As the holiday season fast approaches, our minds increasingly turn to gift giving. This season, I have given extensive thought to the needs of hospitalists, so if you are looking for that perfect gift, look no further.
I know that many of you have gift advice as well, so don’t hesitate to e-mail me your ideas. I will include those in a future column.
Without further delay, here are the Top 10 Gift Ideas for Hospitalists:
1. Improved Vital Sign Alert System: Nothing bothers a hospitalist more than a false alarm or, worse, no alert at all. Hospitalists need better knowledge of vital sign changes, particularly one that takes into effect rate of change.
2. Accurate respiratory rate: This is for the hospitalist who is particularly perturbed about the fact that 90 percent of one’s patients have a respiratory rate of 18. If you haven’t seen the new technology by Hoana Medical, check it out. If this technology pans out, my wish list would be for every hospitalist patient to be monitored and the respiratory rate tied into a sophisticated alert system.
3. An army of physical therapists: This will be hard to gift wrap, but given the fact that deconditioning sets in so fast in hospitalized patients, particularly in elderly patients, this gift is aimed at getting patients moving and preventing the deconditioning from starting.
4. Better nutrition: There is no greater cliché than hospital food. Any improvement would be appreciated. This is not only for the patients, but the physicians, as well. Too many hospitals have a plethora of fast food options, instead of a focus on wholesome choices.
5. Palliative Care: The ideal gift is fairly comprehensive, but it can be separated into several gifts over time. The first and easiest is teaching hospitalists palliative care skills. The second phase is having hospital personnel correctly identify--at admission--patients who need palliative care. The final phase, and the most elusive, is improving physician knowledge of which patients are good candidates for palliation and the correct action steps. This last gift is aimed at the hospitalist who has just admitted a severely demented bed bound patient with AIDs who is still on antiretroviral therapy but no hospice care. Or perhaps the patient with severe CHF admitted for the fifth time this month that is on the correct medications and does weigh himself daily, but also without hospice, or worse, no family understanding that he is dying.
6. More data to understand your practice: This is self explanatory, but many hospitalists are unable to obtain the clinical or financial data they need to understand their practice. Sometimes the data is present, but a better explanation of the data is necessary.
7. EMR that incorporates ALL data: If you can find this gift, please contact me immediately. I am willing to pay top dollar. The Information Technology (IT) department tells me it exists, but I have never actually put my hands on it. This is a single sign-on Electronic Medical Record that has all the clinical data that a hospitalist needs presented in an intuitive interface. And, it’s easily accessible from outside the hospital network.
8. Networked EMR: Link all those EMRs to hospitals across the country.
9. Comprehensive approach to delirium in hospitalized patients: This is for the hospitalist who has just spent the last two hours stopping all delirium provoking medications in a post-surgical elderly patient and talked at length to the family about the fact that this altered mentation is not permanent, not a stroke, and, yes, the anti-psychotic medications are the best medicine.
10. Maintenance of correct attending: This is for the hospitalist whose 15 patients all have a different attending assigned. This gift would ensure that the IT system has my name attached to all my patients at all times. Again, if you receive this gift, please contact me immediately.
In the spirit of being a tad more comprehensive, here are a few gift ideas for hospital medicine in general:
- More primary care physicians. Hospitalists know good primary care prevents hospitalization, but having a physician to refer a patient to after discharge is key.
- Hospital coverage for all U.S. citizens.
- A full understanding of hospital medicine by all hospital administrators.
- Uniform assessment of hospitals, so one can accurately grade/compare hospitals.
- Continued improvement in hospitalist leader skills.
- Continued better pay for hospitalists.
- More mid-level providers in hospital medicine.
- Continued improvement in teamwork amongst hospital personnel.
- Continued improvement in quality and patient safety.
And finally, the best gift of all…more hospitalists!
Happy Holidays! TH
Dr. Cawley is president of SHM.