, thorax and lung.
Define and differentiate the disease processes that may lead to the development of pleural effusion.
Define and differentiate transudative and exudative pleural effusions and their causes.
Explain indications and contraindications of thoracentesis and its potential risks and complications.
Explain the role of chest imaging in the evaluation of pleural effusion.
Explain the appropriate diagnostic testing for pleural fluid.
Describe indications for use of ultrasonography or computed tomography to assess the quantity of pleural fluid and/or guide thoracentesis.
Select the necessary equipment to perform a thoracentesis at the bedside, and differentiate what is needed for diagnostic versus therapeutic thoracentesis.
Define the criteria that distinguish transudative and exudative effusions.
Describe the effects of various disease processes on pleural fluid results.
SKILLS
Hospitalists should be able to:
Elicit a thorough history, identifying potential disease processes and risk factors for the development of pleural effusions.
Perform a chest examination, including specific maneuvers to assess for the presence of pleural effusion.
Properly position the patient and identify anatomic landmarks to perform a thoracentesis.
Use sterile techniques during preparation for and performance of thoracentesis.
Maintain clinician safety with appropriate protective wear.
Recognize and manage complications associated with thoracentesis, especially pneumothorax and re‐expansion pulmonary edema.
Order and interpret the results of pleural fluid analysis.
Order and interpret platelet and coagulation studies when indicated.
Determine need for chest tube placement based on thoracentesis results.
Synthesize a management plan based on history, physical examination, radiographic imaging and results of pleural fluid analysis.
Identify patients with pleural effusions who may benefit from therapeutic thoracentesis, chest tube placement and/or pleurodesis.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, and potential complications; and to obtain informed consent.
Order and promptly review the results of routine post‐procedure chest radiographs.
Manage patient discomfort or pain during and after the procedure.
Recognize indications for specialty consultations, which may include interventional radiology, pulmonary medicine, infectious disease, or cardiothoracic surgery.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Collaborate with radiologists to standardize identification of patients who would benefit from ultrasound‐guided thoracentesis.
Lead, coordinate or participate in efforts to develop strategies to minimize institution complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of thoracentesis.
Lead, coordinate or participate in efforts to organize and consolidate thoracentesis equipment in an identifiable location in the hospital, easily accessible to clinicians who perform the procedure.
Thoracentesis is a bedside procedure involving the withdrawal of fluid from the pleural cavity. Pleural effusions are associated with several disease processes in hospitalized patients and may be evaluated using thoracentesis. The Healthcare Cost and Utilization Project (HCUP) estimates almost 189,000 thoracenteses were performed in hospitalized patients in 2002, although this total includes chest tube placement as well. Using the history, physical examination and radiographic findings, hospitalists identify those patients who would benefit from diagnostic or therapeutic thoracentesis.
KNOWLEDGE
Hospitalists should be able to:
Describe the normal anatomy of the chest wall, thorax and lung.
Define and differentiate the disease processes that may lead to the development of pleural effusion.
Define and differentiate transudative and exudative pleural effusions and their causes.
Explain indications and contraindications of thoracentesis and its potential risks and complications.
Explain the role of chest imaging in the evaluation of pleural effusion.
Explain the appropriate diagnostic testing for pleural fluid.
Describe indications for use of ultrasonography or computed tomography to assess the quantity of pleural fluid and/or guide thoracentesis.
Select the necessary equipment to perform a thoracentesis at the bedside, and differentiate what is needed for diagnostic versus therapeutic thoracentesis.
Define the criteria that distinguish transudative and exudative effusions.
Describe the effects of various disease processes on pleural fluid results.
SKILLS
Hospitalists should be able to:
Elicit a thorough history, identifying potential disease processes and risk factors for the development of pleural effusions.
Perform a chest examination, including specific maneuvers to assess for the presence of pleural effusion.
Properly position the patient and identify anatomic landmarks to perform a thoracentesis.
Use sterile techniques during preparation for and performance of thoracentesis.
Maintain clinician safety with appropriate protective wear.
Recognize and manage complications associated with thoracentesis, especially pneumothorax and re‐expansion pulmonary edema.
Order and interpret the results of pleural fluid analysis.
Order and interpret platelet and coagulation studies when indicated.
Determine need for chest tube placement based on thoracentesis results.
Synthesize a management plan based on history, physical examination, radiographic imaging and results of pleural fluid analysis.
Identify patients with pleural effusions who may benefit from therapeutic thoracentesis, chest tube placement and/or pleurodesis.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the procedure, its expected diagnostic or therapeutic benefits, and potential complications; and to obtain informed consent.
Order and promptly review the results of routine post‐procedure chest radiographs.
Manage patient discomfort or pain during and after the procedure.
Recognize indications for specialty consultations, which may include interventional radiology, pulmonary medicine, infectious disease, or cardiothoracic surgery.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Collaborate with radiologists to standardize identification of patients who would benefit from ultrasound‐guided thoracentesis.
Lead, coordinate or participate in efforts to develop strategies to minimize institution complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of thoracentesis.
Lead, coordinate or participate in efforts to organize and consolidate thoracentesis equipment in an identifiable location in the hospital, easily accessible to clinicians who perform the procedure.
Copyright © 2006 Society of Hospital Medicine
Cardiac arrhythmia
Cardiac arrhythmias are an abnormal heart rate or rhythm. the american heart association (aha) states that in 2002, cardiac arrhythmias were associated with 480,400 deaths and 858,000 hospital discharges. medical reimbursements for arrhythmia‐related diagnoses were $2.2 billion or $6,041 per discharge in 2003. many arrhythmias may lead to hospitalization or may result as a complication during hospitalization. hospitalists identify and treat all types of arrhythmias, coordinate specialty and primary care resources, and guide patients safely and cost effectively through the acute hospitalization and back into the outpatient setting.
KNOWLEDGE
Hospitalists should be able to:
Identify and differentiate the clinical presentation of common arrhythmias.
Distinguish the causes of atrial and ventricular arrhythmias.
Describe the indicated tests required to evaluate arrhythmias.
Explain how medications, metabolic abnormalities and medical co‐morbidities may precipitate various arrhythmias.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat cardiac arrhythmia.
Risk stratify patients with arrhythmias and determine the level of care required.
Describe the management goals and options for patients hospitalized with arrhythmia.
Identify the patient characteristics and co‐morbid conditions that predict outcome.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough history, including medication, family and social history.
Perform a directed physical examination with special emphasis on identifying signs associated with hemodynamic stability, tissue perfusion, and occult cardiac and vascular disease.
Order and interpret ekgs, rhythm monitoring, and telemetry to determine indicated management plan.
Identify specific arrhythmias by utilizing 12‐lead electrocardiogram (ekg) and rhythm strip, and continuous telemetry monitoring.
Formulate patient‐specific, evidence based care plans incorporating diagnostic findings, prognosis and patient characteristics.
Develop patient‐specific care plans that may include rate controlling interventions, cardioversion, defibrillation, or implantable medical devices.
Utilize telemetry resources for identification of malignant rhythms in patients who require potentially arrhythmegenic interventions or patients who are otherwise at high risk for malignant arrhythmias.
Limit the use of telemetry resources in patients with chronic stable arrhythmias.
Quickly recognize high‐risk arrhythmias that require urgent intervention, and implement emergency protocols as indicated.
Assess patients with arrhythmias in a timely manner, identify the level of care required, and manage or co‐manage the patient with the primary requesting service.
ATTITUDE
Hospitalists should be able to:
Communicate with patients and families to explain the history and prognosis of cardiac arrhythmia.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain drug interactions for anti‐arrhythmic drugs, and the importance of strict adherence to medication regimens and laboratory monitoring.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize specific arrhythmias or effects of arrhythmias that require early specialty consultation and procedural interventions.
Employ a multidisciplinary approach, which may include primary care, cardiology, nursing and social services, to develop a care plan for patients with cardiac arrhythmias that begins at admission and continues through all care transitions.
Acknowledge and ameliorate patient discomfort from uncontrolled arrhythmias and electrical cardioversion therapies.
