Effectiveness/Efficiency

We Have a Voice. It’s Time We Use It. #DoctorsSpeakOut

Recently, there have been many times when you may have gotten a news alert on your phone or checked the latest Twitter hashtag and wanted to scream. Or you were too busy to even check until later that day and did not know what to say other than to lurk and watch a trainwreck in progress. You may have thought about saying something, but paused and wondered, “Is this professional? What will this say about me as a doctor? What would my colleagues/supervisors think? What would my patients think?” You are not alone. I get stopped, emailed, and messaged frequently by others wondering if they should enter the fray. Something interesting happened with the recent Repeal and Replace or Repeal and Delay or Repeal and whatever roller coaster: Doctors did speak up! One group that was truly impressive was the pediatricians on Twitter, known as “tweetiatricians” who all recorded short…

Why 7 On/7 Off Doesn’t Meet the Needs of Long-Stay Hospital Patients

by Lauren Doctoroff, MD
By: Lauren Doctoroff, MD Much has been written about the loss of the perspective of the primary care doctor for hospitalized patients and the impact on their hospitalization. However, few have reflected on the challenges posed by the 7 on/7 off hospitalist schedule for complicated long-stay patients. I have been a hospitalist for more than 10 years, and, for the past 3, I have been responsible for a complex patient strategy for my hospital. Having looked at the charts of hundreds of patients with long and complicated hospital stays, it is clear that there is an incompatibility between the on again/off again hospitalist schedule and the needs of these patients. With frequently changing providers, patients suffer not only from their own medical fluctuations, but also the changing plans of their providers. These are not the patients awaiting guardianship or insurance to allow for an adequate discharge plan. These are the…
Dr. Lauren Doctoroff is a hospitalist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. She completed medical school at the University of California at San Francisco in 2003, and a primary care internal medicine internship and residency at Massachusetts General Hospital in 2006. Her clinical responsibilities include hospitalist work on a teaching and a non-teaching service at the BIDMC. In addition, she was the founding medical director of the Healthcare Associates Post Discharge Clinic, a hospitalist-staffed, primary care-based post hospitalization clinic from 2009-2015. She also serves as the medical director of the PACT Transitional Care Program. As of 2015, she serves as the Medical Director for Utilization Management for the BIDMC, and chairs the Utilization Review Committee, and leads multiple initiatives on hospital utilization. She is a fellow of the Society of Hospital Medicine and serves on the SHM Public Policy Committee. She is an Assistant Professor at Harvard Medical School. Her academic interests include transitions in care and post discharge care, as well as hospital utilization particularly among patients with prolonged stays. She has published on post discharge care and outlier patients and has spoken locally and nationally on topics of transitions of care and post discharge care.

You Have Lowered Length of Stay. Congratulations. You’re Fired.

For several decades, providers working within hospitals have had incentives to reduce stay durations and keep patient flow tip-top. DRG-based and capitated payments expedited that shift. Accompanying the change, physicians became more aware of the potential repercussions of sicker and quicker discharges. They began to monitor their care and as best as possible, use what measures they could ascertain as a proxy for quality (readmissions and hospital acquired conditions). Providers balanced the harms of a continued stay over the benefits of added days, not to mention the need for cost savings. However, the narrow focus on the hospital stay, the first three to seven days of illness, distracted us from the out weeks after discharge. With the acceleration of inpatient episodes, we cast patients to post-acute settings unprepared for the hardship they would face. By the latter, I mean, frailty risk, more reliance on others for help, and a greater need…

George Carlin Predicts Hospital Planning Strategy

My wife and I are planning to add square footage to our house. We want more space. We are considering an office expansion, a guest room, and making the master bedroom more master and less bedroom. The kids are growing, the family is always visiting, and we have no plans to relocate. We also need more space for our stuff. "Everybody's gotta have a little place for their stuff. That's all life is about.  Trying to find a place for your stuff." — George Carlin We added a shed, stuffed the closets, and overloaded the garage. How did we get so much stuff? The average US household has 300,000 things in it. In addition, houses in the US have tripled in size since the 1950s, yet fewer people live inside these homes. We're one of the 25% of American households that have a two-car garage but don't put both cars in there.…

A New Face For Online Modules

It is hard for me to get excited by online modules. Perhaps my reflex repulsion stems from my experience – ok, experiences – completing online traffic school courses. Those timers forcing you to stay on a page for a specific amount of time. The quizzes that might not actually teach you anything. Maybe you are a more cautious driver than I am, but if so, just think of the last time you had to complete a mandatory online module for your hospital. I doubt it gripped your attention. The future of education may increasingly be online, but I am unconvinced that mandatory online modules are a format that will change the world. This is why I have spent so much time working with innovative teams to develop interactive learning modules that do not feel like online modules. Vinny Arora and I recently described on this blog our Costs of Care…
12345...102030...