Archive for February 2014

Length of Stay Trending Up: What Next? – Part I

by Dr. Arun Mohan MD, MBA Do the math and it’s easy to understand why hospital medicine grew so quickly.  Multiply the 14-17% reduction in length of stay achieved by hospitalists by the number of admissions a hospitalist does annually and the value proposition becomes clear.  However hospitals continue to look for opportunities to improve efficiency  as cost pressures change, and they often turn to hospitalists to help them figure it out.  So what can hospitals do? As a matter of background, length of stay is important to hospitals for a combination of clinical and, of course, financial reasons.  Clinically, there is a large body of evidence which demonstrates an association between adverse events and length of stay.  It’s hard to know whether complications lead to long lengths of stay or vice versa, but we all know that bad things can happen in the hospital and that more is not…

Why SHM won’t be saying “allied health” anymore

by Brendon Shank
Imagine for a second that, instead of being defined by what you are at work, you were defined by what you aren’t. What if hospitalists were called “non-executive caregivers” or “non-janitorial staff?” Confusing, at best. And potentially even demeaning, depending on the context. That’s what happens to lots of nurse practitioners, physician assistants, pharmacists and other valuable members of the hospital care team all the time. Instead of being called by the titles that they’ve worked hard to earn, some in the hospital use terms that define them by what they aren’t, like “non-physician provider,” “allied health provider,” “physician extender,” or “mid-level.” More to the point, nurse practitioners, physician assistants and pharmacists are a critical part of the hospitalist teams that work to deliver exceptional care to hospitalized patients. This is not a fringe issue. Today, nearly 800 SHM members identify themselves as NPs, PAs, pharmacists, pharmacy technicians, registered nurses,…
Brendon Shank is the Associate Vice President of the Society of Hospital Medicine and is a member of the PRSA Health Academy Executive Committee. You can find him on Twitter, @BShank.

Pull off the BAND-AID

I walked into the office slowly.  It was my third year med school clerkship, I had learned a lot about basic outpatient medicine, prevention, focused exams, and seeing the joy in building relationships with patients.  However one of the most important lessons I had yet to learn. A middle-aged man sat in the exam room with shoulder pain.  He didn't have much in the way of other medical problems, so I honed in on the shoulder.  I practiced all my maneuvers from my physical diagnosis course: empty beer can, range of motion, compare and contrast to the other shoulder. I didn’t find much of anything.  So I started to walk out the room to discuss with my attending.  I grabbed the door handle, then turned around and I asked him, "Oh, by the way, what's with the BAND-AID over your eye?" One of my favorite parables is from the book…

Two Worlds

by Varun Verma, MD Anyone who has worked in Haiti quickly realizes that injustice abounds. I had rushed into the cramped curtained off area and found the pregnant woman with her eyes rolled back to 2-o'clock. She was not responding. Even when I yelled to wake her or when I rubbed her chest forcefully with a clenched fist, she lay silently drenched in her sweat.  Moments later though, she started shaking, and her head, chest and arms lifted up violently off the bed repeatedly as she seized.  A nurse tried valiantly to re-check the blood pressure (the first reading had been 70/40).  When I asked what had happened, one of two foreigners (apparently midwives) standing in the labor and delivery area shrugged and casually informed me that the patient had been seizing for an hour.  An hour?  I told the nurse to drop the BP cuff and draw up 1000…

If You Are Not at the Table, You Are on the Menu

Many years ago with those words, an older and much wiser colleague added to my education, encouraging me to take time away from my day-to-day practice of clinical medicine and get involved with the affairs of my hospital and the medical staff.  It was sage advice and I’ve used it many times to help force me out of my comfort zone as my career has evolved. The Society of Hospital Medicine (SHM) has followed the same philosophy, as it has demanded a prominent seat on the stage of the policy debates that ran up to the passage of the Affordable Care Act (ACA), and as the implementation phase has ensued.  It has paid off to a surprising extent as SHM has turned the energy of our members into positive changes helping shape the healthcare system of the future. Nowhere will this energy and commitment to advocacy be on display more…
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