Inform receiving physician of pending tests and determine who is responsible for checking results.
Employ multidisciplinary teams to facilitate discharge planning and communicate to outpatient providers the diagnosis of the arrhythmia, the care plan that occurred in the hospital, and post‐discharge needs.
Utilize evidence based recommendations to guide diagnosis, monitoring and treatment of cardiac arrhythmias.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Lead, coordinate or participate in multidisciplinary teams to develop patient care guidelines and/or pathways based on peer reviewed outcomes research, patient/physician satisfaction, and cost.
Implement systems to ensure hospital‐wide adherence to national standards and document those measures as specified by recognized organizations (jcaho, aha, acc, ahrq or others).
Lead, coordinate or participate in quality improvement initiates to promote early identification of arrhythmias, reduce preventable complications, and promote appropriate use of telemetry resources.
Cardiac arrhythmias are an abnormal heart rate or rhythm. the american heart association (aha) states that in 2002, cardiac arrhythmias were associated with 480,400 deaths and 858,000 hospital discharges. medical reimbursements for arrhythmia‐related diagnoses were $2.2 billion or $6,041 per discharge in 2003. many arrhythmias may lead to hospitalization or may result as a complication during hospitalization. hospitalists identify and treat all types of arrhythmias, coordinate specialty and primary care resources, and guide patients safely and cost effectively through the acute hospitalization and back into the outpatient setting.
KNOWLEDGE
Hospitalists should be able to:
Identify and differentiate the clinical presentation of common arrhythmias.
Distinguish the causes of atrial and ventricular arrhythmias.
Describe the indicated tests required to evaluate arrhythmias.
Explain how medications, metabolic abnormalities and medical co‐morbidities may precipitate various arrhythmias.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat cardiac arrhythmia.
Risk stratify patients with arrhythmias and determine the level of care required.
Describe the management goals and options for patients hospitalized with arrhythmia.
Identify the patient characteristics and co‐morbid conditions that predict outcome.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough history, including medication, family and social history.
Perform a directed physical examination with special emphasis on identifying signs associated with hemodynamic stability, tissue perfusion, and occult cardiac and vascular disease.
Order and interpret ekgs, rhythm monitoring, and telemetry to determine indicated management plan.
Identify specific arrhythmias by utilizing 12‐lead electrocardiogram (ekg) and rhythm strip, and continuous telemetry monitoring.
Formulate patient‐specific, evidence based care plans incorporating diagnostic findings, prognosis and patient characteristics.
Develop patient‐specific care plans that may include rate controlling interventions, cardioversion, defibrillation, or implantable medical devices.
Utilize telemetry resources for identification of malignant rhythms in patients who require potentially arrhythmegenic interventions or patients who are otherwise at high risk for malignant arrhythmias.
Limit the use of telemetry resources in patients with chronic stable arrhythmias.
Quickly recognize high‐risk arrhythmias that require urgent intervention, and implement emergency protocols as indicated.
Assess patients with arrhythmias in a timely manner, identify the level of care required, and manage or co‐manage the patient with the primary requesting service.
ATTITUDE
Hospitalists should be able to:
Communicate with patients and families to explain the history and prognosis of cardiac arrhythmia.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain drug interactions for anti‐arrhythmic drugs, and the importance of strict adherence to medication regimens and laboratory monitoring.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize specific arrhythmias or effects of arrhythmias that require early specialty consultation and procedural interventions.
Employ a multidisciplinary approach, which may include primary care, cardiology, nursing and social services, to develop a care plan for patients with cardiac arrhythmias that begins at admission and continues through all care transitions.
Acknowledge and ameliorate patient discomfort from uncontrolled arrhythmias and electrical cardioversion therapies.
Inform receiving physician of pending tests and determine who is responsible for checking results.
Employ multidisciplinary teams to facilitate discharge planning and communicate to outpatient providers the diagnosis of the arrhythmia, the care plan that occurred in the hospital, and post‐discharge needs.
Utilize evidence based recommendations to guide diagnosis, monitoring and treatment of cardiac arrhythmias.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Lead, coordinate or participate in multidisciplinary teams to develop patient care guidelines and/or pathways based on peer reviewed outcomes research, patient/physician satisfaction, and cost.
Implement systems to ensure hospital‐wide adherence to national standards and document those measures as specified by recognized organizations (jcaho, aha, acc, ahrq or others).
Lead, coordinate or participate in quality improvement initiates to promote early identification of arrhythmias, reduce preventable complications, and promote appropriate use of telemetry resources.
Cardiac arrhythmias are an abnormal heart rate or rhythm. the american heart association (aha) states that in 2002, cardiac arrhythmias were associated with 480,400 deaths and 858,000 hospital discharges. medical reimbursements for arrhythmia‐related diagnoses were $2.2 billion or $6,041 per discharge in 2003. many arrhythmias may lead to hospitalization or may result as a complication during hospitalization. hospitalists identify and treat all types of arrhythmias, coordinate specialty and primary care resources, and guide patients safely and cost effectively through the acute hospitalization and back into the outpatient setting.
KNOWLEDGE
Hospitalists should be able to:
Identify and differentiate the clinical presentation of common arrhythmias.
Distinguish the causes of atrial and ventricular arrhythmias.
Describe the indicated tests required to evaluate arrhythmias.
Explain how medications, metabolic abnormalities and medical co‐morbidities may precipitate various arrhythmias.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat cardiac arrhythmia.
Risk stratify patients with arrhythmias and determine the level of care required.
Describe the management goals and options for patients hospitalized with arrhythmia.
Identify the patient characteristics and co‐morbid conditions that predict outcome.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit a thorough history, including medication, family and social history.
Perform a directed physical examination with special emphasis on identifying signs associated with hemodynamic stability, tissue perfusion, and occult cardiac and vascular disease.
Order and interpret ekgs, rhythm monitoring, and telemetry to determine indicated management plan.
Identify specific arrhythmias by utilizing 12‐lead electrocardiogram (ekg) and rhythm strip, and continuous telemetry monitoring.
Formulate patient‐specific, evidence based care plans incorporating diagnostic findings, prognosis and patient characteristics.
Develop patient‐specific care plans that may include rate controlling interventions, cardioversion, defibrillation, or implantable medical devices.
Utilize telemetry resources for identification of malignant rhythms in patients who require potentially arrhythmegenic interventions or patients who are otherwise at high risk for malignant arrhythmias.
Limit the use of telemetry resources in patients with chronic stable arrhythmias.
Quickly recognize high‐risk arrhythmias that require urgent intervention, and implement emergency protocols as indicated.
Assess patients with arrhythmias in a timely manner, identify the level of care required, and manage or co‐manage the patient with the primary requesting service.
ATTITUDE
Hospitalists should be able to:
Communicate with patients and families to explain the history and prognosis of cardiac arrhythmia.
Communicate with patients and families to explain goals of care plan, discharge instructions and management after release from hospital.
Communicate with patients and families to explain drug interactions for anti‐arrhythmic drugs, and the importance of strict adherence to medication regimens and laboratory monitoring.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize specific arrhythmias or effects of arrhythmias that require early specialty consultation and procedural interventions.
Employ a multidisciplinary approach, which may include primary care, cardiology, nursing and social services, to develop a care plan for patients with cardiac arrhythmias that begins at admission and continues through all care transitions.
Acknowledge and ameliorate patient discomfort from uncontrolled arrhythmias and electrical cardioversion therapies.
Inform receiving physician of pending tests and determine who is responsible for checking results.
Employ multidisciplinary teams to facilitate discharge planning and communicate to outpatient providers the diagnosis of the arrhythmia, the care plan that occurred in the hospital, and post‐discharge needs.
Utilize evidence based recommendations to guide diagnosis, monitoring and treatment of cardiac arrhythmias.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Lead, coordinate or participate in multidisciplinary teams to develop patient care guidelines and/or pathways based on peer reviewed outcomes research, patient/physician satisfaction, and cost.
Implement systems to ensure hospital‐wide adherence to national standards and document those measures as specified by recognized organizations (jcaho, aha, acc, ahrq or others).
