User login
Team approach and multidsciplinary care
Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.
KNOWLEDGE
Hospitalists should be able to:
Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.
List major barriers to effective team interactions.
Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.
List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.
SKILLS
Hospitalists should be able to:
Determine an effective team composition and designate individual group member functions.
Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.
Assess individual member's strengths and incorporate them effectively and productively into the team.
Assess group dynamics and facilitate optimal team functioning.
Integrate the assessments and recommendations of all contributing team members into the care plan.
Conduct effective multidisciplinary team rounds, which may include patients and their families.
Utilize team members' time effectively, maximizing efficiency and consistency.
Ensure the delivery of timely and accurate information.
Assess performance of team members, including self‐assessment, and identify opportunities for improvement.
ATTITUDES
Hospitalists should be able to:
Employ active listening techniques during interactions with team members and engage team participation.
Communicate frequently with all members of the multidisciplinary team.
Emphasize the importance of mutual respect among team members.
Act as a role model in professional conflict resolution and discussion of disagreements.
Share decision making responsibilities, within the appropriate scopes of practice, with care team members.
Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.
Facilitate opportunities for interactive education among team members and for team members to educate patients and families.
Coordinate seamless transitions of care by utilizing combined expertise of team members.
Establish a hospital wide, non‐punitive culture of error reporting and prevention.
Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.
KNOWLEDGE
Hospitalists should be able to:
Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.
List major barriers to effective team interactions.
Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.
List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.
SKILLS
Hospitalists should be able to:
Determine an effective team composition and designate individual group member functions.
Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.
Assess individual member's strengths and incorporate them effectively and productively into the team.
Assess group dynamics and facilitate optimal team functioning.
Integrate the assessments and recommendations of all contributing team members into the care plan.
Conduct effective multidisciplinary team rounds, which may include patients and their families.
Utilize team members' time effectively, maximizing efficiency and consistency.
Ensure the delivery of timely and accurate information.
Assess performance of team members, including self‐assessment, and identify opportunities for improvement.
ATTITUDES
Hospitalists should be able to:
Employ active listening techniques during interactions with team members and engage team participation.
Communicate frequently with all members of the multidisciplinary team.
Emphasize the importance of mutual respect among team members.
Act as a role model in professional conflict resolution and discussion of disagreements.
Share decision making responsibilities, within the appropriate scopes of practice, with care team members.
Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.
Facilitate opportunities for interactive education among team members and for team members to educate patients and families.
Coordinate seamless transitions of care by utilizing combined expertise of team members.
Establish a hospital wide, non‐punitive culture of error reporting and prevention.
Multidisciplinary care refers to active collaboration between various members in the healthcare system to develop optimal care plans for each hospitalized patient. Multidisciplinary care teams maintain goals to enhance quality and patient safety, improve outcomes, decrease length of stay, and lower costs. Hospitalists coordinate complex inpatient medical care from admission through all care transitions to discharge. Hospitalists lead multidisciplinary teams within their institutions to achieve these goals and to improve care processes.
KNOWLEDGE
Hospitalists should be able to:
Describe the major elements of teamwork, including mutual respect, communication, common goals and plans, and accountability.
List major barriers to effective team interactions.
Describe aspects within an institution, including its local organizational culture, which can impact the structure and function of multidisciplinary teams.
List factors that positively and negatively affect formation and effective performance of multidisciplinary teams.
SKILLS
Hospitalists should be able to:
Determine an effective team composition and designate individual group member functions.
Demonstrate group dynamic skills, including communication, negotiation, conflict resolution, delegation, and time management.
Assess individual member's strengths and incorporate them effectively and productively into the team.
Assess group dynamics and facilitate optimal team functioning.
Integrate the assessments and recommendations of all contributing team members into the care plan.
Conduct effective multidisciplinary team rounds, which may include patients and their families.
Utilize team members' time effectively, maximizing efficiency and consistency.
Ensure the delivery of timely and accurate information.
Assess performance of team members, including self‐assessment, and identify opportunities for improvement.
ATTITUDES
Hospitalists should be able to:
Employ active listening techniques during interactions with team members and engage team participation.
Communicate frequently with all members of the multidisciplinary team.
Emphasize the importance of mutual respect among team members.
Act as a role model in professional conflict resolution and discussion of disagreements.
Share decision making responsibilities, within the appropriate scopes of practice, with care team members.
Create an environment of shared responsibility with patients and caregivers, and provide opportunities for patient and/or caregivers to participate in medical decision making.
Facilitate opportunities for interactive education among team members and for team members to educate patients and families.
Coordinate seamless transitions of care by utilizing combined expertise of team members.
Establish a hospital wide, non‐punitive culture of error reporting and prevention.
Copyright © 2006 Society of Hospital Medicine
Management practices
Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third‐party payer contracts on hospital reimbursement.
Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.
Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.
Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the personnel file, its contents and usage.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Develop practice staffing arrangements and schedules.
Market the hospital medicine program.
Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.
Develop strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and non‐physician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third party payers.
Interpret hospital generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.
Recognize the importance of meeting or exceeding customer and colleague expectations.
Recognize the importance of best management practice.
Recognize the importance of marketing and public relations to foster sustainable practice growth.
Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third‐party payer contracts on hospital reimbursement.
Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.
Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.
Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the personnel file, its contents and usage.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Develop practice staffing arrangements and schedules.
Market the hospital medicine program.
Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.
Develop strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and non‐physician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third party payers.
Interpret hospital generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.
Recognize the importance of meeting or exceeding customer and colleague expectations.
Recognize the importance of best management practice.
Recognize the importance of marketing and public relations to foster sustainable practice growth.
Management practice in hospital medicine refers to program/medical group development and growth, practice management, contract negotiation, performance measurement and financial analysis. Hospitalists require fundamental management skills to enhance their individual success, and to facilitate growth and stability of their hospital medicine groups and institutions in which they practice. Hospitals increasingly need physician leaders with management skills to improve operational efficiency and meet other institutional needs. Hospitalists must acquire and maintain management skills that allow them to define their role and value, create a strategic plan for practice growth, anticipate and respond to change, and achieve financial success.
KNOWLEDGE
Hospitalists should be able to:
Describe different models of physician compensation and incentives.
Explain the impact of third‐party payer contracts on hospital reimbursement.
Discuss the potential impact of Pay for Performance initiatives on patient care, and expectations for individual hospitalists and hospital medicine groups.
Describe Federal statutory restrictions on physicians contracting with hospitals, third‐party payers and group practices.
Describe the impact of medication formularies, utilization review requirements, third party payer contracts and other policies impacting patient care.
Describe required system improvements needed to meet new healthcare legislation or public health guidelines.
Describe the personnel file, its contents and usage.
Define the role and value of hospitalists and hospital medicine programs.
Explain advantages and disadvantages of utilizing physician extenders in a hospital medicine practice.
Describe the necessary elements for effective and compliant billing, coding, and revenue capture.
Define commonly used hospital financial terminology, including but not limited to procedure codes, relative value units (RVUs), direct and indirect costs, average length of stay, and case mix index.
Define the components of a useful financial report.
SKILLS
Hospitalists should be able to:
Apply basic accounting practices to track financial performance and develop a practice budget.
Develop practice staffing arrangements and schedules.
Market the hospital medicine program.
Develop job descriptions for physician and non‐physician employees to facilitate accountability and professional development.
Develop strategies for recruiting and retaining hospitalists.
Conduct or participate in performance reviews for physician and non‐physician staff.
Negotiate effectively with physicians, medical practices, hospitals, and third party payers.
Interpret hospital generated reports on individual and group performance.
Assess satisfaction of community physicians, patients, nurses and other user groups.
Develop strategic planning processes to meet individual and group goals and establish accountability.
Develop business plans to facilitate growth of the practice.
Prepare an annual review of program performance for the hospital executive team.
Demonstrate teamwork, organization, and leadership skills.
ATTITUDES
Hospitalists should be able to:
Lead by example.
Recognize the importance of routine critical analysis of all aspects of practice operations to optimize efficiency, quality and efficacy.
Recognize the importance of meeting or exceeding customer and colleague expectations.
Recognize the importance of best management practice.
Recognize the importance of marketing and public relations to foster sustainable practice growth.
Copyright © 2006 Society of Hospital Medicine
Professionalism and medical ethics
Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.
Describe the concept of double effect.
Define and differentiate competency and decision making capacity.
Explain the utility of power of attorney and advance directives in medical care.
List the key elements of informed consent.
Explain determination of decision making capacity and steps required for surrogate decision making.
Describe local laws and regulations relevant to the practice of hospital medicine.
Explain medical futility.
SKILLS
Hospitalists should be able to:
Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.
Communicate with patient and family members on a regular basis.
Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.
Evaluate patients for medical decision making capacity.
Obtain informed consent when indicated.
Review power of attorney and advanced directives with patients and family members.
Provide compassionate and relevant end of life care.
Apply ethical principles to inpatient care.
Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.
ATTITUDES
Hospitalists should be able to:
Commit to life‐long self learning, maintenance of skills, and clinical excellence.
Promote access to medical care for the community.
Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.
Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.
Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.
Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.
Appreciate that physicians are not required to provide care that is medically futile.
Demonstrate empathy for hospitalized patients.
Endorse that physicians have an obligation not to discriminate against any patient or group of patients.
Observe the boundaries of the physician‐patient relationship.
Promote cost effective care.
Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.
Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.
Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.
Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.
Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.
Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.
Describe the concept of double effect.
Define and differentiate competency and decision making capacity.
