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There are times when Dan Hale, MD, FAAP, wishes he had more standardized tools to use when he leads a team of four full-time and four part-time pediatric hospitalists at Central Maine Medical Center (CMMC) in Lewiston. Even after five years at the community hospital, the pediatric HM program still is searching for the best way to hand off patients who are leaving the hospital to their primary-care physicians (PCPs).

It also would be beneficial to have markers against which CMMC could compare itself with similarly sized pediatric HM programs around the country, says Dr. Hale, chief of pediatrics at the medical center. CMMC, which averages about 4,000 patient encounters per year, is one of three hospitals in the state with a pediatric HM program. “It would be nice to see progress being made in these areas,” he says.

Dr. Hale might not have to wait long to see his wishes granted. More than 20 pediatric hospitalists from across the nation met in Chicago earlier this year, intent on developing a strategic framework for pediatric HM (PHM). About 10% of the 30,000-plus hospitalists practicing in the U.S. focus exclusively on pediatrics, according to SHM’s 2007-2008 “Bi-Annual Survey on the State of the Hospital Medicine Movement.” Like the hospitalist movement in general, PHM is growing in number and influence as pediatric hospitalists take on leadership roles and develop working relationships with hospital administrators. The time has come to clearly define the discipline for other physicians, as well as patients and their families, and leverage PHM’s growth and usefulness to improve medical care for children, says Erin Stucky, MD, FHM, a pediatric hospitalist at Rady Children’s Hospital and Health Center in San Diego.

With this dashboard, we want to be able to say, “Here are the things you should look at to ensure quality care for your kids, and as you look at them, you should probably track them over time.”

—Jennifer Daru, MD, FAAP, FHM, chief, division of pediatric hospital medicine, California Pacific Medical Center, San Francisco

“It’s a little bit of pie in the sky, a little bit of rose-colored glasses, but it’s good to aim high,” she says.

Some PHM leaders think the subspecialty has advanced enough in recent years to apply its collective knowledge and influence on a broader stage. “We have gone through our adolescence, and now we are a big community,” says Jack Percelay, MD, MPH, FHM, a pediatric hospitalist at Saint Barnabas Medical Center in New York City and SHM board member. “We’re active at almost all the major medical centers and we need to step up to the plate. We need to start the hard work of bringing our vision to fruition.”

Definition and Strategy

Drs. Stucky and Percelay attended the Pediatric Hospital Medicine (PHM) Strategic Planning Roundtable and serve on the roundtable’s planning committee. SHM, the Academic Pediatric Association (APA), and the American Academy of Pediatrics (AAP) sponsored the gathering, which included young and veteran pediatric hospitalists, clinicians, researchers, and hospitalists from academic, children’s, and community hospitals. The net was cast far and wide to gather information from a broad cross-section of stakeholders.

We have gone through our adolescence and now we are a big community. We’re active at almost all the major medical centers and we need to step up to the plate.

—Jack Percelay, MD, MPH, FHM, pediatric hospitalist, Saint Barnabas Medical Center, New York City, SHM board member

As pediatric hospitalists strive to better demonstrate how they can help hospitals improve the quality of patient care and safety while decreasing its cost, the roundtable is charged with defining and educating healthcare professionals on the key issues. Also in the crosshairs: simultaneously advancing evidence-based medicine and family-based care.

“We need to distinguish that we are not just house physicians, but really establish ourselves as content-area knowledge experts,” Dr. Percelay says. In other words, pediatric hospitalists are physicians who specialize in effective and efficient medicine in resource-intensive facilities.

Pediatric hospitalists also grapple with how to enhance career satisfaction and sustainability at a time when many PHM programs require a burdensome clinical load that fosters burnout. Many PHM leaders also think pediatric hospitalists need extra training but fear they will lose those physicians to fellowships. And as the PHM ranks fill with physicians who have little or no outpatient training, there is the challenge of explaining the capabilities and limitations pediatric hospitalists and primary-care physicians (PCPs) have in order to avoid unrealistic expectations and friction.

How to Get Involved

Want to learn about volunteer opportunities with the PHM strategic initiative projects, read draft reports issued by the project teams, or receive updates about how the initiatives are going? Your best bet is to join the Section on Hospital Medicine listserv run by AAP. To subscribe, fill out the enrollment form at www.aap.org/sections/hospcare/

listservSOHM.pdf, or send an e-mail to Niccole Alexander, manager of AAP’s division of hospital and surgical services, at nalexander@aap.org.