Lead, coordinate or participate in quality improvement initiates to promote early identification of arrhythmias, reduce preventable complications, and promote appropriate use of telemetry resources.
Copyright © 2006 Society of Hospital Medicine
Risk management
Risk management seeks to reduce hazards to patients through a process identification, evaluation, and analysis of potential or actual adverse events. Hazard involves that harm that may occur as a result of healthcare delivery, which may be heightened in the hospital setting due to the higher acuity of patient illness, time pressures, and presence of trainees. Hospitalists should strive to comply with the letter and spirit of all applicable laws and regulations, avoid conflicts of interest, and conduct hospital business with integrity and ethical fervor. Hospitalists should also take a collaborative and proactive role with various services that may include risk management to help reduce risk in the hospital setting.
KNOWLEDGE
Hospitalists should be able to:
Explain the legal definition of negligence and the concept of standard of care.
Describe the effective components of informed consent.
Explain the circumstances requiring informed consent.
Describe HIPAA regulations related to patient confidentiality.
Explain requirements for billing compliance.
Describe other laws and regulations to the extent they are relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing.
Explain how ethical principles can be applied to risk management.
SKILLS
Hospitalists should be able to:
Elicit informed consent from patients or surrogates for treatment plans and procedures when indicated.
Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents or medical students.
Apply guidelines of clinical ethics to patient care and risk management.
Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.
Ensure patient confidentiality.
Comply with HIPAA regulations.
Conduct medical practice and complete chart documentation to meet care needs and billing compliance, and reduce risks through effective communication.
Conduct medical practice without violating any relevant laws or regulations.
ATTITUDES
Hospitalists should be able to:
Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient centered care.
Practice Hospital Medicine to meet or exceed accepted standards of care and reduce risk.
Appreciate the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.
Respect patient wishes for treatment decisions and plans.
Respect patient confidentiality.
Collaborate with risk management in the required reporting and addressing of sentinel events or other medical errors.
Lead, coordinate or participate in initiatives to improve and maintain HIPAA and billing compliance standards
Lead, coordinate or participate in initiatives that result in processes of care that minimize risk.
Risk management seeks to reduce hazards to patients through a process identification, evaluation, and analysis of potential or actual adverse events. Hazard involves that harm that may occur as a result of healthcare delivery, which may be heightened in the hospital setting due to the higher acuity of patient illness, time pressures, and presence of trainees. Hospitalists should strive to comply with the letter and spirit of all applicable laws and regulations, avoid conflicts of interest, and conduct hospital business with integrity and ethical fervor. Hospitalists should also take a collaborative and proactive role with various services that may include risk management to help reduce risk in the hospital setting.
KNOWLEDGE
Hospitalists should be able to:
Explain the legal definition of negligence and the concept of standard of care.
Describe the effective components of informed consent.
Explain the circumstances requiring informed consent.
Describe HIPAA regulations related to patient confidentiality.
Explain requirements for billing compliance.
Describe other laws and regulations to the extent they are relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing.
Explain how ethical principles can be applied to risk management.
SKILLS
Hospitalists should be able to:
Elicit informed consent from patients or surrogates for treatment plans and procedures when indicated.
Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents or medical students.
Apply guidelines of clinical ethics to patient care and risk management.
Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.
Ensure patient confidentiality.
Comply with HIPAA regulations.
Conduct medical practice and complete chart documentation to meet care needs and billing compliance, and reduce risks through effective communication.
Conduct medical practice without violating any relevant laws or regulations.
ATTITUDES
Hospitalists should be able to:
Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient centered care.
Practice Hospital Medicine to meet or exceed accepted standards of care and reduce risk.
Appreciate the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.
Respect patient wishes for treatment decisions and plans.
Respect patient confidentiality.
Collaborate with risk management in the required reporting and addressing of sentinel events or other medical errors.
Lead, coordinate or participate in initiatives to improve and maintain HIPAA and billing compliance standards
Lead, coordinate or participate in initiatives that result in processes of care that minimize risk.
Risk management seeks to reduce hazards to patients through a process identification, evaluation, and analysis of potential or actual adverse events. Hazard involves that harm that may occur as a result of healthcare delivery, which may be heightened in the hospital setting due to the higher acuity of patient illness, time pressures, and presence of trainees. Hospitalists should strive to comply with the letter and spirit of all applicable laws and regulations, avoid conflicts of interest, and conduct hospital business with integrity and ethical fervor. Hospitalists should also take a collaborative and proactive role with various services that may include risk management to help reduce risk in the hospital setting.
KNOWLEDGE
Hospitalists should be able to:
Explain the legal definition of negligence and the concept of standard of care.
Describe the effective components of informed consent.
Explain the circumstances requiring informed consent.
Describe HIPAA regulations related to patient confidentiality.
Explain requirements for billing compliance.
Describe other laws and regulations to the extent they are relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing.
Explain how ethical principles can be applied to risk management.
SKILLS
Hospitalists should be able to:
Elicit informed consent from patients or surrogates for treatment plans and procedures when indicated.
Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents or medical students.
Apply guidelines of clinical ethics to patient care and risk management.
Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.
Ensure patient confidentiality.
Comply with HIPAA regulations.
Conduct medical practice and complete chart documentation to meet care needs and billing compliance, and reduce risks through effective communication.
Conduct medical practice without violating any relevant laws or regulations.
ATTITUDES
Hospitalists should be able to:
Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient centered care.
Practice Hospital Medicine to meet or exceed accepted standards of care and reduce risk.
Appreciate the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.
Respect patient wishes for treatment decisions and plans.
Respect patient confidentiality.
Collaborate with risk management in the required reporting and addressing of sentinel events or other medical errors.
Lead, coordinate or participate in initiatives to improve and maintain HIPAA and billing compliance standards
Lead, coordinate or participate in initiatives that result in processes of care that minimize risk.
Copyright © 2006 Society of Hospital Medicine
Quality improvement
Quality improvement (QI) is the process of continually evaluating existing processes of care and developing new standards of practice. QI is influenced by objective data and focuses on systems change, rather than individual performance, in order to optimize performance and appropriate resource utilization. Hospitalists may lead or participate in QI teams to optimize management of common inpatient conditions and improve clinical outcomes based on standardized evidence based practices. Hospitalists should use evidence based outcomes data whenever available to support their inpatient practices and QI initiatives.
KNOWLEDGE
Hospitalists should be able to:
Identify and categorize adverse outcomes that may include sentinel events, near misses, or other adverse events.
Describe QI requirements for hospital accreditation that are supported by regulatory organizations.
Describe outcome measurements currently studied by major payers and regulatory agencies.
Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.
Describe and differentiate Root Cause Analysis (RCA) and Healthcare Failure Mode Effects Analysis (HFMEA) and their utility in quality improvement in the hospital setting.
Describe the differences between outcome and process measures.
List the characteristics of high‐reliability organizations.
Describe the elements of effective teams and teamwork.
SKILLS
Hospitalists should be able to:
Apply current outcomes data and evidence based literature to individual hospitalist practice and systems improvements.
Utilize quality data to define hospitalist practice.
Express the relationship between value, quality and cost, and incorporate patient desires and satisfaction into the optimization of health care quality.
Assess and incorporate new technology for systems improvement in hospital practice.
Differentiate outcome measurements from process measurements.
Interpret patient satisfaction metrics.
ATTITUDES
Hospitalists should be able to:
Practice patient centered care and appreciate its value in improving patient safety and satisfaction.
Apply the results of validated outcome studies to inpatient practice.
Promote the adoption of new practices, guidelines and technology as supported by best available evidence.
Structure QI initiatives that reflect evidence based literature and high quality outcomes data.
Lead, coordinate or participate in the design and implementation of QI initiatives at individual, practice, and system levels, using a collaborative multidisciplinary team approach.
Lead, coordinate or participate in Root Cause Analyses (RCA) and/or Healthcare Failure Mode Effects Analyses (HFMEA).
