HCS News
Join Us for the first ever hospitalist CME cruise!
HCS has partnered with Sea Courses to bring you the first ever Hospitalist CME cruise "Clinical Medicine for Hospitalists" , February 19-27 2011. This course provides a comprehensive overview of clinical topics in Hospital Medicine, in line with the SHM Core Competencies and hospitalist needs assessment surveys. In addition, you can sign up for our "Quality Improvement for the hospitalist" primer course. To learn more, you can also contact us at info@hospitalistconsulting.com
HCS partners with the Ontario Hospital Association to organize "Hospitalist Programs"
As part of its commitment to promote hospital medicine and to raise awareness of the hospitalist model of care, Hospitalist Consulting Solutions is collaborating with the Ontario Hospital Association to provide healthcare professionals with a 1 day course entitiled "Hospitalist Programs".
This course aims to provide an opportunity for discussions on various aspects of the hospitalist model, such as defenition of a hospitalist, evidence of the advantages of this model of care, and compensation mechanisms amongst other topics of interest.
Dr. Mark Evans, Senior Partner at HCS will be providing an overview of best practices focused on relationships within the Alberta context.
You can find further information and registration information by clicking here.
HCS Unveils Its Workload Model and Software at The 7th Annual CSHM Hospitalist Conference in Toronto
From September 25 to 27, HCS participated at the 7th Annual Hospitalist Conference of the Canadian Society of Hospital Medicine held for the first time in Toronto, Ontario. The conference brought around 250 hospitalists and their leaders from across Canada together for three days of scientific educational sessions, leadership and procedure pre-courses, and networking. Dr Mark Evans, senior partner at HCS gave a presentation on measuring workload at the pre-conference Leadership Course, and HCS unveiled its workload software during the main conference. (you can read Dr Evans' presentation on our resources page)
Our workload model and software generated a lot of interest amongst many hospitalist leaders who are faced with the challenge of measuring the amount of work that is required, and the need to translate this information into staffing projections. Hospitalists who visited our table at the exhibition hall of the conference were able to see how the workload model works and how it can help them predict their staffing needs based on administrative data and various complexity factors. You can learn about our workload model by visiting our workload software page.
The significant level of interest that was generated by HCS and our solutions amongst Canadian hospitalists encourages us to continue working on developing tools and products that will be help further the growth of hospital medicine in Canada.
News Feed
Jul 1
In Response to: Safety and efficacy of continuous insulin infusion in noncritical care settings
Jul 1
The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia
BACKGROUND:Pneumonia is a leading cause of hospitalization and death in the elderly, and remains the subject of both local and national quality improvement efforts.OBJECTIVE:To describe patterns of hospital and regional performance in the outcomes of elderly patients with pneumonia.DESIGN:Cross-sectional study using hospital and outpatient Medicare claims between 2006 and 2009.SETTING:A total of 4,813 nonfederal acute care hospitals in the United States and its organized territories.PATIENTS:Hospitalized fee-for-service Medicare beneficiaries age 65 years and older who received a principal diagnosis of pneumonia.INTERVENTION:None.MEASUREMENTS:Hospital and regional level risk-standardized 30-day mortality and readmission rates.RESULTS:Of the 1,118,583 patients included in the mortality analysis 129,444 (11.6%) died within 30 days of hospital admission. The median (Q1, Q3) hospital 30-day risk-standardized mortality rate for patients with pneumonia was 11.1% (10.0%, 12.3%), and despite controlling for differences in case mix, ranged from 6.7% to 20.9%. Among the 1,161,817 patients included in the readmission analysis 212,638 (18.3%) were readmitted within 30 days of hospital discharge. The median (Q1, Q3) 30-day risk-standardized readmission rate was 18.2% (17.2%, 19.2%) and ranged from 13.6% to 26.7%. Risk-standardized mortality rates varied across hospital referral regions from a high of 14.9% to a low of 8.7%. Risk-standardized readmission rates varied across hospital referral regions from a high of 22.2% to a low of 15%.CONCLUSIONS:Risk-standardized 30-day mortality and, to a lesser extent, readmission rates for patients with pneumonia vary substantially across hospitals and regions and may present opportunities for quality improvement, especially at low performing institutions and areas. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.