Explain the utility of power of attorney and advance directives in medical care.
List the key elements of informed consent.
Explain determination of decision making capacity and steps required for surrogate decision making.
Describe local laws and regulations relevant to the practice of hospital medicine.
Explain medical futility.
SKILLS
Hospitalists should be able to:
Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.
Communicate with patient and family members on a regular basis.
Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.
Evaluate patients for medical decision making capacity.
Obtain informed consent when indicated.
Review power of attorney and advanced directives with patients and family members.
Provide compassionate and relevant end of life care.
Apply ethical principles to inpatient care.
Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.
ATTITUDES
Hospitalists should be able to:
Commit to life‐long self learning, maintenance of skills, and clinical excellence.
Promote access to medical care for the community.
Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.
Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.
Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.
Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.
Appreciate that physicians are not required to provide care that is medically futile.
Demonstrate empathy for hospitalized patients.
Endorse that physicians have an obligation not to discriminate against any patient or group of patients.
Observe the boundaries of the physician‐patient relationship.
Promote cost effective care.
Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.
Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.
Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.
Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.
Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.
Professionalism refers to guidelines and attributes that require the physician to serve the interests of the patient above his or her self‐interest. At the individual practitioner level, this denotes a commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles. Hospitalists frequently encounter ethical dilemmas in their daily practice because issues arise regarding end of life care, the ability of the patient to consent to treatment, and pressures of resource utilization. Hospitalists lead, coordinate and participate in systems improvements that promote professionalism in health care delivery.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth‐telling, informed consent, and confidentiality.
Describe the concept of double effect.
Define and differentiate competency and decision making capacity.
Explain the utility of power of attorney and advance directives in medical care.
List the key elements of informed consent.
Explain determination of decision making capacity and steps required for surrogate decision making.
Describe local laws and regulations relevant to the practice of hospital medicine.
Explain medical futility.
SKILLS
Hospitalists should be able to:
Observe doctor‐patient confidentiality and identify family members or surrogates to whom information can be released.
Communicate with patient and family members on a regular basis.
Recommend treatment options that optimize patient care, include consideration of resource utilization, and are formulated without regard to financial incentives or other conflicts of interest.
Evaluate patients for medical decision making capacity.
Obtain informed consent when indicated.
Review power of attorney and advanced directives with patients and family members.
Provide compassionate and relevant end of life care.
Apply ethical principles to inpatient care.
Follow patient's wishes as described by the patient, as outlined in advanced directives, or as described by the patient's surrogate decision maker.
ATTITUDES
Hospitalists should be able to:
Commit to life‐long self learning, maintenance of skills, and clinical excellence.
Promote access to medical care for the community.
Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.
Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.
Remain sensitive to differences in patients' gender, age, race, culture, religion, and sexual orientation.
Appreciate that informed adults with decision making capacity may refuse recommended medical treatment.
Appreciate that physicians are not required to provide care that is medically futile.
Demonstrate empathy for hospitalized patients.
Endorse that physicians have an obligation not to discriminate against any patient or group of patients.
Observe the boundaries of the physician‐patient relationship.
Promote cost effective care.
Recognize the obligation to report fraud, professional misconduct, impairment, incompetence or abandonment of patients.
Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.
Recognize potential individual and institutional conflicts of interest with incentive‐based contractual agreements with pharmaceutical companies and other funding agents.
Follow a systematic approach to risks, benefits and conflicts of interest in human subject research.
Serve as a role model for professional and ethical conduct to house staff, medical students and other members of the interdisciplinary team.
Copyright © 2006 Society of Hospital Medicine
Pain management
Pain, defined by International Association for the Study of Pain (IASP), as an unpleasant experience associated with actual or potential tissue damage to a person's body, is a very common presenting or accompanying symptom of hospitalized patients. Pain management involves utilizing various modalities to alleviate suffering and restore patient function. Proper assessment and treatment of pain can improve clinical outcomes, discharge planning and patient and family satisfaction. Pain management of inpatients necessitates understanding the various mechanisms that cause pain, properties of analgesic pharmacological and non‐pharmacological modalities, as well as the accurate assessment of severity and treatment response. Hospitalists assess and manage patients experiencing pain. This role encompasses empathy, clinical excellence, and understanding of the myriad obstacles, cautions and specific knowledge, skills and attitudes necessary for appropriate pain management. Hospitalists serve as leaders of multidisciplinary teams to develop policies and protocols to improve pain management in their health care system.
KNOWLEDGE
Hospitalists should be able to:
Describe the mechanisms that cause pain.
Describe the symptoms and signs of pain.
Differentiate acute, chronic, somatic, neuropathic, referred and visceral pain syndromes.
Differentiate tolerance, dependence, addiction and pseudo‐addiction.
Describe the value and limitations of the physical examination and various validated pain intensity assessment scales.
Explain the relationship between physical, cultural and psychological factors and pain and pain thresholds.
Discuss the genetic, social, and psychological factors that may contribute to opioid addiction.
Explain the indications and limitations of non‐pharmacological methods of pain control available in the inpatient setting.
Explain the indications and limitations of non‐opioids including acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), and topical agents.
Explain the indications and limitations of opioid pharmacotherapy.
Explain the indications and limitations of other analgesics including, tramadol, tricyclic agents and anti‐epileptic medications in the treatment of various pain syndromes.
Describe specific factors that affect dosing regimes, such as drug half‐life, renal and hepatic function.
Establish functional criteria for discharge.
SKILLS
Hospitalists should be able to:
Elicit a detailed history and description of pain and review the medical record to determine likely source and acuity of pain.
Review patient pharmacologic and psychosocial history and identify factors contributing to pain or factors that might impact its management.
Conduct a physical examination to determine the likely source of pain.
Order and interpret diagnostic studies to determine the source of pain when underlying acute illness is suspected.
Assess pain severity using validated measurement tools.
Formulate an initial pain management plan.
Determine appropriate route, dosing and frequency for pharmacologic agents based on patient‐specific factors.
Reassess pain severity and determine the need for escalating therapy and/or adjuvant therapies.
Determine equianalgesic dosing for pharmacologic therapy when needed.
Titrate short and long acting narcotics to desired effect.
Predict and counteract as needed expected analgesic side effects, including use of reversal and specific agents, especially in elderly.
Initiate appropriate therapies to prevent and treat constipation when using opioid analgesics.
Anticipate and manage side effects of pain medications including respiratory depression and sedation, nausea, vomiting and pruritis.
Assess and communicate need for pain management during medical consultation.
ATTITUDES
Hospitalists should be able to:
Promote the ethical imperative of frequent pain assessment and adequate control.
Appreciate that all pain is subjective and acknowledge patients' self‐reports of pain.
Appreciate the value of patient controlled analgesia.
Discuss with patients and families the goals for pain management strategies and functional status, and set targets for pain control.
Recognize indications for specialty consultation, which may include pain service, anesthesiology, and physical and rehabilitation medicine.
Employ a multidisciplinary approach to the assessment and management of patients with pain that begins on admission and continues through all care transitions.
Educate patients and physicians on the importance of appropriate use of opioids in pain management and explain the rarity of opioid addiction in the setting of appropriate pain management.
Establish and maintain an open dialogue with patients and families regarding care goals and limitations, which may include palliative care and end‐of‐life wishes.
Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patient and/or family when indicated or desired.
Document treatment plan and discharge instructions, and communicate with the outpatient clinician responsible for follow‐up.
Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.
Utilize evidence based recommendations, including the World Health Organization (WHO) step approach to pain management.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate, or participate in efforts to develop educational modules, order sets, and/or pathways that facilitate effective pain management in the hospital setting, with goals of improving outcomes and patient satisfaction, decreasing length of stay, and reducing re‐hospitalization rates.
Lead, coordinate or participate in efforts to measure quality of inpatient pain control and operationalize system improvements and reduction of barriers to adequate pain control
Lead, coordinate or participate in efforts to establish or support existing multidisciplinary pain control teams.
Pain, defined by International Association for the Study of Pain (IASP), as an unpleasant experience associated with actual or potential tissue damage to a person's body, is a very common presenting or accompanying symptom of hospitalized patients. Pain management involves utilizing various modalities to alleviate suffering and restore patient function. Proper assessment and treatment of pain can improve clinical outcomes, discharge planning and patient and family satisfaction. Pain management of inpatients necessitates understanding the various mechanisms that cause pain, properties of analgesic pharmacological and non‐pharmacological modalities, as well as the accurate assessment of severity and treatment response. Hospitalists assess and manage patients experiencing pain. This role encompasses empathy, clinical excellence, and understanding of the myriad obstacles, cautions and specific knowledge, skills and attitudes necessary for appropriate pain management. Hospitalists serve as leaders of multidisciplinary teams to develop policies and protocols to improve pain management in their health care system.
KNOWLEDGE
Hospitalists should be able to:
Describe the mechanisms that cause pain.
Describe the symptoms and signs of pain.
Differentiate acute, chronic, somatic, neuropathic, referred and visceral pain syndromes.
Differentiate tolerance, dependence, addiction and pseudo‐addiction.
Describe the value and limitations of the physical examination and various validated pain intensity assessment scales.
Explain the relationship between physical, cultural and psychological factors and pain and pain thresholds.
Discuss the genetic, social, and psychological factors that may contribute to opioid addiction.
Explain the indications and limitations of non‐pharmacological methods of pain control available in the inpatient setting.
Explain the indications and limitations of non‐opioids including acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), and topical agents.
