Patient Care

Pediatric HM Highlights


 

It’s been a while since I went to a buffet and stuffed myself silly, but that’s how my mind felt on the flight home from Kansas City, Mo. After four incredibly packed days at Pediatric Hospital Medicine (PHM) 2011, I was one “wafer-thin mint” away from an explosion. What I wanted was some kind of a mental digestif. What I got instead was a light beer. It helped a little bit, but when I awoke during the landing in Austin, Texas, I realized that I remained in need of a better way to distill the thousand points of information from the conference into something more manageable.

Buoyed by Michelle Marks and Joel Tieder’s Top 10 Articles of the Year luncheon, specifically the piece on neurosurgeons and Kangaroo Care, I thought I might try my own version of a decompressive operation.

Without further delay, here are the top 10 things that I learned at Pediatric Hospital Medicine 2011:

10. We continue to grow as a field. Although the exact number of pediatric hospitalists in the U.S. remains somewhat unclear (but is probably between 1,000 and 2,000), what is known is that attendance at our annual meeting grows every year. Our tripartite meeting, sponsored by the American Academy of Pediatrics (AAP), SHM, and the Academic Pediatric Association (APA), hit a record 450 attendees this year. Beyond the physical numbers, it is quite clear that we are growing in many other domains as well.

9. It is time to re-evaluate the impact of CME on physician practice and outcomes. The literature on continuing professional education has been quite sobering to date, with nothing to show for the thousands of dollars spent per individual. But most of those studies were performed in the last century (think eight hours of lecture a day followed by dinners with big pharma) and I’ll bet that there was not the focus on learner-centered education that was evident in Kansas City.

With a dizzying array of workshops and interactive small group sessions spread amongst seven different tracks, it was difficult, if not impossible, to be a passive participant in the process. And since learning retention rates are generally proportionate to how active a role adults play in their own education, I am going to guess that many other attendees’ brains still have that “I’m thinking” hourglass icon over them. We have the conference planning committee to thank for this.

8. The JCPHM (Joint Council of Pediatric Hospital Medicine) will be increasingly important as we develop. Much like the constant stream of unfamiliar new vaccine names that have appeared in recent years, this proposed new committee comes with another long set of initials and an unfamiliar indication.

We possess expertise in education that dovetails nicely with our need to grow and sustain an experienced, well-trained workforce. Intrinsically, we know that we possess a unique body of skills, knowledge, and attitudes. The explicit articulation of this into longitudinal curricula will headline our evolution as a field.

The JCPHM will function as a coordinating body, ensuring that work done through the AAP, SHM, and AAP are aligned to provide maximal benefit to pediatric hospitalists as a whole. And thus, similar to immunizations, the benefits will be most evident if we remain healthy as we grow in the context of an increasingly complex environment.

7. Our collective research accomplishments merit national recognition. It was not more than just a few years ago that we were in our research infancy. Posters at our meetings largely represented single-site descriptive studies, typically using survey methodology. This year we had four research breakout tracks, in addition to the plenary and three poster sessions.

Pediatric Research in Inpatient Settings (PRIS) leads the way with a Forbes-like listing of million-dollar grants and a partnership with Child Health Corporation of America’s (CHCA) uber-powerful Pediatric Health Information Systems (PHIS) database. Expect some landmark studies in the near future.

In the meantime, it is clear that the rest of the field is not languishing from smaller budgets. From clear outcome and process measurements of family-centered rounds to studying the spectrum of transitions of care to the impact of early warning systems, there was a predominant focus on quality and safety.

In fact, the tone was set at the opening keynote address, as Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), described creative and innovative ways to study and translate work in this area to improved patient care.

6. We are poised to develop effective training systems for our future workforce. From the use of our core competencies in sessions to a full complement of workshops on education (from individual to team and from student to fellow), it is clear that thoughtful deliberation has paved the way for our future. We possess expertise in education that dovetails nicely with our need to grow and sustain an experienced, well-trained workforce.

Intrinsically, we know that we possess a unique body of skills, knowledge, and attitudes. The explicit articulation of this into longitudinal curricula will headline our evolution as a field.

5. Our new peer-reviewed journal has a bright future. Kudos to Shawn Ralston and the rest of the editorial board for publishing the first peer-reviewed edition of Hospital Pediatrics. Original research, evidence-based content, and practical commentary grace the pages with a little bit of something for everyone. The AAP has demonstrated a healthy level of support for this endeavor, as they sent out an introductory email announcing the journal to all of their membership over the weekend. I am confident that support from our pediatric hospitalist community will follow in the form of an exponential increase in quality submissions. Look no further than the PHM 2011 abstract book to get a preview of what our journal will highlight in the near future.

4. We connect with each other through a language of quality and value in our work. Quality spanned the continuum from conversation to collaboration, as like-minded souls shared ideas and passions amidst the sessions. The improved outcomes demonstrated by the Value in Inpatient Pediatrics (VIP) network are a testament to the positive change that can arise from such efforts. VIP, with its focus on inclusive and front-line collaboratives, also announced an upcoming merger with the AAP’s Quality Improvement and Innovation Network (QuIIN), approved by the AAP board in May.

Perhaps more impressive was that more than 12% of the attendees at PHM 2011 attended the annual VIP dinner and similar numbers signed up to participate in future efforts. At this pace, widespread improvement and value are easily within our sights.

3. Complex care is the new family-centered rounds. Atul Gawande’s recent New Yorker article about “Hot Spotters” could very well have been referring to the body of work that is represented by pediatric generalists (to include a fair number of hospitalists) over the past few years. Closing plenary speakers Robert Lyle and Patrick Casey wowed the audience as they described their medical home for medically complex children—and an estimated savings to Arkansas Medicaid of nearly $3 million per year.

As hospitals and hospital systems look to create accountable care organizations (ACOs), this kind of work will be increasingly prioritized, as it has the potential to generate the biggest gains in valued care.

2. STP, yeah, you know me. Chris Maloney and Suzanne Swanson Mendez brought down the house at the PHM Roundtable update as they presented preliminary results of their large and representative STP (strategic planning) Committee, which is mapping out future certification options for pediatric hospitalists. A lively debate ensued as questions surrounding how to best notify and involve pediatric hospitalists in these decisions came to the forefront. Are we a democracy? Are we a republic? Is there a better model for this decision?

Despite the lack of consensus on how to best move toward a decision, the discussion remained open and engaging. In contrast to recent certification decisions from other organizations, the audience clearly relished the opportunity to provide input, and the STP committee continues to look for able and willing participants.

1. A top-10 list is not enough to cover everything from PHM 2011. From clinical and practice conundrums galore to late nights at Spectators to Kevin Powell’s mad acting skills, a 1,500-word-top-10 list simply does not do the meeting justice! I place full blame on the planning committee for this overindulgent buffet and the unfortunate omission of many other meaningful lessons.

Thank you: Erin Stucky Fisher (chair), Brian Pate, Allison Ballantine, Matt Garber, Jeff Simmons, Doug Carlson and Tamara Simon.

If you’re feeling like you missed out, or have already digested and want more, PHM 2012 will be here soon enough to fill your appetite. Cincinnati, look out.

Dr. Shen is pediatric editor of The Hospitalist.

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