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David O Meltzer - One of the best experts on this subject based on the ideXlab platform.
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measuring patient experiences on Hospitalist and teaching services patient responses to a 30 day postdischarge questionnaire
Journal of Hospital Medicine, 2016Co-Authors: Charlie M Wray, David O Meltzer, Andrea Flores, William V Padula, Micah T Prochaska, Vineet M AroraAbstract:BACKGROUND Data comparing patient experiences between general medicine teaching and nonteaching Hospitalist services are lacking. OBJECTIVE Evaluate hospitalized patients' experience on general medicine teaching and nonteaching Hospitalist services by assessing patients' confidence in their ability to identify their physician(s), understand their roles, and their rating of the coordination and overall care. METHODS Retrospective cohort analysis of general medicine teaching and nonteaching Hospitalist services from 2007 to 2013 at an academic medical center. Patients were surveyed 30-days after hospital discharge regarding their confidence in their ability to identify their physician(s), understand the role of their physician(s), and their perceptions of coordination and overall care. A 3-level, mixed effects logistic regression was performed to ascertain the association between service type and patient-reported outcomes. RESULTS Data from 4591 general medicine teaching and 1811 nonteaching Hospitalist service patients demonstrated that those cared for by the Hospitalist service were more likely to report being able to identify their physician (50% vs 45%, P < 0.001), understand their role (54% vs 50%, P < 0.001), and rate greater satisfaction with coordination (68 vs 64%, P = 0.006) and overall care (73% vs 67%, P < 0.001). In regression models, the Hospitalist service was associated with higher ratings in overall care (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.15-1.47), even when Hospitalists were the attendings on general medicine teaching services (OR: 1.17; 95% CI: 1.01-1.31). CONCLUSION Patients on a nonteaching Hospitalist service rated their overall care slightly better than patients on a general medicine teaching service. Team structure and complexity may play a role in this difference. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine
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understanding communication during Hospitalist service changes a mixed methods study
Journal of Hospital Medicine, 2009Co-Authors: David O Meltzer, Keiki Hinami, Jeanne M Farnan, M Vineet A M AroraAbstract:BACKGROUND: Little data exist to inform Hospitalist communication during service changes. OBJECTIVE: To characterize Hospitalist handoffs during service changes. DESIGN: Serial survey study. SETTING: Single academic medical center. MEASUREMENTS: From May to December 2007, 60 service changes among 17 Hospitalists on a nonteaching service were targeted for evaluation using an anonymous 18-item survey that was completed by Hospitalists within 48 hours of assuming care for patients. Survey items assessed completeness of handoff communication, certainty of patient care plans, missed information, time spent recovering information, and near misses/adverse events due to incomplete handoffs. The association between completeness of communication and handoff outcomes was examined. Narrative comments were analyzed qualitatively. RESULTS: Ninety-three percent (56/60) of surveys were returned. All 17 Hospitalists participated. Thirteen percent of respondents reported incomplete handoffs and 18% were uncertain of care plan on transition day. At least 1 near miss, attributable to incomplete communication was reported by 16%. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about patient care plans on the transition day (71% incomplete vs. 10% complete, P < 0.01), discovery of missing information (71% incomplete vs. 24% complete, P = 0.01), near misses/adverse events (57% incomplete vs. 10% complete, P < 0.01), and more time resolving issues arising from missed information (71% incomplete vs. 22% complete, P < 0.01). Qualitative comments suggest the need for a more systematic, focused, team-based, and patient-centered handoff model. CONCLUSIONS: Incomplete handoffs during service changes are associated with uncertainty and potential patient harm. Suggestions to improve the completeness of Hospitalist service change communications are offered. Journal of Hospital Medicine 2009;4:535–540. © 2009 Society of Hospital Medicine.