Explain the indications and limitations of opioid pharmacotherapy.
Explain the indications and limitations of other analgesics including, tramadol, tricyclic agents and anti‐epileptic medications in the treatment of various pain syndromes.
Describe specific factors that affect dosing regimes, such as drug half‐life, renal and hepatic function.
Establish functional criteria for discharge.
SKILLS
Hospitalists should be able to:
Elicit a detailed history and description of pain and review the medical record to determine likely source and acuity of pain.
Review patient pharmacologic and psychosocial history and identify factors contributing to pain or factors that might impact its management.
Conduct a physical examination to determine the likely source of pain.
Order and interpret diagnostic studies to determine the source of pain when underlying acute illness is suspected.
Assess pain severity using validated measurement tools.
Formulate an initial pain management plan.
Determine appropriate route, dosing and frequency for pharmacologic agents based on patient‐specific factors.
Reassess pain severity and determine the need for escalating therapy and/or adjuvant therapies.
Determine equianalgesic dosing for pharmacologic therapy when needed.
Titrate short and long acting narcotics to desired effect.
Predict and counteract as needed expected analgesic side effects, including use of reversal and specific agents, especially in elderly.
Initiate appropriate therapies to prevent and treat constipation when using opioid analgesics.
Anticipate and manage side effects of pain medications including respiratory depression and sedation, nausea, vomiting and pruritis.
Assess and communicate need for pain management during medical consultation.
ATTITUDES
Hospitalists should be able to:
Promote the ethical imperative of frequent pain assessment and adequate control.
Appreciate that all pain is subjective and acknowledge patients' self‐reports of pain.
Appreciate the value of patient controlled analgesia.
Discuss with patients and families the goals for pain management strategies and functional status, and set targets for pain control.
Recognize indications for specialty consultation, which may include pain service, anesthesiology, and physical and rehabilitation medicine.
Employ a multidisciplinary approach to the assessment and management of patients with pain that begins on admission and continues through all care transitions.
Educate patients and physicians on the importance of appropriate use of opioids in pain management and explain the rarity of opioid addiction in the setting of appropriate pain management.
Establish and maintain an open dialogue with patients and families regarding care goals and limitations, which may include palliative care and end‐of‐life wishes.
Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patient and/or family when indicated or desired.
Document treatment plan and discharge instructions, and communicate with the outpatient clinician responsible for follow‐up.
Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.
Utilize evidence based recommendations, including the World Health Organization (WHO) step approach to pain management.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate, or participate in efforts to develop educational modules, order sets, and/or pathways that facilitate effective pain management in the hospital setting, with goals of improving outcomes and patient satisfaction, decreasing length of stay, and reducing re‐hospitalization rates.
Lead, coordinate or participate in efforts to measure quality of inpatient pain control and operationalize system improvements and reduction of barriers to adequate pain control
Lead, coordinate or participate in efforts to establish or support existing multidisciplinary pain control teams.
Pain, defined by International Association for the Study of Pain (IASP), as an unpleasant experience associated with actual or potential tissue damage to a person's body, is a very common presenting or accompanying symptom of hospitalized patients. Pain management involves utilizing various modalities to alleviate suffering and restore patient function. Proper assessment and treatment of pain can improve clinical outcomes, discharge planning and patient and family satisfaction. Pain management of inpatients necessitates understanding the various mechanisms that cause pain, properties of analgesic pharmacological and non‐pharmacological modalities, as well as the accurate assessment of severity and treatment response. Hospitalists assess and manage patients experiencing pain. This role encompasses empathy, clinical excellence, and understanding of the myriad obstacles, cautions and specific knowledge, skills and attitudes necessary for appropriate pain management. Hospitalists serve as leaders of multidisciplinary teams to develop policies and protocols to improve pain management in their health care system.
KNOWLEDGE
Hospitalists should be able to:
Describe the mechanisms that cause pain.
Describe the symptoms and signs of pain.
Differentiate acute, chronic, somatic, neuropathic, referred and visceral pain syndromes.
Differentiate tolerance, dependence, addiction and pseudo‐addiction.
Describe the value and limitations of the physical examination and various validated pain intensity assessment scales.
Explain the relationship between physical, cultural and psychological factors and pain and pain thresholds.
Discuss the genetic, social, and psychological factors that may contribute to opioid addiction.
Explain the indications and limitations of non‐pharmacological methods of pain control available in the inpatient setting.
Explain the indications and limitations of non‐opioids including acetaminophen, nonsteroidal anti‐inflammatory drugs (NSAIDs), and topical agents.
Explain the indications and limitations of opioid pharmacotherapy.
Explain the indications and limitations of other analgesics including, tramadol, tricyclic agents and anti‐epileptic medications in the treatment of various pain syndromes.
Describe specific factors that affect dosing regimes, such as drug half‐life, renal and hepatic function.
Establish functional criteria for discharge.
SKILLS
Hospitalists should be able to:
Elicit a detailed history and description of pain and review the medical record to determine likely source and acuity of pain.
Review patient pharmacologic and psychosocial history and identify factors contributing to pain or factors that might impact its management.
Conduct a physical examination to determine the likely source of pain.
Order and interpret diagnostic studies to determine the source of pain when underlying acute illness is suspected.
Assess pain severity using validated measurement tools.
Formulate an initial pain management plan.
Determine appropriate route, dosing and frequency for pharmacologic agents based on patient‐specific factors.
Reassess pain severity and determine the need for escalating therapy and/or adjuvant therapies.
Determine equianalgesic dosing for pharmacologic therapy when needed.
Titrate short and long acting narcotics to desired effect.
Predict and counteract as needed expected analgesic side effects, including use of reversal and specific agents, especially in elderly.
Initiate appropriate therapies to prevent and treat constipation when using opioid analgesics.
Anticipate and manage side effects of pain medications including respiratory depression and sedation, nausea, vomiting and pruritis.
Assess and communicate need for pain management during medical consultation.
ATTITUDES
Hospitalists should be able to:
Promote the ethical imperative of frequent pain assessment and adequate control.
Appreciate that all pain is subjective and acknowledge patients' self‐reports of pain.
Appreciate the value of patient controlled analgesia.
Discuss with patients and families the goals for pain management strategies and functional status, and set targets for pain control.
Recognize indications for specialty consultation, which may include pain service, anesthesiology, and physical and rehabilitation medicine.
Employ a multidisciplinary approach to the assessment and management of patients with pain that begins on admission and continues through all care transitions.
Educate patients and physicians on the importance of appropriate use of opioids in pain management and explain the rarity of opioid addiction in the setting of appropriate pain management.
Establish and maintain an open dialogue with patients and families regarding care goals and limitations, which may include palliative care and end‐of‐life wishes.
Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patient and/or family when indicated or desired.
Document treatment plan and discharge instructions, and communicate with the outpatient clinician responsible for follow‐up.
Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.
Utilize evidence based recommendations, including the World Health Organization (WHO) step approach to pain management.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate, or participate in efforts to develop educational modules, order sets, and/or pathways that facilitate effective pain management in the hospital setting, with goals of improving outcomes and patient satisfaction, decreasing length of stay, and reducing re‐hospitalization rates.
Lead, coordinate or participate in efforts to measure quality of inpatient pain control and operationalize system improvements and reduction of barriers to adequate pain control
Lead, coordinate or participate in efforts to establish or support existing multidisciplinary pain control teams.
Copyright © 2006 Society of Hospital Medicine
Diagnostic decision making
Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.
KNOWLEDGE
Hospitalists should be able to:
Describe the prevalence of common disease states to the local patient population.
Explain appropriate resources to determine prevalence and incidence of disease states.
Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.
Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.
Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.
Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.
Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.
Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.
Name appropriate sources of information regarding evidence based clinical decision making.
Describe the factors that account for excessive or indiscriminate testing.
SKILLS
Hospitalists should be able to:
Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.
Perform a physical examination to further refine the diagnostic hypothesis.
Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.
Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.
Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.
Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.
Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.
Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.
Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.
Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.
Lead, coordinate or participate in the development of clinical care pathways.
Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.
Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.
KNOWLEDGE
Hospitalists should be able to:
Describe the prevalence of common disease states to the local patient population.
Explain appropriate resources to determine prevalence and incidence of disease states.
Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.
Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.
Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.
Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.
Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.
Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.
Name appropriate sources of information regarding evidence based clinical decision making.
Describe the factors that account for excessive or indiscriminate testing.
SKILLS
Hospitalists should be able to:
Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.
Perform a physical examination to further refine the diagnostic hypothesis.
Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.
Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.
Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.
Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.
Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.
Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.
Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.
Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.
Lead, coordinate or participate in the development of clinical care pathways.
Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.
Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.
KNOWLEDGE
Hospitalists should be able to:
Describe the prevalence of common disease states to the local patient population.
Explain appropriate resources to determine prevalence and incidence of disease states.
Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.
Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.
Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.
Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.
Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.
Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.
Name appropriate sources of information regarding evidence based clinical decision making.
Describe the factors that account for excessive or indiscriminate testing.
SKILLS
Hospitalists should be able to:
Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.
Perform a physical examination to further refine the diagnostic hypothesis.
Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.
Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.
Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.
Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.
Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.
Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.
Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.
Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.
Lead, coordinate or participate in the development of clinical care pathways.
Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.
Copyright © 2006 Society of Hospital Medicine
Information management
Information management refers to the acquisition and utilization of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal work flow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computer based provider order entry, event monitoring, electronic charting and bar coding. Hospitalists use local systems to acquire data and information that support optimal medical decision making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, utilize and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers.
