HM14 – Annual Meeting

Length of Stay Trending Up: What Next? Part II

by Dr. Arun Mohan MD, MBA In my last post, I described substantial geographic variation in length of stay. Although it’s not exactly clear what explains the differences, here are 5 key principles that hospitalists should keep in mind: 1)    Specialization is important.  Research from multiple industries demonstrates that focusing on doing a few things well allows organizations to deliver better outcomes at lower costs. Organizations with narrow focus can build more dedicated facilities, develop more expertise, more effectively standardize care, and learn more quickly. At the hospital level, this may include building centers of excellence or focusing on certain service lines.  At the unit level, this might mean developing units for a given condition or type of patient (e.g. elderly). And at the physician-level, this might mean having hospitalists who are focused on certain conditions. 2)    Workload can effect efficiency.  Studies show that high nurse to patient ratios are…

Dr. Howell’s Quest

Who remembers this? That is 3rd year medical student Lesley Sutherland from the University of Maryland on stage at HM13 last May in Washington, DC being inducted into SHM by Eric Howell, SHM President (and Lesley's brother).  If you recall, just prior to calling Lesley to the stage, Dr Howell told us what he wanted to see in the next year of his presidency more efforts at attracting students and residents to the rolls of SHM.  His goal was to try and reach 1000 total learner members by HM 2014 in Las Vegas, effectively doubling the current representation. His goal was even more audacious because HM 14 was only 10 months away! I was curious as to how his quest was going, so I called him up and here is what I learned. Well to start off the numbers are looking good.  With 9 months since the challenge, we are…

A Hall Bed and a 2 Day Coma

by Jeffrey Frank, MD, MBA Last month, my perfectly healthy 43 year old cousin John D. suffered an adverse hospital event which nearly killed him. Unfortunately his story is a common occurrence of which we witness on a regular basis, work hard to prevent, and thankful when it does not happen to our patients (or family). John’s story starts with the death of his cancer ridden dog of 14 years. After several months of an intense grief reaction, he sought help, was placed on an antidepressant, and then started a rigorous workout regimen. John went to the ED c/o palpitations. He had the usual ED work-up and was going to be admitted for observation. He was started on IV fluids, and given two doses of IV lorazapam for anxiety. The resident agreed to see him when he arrived on the telemetry unit, the usual hand-off for admissions, and John was…

Skills of the Future Hospitalist

by Paul Stander, MD, MBA, FACP I recently completed my 21st year as a hospital CMO at Banner Good Samaritan Medical Center in Phoenix, AZ.  Of course when I first started, there was no Banner Health; we were called Samaritan Health System then.  There was also no such things as a hospitalist at my institution and my main role was to get the medical staff to be more “cost-effective” – in other words, “control” utilization.    Amazingly, I survived all that and, although I have no data to back this up, I’d venture to say that I’m one of the longest-tenured chief medical officers in the country. These are roles that can really take their toll and most (sane) individuals move on to something different well before they get to where I am.  Having said that, I’ve truly enjoyed my time as a CMO and of course I have seen dramatic…

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…