Tag Archives: Hospitalist

Rock as Remedy: Band Builds Work-life Balance

Lots of good advice got dispensed at a session on work-life balance at the Society of Hospital Medicine meeting recently, including the importance of honoring your inner self, having a supportive spouse, working with your hospitalist colleagues to support each other around scheduling difficulties, even hiring a nanny. Surprising to me, nothing was said explicitly about keeping creativity and fun in your life.

Dr. McIlraith is lead singer for The Remedies. (Courtesy Sam Hayashi/Zuma Light Works)

Dr. Thomas McIlraith knows about that last part. The chairman of the hospital medicine department for Mercy Medical Group, a large hospital medicine and multispecialty medical group in Sacramento, Calif., he’s also the lead singer and songwriter for The Remedies, a regionally popular five-member rock band that includes nephrologist Dr. David Pai playing bass and orthopedic surgeon Dr. Dan Anderson, who is the band’s sound engineer.

“My experience has been that if I don’t have music in my life, the rest of my life doesn’t live up to its potential. It’s kind of a left-brain, right-brain balance. I find that when I fulfill that creative need, I have more energy for other things,” he said. “It feeds back on itself; it pays back in the inspiration and energy you have for patient care.”

He first noticed this in medical school at the University of Wisconsin in 1992, when he ran a 15-person band called The Arrhythmias. Scheduling practices, etc. in the era before e-mail was time-consuming. “I was worried that I’d flunk out, but that’s when I got my best grades,” he said.

Scheduling for The Remedies isn’t simple either, with three physicians on board plus drummer and geologist Greg Marquis, who is gone for long stretches in the field, and guitarist and recycling worker Walt Simmons. As the chairman of his department, Dr. McIlraith’s schedule consists of the leftovers after the other 55 hospitalists have claimed shifts to fill their schedules.

“I work a lot of nights, and then work some days, so it can be a little haphazard. Before our recent show, we went three weeks straight when we couldn’t manage to fit in a practice. Then we had two, and the show went great,” he said.

Dr. McIlraith (left) rocks with Walt Simmons (center) and Dr. David Pai. (Courtesy Sam Hayashi/Zuma Light Works)

Playing in the band is fun, but so is watching co-workers let loose at the shows. It’s a work-hard, play-hard thing. “We work very, very hard on very tough issues, and when we play, it’s nice to see these people cuttin’ loose and dancing. That’s very fulfilling for me,” he said.

The Remedies play mostly covers with some original tunes thrown in, including two that Dr. McIlraith wrote specifically about hospitalist work. “The Long Ride” recalls the early difficult days of establishing hospitalist medicine. McIlraith sings,

Switching back and forth between night and day

Getting’ no respect, never getting’ our way

Stood our ground and demanded a say

That’s why we’re all here today

The lyrics specifically call out the contributions of founding hospitalists Dr. Winthrop F. Whitcomb, Dr. John R. Nelson, and Dr. Laurence D. Wellikson, as well as the Society of Hospital Medicine itself:

Come together, stay strong, and SHM will help carry you on

Gonna do more than just get by

Who would have known it would be such a long ride

The CPOE Blues” is another original tune that physicians in many specialties might relate to, singing of the “joys” of computerized physician order entry:

Now, there are a few things I’ve come to hate

Like forgetting to click on “initiate”…

Everybody’s looking ’round for clues

On how they’re s’posed to deal with the CPOE blues

Dr. McIlraith’s roles don’t end with hospitalist and rock musician. He’s also a husband and father of two children. How does he juggle all this? Through the magic ingredient that every session on work-life balance emphasizes as a key factor: a supportive spouse.

His wife works at home as an investment manager and she handles much of the home care as well. “She really takes very good care of all of us,” he acknowledged. “I’m extraordinarily blessed in that regard.”

–Sherry Boschert (@sherryboschert on Twitter)

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Filed under Hospital and Critical Care Medicine, IMNG, Internal Medicine, Nephrology, Surgery, Uncategorized

A Hospitalist’s Call to Action

Dr. Patrick Conway is the Chief Medical Officer at the Centers for Medicare and Medicaid Services, but he also happens to be a practicing pediatric hospitalist. So when he showed up at the Society of Hospital Medicine’s annual meeting earlier this week to deliver one of the keynote addresses, he got a warm welcome from fellow hospitalists happy to see one of their own in a real position to make decisions about Medicare’s policies.