KNOWLEDGE
Hospitalists should be able to:
Describe how hospital information systems are utilized by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.
Identify and describe how to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators and practice guidelines to support optimal patient care.
Explain how information systems can facilitate the practice of evidence based medical decision making.
Explain how computer physician order entry (CPOE) with decision support favorably impacts on patient safety in the hospital setting.
Explain potential pitfalls of the use of CPOE.
Describe potential advantages and disadvantages of written and electronic patient records.
Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.
Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.
SKILLS
Hospitalists should be able to:
Efficiently retrieve and interpret data, images, and other information from available clinical information systems.
Interpret data from digital devices, which may include EKG monitors, glucometers, or oxygen saturation monitors.
Access and interpret information from internet‐based clinical information systems when available.
Interpret results incorporating statistical principles of probability and uncertainty.
ATTITUDES
Hospitalists should be able to:
Recognize the limitations of acquisition devices or equipment, and use clinical judgment to interpret results that fall either within or outside the expected ranges.
Recognize the influence of individual patient factors in the interpretation of available information.
Adhere to principles of data integrity, security and confidentiality.
Lead, coordinate or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.
Lead, coordinate or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.
Advocate for order entry systems that promote patient safety and ease of use.
Advocate for information decision support to facilitate efficient and optimal medical management.
Identify issues, provide feedback, and resolve conflicts within an information systems framework.
Information management refers to the acquisition and utilization of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal work flow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computer based provider order entry, event monitoring, electronic charting and bar coding. Hospitalists use local systems to acquire data and information that support optimal medical decision making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, utilize and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers.
KNOWLEDGE
Hospitalists should be able to:
Describe how hospital information systems are utilized by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.
Identify and describe how to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators and practice guidelines to support optimal patient care.
Explain how information systems can facilitate the practice of evidence based medical decision making.
Explain how computer physician order entry (CPOE) with decision support favorably impacts on patient safety in the hospital setting.
Explain potential pitfalls of the use of CPOE.
Describe potential advantages and disadvantages of written and electronic patient records.
Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.
Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.
SKILLS
Hospitalists should be able to:
Efficiently retrieve and interpret data, images, and other information from available clinical information systems.
Interpret data from digital devices, which may include EKG monitors, glucometers, or oxygen saturation monitors.
Access and interpret information from internet‐based clinical information systems when available.
Interpret results incorporating statistical principles of probability and uncertainty.
ATTITUDES
Hospitalists should be able to:
Recognize the limitations of acquisition devices or equipment, and use clinical judgment to interpret results that fall either within or outside the expected ranges.
Recognize the influence of individual patient factors in the interpretation of available information.
Adhere to principles of data integrity, security and confidentiality.
Lead, coordinate or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.
Lead, coordinate or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.
Advocate for order entry systems that promote patient safety and ease of use.
Advocate for information decision support to facilitate efficient and optimal medical management.
Identify issues, provide feedback, and resolve conflicts within an information systems framework.
Information management refers to the acquisition and utilization of patient data for key hospital activities that include but are not limited to direct patient care. Optimal care of hospitalized patients and optimal work flow require basic clinical information systems. Advanced clinical information systems also provide decision support, which may include computer based provider order entry, event monitoring, electronic charting and bar coding. Hospitalists use local systems to acquire data and information that support optimal medical decision making at the point of care. Hospitalists can lead or coordinate efforts within their institution to develop, utilize and update clinical information systems to improve patient outcomes, reduce costs, and increase satisfaction among providers.
KNOWLEDGE
Hospitalists should be able to:
Describe how hospital information systems are utilized by different departments to manage patient registration and financial data, process clinical results, and schedule appointments and tests.
Identify and describe how to access available sources of reference information, which may include literature search engines, online textbooks, electronic calculators and practice guidelines to support optimal patient care.
Explain how information systems can facilitate the practice of evidence based medical decision making.
Explain how computer physician order entry (CPOE) with decision support favorably impacts on patient safety in the hospital setting.
Explain potential pitfalls of the use of CPOE.
Describe potential advantages and disadvantages of written and electronic patient records.
Explain the limitations of different forms of data and data systems available to clinicians and how information systems can facilitate timely and accurate clinician submissions of bills.
Explain Health Insurance Portability and Accountability Act (HIPAA) regulations and their impact on management of patient information.
SKILLS
Hospitalists should be able to:
Efficiently retrieve and interpret data, images, and other information from available clinical information systems.
Interpret data from digital devices, which may include EKG monitors, glucometers, or oxygen saturation monitors.
Access and interpret information from internet‐based clinical information systems when available.
Interpret results incorporating statistical principles of probability and uncertainty.
ATTITUDES
Hospitalists should be able to:
Recognize the limitations of acquisition devices or equipment, and use clinical judgment to interpret results that fall either within or outside the expected ranges.
Recognize the influence of individual patient factors in the interpretation of available information.
Adhere to principles of data integrity, security and confidentiality.
Lead, coordinate or participate in multidisciplinary initiatives to adopt hospital information systems that improve efficiency and optimize patient care.
Lead, coordinate or participate in multidisciplinary initiatives to continuously improve hospital information systems and physician practice patterns by providing constructive feedback and advice in system development.
Advocate for order entry systems that promote patient safety and ease of use.
Advocate for information decision support to facilitate efficient and optimal medical management.
Identify issues, provide feedback, and resolve conflicts within an information systems framework.
Copyright © 2006 Society of Hospital Medicine
Acute coronary syndrome
Acute coronary syndrome (ACS) defines a spectrum of ischemic heart disease that may include non‐ST‐segment elevation myocardial infarction (NSTEMI) and ST‐elevation myocardial infarction (STEMI). The American Heart Association (AHA) estimates that 942,000 people with ACS were discharged from acute care hospitals in 2002. This number increased to approximately 1.7 million when including secondary discharge diagnoses. According to the AHA, an estimated $142 billion will be spent on the treatment of heart disease in 2005. Hospitalists diagnose, risk stratify, and initiate early management of patients with ACS. Hospitalists provide leadership for multidisciplinary teams that optimize the quality of inpatient care, maximize opportunities for patient education, and efficiently utilize resources. In addition, hospitalists initiate secondary preventive measures, which increase compliance with outpatient medical regimens.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ACS without enzyme leak, NSTEMI and STEMI.
Describe the variable clinical presentations of patients with unstable angina and acute myocardial infarction.
Distinguish ACS from other cardiac and non‐cardiac conditions that may mimic this disease process.
Describe how cardiac biomarkers are used in the diagnosis of ACS, including timing of testing, and the effects of renal disease and other co‐morbidities.
Describe the role of noninvasive cardiac tests.
Explain indications for and risks associated with cardiac catheterization.
List the major and minor risk factors predisposing patients to coronary artery disease.
Explain the value and use of validated risk stratification tools.
Explain indications for hospitalization of patients with chest pain.
Explain indications and contraindications for thrombolytic therapy.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat ACS.
Describe factors that indicate the need for early invasive interventions, including angiography, stenting and/or coronary artery bypass grafting.
Identify clinical, laboratory and imaging studies that indicate severity of disease.
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 with emphasis on presenting symptoms and patient risk factors for coronary artery disease (cad).
Conduct a physical examination with emphasis on the cardiovascular and pulmonary systems, and recognize clinical signs of acs and disease severity.
Diagnose acs through interpretation of expedited testing including history, physical examination, electrocardiogram, chest radiograph, and biomarkers.
Perform early risk stratification using validated risk stratification tools.
Synthesize results of history, physical examination, ekg, laboratory and imaging studies, and risk stratification tools to determine therapeutic options, formulate an evidence‐based treatment plan, and determine level of care required.
Identify patients who may benefit from thrombolytic therapy and/or early revascularization.
Appreciate and treat patient chest pain, anxiety and other discomfort.
Recognize symptoms and signs of decompensation and initiate immediate indicated therapies.
Anticipate and address factors that may complicate acs or its management, which may include inadequate response to therapies, cardiopulmonary compromise, or bleeding.
Assess patients with suspected acs 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 their cardiac disease.
Communicate with patients and families to explain goals of care plan, discharge instructions, and management after release from the hospital.
Communicate with patients and families to explain tests and procedures, and the use and potential side effects of pharmacologic agents.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize indications for early specialty consultation, which may include cardiology and cardiothoracic surgery.
Initiate secondary prevention measures prior to discharge, which may include smoking cessation, dietary modification, and evidence based medical therapies.
Employ a multidisciplinary approach, which may include nursing, nutrition, rehabilitation and social services in the care of patients with acs that begins at admission and continues through all care transitions.
Communicate to outpatient providers the notable events of the hospitalization and post‐discharge needs, including outpatient cardiac rehabilitation.
Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.
Utilize evidence based recommendations and protocols and risk stratification tools for the treatment of acs.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Lead, coordinate or participate in efforts to develop protocols to rapidly identify patients with acs and minimize time to intervention.
Lead, coordinate or participate in efforts between institutions to develop protocols for the rapid identification and transfer of patients with acs to appropriate facilities.
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, which may include acs and chest pain order sets.
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 acs.
