Medicolegal Issues

Hospital Medicine 2007


This year marks the 10-year anniversary of Robert Wachter’s coining of the term “hospitalist,” as well as the celebration of the decade-old SHM. The celebration culminates in a stellar annual meeting that epitomizes the growth of hospital medicine.

The SHM Annual Meeting attendance has grown from just a handful of participants to more than 1,200 expected at the 2007 Annual Meeting. More importantly, as the role of hospitalists has changed from primarily focusing on providing care to the hospitalized patient to serving as the leader of quality improvement, a key staff educator, and a facilitator of care transitions, so have their educational needs. Thus, the annual meeting has evolved in order to provide an educational experience that has relevance on a practical level.

The SHM Annual Meeting attendance has grown from just a handful of participants to more than 1,200 expected at the 2007 Annual Meeting. More importantly, as the role of hospitalists has changed from primarily focusing on providing care to the hospitalized patient to serving as the leader of quality improvement, a key staff educator, and a facilitator of care transitions, so have their educational needs.

The SHM 2007 Annual Meeting Committee (AMC), led by Course Director Chad Whelan, MD, challenged itself to develop a program that will meet the needs of a diverse audience that includes community-based and academic-based hospitalists; research-oriented and clinician-focused seasoned veteran physicians and early career hospitalists; as well as pediatric, geriatric, and family practice hospitalists. Such an effort begins with the big picture: What is happening in the environment that will impact healthcare today and in the future?

The answer is found in the role of information technology, and SHM will welcome two renowned speakers to provide current and future perspectives. David Brailer, MD, PhD, the first National Coordinator for Health Information Technology (2004-2006), will examine the forces driving health information technology and how technology affects pressures on the quality and cost of care. Jonathan Perlin, MD, PhD, chief medical officer and senior vice president for Quality for Hospital Corporation of America, will look to healthcare’s challenges and opportunities in the decade ahead, with a focus on health IT and performance and the role of hospital medicine as it relates to care improvement.

The 2007 Annual Meeting will again feature Robert Wachter, MD, as the keynote speaker in the closing plenary session. Dr. Wachter is sure to entertain as he examines “The Hospitalist Movement a Decade Later: Life as a Swiss Army Knife.”

The goal of a broad-based program will be achieved through separate breakout sessions and workshops, divided into seven tracks. Though the format is similar to other years, the 2007 program has some new twists. One clinical track focuses on “Things You Didn’t Learn in Medical School,” and a palliative care track has been added. Relevant sessions have been selected using the Core Competencies in Hospital Medicine and collaborating with SHM’s committees, which serve the interests of all of the groups.

The connection between the program and SHM’s committees will be strong. The committees will focus their efforts on topics and goals that are important to our members. The AMC solicits ideas for breakout sessions from the committees; it also profiles the output of a committee that has significance to attendees in their daily responsibilities.

Hospital Medicine Fast Facts click for large version

click for large version

Suggestions from the committees have resulted in a combination of pertinent and innovative sessions. Here are just a few to whet your appetite for the complete program:

  • A workshop jointly planned by the Hospital Quality and Patient Safety (HQPS) and Education Committees, designed to obtain input and consensus on SHM-developed communication and hand-off standards;
  • An Academic Track, intended to appeal to those hospitalists focused on teaching, quality improvement, research, and growing a hospital medicine program;
  • A workshop, proposed by the Career Satisfaction Task Force, that addresses relevant career issues from the leaders’ and hospitalists’ perspectives;
  • A Quality Track defined by the HQPS Committee that, in addition to the consensus-building workshop, features medication reconciliation and Toyota Methods sessions;
  • A Pediatric Track, designed to address the needs of our fastest growing member segment, features a range of clinical and leadership topics, including electronic health records, the prevention of the transmission of infectious agents, and the utilization of dashboards to improve care;
  • The work of the Benchmarks Committee will be profiled in a session that will demonstrate how to use key performance metrics to improve hospital medicine and the care of the hospitalized patient;
  • The Public Policy Committee has recommended a pay-for-performance (P4P) breakout session, because P4P has been identified as an important issue in hospital medicine;
  • A Palliative Care Track, proposed and developed by the Palliative Care Task Force, includes relevant topics such as pain management, the ethical and legal considerations of palliative care, and communications skills; and
  • A visiting professor, Stephan Fihn, MD, MPH, will conduct poster rounds, lead a workshop, and participate in “Breakfast with Leaders in Hospital Medicine.”

The Annual Meeting Committee focused on identifying faculty members who can share their experience and expertise in an entertaining and elucidating way. We anticipate that you will enjoy presentations by experts new to the SHM Annual Meeting, as well as return engagements by past faculty.



On p. 6 of the January 2007 issue the “Profile of Academic Hospitalists” contained errors inadvertently introduced in the editing process.

Line 4 of the table should read: “Clinical Full Time Equivalency—Academic Hospitalists .69, All Hospitalists .89.”

Line 8 of the table should read “Nurse Practitioners Per Group—Academic Hospitalists .82, All Hospitalists .43.”