Lead, coordinate or participate in outcomes monitoring at the institutional, regional and national levels, with an emphasis on development of standards and benchmarks.
Quality improvement (QI) is the process of continually evaluating existing processes of care and developing new standards of practice. QI is influenced by objective data and focuses on systems change, rather than individual performance, in order to optimize performance and appropriate resource utilization. Hospitalists may lead or participate in QI teams to optimize management of common inpatient conditions and improve clinical outcomes based on standardized evidence based practices. Hospitalists should use evidence based outcomes data whenever available to support their inpatient practices and QI initiatives.
KNOWLEDGE
Hospitalists should be able to:
Identify and categorize adverse outcomes that may include sentinel events, near misses, or other adverse events.
Describe QI requirements for hospital accreditation that are supported by regulatory organizations.
Describe outcome measurements currently studied by major payers and regulatory agencies.
Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.
Describe and differentiate Root Cause Analysis (RCA) and Healthcare Failure Mode Effects Analysis (HFMEA) and their utility in quality improvement in the hospital setting.
Describe the differences between outcome and process measures.
List the characteristics of high‐reliability organizations.
Describe the elements of effective teams and teamwork.
SKILLS
Hospitalists should be able to:
Apply current outcomes data and evidence based literature to individual hospitalist practice and systems improvements.
Utilize quality data to define hospitalist practice.
Express the relationship between value, quality and cost, and incorporate patient desires and satisfaction into the optimization of health care quality.
Assess and incorporate new technology for systems improvement in hospital practice.
Differentiate outcome measurements from process measurements.
Interpret patient satisfaction metrics.
ATTITUDES
Hospitalists should be able to:
Practice patient centered care and appreciate its value in improving patient safety and satisfaction.
Apply the results of validated outcome studies to inpatient practice.
Promote the adoption of new practices, guidelines and technology as supported by best available evidence.
Structure QI initiatives that reflect evidence based literature and high quality outcomes data.
Lead, coordinate or participate in the design and implementation of QI initiatives at individual, practice, and system levels, using a collaborative multidisciplinary team approach.
Lead, coordinate or participate in Root Cause Analyses (RCA) and/or Healthcare Failure Mode Effects Analyses (HFMEA).
Lead, coordinate or participate in outcomes monitoring at the institutional, regional and national levels, with an emphasis on development of standards and benchmarks.
Quality improvement (QI) is the process of continually evaluating existing processes of care and developing new standards of practice. QI is influenced by objective data and focuses on systems change, rather than individual performance, in order to optimize performance and appropriate resource utilization. Hospitalists may lead or participate in QI teams to optimize management of common inpatient conditions and improve clinical outcomes based on standardized evidence based practices. Hospitalists should use evidence based outcomes data whenever available to support their inpatient practices and QI initiatives.
KNOWLEDGE
Hospitalists should be able to:
Identify and categorize adverse outcomes that may include sentinel events, near misses, or other adverse events.
Describe QI requirements for hospital accreditation that are supported by regulatory organizations.
Describe outcome measurements currently studied by major payers and regulatory agencies.
Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.
Describe and differentiate Root Cause Analysis (RCA) and Healthcare Failure Mode Effects Analysis (HFMEA) and their utility in quality improvement in the hospital setting.
Describe the differences between outcome and process measures.
List the characteristics of high‐reliability organizations.
Describe the elements of effective teams and teamwork.
SKILLS
Hospitalists should be able to:
Apply current outcomes data and evidence based literature to individual hospitalist practice and systems improvements.
Utilize quality data to define hospitalist practice.
Express the relationship between value, quality and cost, and incorporate patient desires and satisfaction into the optimization of health care quality.
Assess and incorporate new technology for systems improvement in hospital practice.
Differentiate outcome measurements from process measurements.
Interpret patient satisfaction metrics.
ATTITUDES
Hospitalists should be able to:
Practice patient centered care and appreciate its value in improving patient safety and satisfaction.
Apply the results of validated outcome studies to inpatient practice.
Promote the adoption of new practices, guidelines and technology as supported by best available evidence.
Structure QI initiatives that reflect evidence based literature and high quality outcomes data.
Lead, coordinate or participate in the design and implementation of QI initiatives at individual, practice, and system levels, using a collaborative multidisciplinary team approach.
Lead, coordinate or participate in Root Cause Analyses (RCA) and/or Healthcare Failure Mode Effects Analyses (HFMEA).
Lead, coordinate or participate in outcomes monitoring at the institutional, regional and national levels, with an emphasis on development of standards and benchmarks.
Copyright © 2006 Society of Hospital Medicine
Patient safety
The National Patient Safety Foundation defines safety as the avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the processes of health care. Hospitalized patients are at risk for a variety of adverse events. Hospitalists anticipate complications from medical assessment and treatment, and take steps to reduce their incidence or severity. Application of individual and system failure analysis can improve patient safety. Hospitalists will increasingly lead and participate in multidisciplinary development of interventions to mitigate system and process failures. They will also need to assess the effects of recommended interventions across the continuum of care.
KNOWLEDGE
Hospitalists should be able to:
Identify the most common safety problems and their causes in different hospitalized patient populations.
Explain the role of human factors in device, procedure and technology‐related errors.
Specify clinical practices and interventions that improve the safe use of high‐alert medications.
Summarize methods of system and process evaluation of patient safety.
Describe the elements of well‐functioning teams.
Differentiate retrospective and prospective methods of evaluating medical errors.
Discuss the significance of sentinel events and near misses and their relationship to voluntary and mandatory reporting regulations.
Describe the components of Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
SKILLS
Hospitalists should be able to:
Prevent iatrogenic complications and proactively reduce risks of hospitalization.
Formulate age‐ and disease‐specific safety practices, which may include reduction of incidence and severity of falls, decubitus ulcers, delirium, hospital‐acquired infections, venous thromboembolism, malnutrition, and medication adverse events.
Develop, implement and evaluate practice guidelines and care pathways as part of an interdisciplinary quality improvement initiative.
Gather, record and transfer patient information utilizing timely, accurate and confidential mechanisms.
Develop systems that promote patient safety and reduce the likelihood of adverse events.
Contribute to and interpret retrospective RCA and prospective Healthcare FMEA multidisciplinary risk evaluations.
Function as a member and/or leader of interdisciplinary safety teams.
Design evaluation methods and resources to define problems and recommend interventions.
ATTITUDES
Hospitalists should be able to:
Appreciate that adverse drug events must be monitored and steps taken to reduce their incidence.
Advocate and help foster a non‐punitive error‐reporting environment.
Exemplify safe medication prescribing and administration practices.
Facilitate practices that reduce the likelihood of hospital‐acquired infection.
Internalize and promote behaviors that minimize workforce fatigue, occupational illness and burnout.
Appreciate that redundant systems may reduce the likelihood of medical errors.
Understand the risk management issues of patient safety efforts.
Utilize evidence based evaluation methods and resources when defining problems and designing interventions.
Lead, coordinate or participate in multidisciplinary teams to improve the delivery of safe patient care.
Judge the effect of patient volume on the quality, efficiency and safety of healthcare services.
Prioritize patient safety evaluation and improvement efforts based on the impact, improvability and general applicability of proposed evaluations and interventions.
Employ continuous quality improvement techniques to identify, construct, implement and evaluate patient safety issues.
Lead, coordinate or participate in the development, use and dissemination of local, regional, or national clinical practice guidelines and patient safety alerts pertaining to the prevention of complications in hospitalized patients.
Lead, coordinate or participate in efforts to create a culture in which issues of patient safety and medical errors can be discussed openly, without fear of repercussion.
The National Patient Safety Foundation defines safety as the avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the processes of health care. Hospitalized patients are at risk for a variety of adverse events. Hospitalists anticipate complications from medical assessment and treatment, and take steps to reduce their incidence or severity. Application of individual and system failure analysis can improve patient safety. Hospitalists will increasingly lead and participate in multidisciplinary development of interventions to mitigate system and process failures. They will also need to assess the effects of recommended interventions across the continuum of care.
KNOWLEDGE
Hospitalists should be able to:
Identify the most common safety problems and their causes in different hospitalized patient populations.
