Medicolegal Issues

Planned Partnerships


 

A day in the life of a hospitalist is not spent in a vacuum. Every day in hospitals across the country, hospitalists coordinate patient care with a host of other physicians, caregivers, and administrators. One minute, a hospitalist could be managing a patient’s treatment with a physician assistant; the next minute, the hospitalist could be reviewing a diagnosis from a cardiologist. The same hospitalist might finish the shift by reporting valuable quality-improvement (QI) data to the hospital’s management staff.

It’s that kind of collaboration that is the hallmark of HM, so it makes sense that the same level of collaboration take place between SHM and a bevy of other healthcare-related organizations.

“The delivery of hospital-based care is a team sport,” says Joe Miller, SHM’s executive advisor to the CEO. “It requires coordination across disciplines, from clinical to managerial. Hospital medicine is in the middle of a complex system, and we can’t do it ourselves. If we’re going to be successful, we need to forge partnerships.”

Chapter Updates

Indiana Chapter

JELLO5700 / ISTOCKPHOTO.COM

The chapter met June 2 at the Tomato Pie Bistro in Indianapolis. The meeting kicked off with a welcome from chapter President Angela Corea, MD, assistant medical director at Saint Vincent Healthcare in Indianapolis, and nominations for the chapter’s 2010 officers.

Mark Bochan, MD, an infectious-disease specialist at St. Vincent’s, spoke to the group about candida and aspergillus infections. Special guest Scott Flanders, MD, FHM, president of SHM, discussed his thoughts on the growth of HM and the challenges currently facing hospitalists. He then opened up the floor for a brief question-and-answer session.

Palmetto/Eastern South Carolina Chapter

The chapter met May 28 at Victor’s Restaurant in Florence. Chapter president Beth Cardosi, DO, a hospitalist with McLeod Inpatient Services in Darlington, welcomed everyone and introduced the guest speaker, Kevin Shea, MD. Dr. Shea presented a program to the group on gram-negative infections in the hospital setting.

Milwaukee Chapter

The chapter met June 8 at Columbia Hospital. Four HM groups attended the meeting. Chapter goals for the coming months were set, including QI, advocacy, policy, and membership initiatives.

Those partnerships have been critical to SHM’s ability to create educational programs and practice management resources. It also factors into SHM’s efforts to enhance patient satisfaction and advocate for QI in healthcare. The list of SHM’s partner organizations and joint projects is an alphabet soup that includes the nation’s most influential professional societies, academies, and government entities, each of which is working to improve the delivery of care to hospitalized patients.

Small Start, Quick Growth

The relationship between SHM and the American Medical Association (AMA) began as a simple research project and has grown into a deeper collaboration. In 2007, the AMA’s Organized Medical Staff Section (OMSS), the department that advocates on behalf of physicians who are members of medical staffs and other organizations, wanted to increase understanding of how hospitalists, primary-care physicians, and other physicians work together in the hospital setting. The association collaborated with SHM to conduct a survey and obtain feedback from hospitalists.

The 2007 survey found that there was still work to be done between the organizations, namely the need for a set of guiding principles for a successful hospitalist practice. OMSS, SHM, AHA, and the Joint Commission developed the principles, which were recently endorsed by OMSS at the association’s annual conference in June.

“We feel they’re appropriate and make sense,” says Jim DeNuccio, director of AMA’s Organized Medical Staff, Group Practice, and Senior Physician Services.

The 2007 survey and the principles for a hospitalist practice have led to a new survey, conducted this year, to track how the issues and challenges within a hospital have changed. The initiatives are just the beginning of a long-term relationship between SHM and AMA.

“It’s very important for all of us to work together to continue to grow,” says DeNuccio, who cites AMA’s courses in practice management, QI, and patient safety as educational opportunities for hospitalists. “Our interest is in the patient. That’s what this is all about. The AMA and OMSS feel strongly that the profession needs to call the shots about how care is delivered in hospitals. They see that engaging the hospitalist is in the interest of the patient.”

SHM and AAPA: Educating Together

Hospitalists and physician assistants (PAs) work hand in hand to care for their patients. At the national level, SHM and the American Academy of Physician Assistants (AAPA) are coordinating educational programs to ensure PAs and hospitalists are properly informed and learning from the same page.

“It’s a very broad spectrum,” says Sharon Kulesz, AAPA director of alliance development and education. “We provide physician assistants with information about hospitalists, and we provide physicians with information about the benefit of working with physician assistants.”