Acute coronary syndrome (ACS) defines a spectrum of ischemic heart disease that may include non‐ST‐segment elevation myocardial infarction (NSTEMI) and ST‐elevation myocardial infarction (STEMI). The American Heart Association (AHA) estimates that 942,000 people with ACS were discharged from acute care hospitals in 2002. This number increased to approximately 1.7 million when including secondary discharge diagnoses. According to the AHA, an estimated $142 billion will be spent on the treatment of heart disease in 2005. Hospitalists diagnose, risk stratify, and initiate early management of patients with ACS. Hospitalists provide leadership for multidisciplinary teams that optimize the quality of inpatient care, maximize opportunities for patient education, and efficiently utilize resources. In addition, hospitalists initiate secondary preventive measures, which increase compliance with outpatient medical regimens.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ACS without enzyme leak, NSTEMI and STEMI.
Describe the variable clinical presentations of patients with unstable angina and acute myocardial infarction.
Distinguish ACS from other cardiac and non‐cardiac conditions that may mimic this disease process.
Describe how cardiac biomarkers are used in the diagnosis of ACS, including timing of testing, and the effects of renal disease and other co‐morbidities.
Describe the role of noninvasive cardiac tests.
Explain indications for and risks associated with cardiac catheterization.
List the major and minor risk factors predisposing patients to coronary artery disease.
Explain the value and use of validated risk stratification tools.
Explain indications for hospitalization of patients with chest pain.
Explain indications and contraindications for thrombolytic therapy.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat ACS.
Describe factors that indicate the need for early invasive interventions, including angiography, stenting and/or coronary artery bypass grafting.
Identify clinical, laboratory and imaging studies that indicate severity of disease.
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 with emphasis on presenting symptoms and patient risk factors for coronary artery disease (cad).
Conduct a physical examination with emphasis on the cardiovascular and pulmonary systems, and recognize clinical signs of acs and disease severity.
Diagnose acs through interpretation of expedited testing including history, physical examination, electrocardiogram, chest radiograph, and biomarkers.
Perform early risk stratification using validated risk stratification tools.
Synthesize results of history, physical examination, ekg, laboratory and imaging studies, and risk stratification tools to determine therapeutic options, formulate an evidence‐based treatment plan, and determine level of care required.
Identify patients who may benefit from thrombolytic therapy and/or early revascularization.
Appreciate and treat patient chest pain, anxiety and other discomfort.
Recognize symptoms and signs of decompensation and initiate immediate indicated therapies.
Anticipate and address factors that may complicate acs or its management, which may include inadequate response to therapies, cardiopulmonary compromise, or bleeding.
Assess patients with suspected acs 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 their cardiac disease.
Communicate with patients and families to explain goals of care plan, discharge instructions, and management after release from the hospital.
Communicate with patients and families to explain tests and procedures, and the use and potential side effects of pharmacologic agents.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize indications for early specialty consultation, which may include cardiology and cardiothoracic surgery.
Initiate secondary prevention measures prior to discharge, which may include smoking cessation, dietary modification, and evidence based medical therapies.
Employ a multidisciplinary approach, which may include nursing, nutrition, rehabilitation and social services in the care of patients with acs that begins at admission and continues through all care transitions.
Communicate to outpatient providers the notable events of the hospitalization and post‐discharge needs, including outpatient cardiac rehabilitation.
Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.
Utilize evidence based recommendations and protocols and risk stratification tools for the treatment of acs.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Lead, coordinate or participate in efforts to develop protocols to rapidly identify patients with acs and minimize time to intervention.
Lead, coordinate or participate in efforts between institutions to develop protocols for the rapid identification and transfer of patients with acs to appropriate facilities.
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, which may include acs and chest pain order sets.
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 acs.
Acute coronary syndrome (ACS) defines a spectrum of ischemic heart disease that may include non‐ST‐segment elevation myocardial infarction (NSTEMI) and ST‐elevation myocardial infarction (STEMI). The American Heart Association (AHA) estimates that 942,000 people with ACS were discharged from acute care hospitals in 2002. This number increased to approximately 1.7 million when including secondary discharge diagnoses. According to the AHA, an estimated $142 billion will be spent on the treatment of heart disease in 2005. Hospitalists diagnose, risk stratify, and initiate early management of patients with ACS. Hospitalists provide leadership for multidisciplinary teams that optimize the quality of inpatient care, maximize opportunities for patient education, and efficiently utilize resources. In addition, hospitalists initiate secondary preventive measures, which increase compliance with outpatient medical regimens.
KNOWLEDGE
Hospitalists should be able to:
Define and differentiate ACS without enzyme leak, NSTEMI and STEMI.
Describe the variable clinical presentations of patients with unstable angina and acute myocardial infarction.
Distinguish ACS from other cardiac and non‐cardiac conditions that may mimic this disease process.
Describe how cardiac biomarkers are used in the diagnosis of ACS, including timing of testing, and the effects of renal disease and other co‐morbidities.
Describe the role of noninvasive cardiac tests.
Explain indications for and risks associated with cardiac catheterization.
List the major and minor risk factors predisposing patients to coronary artery disease.
Explain the value and use of validated risk stratification tools.
Explain indications for hospitalization of patients with chest pain.
Explain indications and contraindications for thrombolytic therapy.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat ACS.
Describe factors that indicate the need for early invasive interventions, including angiography, stenting and/or coronary artery bypass grafting.
Identify clinical, laboratory and imaging studies that indicate severity of disease.
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 with emphasis on presenting symptoms and patient risk factors for coronary artery disease (cad).
Conduct a physical examination with emphasis on the cardiovascular and pulmonary systems, and recognize clinical signs of acs and disease severity.
Diagnose acs through interpretation of expedited testing including history, physical examination, electrocardiogram, chest radiograph, and biomarkers.
Perform early risk stratification using validated risk stratification tools.
Synthesize results of history, physical examination, ekg, laboratory and imaging studies, and risk stratification tools to determine therapeutic options, formulate an evidence‐based treatment plan, and determine level of care required.
Identify patients who may benefit from thrombolytic therapy and/or early revascularization.
Appreciate and treat patient chest pain, anxiety and other discomfort.
Recognize symptoms and signs of decompensation and initiate immediate indicated therapies.
Anticipate and address factors that may complicate acs or its management, which may include inadequate response to therapies, cardiopulmonary compromise, or bleeding.
Assess patients with suspected acs 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 their cardiac disease.
Communicate with patients and families to explain goals of care plan, discharge instructions, and management after release from the hospital.
Communicate with patients and families to explain tests and procedures, and the use and potential side effects of pharmacologic agents.
Communicate with patients and families to explain tests and procedures and their indications, and to obtain informed consent.
Recognize indications for early specialty consultation, which may include cardiology and cardiothoracic surgery.
Initiate secondary prevention measures prior to discharge, which may include smoking cessation, dietary modification, and evidence based medical therapies.
Employ a multidisciplinary approach, which may include nursing, nutrition, rehabilitation and social services in the care of patients with acs that begins at admission and continues through all care transitions.
Communicate to outpatient providers the notable events of the hospitalization and post‐discharge needs, including outpatient cardiac rehabilitation.
Provide and coordinate resources to patients to ensure safe transition from the hospital to arranged follow‐up care.
Utilize evidence based recommendations and protocols and risk stratification tools for the treatment of acs.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, hospitalists should:
Lead, coordinate or participate in efforts to develop protocols to rapidly identify patients with acs and minimize time to intervention.
Lead, coordinate or participate in efforts between institutions to develop protocols for the rapid identification and transfer of patients with acs to appropriate facilities.
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, which may include acs and chest pain order sets.
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 acs.
Copyright © 2006 Society of Hospital Medicine
Hospitalist as teacher
Hospitalist as teacher refers to specific interactions with members of the multidisciplinary care team to educate them about inpatient care plans, hospital protocols, patient safety, and evidence based clinical problem solving. As educators, hospitalists provide leadership in patient care, teach at multiple levels, and facilitate team building. Hospitalists serve as role models and teach the process of clinical decision making as a tool for future physician‐patient encounters. Hospitalists may review, modify, and promote new protocols and guidelines to implement across multiple services in the hospital. The hospitalist as teacher is a core competency essential to the process of effecting organizational change.
KNOWLEDGE
Hospitalists should be able to:
Describe adult education principles.
Explain the conditions that facilitate and inhibit learning.
Define the concept of a teachable moment.
Describe the process of developing a formal educational session, which may include needs assessment, determining goals and objectives, development of materials and teaching activities, and evaluation
Describe practical steps that may be taken to deliver dynamic presentations for multiple venues, which may include bedside teaching to trainees, small group discussions with co‐workers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.
Describe teaching microskills, including obtaining a commitment, probing for supporting evidence, teaching general rules, reinforcing what was right, and correcting mistakes.
Describe the benefits and limitations of various teaching modalities.
Identify resources for training materials.
Explain how the SHM Core Competencies can be applied to curricular development.
Explain the role of the hospitalist as a teacher.
SKILLS
Hospitalists should be able to:
Establish a comfortable and safe learning environment.
Establish expectations for each teaching session and clearly articulate the objectives.
Effectively communicate the goals of the learning session and assess progress towards those goals.
Instruct at the level of learner experience and knowledge, and accommodate for learners at different levels.
Determine the information needs of the intended recipient and evaluate performance.
Tailor messages to the needs and abilities of intended recipient.
Structure and organize the timing and delivery of information and learning experiences to maximize comprehension.
Utilize adult learning principles in the development or selection of educational programs, methods and materials.
Use explicit and relevant language to explain clinical reasoning process for the learner, who may include patients and families.
Make the clinical reasoning process understandable, explicit, and relevant.
Promote clinical problem solving during each patient encounter.