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effects of physician experience on costs and outcomes on an academic general medicine service results of a trial of Hospitalists
Annals of Internal Medicine, 2002Co-Authors: David O Meltzer, Jeanette Morrison, Todd Guth, Willard G. Manning, Manish N. Shah, Lei Jin, Wendy LevinsonAbstract:Background: Hospitalists may decrease costs and improve outcomes in hospitalized patients, but existing evidence is limited and has not identified mechanisms for such effects. Objective: To study the costs and outcomes for patients on an academic general medicine service assigned to teams led by Hospitalists and nonHospitalists. Design: Cohort study. Setting: Academic general medicine service. Patients: 6511 patients admitted to the hospital from July 1997 through June 1999. Intervention: All patients admitted every fourth day were assigned to 1 of 2 Hospitalists caring for inpatients 6 months each year or 1 of 58 nonHospitalists caring for inpatients 1 to 2 months each year. Measurements: Length of stay; inpatient costs; and 30-, 60-, and 365-day mortality. Results: Patients assigned to Hospitalists (24.8%) and nonHospitalists (75.2%) did not differ in age, race, sex, diagnosis mix, or Charison index score. In year 1, average adjusted length of stay was 0.29 day shorter for patients cared for by Hospitalists than by nonHospitalists (95% Cl, -0.66 to 0.06 day; P = 0.06); in year 2, average adjusted length of stay was 0.49 day shorter for patients cared for by Hospitalists (Cl, -0.79 to -0.15 day; P = 0.01). Average adjusted costs were not significantly reduced for Hospitalists compared with nonHospitalists in year 1 but were reduced by $782 in year 2 (CI, -$1313 to -$187; P = 0.01). When years 1 and 2 were combined or when year 1 was analyzed alone, 30-day mortality was not significantly different for Hospitalists and nonHospitalists; however, 30-day mortality was 4.2% for Hospitalists compared with 6.0% for nonHospitalists in year 2 (Cl for difference, 1.8 percentage points [-3.6 to -0.1 percentage points]; P = 0.04) and the adjusted relative risk was 0.65 (Cl, 0.44 to 0.96; P = 0.03). In multivariate analyses, resource use decreased with the physician's cumulative experience in caring for a patient's primary diagnosis. Mortality showed a similar pattern. Conclusions: Hospitalist care was associated with lower costs and short-term mortality in the second but not the first year of Hospitalists' experience. Disease-specific physician experience may reduce resource use and improve patient outcomes; in addition, it may be an important determinant of the effectiveness of Hospitalists.
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effects of physician experience on costs and outcomes on an academic general medicine service results of a trial of Hospitalists
Annals of Internal Medicine, 2002Co-Authors: David O Meltzer, Jeanette Morrison, Todd Guth, Willard G. Manning, Manish N. Shah, Lei Jin, Wendy LevinsonAbstract:Hospitalist care was associated with lower costs and short-term mortality in the second but not the first year of Hospitalists' experience. Disease-specific physician experience may be an important...
Robert M. Wachter - One of the best experts on this subject based on the ideXlab platform.
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the state of hospital medicine in 2008
Medical Clinics of North America, 2008Co-Authors: Robert M. WachterAbstract:In the mid 1990s, a new model for hospital care began to take hold in the United States, in which a separate physician, who I dubbed a "Hospitalist," assumed the responsibility for managing the inpatient stay in place of the primary care physician. A 2006 American Hospital Association survey indicated that there are more than 20,000 Hospitalists in the United States, making this the fastest growing medical specialty in American medical history. In this article, I briefly trace the reasons for the field's remarkable growth, describe some of hospital medicine's key issues and concerns, and speculate about the future shape of the field.
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The surgical Hospitalist: a new model for emergency surgical care.
