Medicolegal Issues

Project BOOST Expands


SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions) is an initiative to improve practices in transition care and reduce readmission rates for hospitals across the country. The project’s toolkit, mentoring program, and national advocacy efforts have proven so successful that the program is expanding this year.

In 2008, SHM began the first round of the Project BOOST mentoring program in six pilot hospitals. The first full cycle of Project BOOST mentoring sites began in March at 24 sites. The Hospitalist will feature updates on the full cycle of Project BOOST later this year. For more information about Project BOOST, visit or e-mail [email protected].

As a pilot site, Southwestern Vermont Medical Center in Bennington has worked with mentors for the past six months. We caught up with project leader Jennifer Fells, RN, MS, to discuss the institution’s participation.

The toolkit has proved to be invaluable. The mentors helped us keep on track and offered us guidance. They share the experiences of the other Project BOOST teams, and we benefit from that information.

—Jennifer Fells, RN, MS, Southwestern Vermont Medical Center, Bennington

Question: Why did your group choose to participate in the mentoring program?

Answer: We wanted to reduce our readmission rate, and we knew we weren’t doing a service to patients. This was also a goal of our organization overall; it’s not only a benefit to the hospital, but a larger value when the patient goes back to the community.

Q: How has the BOOST mentoring program benefited your program?

A: It helped us get organized by beginning the process and affirmed our belief that there were ways to address readmissions. The toolkit has proved to be invaluable. The mentors helped us keep on track and offered us guidance. They share the experiences of the other Project BOOST teams, and we benefit from that information.

Chapter Updates

Georgia Coastal

The chapter’s second meeting was well attended by both of the large hospitalist groups in Atlanta; two hospitalists from a rural institution also were in attendance. Leena Dutta, MD, of North Fulton Regional Hospital in Roswell, spoke about her experience as a hospitalist and the uses of Tygacil.

Los Angeles

The chapter met Feb. 3 for dinner at Valentino’s Restaurant in Santa Monica. Twenty-five hospitalists and residents from academic and private institutions attended the meeting, which featured two presentations. The night started off with a discussion about the management of bloodstream infections, led by Anjay Rastogi, MD, of UCLA Medical Center. Robert Schultz and Craig Steinhauer of financial planning services firm NWF discussed “Navigating Through Rocky Times: A Guide to Investment and Retirement Strategies.”

Miami/South Florida

The chapter met Jan. 22, and the keynote speaker was treasurer Efren Manjarrez, MD, who gave a presentation on “Transition of Care.” He revealed data from a soon-to-be-released SHM task force paper. The presentation was well received, and the local HM programs agreed to collaborate to collect more data for future studies.

The changes in the approach to the discharge process were a surprise to us. After we developed our team, we discovered how fragmented the discharge process was throughout the entire organization. Discharges were handled over multiple disciplines, and it was fragmented by design.

For example, our documentation, discharge plans, discharge recommendations, and patient-education materials are in different parts of our documentation system.

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Q: What did you learn about your program through the initial Project BOOST step: analyze care delivery?

A: We realized that disciplines were not coordinated with one another and there was not enough time for the physician to complete the discharge plan. The process was cumbersome, awkward, and very time-consuming. We were looking to create efficiency in the information that needs to be coordinated to do those discharge orders.

Q: What additional changes do you hope to see in the remaining time with BOOST mentors?

A: We definitely hope to improve our process. We want to have implemented the tools and have a coordinated discharge process, and a centralized way to communicate the discharge plan. We found a lack of communication creates a barrier among disciplines, and we hope to correct that and become more customer-friendly to patients.

Q: How did your site’s BOOST mentor assist in the implementation process? What was the outcome?

A: Our site mentor helped with the clarification of data to be collected for measurement, keeping us on track with the toolkit, and served as another set of eyes. When you are in an organization, and even when you have the appropriate team, you always need somebody to say, “What do you think about this?” or “Did you think about this item?”

It’s another perspective, sharing gained knowledge from other organizations. That’s very critical.

Collaboration, Commitment at the Top

Recognizing the unprecedented need for NPPs and hospitalists to work together, the American Academy of Nurse Practitioners (AANP), the American Association of Physician Assistants (AAPA), and SHM have formed a unique collaborative group that benefits NPPs, hospitalists, and patients.

“It’s a win-win situation,” says Sharon Kulesz, director of alliance development and education for AAPA. “It provides physician specialties with better-trained physician assistants, and it gives physician assistants better training within that specialty. The trainings are intense, high-level, and in concert with the physician organization, so when a physician assistant attends a conference, the physicians know it’s a high-quality, recognized session.”

A wide range of initiatives, including the NPP committee, a recently launched NPP page on SHM’s Web site, an NPP “boot camp,” and NPP educational sessions at HM09 in Chicago, reflect SHM’s commitment to all of the NPPs on hospitalist teams. “From the very beginning, we have envisioned SHM as an open tent,” Miller says. “SHM is a home for everybody involved in the practice of hospital medicine, including nurse practitioners and physician assistants.”

The NPP sessions at HM09 will feature a “basic” session that will serve as an introduction to how NPPs can alleviate workload issues in hospitalist practices; the “advanced” session will help hospitalists who already utilize NPPs to understand how best to work together. The boot camp, scheduled for August and jointly organized by AANP, AAPA, and SHM, will be geared specifically toward entry-level hospitalist NPPs.

AAPA already has seen considerable demand for NPP-focused educational programs. When the group began offering an educational course in hospital medicine two years ago, 30 physician assistants attended. In 2008, the course attracted 60 attendees, and it has a waiting list of nearly 100 for the next course.

The demand for HM courses for NPPs doesn’t surprise Saltzman. She’s seen firsthand the allure HM holds for NPPs. “They are attracted to hospital medicine because it is clinically challenging and intellectually stimulating,” she says. “But, most importantly, they like it because they know they can make a real difference.”—BS

SHM marketing coordinator Nadia Clenending contributed to this report.

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