Along with the American Academy of Nurse Practitioners (AANP), AAPA and SHM have coordinated educational programs at SHM’s annual meeting for hospitalists, and recently developed a stand-alone “Boot Camp” series for nurse practitioners and physician assistants to learn more about HM.

Kulesz notes, however, that not all of the education is exclusively for hospital-based workers. Some of the efforts are geared toward educating the public about hospitals’ patient-care teams. Regardless of the topic or the audience, the key is a comfortable working relationship between teams, she says.

“Our work with SHM is the model that I would like to use in all of our collaborations,” Kulesz says. “SHM gets us. They get what we can do and how a collaborative approach can be of benefit to everyone. It’s like an extended family.”

Join Team Hospitalist

Interested in sharing your professional insight on a variety of HM-related topics? Team Hospitalist is looking for a few good physicians. E-mail your CV and a letter of interest to Editor Jason Carris, jcarris@wiley.com.

Patient-First Collaboration

The new Hospital Care Collaborative takes a team approach to hospital-based care. More than simply a partnership, the group brings together groups that represent healthcare professionals in the hospital—hospitalists, nurses, case managers, respiratory therapists, social workers—to find common approaches to QI and patient safety.

“As a group, the Hospital Care Collaborative is looking for ways to work together to improve the care of the hospitalized patient,” says Larry Wellikson, MD, FHM, CEO of SHM. “We’ve developed common principles, which have been ratified by each of our boards. At its core, the collaborative is looking for real-world ways to integrate medical professionals and help hospitals take a new approach to patient care.”

Part of the answer is in the education, development, and promotion of high-performance teams in hospital settings, Dr. Wellikson says. For instance, if a patient is admitted to the hospital with a blood clot, each team member has the opportunity to contribute his or her expertise and coordinate with others. The hospitalist might make the diagnosis, which leads to the prescription from the hospital pharmacist. With the diagnosis and list of prescriptions in hand, a nurse can then explain to the patient how the medications will affect their daily routine.

“In modern healthcare, no one professional or professional society can have all the perspectives you need,” Dr. Wellikson says. “In SHM’s approach, we’re looking at the hospital as a community, not a building. The problems we’re trying to solve are complex, and it requires an all-hands-on-deck approach. Knitting the perspectives and expertise together will be the key to treating the patient in the 21st century.” TH

Brendon Shank is a freelance writer based in Philadelphia.

Examples of SHM Partnerships and Activities

  • Academic Pediatric Association (APA): SHM and APA share responsibilities for the annual Pediatric HM conference, and the groups develop core competencies for pediatric hospitalists.
  • Agency for Healthcare Research and Quality (AHRQ): SHM is developing this partnership, along with materials on patient safety and QI.
  • American Academy of Clinical Endocrinologists (AACE): The AACE is a contributor to SHM’s Glycemic Control Resource Room.
  • American Academy of Nurse Practitioners (AANP): The societies are partners in education, including the Non-Physician Providers Boot Camp.
  • American Academy of Pediatrics (AAP): SHM and APA share responsibilities for the annual Pediatric HM conference and developing core competencies for pediatric hospitalists.
  • American Academy of Physician Assistants (AAPA): The societies are partners in education, including the Non-Physician Providers Boot Camp.
  • American Association of Critical-Care Nurses (AACN): A member of the Hospital Care Collaborative and a key partner in QI projects.
  • American Board of Internal Medicine (ABIM): SHM and ABIM are working toward a Recognition of Focused Practice in HM as part of maintenance of certification related to HM.
  • American College of Emergency Physicians (ACEP): A co-collaborator in SHM programs to reduce readmissions and increase quality in transitions of care.
  • American College of Healthcare Executives (ACHE): SHM and ACHE collaborated on a book about HM and practice management.
  • American College of Physician Executives (ACPE): The societies co-sponsored a workshop at HM09; future plans include projects on enhancing and growing leaders.
  • American Geriatrics Society (AGS): SHM and AGS are working to promote better transitions of care.
  • American Hospital Association (AHA): Collaborates on QI and educational initiatives for the C-suite and hospitalists with SHM.
  • American Medical Association (AMA): The societies are conducting survey research together, have developed principles for a successful hospitalist practice, and lead the effort on new measures for transitions of care.
  • American Society of Health-System Pharmacists (ASHP): This society is a member of the Hospital Care Collaborative (HCC) and SHM’s pharmacoeconomics advisory board.
  • Case Management Society of America (CMSA): A collaborator in SHM’s national transitions-of-care programs and member of the HCC.
  • Hospital Care Collaborative (HCC): A partnership with leaders in hospital care, including the American Association of Respiratory Care (AARC), the Society for Social Work Leadership in Health Care (SSWLHC), the ASHP, the CMSA, and the AACN.
  • The Joint Commission: Collaborated to develop the principles for a successful hospitalist practice; developing a new book on the role of hospitalists in patient safety.
  • Medical Group Management Association (MGMA): Collaborates on annual surveys focusing on the state of HM.
  • National Quality Forum (NQF): SHM members are on NQF performance and standards committees, and NQF’s partnership to improve care coordination.