Participants in the strategic roundtable aim to address several broad goals outlined in an executive summary, which can be viewed in the “Section on Hospital Medicine” on the AAP Web site (www.aap.org/sections/hospcare/default.cfm). The following are some of the goals:

  • Ensure care for hospitalized children is fully integrated and includes the medical home;
  • Design and support systems for children that eliminate harm associated with hospital care;
  • Develop a skilled and stable workforce that provides expert care for hospitalized children;
  • Use collaborative research models to answer questions of clinical efficacy, comparative effectiveness, and quality improvement inclusive of patient safety, and deliver care based on that knowledge;
  • Provide the expertise that supports innovative continuing education in the care of the hospitalized child for pediatric hospitalists, trainees, midlevel providers, and hospital staff;
  • Create value and provide academic and systems leadership for patients and organizations based on pediatric hospitalists’ unique expertise in PHM clinical care, research, and education; and
  • Be leaders and influential agents in local, state, and national healthcare policies that affect hospital care.

Although it was discussed, the roundtable decided against the establishment of a professional organization for pediatric hospitalists. Instead, the group agreed to continue to utilize the resources and organizational support provided by SHM, APA, and AAP. All three groups contributed money to the roundtable, sent representatives to the meeting, and are interested in the results.

80 pediatric hospitalists have volunteered to help with the PHM roundtable strategic initiatives. DRASCHWARTZ/ISTOCKPHOTO.COM

80 pediatric hospitalists have volunteered to help with the PHM roundtable strategic initiatives.

“The Academic Pediatric Association has been involved with pediatric hospital medicine from the beginning, and we plan on continuing our involvement,” says Daniel Rauch, MD, FHM, associate director of pediatrics at Elmhurst Hospital Center in New York City and co-chair of the APA’s Hospital Medicine Special Interest Group, which is paying close attention to PHM education and research issues.

Strategic Initiatives

The roundtable established four workgroups: clinical practice/workforce, quality and safety, research, and education. The workgroups are directed to create strategic initiative projects focused on advancing the goals laid out at the roundtable meeting and complete most of the projects no later than the July 2010 PHM Conference in Minneapolis (see “A Closer Look at the Pediatric Hospital Medicine Initiatives,” p. 7). At the 2009 PHM conference in Tampa, Fla., roundtable participants reported on some of the initiatives’ preliminary results.

“I walked away … energized and ready to help change the world, which is a pretty great feeling,” says Jennifer Daru, MD, FAAP, FHM, chief of the division of pediatric hospital medicine at California Pacific Medical Center in San Francisco and co-leader of the roundtable’s clinical practice/workforce workgroup.

One of Dr. Daru’s workgroup’s strategic initiative projects should make Dr. Hale and his pediatric hospitalists at Central Maine Medical Center happy. Dr. Daru’s group is creating a clinical practice dashboard template that PHM programs can use to internally track patient care and compare themselves with other programs and national standards.

“I think very few programs have a dashboard, because it’s a relatively newer thing for pediatric hospital medicine,” Dr. Daru says. “With this dashboard, we want to be able to say, ‘Here are the things you should look at to ensure quality care for your kids, and as you look at them, you should probably track them over time.’ ”

Steve Narang, MD, medical director of quality/safety and pediatric emergency services at Our Lady of the Lake Regional Medical Center and Children’s Hospital in Baton Rouge, La., is leading the quality and safety workgroup, which is focused on patient identification, patient handoffs between pediatric hospitalists and PCPs, and clinical outcomes for common pediatric diagnoses.

“Most doctors don’t like standardized forms or cookbook medicine, but they do understand good care. Hopefully, we will show success in these initiatives and they will serve as a launching pad to other initiatives,” Dr. Narang says.

Contribute to The Hospitalist

Have a story idea or a clinical question? We’d like to hear about it. Send your questions and story ideas to editor Jason Carris, jcarris@wiley.com, or to physician editor Jeff Glasheen, MD, FHM, jeffrey.glasheen@ucdenver.edu.

Dr. Hale, for one, is excited by the initiatives and workgroups, and optimistic the strategic projects will help his program. In recent years, the PHM community has talked about these kinds of advances, and he’s encouraged to see them moving forward. “These initiatives contribute to the strength of our field,” says Dr. Hale, who also serves on the executive board of AAP’s Maine chapter.

