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Patients confused about NPs and PAs practicing in hospitalist programs

nurse-with-medicineAnecdotal evidence and some studies show that patients who are treated by nurse practitioners (NP) and physician assistants (PA) are satisfied with their care—but do they really understand the relationship  NPs and PAs have with the hospital or hospitalist service? For that matter, do they really understand the roles NPs and PAs play in their care?

Laura Rosenthal, MSN, ACNP, director of nurse practitioners in the hospitalist medicine service at the University of Colorado Health Sciences Center, has encountered more than a few patients who, after several days in the hospital, report to her that they haven’t seen a physician yet. “I explain that I am their care provider, but if they would like to see an attending physician, I’d be happy to arrange for one to stop by.”


Rankings of best hospitals released

U.S. News & World Report released its annual “America’s Best Hospitals” list last week. Among these “Honor Roll” hospitals, the top 21 feature hospitalist programs, according to the Society of Hospital Medicine Web site.

The top listings were selected from 4,861 hospitals, ranked in 16 specialties. Of those, 174 hospitals, or less than 0.4% of the total considered hospitals, made the final list, with Johns Hopkins Hospital in Baltimore taking the top spot.  

The rankings were based on “how well a hospital handles complex and demanding situations,” according to U.S. News & World Report. The factors included reputation, mortality index, patient safety, and other care-related factors, such as nurse staffing levels and available technology.

Half of PCPs think hospital medicine improves quality

Only half of primary care physicians (PCPs) feel that the presence of hospitalists improves the quality of care, according to an AMA-OMSS and the Society of Hospital Medicine a national survey recently released.

This year, 46% of PCPs agree that hospitalists improve overall care, rising from 40% the year before, as reported by the AMA eVoice Weekly Newsletter on July 10.

Not surprisingly, more than 90% of hospitalists believe their presence does improve care. However, both groups concur that better hospitalist-PCP communication is needed.

“Both primary care physicians and hospitalists want organizations such as the AMA-OMSS to provide resources to improve communication between hospitalists and primary care physicians as well as related resources and educational materials for both groups to more effectively care for patients,” stated the AMA newsletter.

A contrarian view of hospital medicine

By Richard Rohr, MD, MMM, FACP, FHM

I wrote several months ago about the necessity of hospital medicine. While I still think that hospitalists occupy a vital niche in the healthcare system, let’s consider a perspective that generally has not been expressed.

One of the reasons why hospitalists have become necessary is that hospitals have become unmanageable places for doctors to practice. When I finished training in 1985 and joined the medical staffs at several small hospitals, I was greeted by a vice president in each of those institutions. Each VP asked the same questions: “What can we do for you?” and “Can we buy any equipment for you?” Utilization review was rudimentary in those days; formulary controls were few and far between; and there were not many computers in nursing stations. Doctors did pretty much want they wanted to do when they wanted to do it, and hospitals catered to their whims.

Free form: Greeley Medical Staff Institute Symposium introduction letter

We know that travel and education budgets are often the first to get cut during harsh financial times such as these, but we repeatedly hear from our valued customers that need for training and education has never been greater. Hospitals are facing formidable challenges and need contemporary tools to overcome them—and that’s where the Greeley Medical Staff Institute Symposium comes in.

HCPro, Inc., and The Greeley Company have teamed up to create the Greeley Medical Staff Institute Symposium, November 8-9 at the Ritz Carlton in Naples, FL to provide you with the tools and training you need to maintain a successful organization. During the symposium, you’ll have the opportunity to:

  • Develop an ROI strategy for your hospitalist program
  • Assess the value of implementing a surgical hospitalist program
  • Understand and improve publicly reported quality data
  • Organize an efficient and successful peer review process
  • Identify the effect of PSO protections on your peer review process
  • Prepare for the changes healthcare reform will require of physicians and hospitals
  • Identify and prioritize physician economic alignment opportunities
  • Design a strategy for managing conflicts of interest

To help you get the funding you need to attend this dynamic learning event, we’ve developed a letter template that you can customize and present to your manager or leader outlining how important your participation is. We hope this is a useful tool for you.

Download the Greeley Medical Staff Institute Symposium introduction letter here.

Don’t forget, there’s still time to enter to win two FREE registrations on our contest.

For the latest related news and updates on the conference, click on the tag “Greeley Medical Staff Institute Symposium.

Hospital Compare releases readmission rates

Adding more clinical data to the public reporting Web site, HospitalCompare, the Hospital Quality Alliance (HQA) last week released readmission rates for hospitalized Medicare patients. The Web site features data of patients with heart attack, heart failure, and pneumonia who return to the hospital within 30 days of discharge.

“Until now, hospitals have had only information on those patients who return to their own hospital, but not about patients who were readmitted to a different hospital,” according to a July 9 press release from the HQA. “The information on Hospital Compare shows how often a Medicare patient with one of these conditions returns to the same hospital or a different hospital within 30 days following their initial stay.”

The Web site compares a hospital’s readmission rate as “better, worse, or no different” than the national rate in the U.S.

With the goal to reduce nationwide readmissions, HospitalCompare features standardized measures of more than 4,000 hospitals, according to the statement.

Among HQA member organizations are The Joint Commission, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, U.S. Chamber of Commerce, and the American Hospital Association.