Provide bedside teaching that is informative and comfortable for patients, trainees and members of the multidisciplinary care team.
Demonstrate effective mentoring, which may include role modeling.
Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the procedure, and necessary follow‐up.
Demonstrate an efficient and succinct approach to clinical care.
Provide prompt, explicit, and action‐oriented feedback.
ATTITUDES
Hospitalists should be able to:
Advocate the importance of lifelong learning and mentorship.
Balance patient care and teaching.
Demonstrate concern for the privacy and dignity of the patient.
Adhere to time constraints.
Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.
Demonstrate respect for all learners at various knowledge and skill levels.
Promote evaluation standards that are fair and prompt and facilitate career development.
Appreciate the needs of the learner and the patient.
Project enthusiasm for the teaching role.
Admit the limitations of one's knowledge and respond appropriately to mistakes.
Encourage and provide the tools for life‐long, self‐directed learning and clinical problem solving.
Lead, coordinate or participate in efforts to formulate a needs assessment program for hospitalists' continued professional development.
Lead, coordinate and participate in educational scholarship.
Seek feedback on the effectiveness of instruction methods, modalities and materials.
Reflect on teaching moments to identify opportunities for improvement.
Promote evidence based information acquisition and clinical decision making.
Utilize the role of the hospitalist as a clinician educator to lead, coordinate or participate in quality improvement initiatives.
Hospitalist as teacher refers to specific interactions with members of the multidisciplinary care team to educate them about inpatient care plans, hospital protocols, patient safety, and evidence based clinical problem solving. As educators, hospitalists provide leadership in patient care, teach at multiple levels, and facilitate team building. Hospitalists serve as role models and teach the process of clinical decision making as a tool for future physician‐patient encounters. Hospitalists may review, modify, and promote new protocols and guidelines to implement across multiple services in the hospital. The hospitalist as teacher is a core competency essential to the process of effecting organizational change.
KNOWLEDGE
Hospitalists should be able to:
Describe adult education principles.
Explain the conditions that facilitate and inhibit learning.
Define the concept of a teachable moment.
Describe the process of developing a formal educational session, which may include needs assessment, determining goals and objectives, development of materials and teaching activities, and evaluation
Describe practical steps that may be taken to deliver dynamic presentations for multiple venues, which may include bedside teaching to trainees, small group discussions with co‐workers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.
Describe teaching microskills, including obtaining a commitment, probing for supporting evidence, teaching general rules, reinforcing what was right, and correcting mistakes.
Describe the benefits and limitations of various teaching modalities.
Identify resources for training materials.
Explain how the SHM Core Competencies can be applied to curricular development.
Explain the role of the hospitalist as a teacher.
SKILLS
Hospitalists should be able to:
Establish a comfortable and safe learning environment.
Establish expectations for each teaching session and clearly articulate the objectives.
Effectively communicate the goals of the learning session and assess progress towards those goals.
Instruct at the level of learner experience and knowledge, and accommodate for learners at different levels.
Determine the information needs of the intended recipient and evaluate performance.
Tailor messages to the needs and abilities of intended recipient.
Structure and organize the timing and delivery of information and learning experiences to maximize comprehension.
Utilize adult learning principles in the development or selection of educational programs, methods and materials.
Use explicit and relevant language to explain clinical reasoning process for the learner, who may include patients and families.
Make the clinical reasoning process understandable, explicit, and relevant.
Promote clinical problem solving during each patient encounter.
Provide bedside teaching that is informative and comfortable for patients, trainees and members of the multidisciplinary care team.
Demonstrate effective mentoring, which may include role modeling.
Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the procedure, and necessary follow‐up.
Demonstrate an efficient and succinct approach to clinical care.
Provide prompt, explicit, and action‐oriented feedback.
ATTITUDES
Hospitalists should be able to:
Advocate the importance of lifelong learning and mentorship.
Balance patient care and teaching.
Demonstrate concern for the privacy and dignity of the patient.
Adhere to time constraints.
Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.
Demonstrate respect for all learners at various knowledge and skill levels.
Promote evaluation standards that are fair and prompt and facilitate career development.
Appreciate the needs of the learner and the patient.
Project enthusiasm for the teaching role.
Admit the limitations of one's knowledge and respond appropriately to mistakes.
Encourage and provide the tools for life‐long, self‐directed learning and clinical problem solving.
Lead, coordinate or participate in efforts to formulate a needs assessment program for hospitalists' continued professional development.
Lead, coordinate and participate in educational scholarship.
Seek feedback on the effectiveness of instruction methods, modalities and materials.
Reflect on teaching moments to identify opportunities for improvement.
Promote evidence based information acquisition and clinical decision making.
Utilize the role of the hospitalist as a clinician educator to lead, coordinate or participate in quality improvement initiatives.
Hospitalist as teacher refers to specific interactions with members of the multidisciplinary care team to educate them about inpatient care plans, hospital protocols, patient safety, and evidence based clinical problem solving. As educators, hospitalists provide leadership in patient care, teach at multiple levels, and facilitate team building. Hospitalists serve as role models and teach the process of clinical decision making as a tool for future physician‐patient encounters. Hospitalists may review, modify, and promote new protocols and guidelines to implement across multiple services in the hospital. The hospitalist as teacher is a core competency essential to the process of effecting organizational change.
KNOWLEDGE
Hospitalists should be able to:
Describe adult education principles.
Explain the conditions that facilitate and inhibit learning.
Define the concept of a teachable moment.
Describe the process of developing a formal educational session, which may include needs assessment, determining goals and objectives, development of materials and teaching activities, and evaluation
Describe practical steps that may be taken to deliver dynamic presentations for multiple venues, which may include bedside teaching to trainees, small group discussions with co‐workers or managers, academic detailing for new initiatives, and didactic lectures at national meetings.
Describe teaching microskills, including obtaining a commitment, probing for supporting evidence, teaching general rules, reinforcing what was right, and correcting mistakes.
Describe the benefits and limitations of various teaching modalities.
Identify resources for training materials.
Explain how the SHM Core Competencies can be applied to curricular development.
Explain the role of the hospitalist as a teacher.
SKILLS
Hospitalists should be able to:
Establish a comfortable and safe learning environment.
Establish expectations for each teaching session and clearly articulate the objectives.
Effectively communicate the goals of the learning session and assess progress towards those goals.
Instruct at the level of learner experience and knowledge, and accommodate for learners at different levels.
Determine the information needs of the intended recipient and evaluate performance.
Tailor messages to the needs and abilities of intended recipient.
Structure and organize the timing and delivery of information and learning experiences to maximize comprehension.
Utilize adult learning principles in the development or selection of educational programs, methods and materials.
Use explicit and relevant language to explain clinical reasoning process for the learner, who may include patients and families.
Make the clinical reasoning process understandable, explicit, and relevant.
Promote clinical problem solving during each patient encounter.
Provide bedside teaching that is informative and comfortable for patients, trainees and members of the multidisciplinary care team.
Demonstrate effective mentoring, which may include role modeling.
Demonstrate procedures by explaining indications and contraindications, equipment, each sequential step in the procedure, and necessary follow‐up.
Demonstrate an efficient and succinct approach to clinical care.
Provide prompt, explicit, and action‐oriented feedback.
ATTITUDES
Hospitalists should be able to:
Advocate the importance of lifelong learning and mentorship.
Balance patient care and teaching.
Demonstrate concern for the privacy and dignity of the patient.
Adhere to time constraints.
Establish a trusting relationship with patients and families, medical trainees, and the multidisciplinary team.
Demonstrate respect for all learners at various knowledge and skill levels.
Promote evaluation standards that are fair and prompt and facilitate career development.
Appreciate the needs of the learner and the patient.
Project enthusiasm for the teaching role.
Admit the limitations of one's knowledge and respond appropriately to mistakes.
Encourage and provide the tools for life‐long, self‐directed learning and clinical problem solving.
Lead, coordinate or participate in efforts to formulate a needs assessment program for hospitalists' continued professional development.
Lead, coordinate and participate in educational scholarship.
Seek feedback on the effectiveness of instruction methods, modalities and materials.
Reflect on teaching moments to identify opportunities for improvement.
Promote evidence based information acquisition and clinical decision making.
Utilize the role of the hospitalist as a clinician educator to lead, coordinate or participate in quality improvement initiatives.
Copyright © 2006 Society of Hospital Medicine
Stroke
Stroke is defined as damage to brain tissue resulting from interruption in blood flow. The American Heart Association (AHA) reports 942,000 discharges for stroke in 2002. Stroke accounted for 1 in 15 deaths in the United States that same year. The average length of stay has been markedly decreasing, but is still almost six days. The estimated direct and indirect cost of stroke in 2005 is $56.8 billion. Stroke care is a rapidly evolving field in which expeditious and careful inpatient care significantly affects outcome. The hospitalist is frequently the primary provider of care for these inpatients. Therefore, it is incumbent on hospitalists to develop the knowledge and skills to identify and manage all types of strokes, 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:
Describe the ischemic and hemorrhagic causes of stroke.
Describe the relationship between the anatomic location of stroke and clinical presentation.
Employ appropriate imaging and laboratory evaluation to exclude conditions that mimic stroke, guide therapy, and help determine etiology in patients with and without traditional risk factors.
List risk factors for ischemic and hemorrhagic stroke.
State indications and contraindications for thrombolytic therapy in the setting of acute stroke.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat stroke.
