Research

Rounds: Are We Spinning our Wheels?

As a Johns Hopkins undergraduate, I used to run the Welch lecture series in medical history. Through this role, I learned about an interesting tidbit – the origin of the word “rounds.” Johns Hopkins Hospital had a circular ward where the infamous and quotable Dr. Osler made his “rounds” to see patients. While medicine has come a long way since Osler’s days, have rounds? This is the crux of a paper in the Journal of Hospital Medicine by led one of our former Pritzker students Olliver Hulland along with mentors and hospitalists Dr. Jeanne Farnan and Dr. Barrett Fromme. In a 3-site study with UCSF and Georgetown, they conducted focus groups with attendings and medical students to ask the quintessential question, “What is the purpose of rounds?” Interestingly, the answers were markedly similar and revealed the multi-faceted nature of rounds: Communication, which included coordination of patient care team, patient/family communication,…

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…

How Do We Keep Our Providers Safe?

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 authored by Tracy Cardin is the first of two. The second from Danielle Scheurer will publish next Thursday, August 31. In the last three weeks while on clinical service, the police had to be called twice for incidents involving my patients. One involved a patient threatening me and a nurse with physical violence outside of the hospital, and the second included a patient hitting a nurse in the face. She was saved from more serious injury, simply because she fell backwards just as the punch landed. This was just in my panel of patients. Lest you think maybe I need some training on interacting with patients, another patient threw a full cup of coffee, then the cup, at an attending physician. Another patient had…

Is It Time for Health Policy M&Ms?

[caption id="attachment_16917" align="alignnone" width="609"] https://twitter.com/ChrisMoriates/status/890259986873450508[/caption] There are few experiences in my medical training that felt more intimidating, and ultimately more impactful, than our Mortality and Morbidity (M&M) conferences. The patients whose diagnoses I missed. The times I should have called my attending or pushed harder for the cardiologist to come in overnight. They stick with me and I believe ultimately have helped make me a better doctor. This is why I was intrigued by the idea of explicitly incorporating health policy issues into M&M. Over the past few years, I increasingly have seen adverse events that result from issues related to health policy. Inability to access care for appropriate hospital follow-up. Failure to fill a critical prescription due to cost or gaps in coverage. A patient I admitted for “expedited work-up” for rectal bleeding after he told me he had been trying to get a recommended colonoscopy for many months…

We Are Not Done Changing

Recently, the on-line version of JAMA published an original investigation entitled "Patient Mortality During Unannounced Accreditation Surveys at US Hospitals". The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care. The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks, a 5.9% relative decrease. The positive effects of being monitored have been well documented in all kinds of arenas, such as hand washing and antibiotic stewardship. But mortality? This is an interesting outcome, especially considering a recent ordeal I went through with my dear sister-in-law. She was on vacation in a somewhat remote location and suffers from a chronic illness, which requires her to…