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Hospitalist procedures

Jennifer M Oshimura, Benjamin D Bauer, Neha Shah, Eugene Nguyen, Jennifer Maniscalco
OBJECTIVES: Pediatric hospitalists report the need for additional training in clinical and nonclinical domains. Pediatric hospital medicine (PHM) fellowships seek to provide this training and produce leaders in the field. Our objective is to describe current roles and perceived training needs of PHM fellowship graduates. METHODS: In 2014, all PHM fellowship graduates were asked to complete a Web-based survey. Survey questions addressed demographics, past training, current roles, and training needs in clinical care, research, education, and administration...
October 2016: Hospital Pediatrics
Carmen Sulton, Courtney McCracken, Harold K Simon, Kiran Hebbar, Jason Reynolds, Joseph Cravero, Michael Mallory, Pradip Kamat
OBJECTIVES: Dexmedetomidine (DEX) is widely used in pediatric procedural sedation (PPS) by a variety of pediatric subspecialists. The objective of our study was to describe the overall rates of adverse events and serious adverse events (SAEs) when DEX is used by various pediatric subspecialists. METHODS: Patients from the Pediatric Sedation Research Consortium (PSRC) database were retrospectively reviewed and children that received DEX as their primary sedation agent for elective PPS were identified...
September 2016: Hospital Pediatrics
Nilam J Soni, Luis F Reyes, Holly Keyt, Alejandro Arango, Jonathan A Gelfond, Jay I Peters, Stephanie M Levine, Sandra G Adams, Marcos I Restrepo
PURPOSE: The purpose of the study is to evaluate the frequency and barriers to use of ultrasound guidance for central venous catheter (CVC) insertion by physicians specializing in critical care and hospital medicine. MATERIALS AND METHODS: A national cross-sectional electronic survey of intensivists and hospitalists was administered from November 2014 to January 2015. RESULTS: The survey response rate was 5.9% (1013/17 233). Moderate to very frequent use of ultrasound guidance varied by site: internal jugular vein (80%), subclavian vein (31%), and femoral vein (45%)...
July 17, 2016: Journal of Critical Care
Richard S Hoehn, Dennis J Hanseman, Derek Go, Koffi Wima, Alex Chang, Audrey E Ertel, Shimul A Shah, Daniel E Abbott
BACKGROUND: We have previously shown that inferior outcomes at safety-net hospitals are largely dependent on hospital factors. We hypothesized that hospitals providing "high value" care (low cost and better outcomes) would have advantages in human and financial resources. METHODS: The University HealthSystems Consortium Clinical Database and the American Hospital Association Annual Survey were used to examine hospitals performing eight complex surgical procedures from 2009 to 2013...
July 2016: Journal of Surgical Research
Anthony Montuno, Bijou R Hunt, May M Lee
BACKGROUND: The Society of Hospital Medicine has delineated procedures as one of the core competencies for hospitalists. Little is known about whether exposure to a medical procedure service (MPS) impacts the procedural certification rate in internal medicine trainees in a community hospital training program. OBJECTIVE: To determine whether or not exposure to an MPS would impact both the number of procedures performed and the rate of resultant certifications in a community hospital internal medicine training program...
2016: Journal of Community Hospital Internal Medicine Perspectives
Cynthia Kay, Erica M Wozniak, Aniko Szabo, Jeffrey L Jackson
OBJECTIVES: Explore the performance patterns of invasive bedside procedures at an academic medical center, evaluate whether patient characteristics predict referral, and examine procedure outcomes. METHODS: This was a prospective, observational, and retrospective chart review of adults admitted to a general medicine service who had a paracentesis, thoracentesis, or lumbar puncture between February 22, 2013 and February 21, 2014. RESULTS: Of a total of 399 procedures, 335 (84%) were referred to a service other than the primary team for completion...
July 2016: Southern Medical Journal
Jeffrey H Barsuk, Elaine R Cohen, Mark V Williams, Jordan Scher, Joe Feinglass, William C McGaghie, Kelly O'Hara, Diane B Wayne
Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills and self-confidence. This study aimed to (1) assess the effect of SBML on IM residents' simulated thoracentesis skills and (2) compare thoracentesis referral patterns, self-confidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians...
June 8, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Sarah E Hartley, Latoya Kuhn, Staci Valley, Laraine L Washer, Tejal Gandhi, Jennifer Meddings, Michelle Robida, Salas Sabnis, Carol Chenoweth, Anurag N Malani, Sanjay Saint, Scott A Flanders
OBJECTIVE Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention. DESIGN Prospective, interventional trial. SETTING Two community hospitals and a tertiary-care academic center. PATIENTS Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection...
September 2016: Infection Control and Hospital Epidemiology
Bassel Nazha, Alex C Spyropoulos
Atrial fibrillation patients often require warfarin interruption for an invasive procedure or surgery. Heparin bridging therapy has been frequently used during warfarin interruption under the premise of providing a theoretical mitigation against thromboembolism that overweighs expected higher rates of bleeding. Up until recently, little definite clinical evidence was available to guide the hospitalist on optimal perioperative anticoagulant management. The landmark BRIDGE (Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation) trial provided high-quality evidence that a simple interruption of warfarin in the average atrial fibrillation patient undergoing an elective procedure or surgery is noninferior to bridging therapy for efficacy and superior to bridging therapy in preventing major bleeding...
September 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Sandesh Dev, Trisha K Hoffman, Dio Kavalieratos, Paul Heidenreich, Wen-Chih Wu, Dawn C Schwenke, Sarah J Tracy
BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are the most underutilized pharmacotherapy for heart failure. Minimal data are available on the barriers to MRA adoption from the perspective of prescribing clinicians. METHODS AND RESULTS: A mixed-methods study consisting of a survey (n=50), focus groups (n=39), interviews (n=6) with clinicians at a single US Department of Veterans Affairs medical center served to ascertain barriers to optimal use of MRAs...
