Medicolegal Issues

Inside SHM Quality Summit


 

In October, SHM embarked on the exciting endeavor of gathering leaders in education, research, standards, and clinical practice to begin developing ideas for furthering quality improvement initiatives in hospital medicine.

At the one-day Quality Summit in Chicago, participants were asked to consider and discuss their “big-picture” vision for improving quality care in hospitals. The meeting was led by Janet Nagamine, MD, chair of SHM’s Hospital Quality Patient Safety (HQPS) Committee, and Larry Wellikson, MD, the CEO of SHM.

As Dr. Nagamine opened the meeting, she expressed both the great excitement and angst that comes with undertaking such a huge initiative as creating a quality road map for SHM. Explaining that the day was to be devoted to determining vision, Dr. Wellikson further clarified that the goal of the summit was to set priorities and create strategies for moving forward.

Russell Holman, MD, SHM’s president, expressed appreciation for the wealth of experience and background of the attendees and encouraged participants to think as visionaries. Dr. Holman remarked on SHM’s devotion to a higher calling centered on looking at patient care as being inclusive and collaborative. The group was urged to put forth their best thinking to advance the quality and safety agenda.

Pre-work for the summit focused on bringing attendees up to speed with all SHM’s initiatives related to quality improvement. To understand the scope and breadth of work undertaken by SHM, each participant was asked to thoroughly examine the most updated Resource Rooms (Web-based, interactive learning tools) and to look at a comprehensive list of organizations with whom SHM is involved. Armed with a complete picture of what SHM has done, the group was expected to think about plans for progress.

Participants worked in large and small groups to generate themes to pursue in quality endeavors.

The group agreed on the benefit of expanding SHM’s resources in education and implementation.

A generally supported theme was that training in quality improvement should be offered in medical schools and residency and fellowship programs. Additionally, those who have experience with quality improvement can benefit from additional support with implementing projects. Discussions focused on SHM’s success with educational opportunities by creating multidisciplinary teams and focusing on putting principles into practice (e.g., the Venous Thromboembolism Prevention Collaborative).

Additionally, small groups identified the potential for SHM to further the national hospital quality and patient-safety agenda by expanding research efforts into national networks. SHM’s relationships with national organizations and leaders in the quality arena were a focal point of discussion. One small group was devoted entirely to developing an innovative care collaborative comprising national leaders in nursing, pharmacy, quality, and patient care.

One noteworthy conclusion attendees could draw at the end of the summit was that SHM functions with great excitement and initiative. From leadership to members, volunteers, and staff, SHM is not an organization that rests on accomplishments but one that uses progress as a launch pad for continued improvement.

The people making decisions about quality endeavors to pursue have front-line experience and are in touch with what will improve patient care.

It was evident that while no one person or organization has all the answers, SHM is willing to do what it takes in terms of trying new things and forging new relationships.

Chapter Summaries

East Central Florida

The East Central Florida Chapter of SHM met Nov. 11 in Cocoa Beach. Michael C. Ott, MD, a pulmonary/critical care specialist at Holmes Regional Medical Center in Melbourne, spoke about prophylaxis of deep vein thrombosis in patients with severely restricted mobility during acute illness.

Milwaukee

Milwaukee hospitalists organized their first meeting in approximately four years. Fifteen physicians and two physician assistants gathered to hear four speakers at the daylong event. President Josiah Halm, MD, assistant clinical professor of medicine, University of Wisconsin Aurora Sinai Medical Center, kicked off the meeting with an introduction and then presented information about SHM. Dr. Halm also spoke about the rapid growth of the hospitalist movement, the Journal of Hospital Medicine, and the move toward certification in hospital medicine. Speakers included Mary-Ann Emanuele, MD, professor of medicine, Loyola University, who presented “Update: Management of Hyperglycemia in the Hospital Setting”; James Sebastian, MD, professor, the Medical College of Wisconsin, who gave “An Update in Anticoagulation in the Hospitalists Setting”; and Eric Siegal, MD, director of hospital medicine, Cogent Healthcare, who spoke about hospitalist malpractice.

Montana

The quarterly meeting was held Nov. 1 in Billings. Robert Wilmouth, MD, talked about the Institute for Healthcare Improvement’s (IHI’s) efforts in patient safety, particularly the “5 Million Lives Campaign.” Bryn Burnham, DO, a hospitalist at St. Vincent’s Healthcare in Billings, was installed as president-elect and gave a profile of her program.

Northern Wisconsin

The chapter held its fall meeting Oct 24. Gary Gonseth, MD, of the Department of Neurology at University of Kansas Medical Center, reviewed clinical studies regarding primary and secondary stroke prevention and the clinical applications for hospitalist practices. Attendees discussed how they are coping with changes in their hospitals, including struggles with staffing and finances.

Philadelphia

The Philadelphia Chapter met Nov. 13. Benjamin Solomon, MD, ICU director at St. Mary Medical Center in Langhorne, Pa., lectured on the evidence-based treatment of sepsis. The talk was preceded by an informational session regarding current SHM initiatives, ideas for future meeting topics, and a presentation about increasing participation from groups in Philadelphia and surrounding cities with the collection of data for the “2007-2008 Bi-Annual Survey on the State of the Hospital Medicine Movement.”

Upstate South Carolina

The Upstate South Carolina Chapter gathered Oct. 24 in Greenville. Chapter President Zafar Hossain, MD, opened the meeting with a welcome, and attendees introduced themselves. A report on this year’s SHM National Meeting was given by Imran Shaikh, MD. The group discussed how hospitalists could ensure their skills are up to date on the office side of the internal medicine practice.

10 Key Metrics

Hospital Medicine Fast Facts 10 Key Metrics for Monitoring Hospitalist Performance

  1. Volume data: Measurements indicating “volume of services” provided by a hospitalist group or by individual hospitalists. Volume data, in general terms, are counts of services performed by hospitalists.
  2. Case mix: A tool used to characterize the clinical complexity of the patients treated by the hospital medicine group (and comparison groups). The goal of case mix is to allow “apples to apples” comparisons.
  3. Patient satisfaction: A survey-based measure often considered an element of quality outcomes. Surveys, often designed and administered by vendors, are typically designed to measure a patient’s perception of his or her overall hospital experience.
  4. Length of stay: The number of days of inpatient care utilized by a patient or a group of patients.
  5. Hospital cost: Measures the money expended by a hospital to care for its patients, most often expressed as cost per unit of service (e.g., cost per patient day or cost per discharge).
  6. Productivity measures: Objective qualifications of physician productivity (e.g., encounters, Relative Value Units).
  7. Provider satisfaction: The most common metric addresses referring-physician satisfaction and uses a survey to measure perceptions of their overall experience with the hospital medicine program (e.g., the care of their patient and interactions with the hospitalists). Other providers could be monitored for satisfaction, including specialists and nurses.
  8. Mortality: A measure of the number of patient deaths over a defined time period. Typically, the observed mortality metric is compared with expected mortality.
  9. Readmission rate: Describes how often patients admitted to the hospital by a physician or practice are admitted again, within a defined period following discharge.
  10. Joint Commission Core Measures: These are evidence-based, standardized “core” measures to track the performance of hospitals in providing quality healthcare. Four diagnoses are included: acute myocardial infarction, congestive heart failure, community-acquired pneumonia, and pregnancy and related conditions.

To download “Measuring Hospitalist Performance: Metrics, Reports, and Dashboards.” Visit the “SHM Initiatives” section at www.hospitalmedicine.org.

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