The SHM Annual Meeting traditionally offers networking opportunities with more than 1,100 hospitalists. Special Interest Forums provide each attendee not only with a unique occasion to meet with hospitalists who share similar interests but also with the venue to express their opinions on a national level. SHM utilizes the input to change and grow the organization and hospital medicine. Planned Special Interest Forums include:

  • Research;
  • Community-based hospitalists;
  • Pediatric hospitalists;
  • Medical directors and leadership;
  • Family practice hospitalists;
  • Geriatric hospitalists;
  • Nurse practitioners and physician assistants;
  • Women in hospital medicine;
  • Early career hospitalists;
  • Education;
  • Curriculum/fellowship;
  • Public policy; and
  • History of medicine.

Other networking mainstays of the Annual Meeting, including the Research, Innovations, and Clinical Vignettes Competition; Exhibits; President’s Lunch; and Town Meeting, will again be featured. Satellite symposia are planned, as well as the following pre-courses:

  • Inpatient Coding and Documentation: Getting Paid What You Deserve;
  • Best Practices in Managing a Hospital Medicine Program;
  • Critical Care Medicine for the Hospitalist;
  • Perioperative Medicine for the Hospitalist; and
  • High Impact Quality Improvement: How to Ensure a Successful Project.

Additionally, a PICC Line Placement for Pediatric and Adult Hospitalists pre-course is being proposed by the Pediatrics Committee.

As you can see, 2007 Annual Meeting will present variety and choice; there is something for everyone. Don’t miss this premier educational event for hospitalists and the opportunity to be a part of the hospital medicine movement. The SHM 2007 Annual Meeting will be held at the Gaylord Texan Resort and Convention Center outside Dallas on May 24 and 25, with pre-courses held on May 23. Visit the SHM Web site at for complete program details or to register online. You may also register by calling SHM at (800) 843-3360. Come to Texas and help us celebrate 10 years of improving the quality of healthcare!

SHM Chapter reports

Northern California

On October 25, 2006, the Northern California chapter had a general membership meeting attended by hospitalists from a number of different hospitals. We were happy to see new faces, as well as a number of members who haven’t attended meetings in awhile. The quiet, closed setting at Piatti’s Restaurant provided an excellent environment for conversation; many ideas on effective communication between hospitalists were exchanged.

Sundar Natarajan, MD, MSc, led the meeting and introduced some of the chapter’s future goals. Cecelia Hernandez, MD, reviewed past successes and asked the attendees what topics and goals were important to them—both currently and for the future—as hospitalists. Some of the ideas expressed for SHM include: SHM’s Core Competencies, the role of the nurse practitioner within the hospital, and the development of best practice guidelines as a hospitalist.

In marketing our upcoming event with Robert Wachter, MD, (scheduled at press time for January 24 at the Emeryville Marriott) we discussed a number of ideas regarding how to spread the word. The marketing ideas included: using promotional flyers, contacting residents more effectively, maintaining a database, having a designated representative from each hospital, and including more administrators, nurse practitioners, and pharmacists. The meeting was sponsored by GlaxoSmithKline.

San Diego

The San Diego Chapter of SHM met at a local restaurant on November 14, 2006, to hear Carlos Perez, MD, speak on the topic of venous thromboembolism prevention in medical inpatients. Dr. Perez is the lead hospitalist at Scripps Encinitas Medical Center. Greg Maynard, MD, of the University of California at San Diego, also introduced the audience to the SHM VTE Prevention Collaborative, featuring longitudinal mentoring for hospitalist leaders who wish to lead efforts on VTE prevention programs in their own centers. Hospitalists from five different programs enjoyed the presentation from Dr. Perez and the interactive discussions that followed. Sanofi-Aventis sponsored the evening’s activities.TH



By Tina Budnitz, MPH

This is the time of year when many New Year’s resolutions dissolve. In some cases, people set unrealistic goals. Others lack the tools to succeed or live in an environment that makes change too difficult. In 2006 I resolved to start running each morning before work. I have the determination and the physical ability to meet this goal. Disarming the house alarm at 5 a.m., however, awakens my two toddlers. And detaching two toddlers from my legs proves to be quite a challenge. It also turns out that my tolerance for cold weather is low, while my ability to forgive a missed run is high.

Sustaining quality improvement initiatives at the hospital is lot like sustaining New Year’s resolutions. The best of intentions are often thwarted by a lack of time, resources, or energy to change the system, as well as by those within the system who resist change. For example, SHM members tell me that attempting to introduce a new discharge planning process feels a lot like trying to run through the hospital with two toddlers hanging on to your legs. SHM strives to support hospitalists in their resolutions to implement positive change in the hospital.

My role at SHM is to lead the development of programs, tool kits, and support mechanisms that will enable you, our members, to implement and sustain local quality improvement efforts.

SHM currently supports members in their efforts to improve outcomes for patients with heart failure, stroke, or diabetes; we work to prevent venous thromboembolism (VTE) and hospital-acquired blood-stream infections. We also support members in their efforts to improve the discharge process for older adults, thereby reducing readmission rates and adverse drug events while improving communications with receiving physicians.