Dr. Conway gave the standard speech about what CMS officials are doing to transform the health care system. Then he turned to his hospitalist colleagues and gave them some things to do, too. Hospitalists need to partner with the hospital administration and their quality improvement teams. They need to understand their hospital’s performance data. And they need to take charge, he said, by leading multidisciplinary teams.

“We’re at a unique time in health care where we can drive change,” Dr. Conway said. “My challenge to you would be, please don’t sit on the sidelines.”

Dr. Patrick Conway

He urged the audience – hospitalists gathered in San Diego for continuing education and networking – to make an effort to lead some type of system improvement in their hospital. “I don’t actually care what it is, but work on some broader system changes in your local setting,” Dr. Conway said.

If hospitalists are looking for a reason to get out in front when it comes to system change, there are plenty of financial carrots and sticks coming very soon from the Medicare program. Dr. Conway outlined many of them, from Accountable Care Organizations to the readmission reduction program to the hospital value-based purchasing program. But the best reason to be active in changing the way the health system works is for the benefit of patients, he said. That’s the reason that Dr. Conway still works as a hospitalist nearly every weekend for free. “It’s about those families that you take care of,” he said.

— Mary Ellen Schneider

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Filed under Health Policy, health reform, IMNG, Pediatrics, Physician Reimbursement, Practice Trends

A.W.O.L. in the Hospital

Ask any new parent to part with her baby in the hospital for even a few moments and it’s likely to set in motion a mental high-speed, Guy Ritchie-like montage, complete with squealing tires, deranged abductors, and shadowy baby-sale rings. (Well, it did for me.)

When it comes to why children go A.W.O.L. in the hospital, however, researchers say we want to look a little closer to home.

It turns out that some parents are taking off the ID bands used to keep track of their child in the hospital.

Photos by Patrice Wendling

A learning collaborative of six hospitals found that the overwhelming (90%) reason for pediatric ID band failure was that the band was simply not in place. The most frequent reasons were that it fell off, was taken off by the parent or the patient, or was put on another object such as a crib,  Dr. Shannon Phillips and her co-authors reported at Pediatric Hospital Medicine 2011.

“A lot of times, the patients had been at the hospital for a long time and the parent would say ‘Everyone knows my child’or ‘I’m always here at the bedside,’ co-author Dr. Michele Saysana explained. “Many of the parents were taking [the ID band] off, but when we educated them on the importance of keeping the ID band on, they had a better understanding.”

In addition to family/patient education, the collaborative staged other interventions including educating front-line staff on the importance of correct ID bands as a safety strategy; conducting audits, often by night nursing administrators; and changing to softer ID bands, including luggage tag-type bands in some NICUs.

“In bigger systems with adults, you must have different bands,” said Dr. Saysana, who directs the pediatric hospitalist program at Riley Hospital for Children in Indianapolis. “The one-size-fits-all doesn’t work for the little guys.”

Dr. Michele Saysana

Post-intervention, the collaborative saw a 13% absolute reduction, corresponding to a 77% relative reduction, in pediatric band failures between September 2009 and September 2010. Their goal had been to reduce errors across the collaborative by 50% in 12 months.

The keys to sustaining this kind of success?

“The lessons learned are having leadership be involved, having continuous audits, and just doing education every time you catch something,” she said.

—Patrice Wendling

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Filed under Emergency Medicine, Hospital and Critical Care Medicine, IMNG, Pediatrics

Could You Gather ‘Round, Please?

  Two new studies suggest that the popular practice of including patients and family members during hospital rounds is gaining even greater momentum.

Family-centered rounds were the most common rounding practice among 265 U.S. and Canadian pediatric hospitalists surveyed as part of the PRIS (Pediatric Research in Inpatient Settings) Network Triennial Survey.

 The recently published survey, described as the first national study of pediatric hospitalists to identify current rounding practices, reported that 48% of academic and 31% of non-academic respondents used family-centered rounds.