March 2016: Journal of the American Heart Association
E Allen Liles, Carlton R Moore, Jacob Stein
OBJECTIVES: Readmissions are an increasing area of focus for quality improvement initiatives. Widely variable estimates exist on preventability and impact of multipronged readmission interventions. Given the rotating nature of attending physicians in academic centers, physicians often are unaware of readmissions. We present a before-and-after (uncontrolled) trial evaluating timely feedback of readmissions to hospitalist physicians. METHODS: A daily list of patients (inpatient, observation, procedure, or emergency department) who are registered as receiving care within University of North Carolina hospitals was filtered to include only inpatients within the last 30 days and cared for by a faculty member from the hospital medicine program, and readmissions were tracked...
June 2015: Southern Medical Journal
Jed D Gonzalo, Ethan F Kuperman, Cynthia H Chuang, Erik Lehman, Frendy Glasser, Thomas Abendroth
BACKGROUND: Many academic hospitals have implemented overnight hospitalists to supervise house staff and improve outcomes, but few studies have described the impact of this role. OBJECTIVE: To investigate the effect of an overnight academic hospitalist program on patient-level outcomes. Secondary objectives were to describe the program's revenue generation and work tasks. DESIGN: Retrospective interrupted time-series analysis of patients admitted to the medicine service before and after implementation of the program...
December 2015: Journal of General Internal Medicine
S Burjonrappa, A Theodorus, A Shah, I T Cohen
INTRODUCTION: Hospital readmission rates are used as a metric of the quality of patient care in adults. Readmission data is lacking for pediatric surgical patients. The objective of this study is to evaluate our institution's 30-day unexpected pediatric surgical readmission data to identify potentially preventable readmissions. METHODS: An internal database of all pediatric surgical 30-day readmissions to two tertiary-referral children's hospitals in a single health system was reviewed...
June 2015: Pediatric Surgery International
Mythili Srinivasan, Shobha Bhaskar, Douglas W Carlson
BACKGROUND AND OBJECTIVE: Children often need procedural sedation for painful procedures. There are few data on type of provider, site of sedation, and agents used for procedural sedation in hospitals across the nation. The objective was to determine procedural sedation practices for hospitalized children outside the PICU and emergency department. METHODS: Surveys were sent to 89 pediatric hospitalist (PH) leaders in hospitals belonging to the Child Health Corporation of America or the National Association of Children's Hospitals and Related Institutions...
March 2015: Hospital Pediatrics
Eelam Adil, Roy Xiao, Trevor McGill, Reza Rahbar, Michael Cunningham
IMPORTANCE: Maintaining an outpatient practice and providing high-quality inpatient care pose significant challenges to the traditional call team approach. OBJECTIVE: To introduce a unique rotating hospitalist inpatient program and assess its clinical, educational, and financial impact. The chief of service (COS) program requires 1 attending physician to rotate weekly as chief of the inpatient service with no conflicting elective duties. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective internal billing data review performed at a tertiary pediatric hospital...
September 2014: JAMA Otolaryngology—Head & Neck Surgery
Jack M Percelay, David G Zipes
Pediatric hospital medicine (PHM) programs are mission driven, not margin driven. Very rarely do professional fee revenues exceed physician billing collections. In general, inpatient hospital care codes reimburse less than procedures, payer mix is poor, and pediatric inpatient care is inherently time-consuming. Using traditional accounting principles, almost all PHM programs will have a negative bottom line in the narrow sense of program costs and revenues generated. However, well-run PHM programs contribute positively to the bottom line of the system as a whole through the value-added services hospitalists provide and hospitalists' ability to improve overall system efficiency and productivity...
July 2014: Pediatric Annals
George Everett, Nizam Uddin
Cardiologists may be the principal attending physician or the consultant to general internists or hospitalists in hospitalized patients with cardiovascular diseases. To find out which role may be best for quality and efficiency, a retrospective cohort study of 15, 113 patients in 11 cardiovascular diagnosis groups was carried out. Hospital cost, length of stay, mortality, and 30-day readmissions were compared among attending physicians who were hospitalists, general internists, or cardiologists. After adjustment for differences in demography and severity, cardiologists generally had substantially lower cost and length of stay compared with internists or hospitalists, especially when the diagnosis group included a cardiovascular procedure...
2011: American Heart Hospital Journal
Joan Teno, David O Meltzer, Susan L Mitchell, Ana T Fulton, Pedro Gozalo, Vincent Mor
Striking variation has been documented in the rates of feeding tube insertion for hospitalized patients with advanced dementia. This occurs despite the harms of the procedure, which may outweigh its benefits, and the procedure's inconsistency with care focused on the patient's comfort. Among nursing home residents with advanced dementia who were hospitalized in 2001-10 with an infection or dehydration, we found that rates of insertion of a percutaneous endoscopic gastrostomy feeding tube varied by type of attending physician...
April 2014: Health Affairs
David Feinbloom
The management of antithrombotic medications in patients requiring invasive procedures is a common problem in hospital medicine, for which there is limited evidence to guide clinical decision making. Existing guidelines do not address many hospital-based procedures and have not kept pace with the introduction of newer antiplatelet and anticoagulant medications. This article provides a conceptual framework for the periprocedural management of antithrombotic therapy, with a focus on the procedures that hospitalists are most likely to perform and the pharmacology of the common and newer antithrombotic medications...
May 2014: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Marijke J C Timmermans, Anneke J A H van Vught, Michel Wensing, Miranda G H Laurant
BACKGROUND: Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. METHODS/DESIGN: In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model)...
2014: BMC Health Services Research
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