We support members in their efforts to implement, evaluate, and sustain QI initiatives using a variety of methodologies. We offer symposia, workshops, and a full-day Annual Meeting Pre-Course on quality improvement; we also provide Leadership Academy Level I and Level II and networking opportunities for members and their mentors. We’ve designed Web-based clinical tool kits around specific disease states and special patient populations. We offer Web-based resource rooms to guide members from start to finish through a new local QI initiative. We have funded demonstration projects to pilot new approaches and tools for use in discharge planning, along with innovative research to improve care for heart failure patients. And we’ve only just begun.

Researching the Approach

For each QI area we address, an advisory board is recruited to represent the best available experts, organizations, and multidisciplinary professionals. For example, the Discharge Planning for Older Adults Advisory Board includes representatives from the American Geriatrics Society (AGS), the Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), the Society of General Internal Medicine (SGIM), the Case Management Society of America (CMSA), the National Quality Forum (NQF), and the Association for Health-System Pharmacists (AHSP), in addition to nationally renowned leaders in care transitions, geriatrics, nursing, patient literacy, and pharmacy.

Each Advisory Board conducts a needs assessment and a review of the literature to examine interventions and approaches. The board identifies existing “gaps” in clinical tools and guidelines. Finally, the Advisory Board determines specific, measurable targets for a hospitalist-led intervention and suggests the evidence-based approach(es) that should be most effective.

Implementing an Intervention: Where the Rubber Meets the Road

As I pointed out earlier, resolving what should be done and getting it done are two very different things. In most cases, few people debate the need for the intervention—reducing the incidence of inpatient VTEs, for example—or the validity of the proposed intervention. The challenge arises in changing the system of care so that the intervention becomes the new standard of care. Therefore, after the Advisory Board has determined the aims and intervention(s), SHM develops a “workbook,” a step-by-step field guide for hospitalists that walks them through the process of building a project team, establishing project aims and key metrics, obtaining institutional support, planning the intervention, launching the intervention, measuring impact, and sustaining system improvements.

The workbooks are posted in the SHM Resource Rooms along with other key resources, including slide sets, bedside teaching tools, patient education literature, CME modules, reviews of key literature, interactive “Ask the Expert” discussion boards, and improvement reports detailing the strategies, successes, and setbacks of other institutions. SHM currently offers resource rooms for Preventing VTE, Heart Failure, Stroke, Discharge Planning for the Elderly, Glycemic Control, and Antimicrobial Resistance. To access the resource rooms, visit our Web site at

Training Leaders

SHM offers its members diverse training opportunities designed to accommodate the range of knowledge, expertise, and resources available at local institutions. The resource rooms and workbooks described above are made freely available to everyone. At the 2007 SHM Annual Meeting, we will offer a quality pre-course for hands-on training to lead a QI initiative for discharge planning, VTE prevention, or glycemic control.

For SHM members who desire additional support, SHM is developing “Mentored Implementation” and “On-Site Consulting” programs. The Mentored Implementation Program provides enrolled sites with all of the tools described above and an additional yearlong training program conducted via monthly conference calls with SHM mentors and/or one-day training programs. The On-Site Consulting Program surveys an institution’s resources and infrastructure. The SHM consultant team reviews the assessment with the site. Following this assessment, the consultant team visits the site to meet with hospital administrators, QI teams, and others to further assess the site and to help build internal support for the QI initiative. Following the visit, each site receives a customized report detailing recommendations and strategies to advance specific local QI initiatives.

SHM recently launched a Mentored Implementation and On-Site Consulting Program for VTE (known as the SHM VTE Collaborative). Similar programs are scheduled to launch for discharge planning this spring. In the coming years, we hope to add training programs in several other key patient safety areas.

Additionally, SHM is engaged in a strategic planning process to determine how best to attract the highest caliber medical students into hospital medicine and to mentor, train, and retain the next generation of leaders.

In summary, I hope the range of training opportunities and educational programs, the depth of SHM tool kits, and the scope of patient safety initiatives are meeting your needs to plan, implement, evaluate, and sustain positive change at your institution. If you are interested in learning more about SHM QI programs or have suggestions on how we might improve them to better meet your needs, please e-mail me at [email protected].

And, in case you were wondering, I’m making progress on my resolution to run. This year my resolution has the support of my department chairs (Jacob, five; Noah, two), with better-defined outcomes (run three times a week for more than 40 minutes each time), and a better tool kit (gloves, ear muffs). In the planning stage, I addressed my biggest barrier (leave the alarm off) and built a support team (my neighbor joins me).

If you see me at the annual meeting, please let me know how your resolutions are working to prevent DVT or to improve the discharge process, glycemic control, or heart failure care. Or better yet, submit those stories to me to share with members in our “Improvement Stories” or resource rooms Web site areas or in print via The Hospitalist or Journal of Hospital Medicine.

Budnitz is senior advisor, quality initiatives, for SHM.

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