The long-standing concern that having family members present would increase rounding time did not materialize, with academic setting and higher daily patient censuses being the only significant causes of longer rounding duration.

 This finding contradicts previous research and “may be used to enhance FCR buy-in by hospitals considering or initiating FCRs,” the authors suggest.

The most common perceived barrier to FCR, cited by 44% of respondents, was that the rounding team size was prohibitive. Other barriers include trainees’ fear of not appearing knowledgeable in front of families, a negative impact on physician work flow and patient confidentiality.

Several professional groups, including the American Academy of Pediatrics, already endorse family-centered care as a way to improve team communication and outcomes.

 Indeed, the study noted that bedside nurse participation was perceived as being significantly greater on FCR rounds than on other types such as sit-down or hallway rounds (83% vs. 51%). Considering their work in the trenches, this finding says a lot.

 In a second study, presented at the Pediatric Hospital Medicine 2010 meeting, EEGs and head MRIs were completed faster after implementation of FCR at Riley Hospital for Children in Indianapolis.

FCR also increased the percentage of discharges on the first shift, from 40% to 47% – not an insignificant amount, according to lead author Dr. Jennifer Oshimura, a pediatric hospitalist fellow at the Indianapolis-based hospital.

 “It took a little while for the whole staff to buy in,” she said in an interview. “It takes more effort for the medical students, residents and interns to know what to present. It helps for them to learn; otherwise they just spit up data.”

For anyone who’s ever been on the receiving end of that data, the effort is appreciated.

– Patrice Wendling (on Twitter @pwendl)

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Filed under Family Medicine, Hospital and Critical Care Medicine, IMNG, Uncategorized

Hospitalists: We Are the Champions

From the Society of Hospital Medicine annual meeting, National Harbor, Md.

The Society of Hospital Medicine just wrapped up 3 days of meeting, in which pretty much every SHM officer who got in front of a podium proclaimed that hospitalists are #1 and rising with a bullet.  In case anyone missed the point, Dr. Jeff Wiese, the incoming SHM president, closed out his forward-looking speech by quoting directly from Queen’s nauseatingly triumphant “We Are the Champions.” The crowd was ushered out of the ballroom with the song blaring over the sound system.

Photo courtesy Flickr Creative Commons user Tiago Ribeiro

Do they really have so much to crow about? Well, yes, and no. In case you hadn’t noticed, hospital medicine is one of the, if not the, fastest growing medical specialties.  (For a definition of “hospitalist,” go here.) There are more than 30,000 hospitalists, according to SHM, up from less than 1,000 just 10 years ago. Dr. Scott Flanders, the current SHM president, said that in 2003, only 30% of hospitals had an established hospital medicine program. Now, almost 70% do.

It’s a young, energetic group. From what I could see, there wasn’t a lot of gray hair in the crowd of 2,500 attendees. They are savvy in the ways of politics, business, and social media. They took meetings at the White House and with staff members of key Senate committees during health reform. They aren’t talking about how much less Medicare is paying them or how they didn’t get what they wanted in that law.

Instead, from their perspective, hospitalists see themselves as the keepers of the keys to “bending the cost curve” in health care. They think they can treat people more efficiently and cost effectively in the hospital, and already have protocols in place to reduce readmissions (which Medicare is demanding).

SHM’s own blog coverage of its meeting noted that Dr. Larry Wellikson, the society’s CEO, described the field as “the rocketship moving upward almost to a limitless future.”

But how much of a future is there in treating inpatients if the oft-stated goal of health reform is to keep people out of the hospital? If Americans continue their slothful ways, it’s entirely possible hospitalists will have a wealth of ongoing business, at least for the current crop of physicians.

Where do you think hospital medicine is headed?

— Alicia Ault (on Twitter @aliciaault)

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Filed under health reform, Hospital and Critical Care Medicine, IMNG, Practice Trends, Uncategorized

Firing physicians?

The Society of Hospital Medicine (www.hospitalmedicine.org) closed its annual meeting with a bang, with hospital medicine rock star Dr. Robert Wachter, calling for balance between individual physician accountability and the no-blame culture that has dominated the patient safety field until recently.

The outside world sees physicians as “circling the wagons” and “not willing to ask the hard questions and take the hard action,” he said. “I think they’re actually completely right.”