About 80 pediatric hospitalists have volunteered to help with the strategic initiatives. Earlier this year, a request for help was broadcast over the Section on Hospital Medicine listserv run by the AAP. It was announced at HM09 in Chicago and the PHM conference in Tampa. Everyone who submitted a resume or CV, references, and a statement of interest is included, Dr. Percelay says. “This is not supposed to be some exclusive club that no one can get into,” he says. “We are committed to a transparent process.”

While the application deadline has passed, organizers expect additional calls for volunteers in the future as strategic projects move forward, projects are added, and current volunteers depart (see “How to Get Involved,” above).

“They will be the next volunteer go-tos. We will essentially build them into new projects that come up or if gaps emerge,” Dr. Daru says. “We want to have as many people as possible who are really motivated.”

Group Effort

You don’t necessarily have to volunteer for workgroups to be a part of the broader effort. You can read and comment on draft reports released by some of the project teams, or review the roundtable’s executive summary and find ways to apply the vision and goals to your own PHM program, says Mark Shen, MD, medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas, and pediatric editor of The Hospitalist.

“If each pediatric hospitalist set strategic initiatives for their own group or hospital, chances are they would find remarkable similarity between what they came up with and what the strategic planning roundtable came up with,” says Dr. Shen, who is directing one of the quality and safety workgroup’s initiatives. “There are plenty of ways to think globally and act locally.” TH

Lisa Ryan is a freelance writer based in New Jersey.

Top Image Source: HOMER SYKES/ALAMY

A Closer Look at the Pediatric Hospital Medicine Initiatives

Four workgroups emerged from the Pediatric Hospital Medicine Strategic Planning Roundtable in February. Each group was charged with directing strategic initiative projects over the next 16 to 18 months. The mission is to transform the delivery of hospital care for children. Here is a synopsis of the workgroup initiatives, some of which have estimated completion dates:

A Closer Look at the Pediatric Hospital Medicine Initiatives SJLOCKE/ISTOCKPHOTO.COM

SJLOCKE/ISTOCKPHOTO.COM

Clinical Practice/Workforce

  • Create a PHM position paper that defines what it means to be a pediatric hospitalist and where the field is headed. A progress report is to be published within the next few months.
  • Create a clinical practice dashboard template that PHM programs can use to monitor patient care and eventually compare their program with other programs and national standards. The template will include such markers as patient readmissions and pediatric rapid response events that PHM programs should measure and track. The first version of the dashboard template should be ready by the end of 2009; test sites are to be selected by 2010.
  • Develop a “return on investment” document to help pediatric hospitalists effectively discuss with hospital administrators and other stakeholders the benefits of adding or expanding PHM programs. Target deadline: February 2010.
  • Assess career satisfaction among pediatric hospitalists. A large part of this initiative will involve SHM’s career satisfaction survey.

Quality and Safety

  • Launch a safety project involving six to eight hospitals that is aimed at improving pediatric patient identification. Preliminary results are expected by July 2010.
  • Develop a standardized communications tool that pediatric hospitalists can use when handing off patients to primary-care physicians after patients leave the hospital.
  • Create a benchmarking process for the most common pediatric inpatient diagnoses (e.g., bronchiolitis, skin infections, and pneumonia) by expanding the Value in Inpatient Pediatrics (VIP) Network, a pediatric-hospitalist-led effort to find cost-effective ways to treat patients.

Research

  • Restructure the existing Pediatric Research in Inpatient Settings (PRIS) network, an independent entity founded through a joint SHM-AAP-APA effort, to better advance research on issues important to pediatric care.
  • Secure funding to conduct studies relevant to inpatient pediatrics. Tap into American Recovery and Reinvestment Act of 2009 (ARRA) funding for comparative effectiveness research. Target deadline: ARRA proposals by fall 2009.
  • Create a mentorship system to connect pediatric hospitalists who are interested in research with PHM researchers through the AAP listserv.

Education

  • Develop an educational plan supporting PHM core competencies to assist medical schools, post-graduate training programs, and continuing medical education programs in PHM teaching. The core competencies should be released by the end of the year.
  • Meet the needs of PHM educators by focusing efforts on topics of interest to them, such as family-centered rounds, night float curriculum, and handoffs. Establish a repository of curriculum information that educators can access for guidance.

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