Quality Improvement (QI)

How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)

Dont Compare HM Group Part B Costs Hospital to Hospital. It’s About the Variation Between Individuals.

I have been and will be light on the blogging these days.  However, a new JAMA online first study out looking at hospitalist Part B cost variation deserves some attention.  Bestill my heart.  It's not about groups.  It's about individual physicians.  The gap between high- and low-spending doctors in the same hospital was larger than the gap in spending between hospitals. From the editorial: In this issue, Tsugawa et al3 analyze spending by individual physicians in relation to patient outcomes. The research team compared Medicare Part B spending per hospitalization by hospitalists practicing within the same hospital. To profile each physician’s level of spending, average Part B spending per hospitalization for 2011 and 2012 was used, then applied to clinical outcomes (30-day readmission and 30-day mortality rates) for 2013 and 2014. The split-sample approach mitigates bias if a physician treats a complex set of patients in one year and therefore has…

Is Patient-Centered Care Bad for Resident Education? #JHMChat Explores #meded & #ptexp

The term “patient-centered” has become a healthcare buzzword and was certainly popularized by the creation of the patient-centered medical home in ambulatory care. In the inpatient world, patient-centered rounds symbolizes this effort to improve patient experience and is the subject of a new study in this month’s Journal of Hospital Medicine, which we'll discuss on next Monday's #JHMChat at 9 p.m. EST on Twitter. In a randomized trial, Brad Monash and UCSF colleagues explored the impact of patient-centered rounds on patient experience. Patient-centered rounds was a bundle of 5 evidence-based practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; and 5) whiteboard updates. The control group continued with routine practice of attending rounds. The study was impressive for several reasons, but one in particular caught my attention – an army of 30 pre-med students volunteered to be observers (and also get shadowing experience?) to monitor…

Should Resource Overutilization Be Considered an Adverse Event?

We have all seen the Choosing Wisely lists and the new “Things We Do for No Reason” section in the Journal of Hospital Medicine. We have heard a lot about common areas of overuse in hospitals. Sure, there have been some success stories of hospitalists leading projects to decrease an area of overuse, but when you get down to it, have we really done much to not just recognize overuse but to actually decrease it? Think about the patient safety movement over the last two decades. Telling horrifying stories of wrong-limb surgeries may have caught headlines, but that did not do much to stop the problem from still happening. The medical world had to shift our thinking from one of individual blame to recognizing the role of systems and environments in creating these problems. We had to put structures in place, such as safety review committees and mandated processes for…

A GIF Is Worth 3000 Words: Introducing #VisualAbstract for #JHMChat

by Charlie M. Wray, DO, MS
If you’re like most hospitalists, your day usually starts around dawn (or dusk, for our nocturnal colleagues). After arriving at the hospital and quickly receiving sign out on your patients, you down the last bit of coffee and rush off to spend a morning on the wards. As you’re getting into a rhythm, the charge nurse on 3C grabs you as you walk by and lets you know that Mr. Sanchez’s son arrived and would like an update. BEEP. BEEP. BEEP: “Mrs. Jones wants to know when she can eat.” Just as you head her way, the cardiology fellow sees you and wants to discuss the follow-up plan on Mr. Aldridge… By 3PM, you’ve grabbed a quick bite to eat, and you’re likely leading the Patient Safety Committee meeting (while still fielding intermittent pages, of course). By early evening, you’re placing a few last minute orders and putting out small…
Charlie M. Wray, DO, MS is an Assistant Professor of Medicine at the University of California, Francisco and the San Francisco VA Medical Center. He completed medical school at Western University – College of Osteopathic Medicine, residency at Loma Linda University Medical Center, and a Hospital Medicine Research Fellowship at The University of Chicago. Dr. Wray’s research interests are focused on inpatient care transitions, care fragmentation in the hospital setting, and overutilization of hospital resources. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Dr. Wray can often be found tweeting under @WrayCharles.
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