Explain the role of human factors in device, procedure and technology‐related errors.
Specify clinical practices and interventions that improve the safe use of high‐alert medications.
Summarize methods of system and process evaluation of patient safety.
Describe the elements of well‐functioning teams.
Differentiate retrospective and prospective methods of evaluating medical errors.
Discuss the significance of sentinel events and near misses and their relationship to voluntary and mandatory reporting regulations.
Describe the components of Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
SKILLS
Hospitalists should be able to:
Prevent iatrogenic complications and proactively reduce risks of hospitalization.
Formulate age‐ and disease‐specific safety practices, which may include reduction of incidence and severity of falls, decubitus ulcers, delirium, hospital‐acquired infections, venous thromboembolism, malnutrition, and medication adverse events.
Develop, implement and evaluate practice guidelines and care pathways as part of an interdisciplinary quality improvement initiative.
Gather, record and transfer patient information utilizing timely, accurate and confidential mechanisms.
Develop systems that promote patient safety and reduce the likelihood of adverse events.
Contribute to and interpret retrospective RCA and prospective Healthcare FMEA multidisciplinary risk evaluations.
Function as a member and/or leader of interdisciplinary safety teams.
Design evaluation methods and resources to define problems and recommend interventions.
ATTITUDES
Hospitalists should be able to:
Appreciate that adverse drug events must be monitored and steps taken to reduce their incidence.
Advocate and help foster a non‐punitive error‐reporting environment.
Exemplify safe medication prescribing and administration practices.
Facilitate practices that reduce the likelihood of hospital‐acquired infection.
Internalize and promote behaviors that minimize workforce fatigue, occupational illness and burnout.
Appreciate that redundant systems may reduce the likelihood of medical errors.
Understand the risk management issues of patient safety efforts.
Utilize evidence based evaluation methods and resources when defining problems and designing interventions.
Lead, coordinate or participate in multidisciplinary teams to improve the delivery of safe patient care.
Judge the effect of patient volume on the quality, efficiency and safety of healthcare services.
Prioritize patient safety evaluation and improvement efforts based on the impact, improvability and general applicability of proposed evaluations and interventions.
Employ continuous quality improvement techniques to identify, construct, implement and evaluate patient safety issues.
Lead, coordinate or participate in the development, use and dissemination of local, regional, or national clinical practice guidelines and patient safety alerts pertaining to the prevention of complications in hospitalized patients.
Lead, coordinate or participate in efforts to create a culture in which issues of patient safety and medical errors can be discussed openly, without fear of repercussion.
The National Patient Safety Foundation defines safety as the avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the processes of health care. Hospitalized patients are at risk for a variety of adverse events. Hospitalists anticipate complications from medical assessment and treatment, and take steps to reduce their incidence or severity. Application of individual and system failure analysis can improve patient safety. Hospitalists will increasingly lead and participate in multidisciplinary development of interventions to mitigate system and process failures. They will also need to assess the effects of recommended interventions across the continuum of care.
KNOWLEDGE
Hospitalists should be able to:
Identify the most common safety problems and their causes in different hospitalized patient populations.
Explain the role of human factors in device, procedure and technology‐related errors.
Specify clinical practices and interventions that improve the safe use of high‐alert medications.
Summarize methods of system and process evaluation of patient safety.
Describe the elements of well‐functioning teams.
Differentiate retrospective and prospective methods of evaluating medical errors.
Discuss the significance of sentinel events and near misses and their relationship to voluntary and mandatory reporting regulations.
Describe the components of Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
SKILLS
Hospitalists should be able to:
Prevent iatrogenic complications and proactively reduce risks of hospitalization.
Formulate age‐ and disease‐specific safety practices, which may include reduction of incidence and severity of falls, decubitus ulcers, delirium, hospital‐acquired infections, venous thromboembolism, malnutrition, and medication adverse events.
Develop, implement and evaluate practice guidelines and care pathways as part of an interdisciplinary quality improvement initiative.
Gather, record and transfer patient information utilizing timely, accurate and confidential mechanisms.
Develop systems that promote patient safety and reduce the likelihood of adverse events.
Contribute to and interpret retrospective RCA and prospective Healthcare FMEA multidisciplinary risk evaluations.
Function as a member and/or leader of interdisciplinary safety teams.
Design evaluation methods and resources to define problems and recommend interventions.
ATTITUDES
Hospitalists should be able to:
Appreciate that adverse drug events must be monitored and steps taken to reduce their incidence.
Advocate and help foster a non‐punitive error‐reporting environment.
Exemplify safe medication prescribing and administration practices.
Facilitate practices that reduce the likelihood of hospital‐acquired infection.
Internalize and promote behaviors that minimize workforce fatigue, occupational illness and burnout.
Appreciate that redundant systems may reduce the likelihood of medical errors.
Understand the risk management issues of patient safety efforts.
Utilize evidence based evaluation methods and resources when defining problems and designing interventions.
Lead, coordinate or participate in multidisciplinary teams to improve the delivery of safe patient care.
Judge the effect of patient volume on the quality, efficiency and safety of healthcare services.
Prioritize patient safety evaluation and improvement efforts based on the impact, improvability and general applicability of proposed evaluations and interventions.
Employ continuous quality improvement techniques to identify, construct, implement and evaluate patient safety issues.
Lead, coordinate or participate in the development, use and dissemination of local, regional, or national clinical practice guidelines and patient safety alerts pertaining to the prevention of complications in hospitalized patients.
Lead, coordinate or participate in efforts to create a culture in which issues of patient safety and medical errors can be discussed openly, without fear of repercussion.
Copyright © 2006 Society of Hospital Medicine
Vascular access
Vascular access involves inserting a catheter into an appropriate blood vessel in order to measure useful diagnostic parameters, draw blood for diagnostic testing, and/or provide specific therapeutic interventions.
Vascular access procedures were performed in approximately 417,000 discharges in 2002, according to the Healthcare Cost and Utilization Project (HCUP). Many hospitalized patients require vascular access, and hospitalists will differentiate patients who simply need peripheral venous access from those who require more invasive types of arterial or central venous access. Complications of vascular catheters can cause prolonged hospital stays and increase morbidity and mortality. Hospitalists advocate for patients to determine the most appropriate type of vascular access based on the patient's diagnostic and therapeutic requirements and overall clinical condition.
KNOWLEDGE
Hospitalists should be able to:
Name the various locations for peripheral venous access and describe the normal vasculature and surrounding anatomy of the site chosen for access.
Name the various locations for arterial or central venous access and describe the normal vasculature and surrounding anatomy of the site chosen for vascular access.
Describe the collateral flow for arterial access procedures.
Describe the clinical findings or disease processes that require arterial or central venous access.
Explain the role of ultrasonography in vascular access placement.
Explain indications and contraindications of the various arterial or central venous access procedures.
Describe and differentiate the potential risks and complications of individual vascular access procedures based on the site chosen and other risk factors.
Select the necessary equipment to perform the indicated vascular access procedure at the bedside.
SKILLS
Hospitalists should be able to:
Elicit an accurate and thorough history to identify co‐morbid conditions and risk factors for complications related to arterial or central venous vascular access placement.
Identify absolute and relative contraindications to placement of arterial access or central venous access at specific sites.
Perform a directed physical examination of the site(s) intended for vascular access.
Perform specific maneuvers to evaluate for collateral flow for arterial access procedures.
Properly position the patient and identify anatomic landmarks to obtain vascular access.
Use sterile techniques during preparation for and performance of vascular access procedures.
Anticipate and manage complications from the vascular access procedure and in‐dwelling catheter.
Identify and manage the complications of vascular access procedures, which may include infection, thrombotic, and mechanical complications.
Order and interpret platelet and coagulation studies when indicated.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the indications and alternatives to vascular access.
Communicate with patients and families to explain the procedure, its expected therapeutic benefits and potential complications; and to obtain informed consent.
Provide education to patients and their families regarding the care of long‐term vascular access.
Recognize the importance of proper positioning during the procedure.