Explain the optimal blood pressure control for individual patients presenting with different types of stroke.
State indications for early surgical and endovascular interventions.
Explain the spectrum of functional outcomes of different types of stroke and how these relate to the initial presentation.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit pertinent details of clinical history and symptoms that are typical of stroke.
Perform a directed physical examination with emphasis on thorough neurological examination to help guide further evaluation and treatment.
Diagnose the etiology of stroke through interpretation of initial testing including history, physical examination, electrocardiogram, neurological imaging, and laboratory results.
Initiate indicated acute therapies to improve the prognosis of stroke.
Identify patients at risk for acute decompensation, which may include those with signs of increased intracranial pressure and posterior circulation disease, and initiate appropriate therapy.
Identify patients at risk for aspiration and address nutritional issues.
Manage the airway when indicated.
Maintain temperature, blood pressure and glycemic control.
Assess patients with stroke in a timely manner, 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 stroke.
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.
Communicate with patients and families to explain the tests and procedures and their indications, and to obtain informed consent.
Recognize the indications for early specialty consultation, which may include neurology, neurosurgery and interventional radiology.
Employ prophylaxis against common complications, which may include urinary tract infection, aspiration pneumonia, and venous thromboembolism.
Initiate secondary stroke prevention.
Employ an early and multidisciplinary approach to the care of stroke patients that begins at admission and continues through all care transitions.
Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patients and/or families when indicated or desired.
Recognize barriers to follow‐up care of stroke patients and involve multidisciplinary hospital staff to accordingly tailor medications and transition of care plans.
Communicate to outpatient providers the notable events of the hospitalization and post‐discharge needs, which may include outpatient cardiac rehabilitation.
Utilize evidence based recommendations and protocols and risk stratification tools for the treatment of stroke.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary teams, which may include neurology, rehabilitation medicine, nursing, physical and occupational therapy, speech pathology and other allied health professionals, early in the hospital course to reduce complications, facilitate patient education and discharge planning.
Lead, coordinate or participate in multidisciplinary efforts to develop protocols to rapidly identify stroke patients with indications for acute interventions and minimize time to intervention.
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization, including aggressive treatment of risk factors and rehabilitation.
Stroke is defined as damage to brain tissue resulting from interruption in blood flow. The American Heart Association (AHA) reports 942,000 discharges for stroke in 2002. Stroke accounted for 1 in 15 deaths in the United States that same year. The average length of stay has been markedly decreasing, but is still almost six days. The estimated direct and indirect cost of stroke in 2005 is $56.8 billion. Stroke care is a rapidly evolving field in which expeditious and careful inpatient care significantly affects outcome. The hospitalist is frequently the primary provider of care for these inpatients. Therefore, it is incumbent on hospitalists to develop the knowledge and skills to identify and manage all types of strokes, 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:
Describe the ischemic and hemorrhagic causes of stroke.
Describe the relationship between the anatomic location of stroke and clinical presentation.
Employ appropriate imaging and laboratory evaluation to exclude conditions that mimic stroke, guide therapy, and help determine etiology in patients with and without traditional risk factors.
List risk factors for ischemic and hemorrhagic stroke.
State indications and contraindications for thrombolytic therapy in the setting of acute stroke.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat stroke.
Explain the optimal blood pressure control for individual patients presenting with different types of stroke.
State indications for early surgical and endovascular interventions.
Explain the spectrum of functional outcomes of different types of stroke and how these relate to the initial presentation.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit pertinent details of clinical history and symptoms that are typical of stroke.
Perform a directed physical examination with emphasis on thorough neurological examination to help guide further evaluation and treatment.
Diagnose the etiology of stroke through interpretation of initial testing including history, physical examination, electrocardiogram, neurological imaging, and laboratory results.
Initiate indicated acute therapies to improve the prognosis of stroke.
Identify patients at risk for acute decompensation, which may include those with signs of increased intracranial pressure and posterior circulation disease, and initiate appropriate therapy.
Identify patients at risk for aspiration and address nutritional issues.
Manage the airway when indicated.
Maintain temperature, blood pressure and glycemic control.
Assess patients with stroke in a timely manner, 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 stroke.
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.
Communicate with patients and families to explain the tests and procedures and their indications, and to obtain informed consent.
Recognize the indications for early specialty consultation, which may include neurology, neurosurgery and interventional radiology.
Employ prophylaxis against common complications, which may include urinary tract infection, aspiration pneumonia, and venous thromboembolism.
Initiate secondary stroke prevention.
Employ an early and multidisciplinary approach to the care of stroke patients that begins at admission and continues through all care transitions.
Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patients and/or families when indicated or desired.
Recognize barriers to follow‐up care of stroke patients and involve multidisciplinary hospital staff to accordingly tailor medications and transition of care plans.
Communicate to outpatient providers the notable events of the hospitalization and post‐discharge needs, which may include outpatient cardiac rehabilitation.
Utilize evidence based recommendations and protocols and risk stratification tools for the treatment of stroke.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary teams, which may include neurology, rehabilitation medicine, nursing, physical and occupational therapy, speech pathology and other allied health professionals, early in the hospital course to reduce complications, facilitate patient education and discharge planning.
Lead, coordinate or participate in multidisciplinary efforts to develop protocols to rapidly identify stroke patients with indications for acute interventions and minimize time to intervention.
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization, including aggressive treatment of risk factors and rehabilitation.
Stroke is defined as damage to brain tissue resulting from interruption in blood flow. The American Heart Association (AHA) reports 942,000 discharges for stroke in 2002. Stroke accounted for 1 in 15 deaths in the United States that same year. The average length of stay has been markedly decreasing, but is still almost six days. The estimated direct and indirect cost of stroke in 2005 is $56.8 billion. Stroke care is a rapidly evolving field in which expeditious and careful inpatient care significantly affects outcome. The hospitalist is frequently the primary provider of care for these inpatients. Therefore, it is incumbent on hospitalists to develop the knowledge and skills to identify and manage all types of strokes, 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:
Describe the ischemic and hemorrhagic causes of stroke.
Describe the relationship between the anatomic location of stroke and clinical presentation.
Employ appropriate imaging and laboratory evaluation to exclude conditions that mimic stroke, guide therapy, and help determine etiology in patients with and without traditional risk factors.
List risk factors for ischemic and hemorrhagic stroke.
State indications and contraindications for thrombolytic therapy in the setting of acute stroke.
Explain indications, contraindications and mechanisms of action of pharmacologic agents used to treat stroke.
Explain the optimal blood pressure control for individual patients presenting with different types of stroke.
State indications for early surgical and endovascular interventions.
Explain the spectrum of functional outcomes of different types of stroke and how these relate to the initial presentation.
Explain goals for hospital discharge, including specific measures of clinical stability for safe care transition.
SKILLS
Hospitalists should be able to:
Elicit pertinent details of clinical history and symptoms that are typical of stroke.
Perform a directed physical examination with emphasis on thorough neurological examination to help guide further evaluation and treatment.
Diagnose the etiology of stroke through interpretation of initial testing including history, physical examination, electrocardiogram, neurological imaging, and laboratory results.
Initiate indicated acute therapies to improve the prognosis of stroke.
Identify patients at risk for acute decompensation, which may include those with signs of increased intracranial pressure and posterior circulation disease, and initiate appropriate therapy.
Identify patients at risk for aspiration and address nutritional issues.
Manage the airway when indicated.
Maintain temperature, blood pressure and glycemic control.
Assess patients with stroke in a timely manner, 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 stroke.
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.
Communicate with patients and families to explain the tests and procedures and their indications, and to obtain informed consent.
Recognize the indications for early specialty consultation, which may include neurology, neurosurgery and interventional radiology.
Employ prophylaxis against common complications, which may include urinary tract infection, aspiration pneumonia, and venous thromboembolism.
Initiate secondary stroke prevention.
Employ an early and multidisciplinary approach to the care of stroke patients that begins at admission and continues through all care transitions.
Address resuscitation status early during hospital stay; implement end‐of‐life decisions by patients and/or families when indicated or desired.
Recognize barriers to follow‐up care of stroke patients and involve multidisciplinary hospital staff to accordingly tailor medications and transition of care plans.
Communicate to outpatient providers the notable events of the hospitalization and post‐discharge needs, which may include outpatient cardiac rehabilitation.
Utilize evidence based recommendations and protocols and risk stratification tools for the treatment of stroke.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their organizations, Hospitalists should:
Lead, coordinate or participate in multidisciplinary teams, which may include neurology, rehabilitation medicine, nursing, physical and occupational therapy, speech pathology and other allied health professionals, early in the hospital course to reduce complications, facilitate patient education and discharge planning.
Lead, coordinate or participate in multidisciplinary efforts to develop protocols to rapidly identify stroke patients with indications for acute interventions and minimize time to intervention.
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization, including aggressive treatment of risk factors and rehabilitation.
Copyright © 2006 Society of Hospital Medicine
Paracentesis
Paracentesis, the aspiration of fluid from the abdominal cavity, is a diagnostic and therapeutic procedure frequently performed in the hospital. Paracentesis was performed in almost 90,000 discharges in 2002, according to the Healthcare Cost and Utilization Project (HCUP). Hospitalists identify patients with suspected ascites on the basis of the clinical presentation, physical examination and/or ultrasonography. Utilizing evidence based decision making, hospitalists determine whether paracentesis is indicated in the diagnosis of disease or palliation of patient symptoms.