[via Patient Safety Monitor Blog]

Pediatric hospitalists can help cut down on medication errors

A multidisciplinary team that includes a pediatric hospitalist can help reduce adverse drug events in patients, according to “A Multidisciplinary Approach to Adverse Drug Events in Pediatric Trauma Patients in an Adult Trauma Center,” published in the June issue of Pediatric Emergency Care.

Researchers at the Christiana Care Hospital and Health Care System, in Newark, DE, developed a team that consisted of the following providers:

  • Pediatric hospitalist
  • Pediatric care coordinator
  • Pediatric nurse
  • Pharmacist
  • Trauma service

This team collectively decided medication for patients and set up a system for reporting errors. Out of the 259 pediatric trauma patients, the researchers found that the team approach:

  • Reduced medication prescribing errors
  • Reduced medication administration errors
  • Improved weight documentation

“Instituting a multidisciplinary approach to pediatric trauma patient care is practical and can significantly decrease adverse medication events,” states the study's abstract.

How to figure out the right number of hospitalists

calculator-13Initially, many primary care physicians (PCPs) resisted having a hospital-based physician care for their patients because of concerns about discontinuity in patient care and lower patient and family satisfaction. However, since then, proponents of the hospitalist model cite two major benefits: increased quality of care and greater efficiency.

Many hospitals now want to know how many hospitalists they need. One approach is to calculate hospitalist need as a percentage of adult primary care need. Many hospitals determine the need for PCPs by geographic subarea by dividing their primary or primary and secondary service area into directional subsets (e.g., southeast, northeast, central, or west). Other hospitals define a smaller core service area in the immediate vicinity and a set of surrounding subareas that complete its primary or primary and secondary service area. However it is defined, the hospital’s effective service population for primary care in each geographic subarea is determined solely by its market share in the subarea.


Hospitalists’ prescribing habits call for better communication with PCPs

pharmacyAccording to the June 2009 issue of Today’s Hospitalist, hospitalists write 44 prescriptions during an average 11-hour shift, which means one prescription every 15 minutes. Hospitalists change about 30% of patients’ existing prescriptions.  That’s a lot of prescriptions—and a lot of opportunity for risk.

The Today’s Hospitalist survey also asked hospitalists how they enhance patients’ compliance with their prescription regimen. On average, hospitalists use between four and five methods to help patients comply, including educating patients on their medical condition (96%), clearly explaining instructions (88.4%), asking patients if they understand the instructions (76.1%), writing down instructions for patients (75.4%), providing the patient with educational material (73.4%), and following up with patients (36.2%).


Enter to win free registration to the Greeley Medical Staff Institute Symposium


We know budgets are tight. In an effort to make the upcoming Greeley Medical Staff Institute Symposium (November 8-9, 2009, Naples, FL) more accessible to everyone, we will hold a drawing each month for two FREE registrations to the symposium!

Each month, we will waive the registration fee of $1,095 for the winner and one of his or her colleagues. So, what’s the catch? To enter into the drawing, please submit a short description of something–a form or tool you’ve found particularly helpful, or a best practice from you or your program–that streamlines medical staff office tasks, improves return on investment, or raises the quality of patient care.

The drawings will take place on the 30th of every month until the live seminar (July 30, August 30, Sept. 30, and Oct. 30). Keep in mind that winners will have to pay for airfare and hotel, but not the registration fee. Those who have already registered for the conference are not eligible to win.

E-mail your contribution to me at Responses and winners will be posted on the Blog. You can get the latest news, updates, and contest winners on the conference by clicking on the tag, “Greeley Medical Staff Institute Symposium.”

Looking forward to seeing you in Naples!

Karen M. Cheung
Associate Editor, Medical Staff
HCPro, Inc.

Don’t pull that plug! EMRs are here to stay

wmn-computer-bookHospitals in Arizona are pulling the plug on their EMR contracts after fervently trying for several years to comply with former governor Janet Napolitano’s executive order that all hospitals adopt EMRs by 2010, according to Healthcare IT News. Difficulties implementing electronic systems, as well as lack of funding and training, are to blame for this growing trend.

But President Obama seems determined to include EMR in his ever-evolving plan to resuscitate healthcare, so are these hospitals pulling the plug too soon? Granted, an EMR isn’t going to do you any good if you can’t afford it or launch it, or if you staff doesn’t know how to use it properly, but it is the way of the future, and you can’t just walk away from it.

Perhaps before anyone decrees that EMR is a must-have in healthcare, regulators should recruit and release a SWAT team of EMR experts—the healthcare Geek Squad, if you will—to ensure proper implementation. I mean, you wouldn’t go sky diving without first purchasing the right equipment and taking a few lessons, and you’d never go alone, would you?

What makes a successful hospitalist-run short stay?

Diagnostic tests and consultative services are the most important indicators for successful short-stay units, according to “A Hospitalist-Run Short-Stay Unit: Features that Predict Length of Stay and Eventual Admission to Traditional Inpatient Services,” published in the May issue of the Journal of Hospital Medicine.

Right now,one-third of U.S. hospitals use short-stay units, which are typically located next to emergency departments to observe low-risk chest pain patients, for example. Today, short-stay units provide more complex inpatient services, according to researchers at Stroger Hospital of Cook County and Rush Medical College, both in Chicago.

The researchers considered a short stay successful if patients stayed at the hospital less than three days (72 hours) and didn't require admission to the traditional inpatient service. Unsuccessful stays were due to inaccessibility of diagnostic tests and the need for specialty consultation. The study indicates that hospitalists should promote access to these services.