Remove all central venous catheters and arterial catheters as soon as they are no longer needed.
Promote the use of peripheral venous access over central venous access whenever possible.
Manage patient discomfort or pain during and after the procedure.
Recognize the indications for specialty consultation, which may include interventional radiology, surgery, or critical care medicine.
Arrange appropriate care for patients being discharged with long‐term vascular access.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in development of IV access teams to improve the placement and maintenance of IV catheters.
Lead, coordinator or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of vascular access.
Lead, coordinate or participate in implementation of standard nursing protocols for catheter care.
Lead, coordinate or participate in efforts to organize and consolidate equipment in an identifiable location in the hospital that is easily accessible to clinicians who perform the procedure.
Vascular access involves inserting a catheter into an appropriate blood vessel in order to measure useful diagnostic parameters, draw blood for diagnostic testing, and/or provide specific therapeutic interventions.
Vascular access procedures were performed in approximately 417,000 discharges in 2002, according to the Healthcare Cost and Utilization Project (HCUP). Many hospitalized patients require vascular access, and hospitalists will differentiate patients who simply need peripheral venous access from those who require more invasive types of arterial or central venous access. Complications of vascular catheters can cause prolonged hospital stays and increase morbidity and mortality. Hospitalists advocate for patients to determine the most appropriate type of vascular access based on the patient's diagnostic and therapeutic requirements and overall clinical condition.
KNOWLEDGE
Hospitalists should be able to:
Name the various locations for peripheral venous access and describe the normal vasculature and surrounding anatomy of the site chosen for access.
Name the various locations for arterial or central venous access and describe the normal vasculature and surrounding anatomy of the site chosen for vascular access.
Describe the collateral flow for arterial access procedures.
Describe the clinical findings or disease processes that require arterial or central venous access.
Explain the role of ultrasonography in vascular access placement.
Explain indications and contraindications of the various arterial or central venous access procedures.
Describe and differentiate the potential risks and complications of individual vascular access procedures based on the site chosen and other risk factors.
Select the necessary equipment to perform the indicated vascular access procedure at the bedside.
SKILLS
Hospitalists should be able to:
Elicit an accurate and thorough history to identify co‐morbid conditions and risk factors for complications related to arterial or central venous vascular access placement.
Identify absolute and relative contraindications to placement of arterial access or central venous access at specific sites.
Perform a directed physical examination of the site(s) intended for vascular access.
Perform specific maneuvers to evaluate for collateral flow for arterial access procedures.
Properly position the patient and identify anatomic landmarks to obtain vascular access.
Use sterile techniques during preparation for and performance of vascular access procedures.
Anticipate and manage complications from the vascular access procedure and in‐dwelling catheter.
Identify and manage the complications of vascular access procedures, which may include infection, thrombotic, and mechanical complications.
Order and interpret platelet and coagulation studies when indicated.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the indications and alternatives to vascular access.
Communicate with patients and families to explain the procedure, its expected therapeutic benefits and potential complications; and to obtain informed consent.
Provide education to patients and their families regarding the care of long‐term vascular access.
Recognize the importance of proper positioning during the procedure.
Remove all central venous catheters and arterial catheters as soon as they are no longer needed.
Promote the use of peripheral venous access over central venous access whenever possible.
Manage patient discomfort or pain during and after the procedure.
Recognize the indications for specialty consultation, which may include interventional radiology, surgery, or critical care medicine.
Arrange appropriate care for patients being discharged with long‐term vascular access.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in development of IV access teams to improve the placement and maintenance of IV catheters.
Lead, coordinator or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of vascular access.
Lead, coordinate or participate in implementation of standard nursing protocols for catheter care.
Lead, coordinate or participate in efforts to organize and consolidate equipment in an identifiable location in the hospital that is easily accessible to clinicians who perform the procedure.
Vascular access involves inserting a catheter into an appropriate blood vessel in order to measure useful diagnostic parameters, draw blood for diagnostic testing, and/or provide specific therapeutic interventions.
Vascular access procedures were performed in approximately 417,000 discharges in 2002, according to the Healthcare Cost and Utilization Project (HCUP). Many hospitalized patients require vascular access, and hospitalists will differentiate patients who simply need peripheral venous access from those who require more invasive types of arterial or central venous access. Complications of vascular catheters can cause prolonged hospital stays and increase morbidity and mortality. Hospitalists advocate for patients to determine the most appropriate type of vascular access based on the patient's diagnostic and therapeutic requirements and overall clinical condition.
KNOWLEDGE
Hospitalists should be able to:
Name the various locations for peripheral venous access and describe the normal vasculature and surrounding anatomy of the site chosen for access.
Name the various locations for arterial or central venous access and describe the normal vasculature and surrounding anatomy of the site chosen for vascular access.
Describe the collateral flow for arterial access procedures.
Describe the clinical findings or disease processes that require arterial or central venous access.
Explain the role of ultrasonography in vascular access placement.
Explain indications and contraindications of the various arterial or central venous access procedures.
Describe and differentiate the potential risks and complications of individual vascular access procedures based on the site chosen and other risk factors.
Select the necessary equipment to perform the indicated vascular access procedure at the bedside.
SKILLS
Hospitalists should be able to:
Elicit an accurate and thorough history to identify co‐morbid conditions and risk factors for complications related to arterial or central venous vascular access placement.
Identify absolute and relative contraindications to placement of arterial access or central venous access at specific sites.
Perform a directed physical examination of the site(s) intended for vascular access.
Perform specific maneuvers to evaluate for collateral flow for arterial access procedures.
Properly position the patient and identify anatomic landmarks to obtain vascular access.
Use sterile techniques during preparation for and performance of vascular access procedures.
Anticipate and manage complications from the vascular access procedure and in‐dwelling catheter.
Identify and manage the complications of vascular access procedures, which may include infection, thrombotic, and mechanical complications.
Order and interpret platelet and coagulation studies when indicated.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the indications and alternatives to vascular access.
Communicate with patients and families to explain the procedure, its expected therapeutic benefits and potential complications; and to obtain informed consent.
Provide education to patients and their families regarding the care of long‐term vascular access.
Recognize the importance of proper positioning during the procedure.
Remove all central venous catheters and arterial catheters as soon as they are no longer needed.
Promote the use of peripheral venous access over central venous access whenever possible.
Manage patient discomfort or pain during and after the procedure.
Recognize the indications for specialty consultation, which may include interventional radiology, surgery, or critical care medicine.
Arrange appropriate care for patients being discharged with long‐term vascular access.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in development of IV access teams to improve the placement and maintenance of IV catheters.
Lead, coordinator or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of vascular access.
Lead, coordinate or participate in implementation of standard nursing protocols for catheter care.
Lead, coordinate or participate in efforts to organize and consolidate equipment in an identifiable location in the hospital that is easily accessible to clinicians who perform the procedure.
Copyright © 2006 Society of Hospital Medicine
Leadership
Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for the patient, building consensus, and balancing the needs of individual patients with the resources available to the hospital. Hospitalists also lead efforts to assess, identify and improve patient outcomes, resource utilization, cost‐effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of health care.
KNOWLEDGE
Hospitalists should be able to:
Differentiate management and leadership.
Describe hospitalist responsibilities and opportunities to provide active leadership.
Describe the key elements of a message.
Discuss how mentor relationships impact the development and advancement of the field of hospital medicine.
Explain the attributes and effects of modeling positive and negative behaviors.
Name the key elements of strategic planning processes.
Explain factors that predict the success or failure of strategic plans.
Describe styles of leadership.
Explain the attributes of effective leadership.
Articulate the business and financial motivators that impact decision making.
Explain the specific factors that affect positive change.
Explain effective negotiation and conflict resolution techniques.
SKILLS
Hospitalists should be able to:
Tailor messages to specific target audiences.
Develop effective communication skills using multiple modalities.
Plan and conduct an effective meeting.
Construct program mission and vision statements.
Develop personal, team and program goals, and identify indicators of achievement.
Establish, measure and report key performance metrics.
Utilize established metrics to assess progress and set new goals for performance and outcomes.