Glycemic Control Mentorship Program Takes Off

With diabetes rates on the rise, the number of patients requiring intensive glucose management have never been higher. Whether it’s a hyperglycemic patient with pneumonia or a surgical patient at risk of hypoglycemia, the responsibility of managing blood sugars often falls to a hospitalist.

Managing glycemic levels can be a daunting task for the patient-care team, which is why SHM has established the first national Glycemic Control Mentored Implementation (GCMI) program, which is sponsored by Sanofi-Aventis US LLC. By November, 30 hospital sites across the country will rely on nationally recognized experts in the field to tackle site-specific issues through proven QI techniques.

Each GCMI site will take advantage of a unique mix of resources: a clinical toolkit, data collection and project management tools, and a review of key literature. Person-to-person mentorship opportunities will form the foundation of the GCMI program.

Because every site will face similar challenges in implementing a glycemic control program, GCMI brings hospitalists and experts together to share their experiences and newfound best practices. SHM will facilitate the knowledge-sharing through monthly conference calls and other networking opportunities.

For more information about GCMI, visit the quality improvement resource rooms at www.hospitalmedicine.org.—BS

SHM Glycemic Control Mentored Implementation Sites:

  • Abbott Northwestern Hospital, Minneapolis
  • Alexian Brothers Medical Center, Elk Grove Village, Ill.
  • Baptist Hospital, Brentwood, Tenn.
  • Champlain Valley Physicians Hospital Medical Center, Plattsburgh, N.Y.
  • Cooper University Hospital, Camden, N.J.
  • Emory University Hospital, Snellville, Ga.
  • Exeter Hospital, Exeter, N.H.
  • Healthcare Authority for Medical West, Bessemer, Ala.
  • John C. Lincoln Hospital North Mountain, Phoenix
  • Kaiser Sunnyside Medical Center, Clackamas, Ore.
  • Kentfield Rehabilitation and Specialty Hospital, Kentfield, Calif.
  • Kootenai Medical Center, Coeur d’Alene, Idaho
  • Lakeland Regional Medical Center, Lakeland, Fla.
  • Memorial Medical Center, Springfield, Ill.
  • Mercy Iowa City, Iowa City, Iowa
  • Morton Plant Hospital, Clearwater, Fla.
  • Oneida Healthcare Center, Oneida, N.Y.
  • Portland Veterans Affairs Medical Center, Portland, Ore.
  • Poudre Valley Health System, Fort Collins, Colo.
  • Providence Portland Medical Center, Portland, Ore.
  • Sacramento Sutter Medical Center, Sacramento, Calif.
  • St. Mary's Hospital, San Francisco
  • St. John's Mercy Medical Center, St. Louis
  • The George Washington University Medical Center, Washington, D.C.
  • University of Virginia Medical Center, Charlottesville, Va.

Now Accepting Senior FHM Applications

Earlier this year, more than 500 hospitalists were honored by SHM with the Fellow in Hospital Medicine (FHM) designation. In 2010, the inaugural class of Senior Fellow in Hospital Medicine (SFHM) designees will join the next class of FHM.

If things go right for Rachel Lovins, MD, FHM, she’ll be among the first to affix “SFHM” to the end of her title. As one of the fellows inducted in Chicago and director of the hospitalist program at Waterbury Hospital in Connecticut, she sees even greater promise in the SFHM designation.

“This is an exploding field with lots of opportunities—not just in my hospital, but nationally. I want to be involved in that,” says Dr. Lovins, who is an assistant clinical professor of medicine at Yale University. “I want to do whatever I can do to position myself as a bigger player and part of the movement.”

SFHM designation is the next step for hospitalists actively working to distinguish themselves in the hospital-care setting. SFHM applicants will demonstrate their contributions to the specialty by earning points in the FHM program.

“We were thrilled with the number of applicants to the inaugural year of the fellow designation,” says Todd Von Deak, SHM vice president of membership and marketing. “We’re eager to receive even more for the FHM and SFHM this fall.”

For program updates and application instructions, visit www.hospital medicine.org/fellow or send e-mail to fhmcandidate@hospitalmedicine.org. —BS

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