Jul 1
Impact of bacterial meningitis-associated conditions on pediatric inpatient resource utilization
OBJECTIVE:To define the epidemiology of systemic complications and focal infections associated with bacterial meningitis and quantify how the presence of such complications affects in-hospital healthcare resource utilization.METHODS:Retrospective cohort study using administrative data from 27 children's hospitals. Children <18 years of age diagnosed with bacterial meningitis from 2001 to 2006 were eligible. The primary exposure of interest was the presence of a bacterial meningitis-associated condition, classified as either systemic complications (eg, sepsis), associated focal infections (eg, pneumonia) or both. The primary outcomes were total in-hospital charges and length of stay (LOS).RESULTS:A total of 574 of 2319 (25%) of children had a systemic complication or an associated focal infection. Compared with children without complications, in-hospital charges were significantly higher in children with systemic complications (136% increase), associated focal infections (118% increase), and both conditions (351% increase). LOS was also significantly increased in those with systemic complications (by 72%), associated focal infections (by 78%), or both conditions (by 211%). The presence of systemic complications was more common in younger children while the presence of an associated focal infection was more common in older children.CONCLUSIONS:Children with bacterial meningitis often have additional morbidity due to systemic complications or associated focal infections indicated by increase use of acute in-hospital resource utilization. The apparent increase in in-hospital morbidity related to these conditions should be considered in future evaluations of vaccine efficacy, novel therapeutics, and hospital resource allocation. Journal of Hospital Medicine 2010;5:E1–E7. © 2010 Society of Hospital Medicine.
Jul 1
A fall to remember
Jul 1
Unscripted
Jul 1
Comparing academic and community-based hospitalists
In 2006, hospitalist programs were formally introduced at both an academic and community hospital in the same city providing an opportunity to study the similarities and differences in workflows in these two settings. The data were collected using a time-flow methodology allowing the two workflows to be compared quantitatively. The results showed that the hospitalists in the two settings devoted similar proportions of their workday to the task categories studied. Most of the time was spent providing indirect patient care followed by direct patient care, travel, personal, and other. However, after adjusting for patient volumes, the data revealed that academic hospitalists spent significantly more time per patient providing indirect patient care (Academic: 54.7 ± 11.1 min/patient, Community: 41.9 ± 9.8 min/patient, p < 0.001). Additionally, we found that nearly half of the hospitalists' time at both settings was spent multitasking. Although we found subtle workflow differences between the academic and community programs, their similarities were more striking as well as greater than their differences. We attribute these small differences to the higher case mix index at the academic program as well greater complexity and additional communication hand-offs inherent to a tertiary academic medical center. It appears that hospitalists, irrespective of their work environment, spend far more time documenting, communicating and coordinating care than they do at the bedside raising the question, is this is a necessary feature of the hospitalist care model or should hospitalists restructure their workflow to improve outcomes? Journal of Hospital Medicine 2010;5:349–352. © 2010 Society of Hospital Medicine.
Jul 1
Effectiveness of a course designed to teach handoffs to medical students
INTRODUCTION:Handoffs of patient care are increasingly common and are known to contribute to medical errors. A significant number, if not the large majority, of first-year Internal Medicine residents have not received formal education pertaining to handoffs during medical school.AIM:To develop a program designed to teach handoffs to medical students entering their fourth year of training.SETTING:University of Colorado Denver School of Medicine.PROGRAM DESCRIPTION:Our Handoff Selective was first offered in April 2007 as part of a 2-week Integrated Clinician's Course conducted once yearly between the third and fourth years of medical school. The Selective consisted of a didactic session in which communication theory and elements were discussed and a practicum in which students used faculty-developed case scenarios to practice both giving and receiving handoffs.PROGRAM EVALUATION:Sixty (the maximum number of spots available) out of 150 students participated in the course, although many more students chose the course than spots available. Prior to taking the Selective, medical students' confidence in performing handoffs was poor, but it improved after the course (P < 0.001); 92% of students felt the Handoff Selective was “useful” or “extremely useful.” While both components of the course were thought to be useful to the large majority of students, the practicum portion was thought to be more useful (P < 0.001).DISCUSSION:Formal education on handoffs is well received by medical students and improves their self-perceived understanding and performance of handoffs. Journal of Hospital Medicine 2010;5:344–348. © 2010 Society of Hospital Medicine.
Jul 1
Systematic Review of Time Studies Evaluating Physicians in the Hospital Setting
BACKGROUND:Time studies, first developed in the late 19th century, are now being used to evaluate and improve worker efficiency in the hospital setting. This is the first review of hospital time study literature of which we are aware.PURPOSE:We performed a systematic review of the literature to better understand the available time study literature describing the activities of hospital physicians.DATA SOURCES:We searched MEDLINE, EMBASE, EMBASE Classic, PsycINFO, Cochrane Library, CINAHL, and Web of Science. We also manually reviewed the reference lists of retrieved articles and consulted experts in the field to identify additional articles for review.STUDY SELECTION:We selected studies that used time-motion or work-sampling performed via direct observation, included physicians, medical residents, or interns in their study population, and were performed on an inpatient hospital ward.DATA EXTRACTION:We abstracted data on subject population, study site, collection tools, and percentage of time spent on key categories of activity.DATA SYNTHESIS:Our search produced 11 time-motion and 2 work-sampling studies that met our criteria. These studies focused primarily on academic hospitals (92%) and the activities of physicians in training (69%). Other results varied widely. A lack of methodological standardization and dissimilar activity categorizations inhibited our efforts to summarize detailed findings across studies. However, we consistently found that activities indirectly related to a patient's care took more of hospital physicians' time than direct interaction with hospitalized patients.CONCLUSIONS:Time studies, when properly performed, have a great deal to offer in helping us understand and reengineer hospital care. Journal of Hospital Medicine 2010;5:353–359. © 2010 Society of Hospital Medicine.