Analyze personal leadership style.
Demonstrate the ability to effectively work with various leadership styles.
Develop budgets to support goals using accepted financial principles.
Translate performance into measurable financial outcomes.
Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.
Demonstrate effective and creative problem solving techniques.
Resolve conflicts using specific negotiation techniques.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Practice active listening techniques.
Provide and seek timely, useful feedback.
Provide leadership in teaching, educational scholarship, quality improvement and other areas that serve to improve patient outcomes and advance the field of hospital medicine.
Explain the importance of finding mentor(s) and serving as a mentor.
Recognize the importance and influence of positive role modeling.
Assess and address personal leadership strengths and weaknesses.
Seek and participate in opportunities for professional development.
Advocate for financial and other resources needed to support goals and initiatives.
Exemplify professionalism.
Accept responsibility and accountability for management decisions.
Build consensus in support of key decisions.
Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for the patient, building consensus, and balancing the needs of individual patients with the resources available to the hospital. Hospitalists also lead efforts to assess, identify and improve patient outcomes, resource utilization, cost‐effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of health care.
KNOWLEDGE
Hospitalists should be able to:
Differentiate management and leadership.
Describe hospitalist responsibilities and opportunities to provide active leadership.
Describe the key elements of a message.
Discuss how mentor relationships impact the development and advancement of the field of hospital medicine.
Explain the attributes and effects of modeling positive and negative behaviors.
Name the key elements of strategic planning processes.
Explain factors that predict the success or failure of strategic plans.
Describe styles of leadership.
Explain the attributes of effective leadership.
Articulate the business and financial motivators that impact decision making.
Explain the specific factors that affect positive change.
Explain effective negotiation and conflict resolution techniques.
SKILLS
Hospitalists should be able to:
Tailor messages to specific target audiences.
Develop effective communication skills using multiple modalities.
Plan and conduct an effective meeting.
Construct program mission and vision statements.
Develop personal, team and program goals, and identify indicators of achievement.
Establish, measure and report key performance metrics.
Utilize established metrics to assess progress and set new goals for performance and outcomes.
Analyze personal leadership style.
Demonstrate the ability to effectively work with various leadership styles.
Develop budgets to support goals using accepted financial principles.
Translate performance into measurable financial outcomes.
Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.
Demonstrate effective and creative problem solving techniques.
Resolve conflicts using specific negotiation techniques.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Practice active listening techniques.
Provide and seek timely, useful feedback.
Provide leadership in teaching, educational scholarship, quality improvement and other areas that serve to improve patient outcomes and advance the field of hospital medicine.
Explain the importance of finding mentor(s) and serving as a mentor.
Recognize the importance and influence of positive role modeling.
Assess and address personal leadership strengths and weaknesses.
Seek and participate in opportunities for professional development.
Advocate for financial and other resources needed to support goals and initiatives.
Exemplify professionalism.
Accept responsibility and accountability for management decisions.
Build consensus in support of key decisions.
Hospitalists assume formal and informal leadership roles in the hospital system and community. In their individual institutions, hospitalists are responsible for the management and coordination of patient care. This role requires advocating for the patient, building consensus, and balancing the needs of individual patients with the resources available to the hospital. Hospitalists also lead efforts to assess, identify and improve patient outcomes, resource utilization, cost‐effectiveness, and quality of inpatient medical care. In the larger community, hospitalists lead innovations in hospital medicine research and education and the delivery of health care.
KNOWLEDGE
Hospitalists should be able to:
Differentiate management and leadership.
Describe hospitalist responsibilities and opportunities to provide active leadership.
Describe the key elements of a message.
Discuss how mentor relationships impact the development and advancement of the field of hospital medicine.
Explain the attributes and effects of modeling positive and negative behaviors.
Name the key elements of strategic planning processes.
Explain factors that predict the success or failure of strategic plans.
Describe styles of leadership.
Explain the attributes of effective leadership.
Articulate the business and financial motivators that impact decision making.
Explain the specific factors that affect positive change.
Explain effective negotiation and conflict resolution techniques.
SKILLS
Hospitalists should be able to:
Tailor messages to specific target audiences.
Develop effective communication skills using multiple modalities.
Plan and conduct an effective meeting.
Construct program mission and vision statements.
Develop personal, team and program goals, and identify indicators of achievement.
Establish, measure and report key performance metrics.
Utilize established metrics to assess progress and set new goals for performance and outcomes.
Analyze personal leadership style.
Demonstrate the ability to effectively work with various leadership styles.
Develop budgets to support goals using accepted financial principles.
Translate performance into measurable financial outcomes.
Assess the barriers and facilitating factors to effect change and incorporate those factors into a strategic approach.
Demonstrate effective and creative problem solving techniques.
Resolve conflicts using specific negotiation techniques.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Practice active listening techniques.
Provide and seek timely, useful feedback.
Provide leadership in teaching, educational scholarship, quality improvement and other areas that serve to improve patient outcomes and advance the field of hospital medicine.
Explain the importance of finding mentor(s) and serving as a mentor.
Recognize the importance and influence of positive role modeling.
Assess and address personal leadership strengths and weaknesses.
Seek and participate in opportunities for professional development.
Advocate for financial and other resources needed to support goals and initiatives.
Exemplify professionalism.
Accept responsibility and accountability for management decisions.
Build consensus in support of key decisions.
Copyright © 2006 Society of Hospital Medicine
Drug safety, pharmacoeconomics and pharmacoepidemiology
The number of new therapeutic agents approved by the Food and Drug Administration (FDA) is rapidly increasing. With the availability of these new agents and the widening use of other agents, pharmaceutical costs have grown more than any other sector of healthcare, as have concerns about adverse drug events (ADEs) from these agents. Hospitalists who strive to prescribe evidence based therapies must understand how to evaluate the benefits, harms, and financial costs of drug therapy for individual patients. Hospitalists promote and lead multidisciplinary teams to implement protocols, guidelines and clinical pathways that recommend preferred drug therapies. Hospitalists should be able to interpret outcomes measurement (pharmacoepidemiology) and economic analyses (pharmacoeconomics).
KNOWLEDGE
Hospitalists should be able to:
Discuss principles of evaluating clinical efficacy, pharmacokinetics, dosing, drug and food interactions, and adverse effects that can affect the hospitalist's choice of agent, dosing frequency and route of administration.
Explain options for measuring medication benefit.
Explain the evidence based rationale for prophylactic drug therapies, comparing the costs, risks and benefits of competing strategies.
Explain how pharmacodynamics change with age, liver disease and renal insufficiency.
Describe the incidence of various types of ADEs in hospitalized patients, which may include adverse effects, interactions, and errors.
Explain the role of polypharmacy in the development of delirium, ADEs, and noncompliance.
Describe how the overuse of broad spectrum antibiotics promotes resistance.
Describe key principles for interpreting pharmacoeconomic analyses including inflation rate, discounting rate, incremental analysis, sensitivity analysis, and inherent bias.
Describe the clinical efficacy, safety profile, pharmacokinetics, dosing, drug and food interactions, and costs of commonly prescribed medications and biological agents (e.g., blood products).
SKILLS
Hospitalists should be able to:
Prescribe medications for elderly hospitalized patients based on altered pharmacokinetics and co‐morbid conditions.
Apply treatment guidelines to individual patients in the use of antibiotics to reduce cost and the emergence of resistance.
Minimize ADEs by using best practice models of medication ordering and administration.
Document medications accurately and legibly taking into account approved abbreviation, and indicate start and stop dates for short‐term medications.
Arrange adequate follow‐up for therapies that require outpatient monitoring, dosage adjustment, and education (e.g., anticoagulants, antibiotics).
Balance the benefits, risks, and cost of prophylactic therapies, which may include venous thromboembolism and stress ulcer prophylaxis
Convert intravenous medications to the oral route when indicated to promote patient safety, satisfaction, and reduce cost.
Standardize blood transfusion practices.
ATTITUDES
Hospitalists should be able to:
Educate patients and families about the importance of acquiring medication information and communicating medication history to clinicians at each transition of care.