The no-blame culture arose from a seminal paper, “The Wrong Patient,” reported in 2002 that examined a patient who was mistaken taken for another patient’s invasive cardiac procedure. A root cause analysis identified 17 distinct errors, no single one of which could have caused the adverse event by itself. The interpretation of this and other cases like it was that the system was at fault and that blame is inappropriate and distracting.

But much has transpired since 2002.

“What’s changed is the recognition that our system produces low quality, unsafe, unreliable care, partly because there’s been no incentive to do any thing other than professionalism, which we’ve come to recognize is too weak an incentive to get systems to completely transform the way they do their work…,” Dr. Wachter said.

Individual physicians have been somewhat insulated from the pressures of accountability because hospitals – by their very size and capacity for data handling – are more likely to end up in the cross hairs of governing agencies, media and patients. Consider the popularity of Web sites like Hospital Compares  and Dr. Wachter’s favorite.

Hospitalists however, may find themselves the target of hospital accountability, he suggests, because they draw most of their dollars from hospitals and have positioned themselves as the quality and safety leaders. “Who are hospitals going to pressure? Neurosurgeons” who bring in thousands of dollars?, he asked.

Still, Dr. Wachter sees this as an opportunity for hospitalists to ultimately change the nature of the way care is delivered in hospitals through leadership and the creation of new quality and safety systems that reduce errors and improve quality. No less than 400 papers detailing such efforts were submitted to SHM 2009 alone.

While there remains a place for withholding blame, the new thinking is that there should be a clear demarcation of blameworthy acts, he said.

“There are firing offenses in every safe industry,” he said. “They mostly are no blame; they want to encourage people to speak up, but they have certain lines that are quite clear that require real action. We have not done that and I think we have to change that.”

-By Patrice Wendling

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Filed under Hospital and Critical Care Medicine

The Untimely Death of Mr. Wiener

With New York reporting its first swine flu death this weekend, the nation’s attention is once again focused on the 2009-H1N1 influenza outbreak that began in April. The May 17 death of New York City public school assistant principal Mitchell Wiener of complications of H1N1 influenza occurred as Japan announced it is closing more than 1,000 schools and kindergartens in response to a rising number of cases there.

As of May 17, 39 countries have officially reported 8,480 cases of influenza A H1N1 infection, according to the World Health Organization. Case numbers dominate media reports about the influenza outbreak, but the CDC’s focus on patterns of transmission may be more germane to a global pandemic.

Speaking at the annual meeting of the Society of Hospital Medicine, Dr. James Pile noted that the mother of all influenza outbreaks – the 1918 Spanish influenza pandemic – had three distinct peaks with periods of relative inactivity in between. Samples have been retrieved from some victims of that pandemic, but it remains unknown if the virus changed or was the same throughout the three waves.

Yet Dr. Pile, a hospitalist and infectious diseases specialist with MetroHealth Medical Center in Cleveland, spoke to fewer than 30 attendees in a grand ballroom at a sold-out meeting of more than 2,000 physicians. The other competing sessions scheduled for the same time at the meeting were far better attended.

Has the 2009-H1N1 2009 flu become yesterday’s news? Are physicians burned out about a now quieting (at least for now) epidemic? Just two weeks earlier, an overflow crowd filled the same Hyatt Regency in Chicago for an influenza session at the American Geriatrics Society. At both meetings, drug companies handed out antibacterial gel in the exhibition hall, but the bottles of hand gel dotting the registration desk were now missing, as were the odd face masks present among the geriatricians.

The hospitalist panel said that this could be just the initial spike of the epidemic; if so, a second, third and fourth spike could overwhelm the health care system. Given this possible scenario, Dr. Jennifer Hanrahan, also with MetroHealth, advised hospitalists to get the H1N1 vaccine as soon as it becomes available. Healthcare workers are a vehicle for the virus and owe it to their patients to be healthy in the event of an outbreak. She acknowledged concerns about the risk of Guillain-Barre syndrome associated with the vaccine, but noted “influenza can cause Guillain-Barre as well.”

— By Patrice Wendling and Mary Jo Dales
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Filed under Hospital and Critical Care Medicine, Infectious Diseases, Uncategorized