KNOWLEDGE
Hospitalists should be able to:
Describe the normal anatomy of the abdomen and pelvis.
Define and differentiate pathophysiologic processes that may lead to the development of ascites.
Describe clinical presentations consistent with spontaneous bacterial peritonitis.
Explain indications and contraindications for paracentesis, including potential risks and complications.
Describe the physical examination maneuvers used in the evaluation of ascites and identify their sensitivity and specificity.
Differentiate the indications for a diagnostic paracentesis versus a large‐volume paracentesis.
Explain the appropriate diagnostic testing for ascitic fluid.
Describe indications for use of ultrasonography to assess the quantity of ascitic fluid and/or to guide paracentesis.
Select the necessary equipment to perform a paracentesis at the bedside, and differentiate what is needed for a diagnostic versus a large‐volume paracentesis.
Define the serum‐ascites albumin gradient and its role in the evaluation of ascites.
Identify the indications for administration of albumin in conjunction with paracentesis.
Identify patients with ascites who may benefit from large‐volume paracentesis.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history to identify co‐morbid conditions and risk factors for the development or complications of ascites.
Perform a thorough physical examination, evaluating for signs associated with chronic liver disease or malignancy.
Perform an abdominal examination, including specific maneuvers to assess for the presence of ascites.
Properly position the patient and identify anatomic landmarks to perform a paracentesis.
Use sterile techniques during preparation for and performance of paracentesis.
Maintain clinician safety with appropriate protective wear.
Manage the complications of paracentesis following the procedure, which ma include bleeding, persistent leak of ascitic fluid, and hemodynamic compromise.
Order and interpret the results of ascitic fluid analysis, including cell count, differential, gram stain and culture, and serum‐ascites albumin gradient.
Order and interpret platelet and coagulation studies when indicated.
Synthesize a management plan based on history, physical examination, radiographic imaging and the results of fluid testing.
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.
Manage patient discomfort or pain during and after the procedure.
Identify patients who may benefit from transfusion of fresh frozen plasma and/or platelets prior to paracentesis.
Recognize the indications for specialty consultations, which may include interventional radiology or gastroenterology.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their institutions, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in development of institutional guidelines for the pre‐procedure utilization of fresh frozen plasma and platelet transfusions in patients with coagulopathy or thrombocytopenia.
Lead, coordinate or participate in development of institutional guidelines to identify patients who should receive albumin peri‐procedure.
Collaborate with radiologists to standardize identification of patients who would benefit from ultrasound‐guided paracentesis.
Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of paracentesis.
Lead, coordinate, or participate in efforts to organize and consolidate paracentesis equipment in an identifiable location in the hospital, easily accessible to clinicians who perform the procedure.
Paracentesis, the aspiration of fluid from the abdominal cavity, is a diagnostic and therapeutic procedure frequently performed in the hospital. Paracentesis was performed in almost 90,000 discharges in 2002, according to the Healthcare Cost and Utilization Project (HCUP). Hospitalists identify patients with suspected ascites on the basis of the clinical presentation, physical examination and/or ultrasonography. Utilizing evidence based decision making, hospitalists determine whether paracentesis is indicated in the diagnosis of disease or palliation of patient symptoms.
KNOWLEDGE
Hospitalists should be able to:
Describe the normal anatomy of the abdomen and pelvis.
Define and differentiate pathophysiologic processes that may lead to the development of ascites.
Describe clinical presentations consistent with spontaneous bacterial peritonitis.
Explain indications and contraindications for paracentesis, including potential risks and complications.
Describe the physical examination maneuvers used in the evaluation of ascites and identify their sensitivity and specificity.
Differentiate the indications for a diagnostic paracentesis versus a large‐volume paracentesis.
Explain the appropriate diagnostic testing for ascitic fluid.
Describe indications for use of ultrasonography to assess the quantity of ascitic fluid and/or to guide paracentesis.
Select the necessary equipment to perform a paracentesis at the bedside, and differentiate what is needed for a diagnostic versus a large‐volume paracentesis.
Define the serum‐ascites albumin gradient and its role in the evaluation of ascites.
Identify the indications for administration of albumin in conjunction with paracentesis.
Identify patients with ascites who may benefit from large‐volume paracentesis.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history to identify co‐morbid conditions and risk factors for the development or complications of ascites.
Perform a thorough physical examination, evaluating for signs associated with chronic liver disease or malignancy.
Perform an abdominal examination, including specific maneuvers to assess for the presence of ascites.
Properly position the patient and identify anatomic landmarks to perform a paracentesis.
Use sterile techniques during preparation for and performance of paracentesis.
Maintain clinician safety with appropriate protective wear.
Manage the complications of paracentesis following the procedure, which ma include bleeding, persistent leak of ascitic fluid, and hemodynamic compromise.
Order and interpret the results of ascitic fluid analysis, including cell count, differential, gram stain and culture, and serum‐ascites albumin gradient.
Order and interpret platelet and coagulation studies when indicated.
Synthesize a management plan based on history, physical examination, radiographic imaging and the results of fluid testing.
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.
Manage patient discomfort or pain during and after the procedure.
Identify patients who may benefit from transfusion of fresh frozen plasma and/or platelets prior to paracentesis.
Recognize the indications for specialty consultations, which may include interventional radiology or gastroenterology.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their institutions, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in development of institutional guidelines for the pre‐procedure utilization of fresh frozen plasma and platelet transfusions in patients with coagulopathy or thrombocytopenia.
Lead, coordinate or participate in development of institutional guidelines to identify patients who should receive albumin peri‐procedure.
Collaborate with radiologists to standardize identification of patients who would benefit from ultrasound‐guided paracentesis.
Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of paracentesis.
Lead, coordinate, or participate in efforts to organize and consolidate paracentesis equipment in an identifiable location in the hospital, easily accessible to clinicians who perform the procedure.
Paracentesis, the aspiration of fluid from the abdominal cavity, is a diagnostic and therapeutic procedure frequently performed in the hospital. Paracentesis was performed in almost 90,000 discharges in 2002, according to the Healthcare Cost and Utilization Project (HCUP). Hospitalists identify patients with suspected ascites on the basis of the clinical presentation, physical examination and/or ultrasonography. Utilizing evidence based decision making, hospitalists determine whether paracentesis is indicated in the diagnosis of disease or palliation of patient symptoms.
KNOWLEDGE
Hospitalists should be able to:
Describe the normal anatomy of the abdomen and pelvis.
Define and differentiate pathophysiologic processes that may lead to the development of ascites.
Describe clinical presentations consistent with spontaneous bacterial peritonitis.
Explain indications and contraindications for paracentesis, including potential risks and complications.
Describe the physical examination maneuvers used in the evaluation of ascites and identify their sensitivity and specificity.
Differentiate the indications for a diagnostic paracentesis versus a large‐volume paracentesis.
Explain the appropriate diagnostic testing for ascitic fluid.
Describe indications for use of ultrasonography to assess the quantity of ascitic fluid and/or to guide paracentesis.
Select the necessary equipment to perform a paracentesis at the bedside, and differentiate what is needed for a diagnostic versus a large‐volume paracentesis.
Define the serum‐ascites albumin gradient and its role in the evaluation of ascites.
Identify the indications for administration of albumin in conjunction with paracentesis.
Identify patients with ascites who may benefit from large‐volume paracentesis.
SKILLS
Hospitalists should be able to:
Elicit a thorough and relevant history to identify co‐morbid conditions and risk factors for the development or complications of ascites.
Perform a thorough physical examination, evaluating for signs associated with chronic liver disease or malignancy.
Perform an abdominal examination, including specific maneuvers to assess for the presence of ascites.
Properly position the patient and identify anatomic landmarks to perform a paracentesis.
Use sterile techniques during preparation for and performance of paracentesis.
Maintain clinician safety with appropriate protective wear.
Manage the complications of paracentesis following the procedure, which ma include bleeding, persistent leak of ascitic fluid, and hemodynamic compromise.
Order and interpret the results of ascitic fluid analysis, including cell count, differential, gram stain and culture, and serum‐ascites albumin gradient.
Order and interpret platelet and coagulation studies when indicated.
Synthesize a management plan based on history, physical examination, radiographic imaging and the results of fluid testing.
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.
Manage patient discomfort or pain during and after the procedure.
Identify patients who may benefit from transfusion of fresh frozen plasma and/or platelets prior to paracentesis.
Recognize the indications for specialty consultations, which may include interventional radiology or gastroenterology.
SYSTEM ORGANIZATION AND IMPROVEMENT
To improve efficiency and quality within their institutions, Hospitalists should:
Lead, coordinate or participate in multidisciplinary initiatives to promote patient safety and optimize resource utilization.
Lead, coordinate or participate in development of institutional guidelines for the pre‐procedure utilization of fresh frozen plasma and platelet transfusions in patients with coagulopathy or thrombocytopenia.
Lead, coordinate or participate in development of institutional guidelines to identify patients who should receive albumin peri‐procedure.
Collaborate with radiologists to standardize identification of patients who would benefit from ultrasound‐guided paracentesis.
Lead, coordinate or participate in efforts to develop strategies to minimize institutional complication rates.
Lead, coordinate or participate in quality improvement programs to monitor hospitalists' performance and/or supervision of paracentesis.
Lead, coordinate, or participate in efforts to organize and consolidate paracentesis equipment in an identifiable location in the hospital, easily accessible to clinicians who perform the procedure.
Copyright © 2006 Society of Hospital Medicine