Medicolegal Issues

New Faces in Key Places


 

Healthcare quality and patient safety is a hot topic in hospitals across the country, as well as here at The Society of Hospital Medicine (SHM). It seems like every day we hear of new regulatory requirements from the Centers for Medicare and Medicaid Services (CMS), The Joint Commission, and state health departments, or requirements from other health care organizations, including insurance companies. It’s hard to keep up with it all.

To help hospitals with their quality initiatives, SHM recently beefed up its Quality Initiatives Department by adding three new staff members, including myself. I’d like to introduce you to our newest members. My name is Jane Kelly-Cummings, and I joined SHM in July as the senior director of Quality Initiatives. I’m responsible for the strategic planning, development and implementation of quality initiatives for the society and the staff liaison for the Hospital Quality and Patient Safety Committee. I’ve been a registered nurse (RN) for more than 20 years and have been working in the quality world for more than a decade.

Linda Boclair joined SHM in June as director of Quality Initiatives. She is responsible for proposal/grant writing, managing select quality initiative projects, and department operations. She has a background in medical technology and industrial relations/organizational behavior. Linda currently is working on a medication reconciliation project, an advisory panel on pharmacoeconomics, and she is working on the new co-management taskforce.

Lauren Valentino also joined SHM in June as the departments project coordinator. She is responsible for supporting the Quality Initiatives department through project planning and implementation. Lauren also is a support resource for the society, providing documentation and coordination to the committees, task forces, and various special interest groups.

The new staffers join Joy M. Wittnebert-Barnosky, senior project manager; Tina Budnitz, senior advisor for Quality Initiatives; and Kathleen Kerr, project manager of QI Mentored Implementation in rounding out SHM’s new Quality Initiatives Department.

In order to best meet the quality initiatives needs of our members, we have been developing SHM’s quality initiatives strategic plan. We had the chance to share the plan with SHM board members at the bi-annual board meeting in October. The board received the strategic plan well, and the group is looking forward to an update at the January board meeting. SHM’s strategic quality initiative planning began in October 2007, when a group of SHM leaders met to begin the process of developing a 10-year strategic plan for quality initiatives. The output of this meeting led to six areas of focus, which we refer to as core strategies:

  • Develop education programs and technical support tools in quality improvement or patient safety;
  • Advance a national quality agenda for hospitals and hospitalists;
  • Facilitate cultural change and develop initiatives to promote hospital medicine’s role in quality initiatives within the C-suite at our nation’s hospitals;
  • Evaluate effectiveness of current offerings in quality improvement or patient safety;
  • Promote adoption of health information technologies to advance patient safety and quality improvement; and
  • Promote and support the new science of QI (i.e., develop a research agenda).

Linking these focus areas with SHM’s Core Competencies in Hospital Medicine and current national industry quality initiatives, such as The Joint Commission’s National Patient Safety Goals and Core Measures, is the basic foundation for SHM’s strategic quality plan. This plan will allow SHM to become more proactive in our approach to quality initiatives for the next one, three, five, and 10 years. It will help us focus on the areas identified as needs for hospitalists and hospital medicine.

Plan Breakdown

A Typical Day in the Hospital

Hospitalists are the definition of multi-tasker. The breakdown of a typical work day:

  • Admissions, Follow-ups, Discharges: 73.6%
  • Consultations: 8.2%
  • Observation Days: 8.0%
  • Critical Care: 4.0%
  • Procedures: 2.0%
  • Office Encounters/Consultations: 1.1%
  • SNF/Rest Home Visits: 1.0%
  • ED Encounters 0.9%
  • Other Encounters: 1.1%

Source: The 2007-2008 Bi-Annual Survey on the State of the Hospital Medicine Movement. For more info, visit www.hospitalmedicine.org/survey.

I would like to tell you about some of the newest quality initiatives currently underway. First is an advisory board on pharmacoeconomics. We are pulling together 11 industry leaders, including CEOs, chief financial officers, chief medical officers, pharmacists, and thought leaders in quality. This advisory board will be evaluating the standard operating procedures in hospitals across the country regarding the use of pharmacoeconomics in decisions to utilize medications, especially newer and more expensive agents, using venous thromboembolism (VTE) prevention as a case example.

We have assembled another advisory board, which is just underway, to look at complicated skin and skin structure infections (cSSSI). This board will include hospitalists, infection control physicians, emergency room physicians, pharmacists, wound care nurses, and quality improvement experts.

Lastly, we have a second VTE project charged with the development of an automated, electronic query for a major commercial clinical information system. The project team is tasked to develop and demonstrate how a system can dramatically increase the prevalence of VTE prophylaxis in hospitals where it will be piloted.

Collaborative Efforts

I also would like to share a few of the other exciting activities the quality department has been up to recently. SHM is in the process of collaborating on a book with the Joint Commission Resources on Hospitalists and Patient Safety. The book is scheduled for release this spring, so be on the lookout. We also are writing an article for the The Physician Executive, which is the journal of the American College of Physician Executives. The article focuses on how quality, patient safety, and patient satisfaction are becoming priorities for physician executives, and how hospitalists are a critical element of a strategy to address this priority. We also are talking with other organizations, such as the American Hospital Association and United Health Group, about potential collaborative work in the future.

So, you can see things at SHM headquarters are anything but dull. The entire QI department—both the veterans and new staff—are looking forward to helping you make your quality and patient safety initiatives more successful and improve the care of patients throughout the country. TH

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