Sometimes the first impression really is the right one.
Nearly 150 HM-focused innovations abstracts were submitted for the 2012 Research, Innovations, and Clinical Vignettes poster competition at HM12, and more than 60 of the submitters were invited to display posters in San Diego. A judging committee reviewed 24 poster finalists, and the consensus was that one poster stood out from the start: “Structured Interdisciplinary Bedside Rounds at Emory University School of Medicine in Atlanta, Ga.,” presented by Emory hospitalist Christina Payne, MD.
One of the Innovations judges noted the 73% reduction in mortality rates realized via Emory’s Accountable Care Unit, along with a one-day reduction in length of stay and a 90% reduction in catheter-related bloodstream infections. “My God, what’s going on there?” one judge exclaimed.
Added a second judge: “We tried something like this and didn’t succeed—but we didn’t have a champion like [Dr. Payne].”
SHM’s Innovations co-chair, Andrew Modest, MD, assistant clinical professor of medicine at Harvard Medical School and Mount Auburn Hospital in Cambridge, Mass., explained that the poster contests are a real stepping-stone opportunity for young clinicians—particularly junior faculty and residents. “You can go on to do more elaborate work and, with some statistical analysis, all of a sudden, you have a research paper,” Dr. Modest said, “or else turn it into a true quality-improvement project for your hospital. And if you’re a poster finalist at SHM, that goes on your resume.”
Innovation implies either something new or a new and effective application of existing methods for addressing an issue that all hospitalists deal with, Dr. Modest said. At HM12, posters featured innovative approaches to such issues as scheduling, readmissions, care transitions, and team communication.
“What I like to see is a buzz in the room,” Dr. Modest said. “Something that people recognize they can just take home and start using.”
In addition to Dr. Payne’s winning poster, the judges also chose five abstracts for oral presentations on Day Two of the annual meeting; one abstract was chosen and orally presented to start the Day Two plenary session before all HM12 attendees.
The Innovations judges, in teams of two, each met with four or five poster finalists in front of their panels; each principal investigator was asked to briefly summarize the innovation.
For example, at the University of Texas Health Sciences Center at San Antonio, financial support to add a fourth chief resident dedicated to quality led to the launch of a procedural service, explained by principal investigator David Schmit, MD. Medical interns now are taught in a one-month rotation to perform a number of medical procedures, aided by ultrasound, using a standardized curriculum, checklists, video training, and practice on a simulator. In Month Two, they perform the procedures on actual patients. Trained interns have performed 342 procedures, with 100% success rates for paracentesis and thoracentesis, Dr. Schmit said.
“This has to be incorporated into physicians’ training,” noted judge James Yturri, MD, a hospitalist from Great Falls, Mont. “How many programs are actually doing this?”
The service, Dr. Schmit said, has required a lot of coordination, infrastructure, and investment from the hospitalist group, residency program, and three participating hospitals.
“How did you get them all to buy in?” Dr. Yturri asked.
“I think the data on patient safety was persuasive,” Dr. Schmit said. “If you look at our low rate of pneumothorax, we saved money.”
When the 10 judges reconvened, discussion focused on innovative telemedicine and real-time reporting of VTE. A statewide collaborative to improve care transitions in Michigan was singled out for its active participation by the state’s health payors.
“I’m partial to the procedural project,” said Michael Pistoria, DO, SFHM, a hospitalist at Lehigh Valley Health Network in Allentown, Pa., and HM13 course director.
Kimberly Tartaglia, MD, was complimented for a succinct presentation of her poster about improving the inpatient management of neonatal jaundice. “Nicely done,” Dr. Modest told the hospitalist from Ohio State University Medical Center in Columbus.
But the judges eventually circled back to the Emory poster about rounds done on a nonteaching, medical accountable-care unit, defined as a unit that is consistently responsible for the outcomes it produces. On the unit, interns are trained to lead team-based, patient-centered rounds.
“They really have learned to love it,” Dr. Payne said.
Rounds start punctually each morning, with five minutes spent in each room for updates from the intern, nurse, social worker, patient and family, leading to a plan for the day with a safety checklist and discharge planning checklist, all entered in real time into the medical record by a second intern.
“How hard is it to get through all that in five minutes?” Dr. Modest queried.
“Every month, I get a new set of learners,” Dr. Payne replied. “At the beginning of the month, it doesn’t work as well. But by Week Two, we’re a well-oiled machine.”
The judges huddled again, but quickly agreed to award the poster prize to Dr. Payne.