Posts by Danielle Scheurer

Do Hospitalists Improve Inpatient Outcomes?

Long continues the debate of what impact hospitalists have on inpatient outcomes. This issue has been playing out in the medical literature for 20 years, since the coining of the term in 1997. In the most recent iteration of the debate, a study was recently published in JAMA Internal Medicine entitled “Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists”. The study retrospectively evaluated healthcare resources and outcomes from over a half million Medicare beneficiaries hospitalized in 2013 for 20 common DRGs, by type of physician provider (hospitalist, their primary care physician, or other generalist). The study found that non-hospitalists used more consultations and had longer lengths of stays compared to hospitalists. In addition, relative to hospitalists, PCPs were more likely to discharge patients to home, had similar readmission rates, and lower 30-day mortality rates; but generalists were less likely to discharge patients home,…

When It Comes to Healthcare Violence, Silence Isn’t an Option

Editor’s note: As the topic of violence in healthcare has become a hot topic, The Hospital Leader is offering perspectives from two of our expert bloggers. This piece is the second of two; to view the first blog post from Tracy Cardin, click here.  Our health system recently started reporting the number of workplace violence occurrences on our daily safety call. Before now, most of us had no idea how incredibly common these events were within our walls! It reminded me of an event I experienced a few years ago, while rounding on a young male patient who had significant issues with chronic pain and opioid abuse. While discussing his pain regimen in his room one day on rounds, he became extremely agitated with physically aggressive mannerisms. I quickly realized that not only was I alone in the room, but he was between me and the door. Thankfully, a nurse in the…

Wrongful Life

There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live”, but rather on the “right to die”. These cases have involved patients who received aggressive treatment, despite having documentation of their wishes not to receive such aggressive treatment. Although unsettling, it is not surprising that this issue has arisen, given the national conversations about the exorbitant cost of care at the end of life in the U.S., and the frequency with which patients do not receive end of life care that is concordant with their wishes. These conversations have spurned providers and patients to discuss and document their wishes, via advanced care directives and/or POLST orders (Physicians Orders for Life Sustaining Treatment). There is now even a national day devoted to advanced care decision making (National Healthcare Decisions Day). While these documents are increasingly available for hospitalists…

Overcoming a Continued Physician Shortage

Updated statistics from the Association of American Medical Colleges (AAMC) show that the United States will continue to face a physician shortage over the next decade, ranging from a conservative estimate of a shortfall of approximately 40,000 to a pessimistic estimate of about 105,000 by 2030. The statistics are based on modeling a variety of policy and health care scenarios over the next 10-20 years to determine what the physician workforce requirements will be compared to the expected pipeline. Although the current and projected healthcare landscape is complex, dynamic, and uncertain, every estimate projects a shortage that is significant enough to affect patient care in the United States. The US population is both growing and aging, which creates an ongoing need for hospitalists and hospital-based patient care; between 2015 and 2030, the US population aged 65 and older will increase by 55%. Hospitalist groups will not only be impacted by…

The Impact of Hospital Design on Health – for Patients AND Providers

I was rounding on the inpatient general medicine teaching service last weekend and offered to meet my team of students and residents in the “resident library” on Saturday morning. (Although it holds the name “library,” there were no books or periodicals to be seen.) I had not been in the library for many months and was struck by a few things as I entered. It is a dimly lit space, lined on 3 of the 4 walls with rickety desks and desktop computers all facing the walls. The walls are painted an off-white color with innumerable dings and nicks, presumably accumulated over the course of years. There was a string of garland in the shape of a Christmas tree pinned to the wall (P.S. it is March), the entire left side of which was sagging and misshapen. There were various tattered and coffee-stained papers scattered haphazardly throughout the room, including…
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