Posts by Guest Post

The Strange Case of Dr. Jekyll and Mr. Hyde

by Frank Zadravecz, MPH This story intrigues me, not so much its time-tested message on good versus evil, rather strangely its reflections on scientific inquiry. Robert Louis Stevenson paints the character Dr. Hastie Lanyon as a man committed to deductive reasoning and logic, conveniently the antithesis of Dr. Jekyll. After Lanyon witnesses Jekyll’s transformation from the grotesque Mr. Hyde, he makes this honest comment about pursuing knowledge: “I sometimes think if we knew all, we should be more glad to get away.” Medicine challenges us to become physician-scientists along the life course of our study, but at times this duality feels unwieldy, similar to a rewrite where Jekyll, M.D. became Hyde, Ph.D. Our research findings may make perfect sense scientifically yet seem impossible to implement clinically. Our long held teachings might make for seamless clinical workflow yet lack the support of cruel, hard data. Physician-science tries to know the “all”…

Wake Up! How Hospital Noise Is Preventing Sleep & Recovery

by Monica Shah When I first stepped onto patient floors, I noticed the amount of commotion, from alarms beeping to staff conversations to loud knocks on patient doors. I couldn’t help but think, I wish I had some ear plugs! That was when it hit me that if I was feeling jolted just by visiting patient floors, what were patients thinking, especially those trying to sleep through this chaos? What impact does this commotion have on patient outcomes and their recoveries? I am excited that I am going to find out that answer through my research project at the University of Chicago Hospital investigating sleep and functional recovery for older patients during hospital stay and post discharge. This study uses a variety of initial evaluation sleep surveys to look at patient’s sleep quality over the past month. We then do daily follow ups to assess patient’s sleep quality each night…

Meet The Villain of Hospital Costs: The Chargemaster

by Christopher Moriates, MD Author of Understanding Value-Based Healthcare* The hospital chargemaster has become nearly a household term, following its turn as the villain in highly publicized features in Time magazine, The New York Times, and the The Daily Show. Nobody seems to like the chargemaster. But what exactly is it and how does it relate to hospital costs? The first step is to understand basic hospital accounting terms including “costs,” “charges,” “prices,” and “reimbursement”: [caption id="attachment_12969" align="aligncenter" width="980"] Figure from: Moriates, Arora, Shah. Understanding Value-Based Healthcare. New York, New York: Mcgraw-Hill, 2015.[/caption] The chargemaster (also known as the charge description master or “CDM”) is the list of charges for the tens of thousands of billable items at a given hospital – sort of like a menu at a restaurant, but one that is very long and includes reams of inscrutable acronyms and abbreviations. The chargemaster contains the itemized charge…

Reimagining the Sounds of the Hospital: Theory to Practice

By Mimi Zander During my undergraduate studies at Rutgers University, I studied English, women's and gender studies, and literary theory. As part of The Institute for Women's Leadership Scholars Program, during class discussions, we would circle back to the idea of bridging theory and practice. The first step is identifying the problem. The next step is to discuss, research, and theorize about the problem. Finally, we need to leave our safe academic bubble and enact the solutions that we colorfully described to each other and our professors. I am finding this framework to be enormously helpful in unpacking the work I am doing at The Children's Hospital of Philadelphia (CHOP) as part of the Society of Hospital Medicine's Student Scholars program. My work at CHOP tackles step one and two in a scientifically rigorous way: identify alarm fatigue in our hospital and determine how it occurs on our floors. What…

What’s Wrong with Our “Big Data” on the Wards?

by Frank Zadravecz, MPH Across industries, Big Data is widely believed to offer a higher form of intelligence and knowledge that can generate insights that were previously impossible. However, the current cacophony of patient alarms we experience on the wards is not as informative for medical providers as we would hope. Are these alarms adding noise to otherwise informative Big Data? In the June 2015 issue of The Hospitalist, Karen Appold highlights the unique position that hospitalists hold in the fight against the overwhelming number of alarms generated by patient bedside monitors. In an interview with Ms. Appold, Vladmir Cadet of the ECRI Institute frames alarm load in the context of our current healthcare system, and suggests that alarm fatigue has become an enterprise-wide issue potentially due to sector-wide implementation of error-prone systems. The presence of non-specific alarm settings on our wards hints that alarm mismanagement may be rooted deeper…
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