Ensure patients and families comprehend medication instructions.
Recognize the benefits and hazards of drug therapy.
Recognize the risk of ADEs at the time of transfer of care.
Reconcile outpatient medications with inpatient medications at the time of admission and discharge.
Reconcile all documentation of medications at the time of discharge.
Integrate knowledge of benefits and risks of drug therapies into medical decision making for individual patients, and routinely reassess decisions.
Critically assess and apply results of new outcome studies to improve drug treatment and patient safety for individual patients.
Collaborate with pharmacists to improve drug safety for individual patients and reduce hospital costs.
Apply the principles of pharmacoepidemiology and drug safety to patient management.
Lead, coordinate and participate in the development, use, and dissemination of local, regional, and national practice guidelines and patient safety alerts pertaining to the prevention of complications.
Apply the principles of pharmacoepidemiology and pharmacoeconomics to implement practice guidelines and protocols for a hospital.
The number of new therapeutic agents approved by the Food and Drug Administration (FDA) is rapidly increasing. With the availability of these new agents and the widening use of other agents, pharmaceutical costs have grown more than any other sector of healthcare, as have concerns about adverse drug events (ADEs) from these agents. Hospitalists who strive to prescribe evidence based therapies must understand how to evaluate the benefits, harms, and financial costs of drug therapy for individual patients. Hospitalists promote and lead multidisciplinary teams to implement protocols, guidelines and clinical pathways that recommend preferred drug therapies. Hospitalists should be able to interpret outcomes measurement (pharmacoepidemiology) and economic analyses (pharmacoeconomics).
KNOWLEDGE
Hospitalists should be able to:
Discuss principles of evaluating clinical efficacy, pharmacokinetics, dosing, drug and food interactions, and adverse effects that can affect the hospitalist's choice of agent, dosing frequency and route of administration.
Explain options for measuring medication benefit.
Explain the evidence based rationale for prophylactic drug therapies, comparing the costs, risks and benefits of competing strategies.
Explain how pharmacodynamics change with age, liver disease and renal insufficiency.
Describe the incidence of various types of ADEs in hospitalized patients, which may include adverse effects, interactions, and errors.
Explain the role of polypharmacy in the development of delirium, ADEs, and noncompliance.
Describe how the overuse of broad spectrum antibiotics promotes resistance.
Describe key principles for interpreting pharmacoeconomic analyses including inflation rate, discounting rate, incremental analysis, sensitivity analysis, and inherent bias.
Describe the clinical efficacy, safety profile, pharmacokinetics, dosing, drug and food interactions, and costs of commonly prescribed medications and biological agents (e.g., blood products).
SKILLS
Hospitalists should be able to:
Prescribe medications for elderly hospitalized patients based on altered pharmacokinetics and co‐morbid conditions.
Apply treatment guidelines to individual patients in the use of antibiotics to reduce cost and the emergence of resistance.
Minimize ADEs by using best practice models of medication ordering and administration.
Document medications accurately and legibly taking into account approved abbreviation, and indicate start and stop dates for short‐term medications.
Arrange adequate follow‐up for therapies that require outpatient monitoring, dosage adjustment, and education (e.g., anticoagulants, antibiotics).
Balance the benefits, risks, and cost of prophylactic therapies, which may include venous thromboembolism and stress ulcer prophylaxis
Convert intravenous medications to the oral route when indicated to promote patient safety, satisfaction, and reduce cost.
Standardize blood transfusion practices.
ATTITUDES
Hospitalists should be able to:
Educate patients and families about the importance of acquiring medication information and communicating medication history to clinicians at each transition of care.
Ensure patients and families comprehend medication instructions.
Recognize the benefits and hazards of drug therapy.
Recognize the risk of ADEs at the time of transfer of care.
Reconcile outpatient medications with inpatient medications at the time of admission and discharge.
Reconcile all documentation of medications at the time of discharge.
Integrate knowledge of benefits and risks of drug therapies into medical decision making for individual patients, and routinely reassess decisions.
Critically assess and apply results of new outcome studies to improve drug treatment and patient safety for individual patients.
Collaborate with pharmacists to improve drug safety for individual patients and reduce hospital costs.
Apply the principles of pharmacoepidemiology and drug safety to patient management.
Lead, coordinate and participate in the development, use, and dissemination of local, regional, and national practice guidelines and patient safety alerts pertaining to the prevention of complications.
Apply the principles of pharmacoepidemiology and pharmacoeconomics to implement practice guidelines and protocols for a hospital.
The number of new therapeutic agents approved by the Food and Drug Administration (FDA) is rapidly increasing. With the availability of these new agents and the widening use of other agents, pharmaceutical costs have grown more than any other sector of healthcare, as have concerns about adverse drug events (ADEs) from these agents. Hospitalists who strive to prescribe evidence based therapies must understand how to evaluate the benefits, harms, and financial costs of drug therapy for individual patients. Hospitalists promote and lead multidisciplinary teams to implement protocols, guidelines and clinical pathways that recommend preferred drug therapies. Hospitalists should be able to interpret outcomes measurement (pharmacoepidemiology) and economic analyses (pharmacoeconomics).
KNOWLEDGE
Hospitalists should be able to:
Discuss principles of evaluating clinical efficacy, pharmacokinetics, dosing, drug and food interactions, and adverse effects that can affect the hospitalist's choice of agent, dosing frequency and route of administration.
Explain options for measuring medication benefit.
Explain the evidence based rationale for prophylactic drug therapies, comparing the costs, risks and benefits of competing strategies.
Explain how pharmacodynamics change with age, liver disease and renal insufficiency.
Describe the incidence of various types of ADEs in hospitalized patients, which may include adverse effects, interactions, and errors.
Explain the role of polypharmacy in the development of delirium, ADEs, and noncompliance.
Describe how the overuse of broad spectrum antibiotics promotes resistance.
Describe key principles for interpreting pharmacoeconomic analyses including inflation rate, discounting rate, incremental analysis, sensitivity analysis, and inherent bias.
Describe the clinical efficacy, safety profile, pharmacokinetics, dosing, drug and food interactions, and costs of commonly prescribed medications and biological agents (e.g., blood products).
SKILLS
Hospitalists should be able to:
Prescribe medications for elderly hospitalized patients based on altered pharmacokinetics and co‐morbid conditions.
Apply treatment guidelines to individual patients in the use of antibiotics to reduce cost and the emergence of resistance.
Minimize ADEs by using best practice models of medication ordering and administration.
Document medications accurately and legibly taking into account approved abbreviation, and indicate start and stop dates for short‐term medications.
Arrange adequate follow‐up for therapies that require outpatient monitoring, dosage adjustment, and education (e.g., anticoagulants, antibiotics).
Balance the benefits, risks, and cost of prophylactic therapies, which may include venous thromboembolism and stress ulcer prophylaxis
Convert intravenous medications to the oral route when indicated to promote patient safety, satisfaction, and reduce cost.
Standardize blood transfusion practices.
ATTITUDES
Hospitalists should be able to:
Educate patients and families about the importance of acquiring medication information and communicating medication history to clinicians at each transition of care.
Ensure patients and families comprehend medication instructions.
Recognize the benefits and hazards of drug therapy.
Recognize the risk of ADEs at the time of transfer of care.
Reconcile outpatient medications with inpatient medications at the time of admission and discharge.
Reconcile all documentation of medications at the time of discharge.
Integrate knowledge of benefits and risks of drug therapies into medical decision making for individual patients, and routinely reassess decisions.
Critically assess and apply results of new outcome studies to improve drug treatment and patient safety for individual patients.
Collaborate with pharmacists to improve drug safety for individual patients and reduce hospital costs.
Apply the principles of pharmacoepidemiology and drug safety to patient management.
Lead, coordinate and participate in the development, use, and dissemination of local, regional, and national practice guidelines and patient safety alerts pertaining to the prevention of complications.
Apply the principles of pharmacoepidemiology and pharmacoeconomics to implement practice guidelines and protocols for a hospital.
Copyright © 2006 Society of Hospital Medicine