Jul 1
The impact of fragmentation of hospitalist care on length of stay
BACKGROUND:Different hospitalist staffing models provide different levels of inpatient continuity of care, which may impact length of stay (LOS).OBJECTIVE:To determine if fragmentation of care (FOC) by hospitalist physicians is associated with LOS.DESIGN:Concurrent control study.SETTING:Hospitalist practices managed by IPC The Hospitalist Company.PATIENTS:A total of 10,977 patients admitted for diagnosis-related group (DRG) of 89 pneumonia with complications or comorbidities (PNA) or a DRG of 127 heart failure and shock (HF) between December 2006 and November 2007.MEASUREMENTS:FOC was defined as the percentage of care given by hospitalists other than the hospitalist who saw the patient the majority of the stay. Negative binomial regression was performed on DRG 89 and DRG 127 patients with LOS as the dependent variable. We adjusted for gender, age, severity of illness (SOI) scores, risk of mortality (ROM) scores, and number of secondary diagnoses, and admission day of the week.RESULTS:A 10% increase in fragmentation was associated with an increase of 0.39 days (P < 0.0001) in the LOS for pneumonia, and an increase of 0.30 days (P < 0.0001) in LOS for heart failure.CONCLUSIONS:As FOC increased for pneumonia and heart failure, the LOS increased significantly. Methods to reduce fragmentation should be explored, while more research is needed to identify the source of the relationship between FOC and LOS. Journal of Hospital Medicine 2010;5:335–338. © 2010 Society of Hospital Medicine.
Jul 1
Hospitalist time usage and cyclicality: Opportunities to improve efficiency
BACKGROUND:Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow.DESIGN:We performed a time-motion study of hospitalists carrying the admission pager throughout the 3 types of shifts we have at our hospital (day shift, swing shift, and night shift).SETTING:Tertiary academic medical center in the Midwest.RESULTS:Hospitalists spend about 15% of their time on direct patient care, and two-thirds of their time on indirect patient care. Of the indirect activities, communication and documentation dominate. Travel demands make up over 7% of a hospitalists' time. There are spikes in indirect patient care, followed closely by spikes in direct patient care, at shift changes.CONCLUSIONS:At our AMC, indirect patient care activities accounted for the majority of the admitting hospitalists' time spent in the hospital, with documentation and communication dominating this time. Travel takes a significant fraction of hospitalists' time. There is also a cyclical nature to activities performed throughout the day, which can cause patient delays and impose variability on support services. There is a need for both service-specific and systemic improvements for AMCs to efficiently manage further growth in their inpatient volume. Journal of Hospital Medicine 2010;5:329–334. © 2010 Society of Hospital Medicine.
Jul 1
Pediatric hospital medicine core competencies: Development and methodology
Background:Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed.Methods:In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM.Results:The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care.Conclusion:These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. Journal of Hospital Medicine 2010; 5:339–343. © 2010 Society of Hospital Medicine
Jul 1
Where did the day go?—A time-motion study of hospitalists
BACKGROUND:Within the last decade hospitalists have become an integral part of inpatient care in the United States and now care for about half of all Medicare patients requiring hospitalization. However, little data exists describing hospitalist workflow and their activities in daily patient care.OBJECTIVE:To clarify how hospitalists spend their time and how patient volumes affect their workflow.DESIGN:Observers continuously shadowed each of 24 hospitalists for two complete shifts. Observations were recorded using a handheld computer device with customized data collection software.SETTING:Urban, tertiary care, academic medical center.RESULTS:Hospitalists spent 17% of their time on direct patient contact, and 64% on indirect patient care. For 16% of all time recorded, more than one activity was occurring simultaneously (i.e., multitasking). Professional development, personal time, and travel each accounted for about 6% of their time. Communication and electronic medical record (EMR) use, two components of indirect care, occupied 25% and 34% of recorded time respectively. Hospitalists with above average patient loads spent less time per patient communicating with others and working with the EMR than those hospitalists with below average patient loads, but reported delaying documentation until later in the evening or next day. Patient load did not change the amount of time hospitalists spent with each patient.CONCLUSIONS:Hospitalists spend more time reviewing the EMR and documenting in it, than directly with the patient. Multi-tasking occurred frequently and occupied a significant portion of each shift. Journal of Hospital Medicine 2010;5:323–328. © 2010 Society of Hospital Medicine.
Dec 31
A Small kindness
Dec 31
Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up
Dec 31
Iliac vein compression syndrome: An underdiagnosed cause of lower extremity deep venous thrombosis
Dec 31
A multiple choice answer?
Dec 31
Quality and financial outcomes from gainsharing for inpatient admissions: A three-year experience
Dec 31
Clinical and economic outcomes in patients with community-acquired Staphylococcus aureus pneumonia
Dec 31