Journal of the American College of Surgeons, 2007Co-Authors: John Maa, Jonathan T. Carter, Jessica E. Gosnell, Robert M. Wachter, Hobart W. HarrisAbstract:Background Quality of acute surgical care in the US is threatened by a shortage of surgeons performing emergency procedures because of rising costs of uncompensated care, liability concerns, declining reimbursement, and lifestyle considerations. In July 2005, we restructured the general surgery service at our medical center into a Hospitalist model to improve patient access to surgical care. Study Design We hypothesized that a surgical Hospitalist program could improve timeliness of care, emergency department (ED) efficiency and physician satisfaction, resident supervision, continuity of care, and revenue generation. We reviewed our program after 1 year, including patient demographics, diagnosis, and time to consult. Results Three surgical Hospitalists cared for 853 patients during 1 year. Patients ranged from 17 to 100 years of age and presented with abdominal pain (66%), infection (18%), malignancy (6%), hernia (4%), and trauma (3%). Fifty-seven percent of consults originated from the ED; 8% came from other surgeons. Mean time to consult was 20 minutes. A survey of ED physicians reported shorter ED length of stay, better patient satisfaction, improved professionalism and resident supervision, and better overall quality of care. Average waiting time for patients with acute appendicitis to undergo operation was reduced from 16 ± 10 hours to 8 ± 4 hours (p Conclusions The surgical Hospitalist model provides a cost-effective way for general surgeons to provide timely and high-quality emergency surgical care and enhance patient and referring provider satisfaction.
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reflections the Hospitalist movement a decade later
Journal of Hospital Medicine, 2006Co-Authors: Robert M. WachterAbstract:August 2006 marks the 10th anniversary of the publication of an article in the New England Journal of Medicine in which Lee Goldman and I coined the term Hospitalist—an event that many people characterize as the start of the Hospitalist movement in the United States. The present article describes the history of those early days, highlighting some of the choices the field's initial leaders made to nurture the new specialty. In retrospect, although there were many examples of fortunate serendipity, there were also several key strategic choices, including the focus on gathering research data to demonstrate the value of the field to external stakeholders; the forceful rejection of mandatory Hospitalist systems, particularly those promoted by managed care organizations; and the purposeful linking of our new field to the burgeoning movements to improve quality and patient safety in hospitals. Most of all, the field's spectacular growth and successes can be attributed to the daily work of thousands of Hospitalists in clinical care, education, research, and systems improvement. These individuals have given life to our theoretical notion a decade ago that a new model for inpatient care would improve the American health care system and the care of inpatients. Journal of Hospital Medicine 2006;1:248–252. © 2006 Society of Hospital Medicine.
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effects of Hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations
JAMA Internal Medicine, 2004Co-Authors: Karen E Hauer, Robert M. Wachter, Charles E Mcculloch, Garmen A Woo, Andrew D AuerbachAbstract:Background Hospitalists are increasingly serving as inpatient attendings at teaching hospitals. The educational impact of this new model is unclear. We evaluated the relationship between type of attending (Hospitalist vs traditional) and trainees' ratings of attending teaching and the overall ward rotation. Methods We analyzed data from a Web-based evaluation system containing all house staff and student evaluations of their attendings and internal medicine ward rotations at 2 university-affiliated teaching hospitals over a 2-year period (1999-2001). Results The overall evaluation completion rate was 91% (1587 of 1742 evaluations) by trainees working with 17 Hospitalists and 52 traditional attendings. Trainees reported significantly more overall satisfaction with Hospitalists than traditional attendings (8.3 vs 8.0 on a 9-point scale; P P P = .04). Trainees evaluated Hospitalists' knowledge, teaching, and feedback as superior to that of traditional attendings. There were no significant differences in reports of attendings' interest in teaching or patients, availability, or emphasis on cost-effectiveness. Conclusions Trainees reported more effective teaching and more satisfying inpatient rotations when supervised by Hospitalists. This analysis suggests that Hospitalists may possess or accrue a specific inpatient knowledge base and teaching skill that distinguishes them from nonHospitalists.
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medical and surgical comanagement after elective hip and knee arthroplasty a randomized controlled trial
Annals of Internal Medicine, 2004Co-Authors: Jeanne M. Huddleston, Kirsten Hall Long, David J. Vanness, Dirk R Larson, James M Naessens, Robert T Trousdale, Matt Plevak, Miguel E Cabanela, Duane Ilstrup, Robert M. WachterAbstract:BACKGROUND: Hospitalists are assuming an increasing role in the care of surgical patients, but the impact of this model of care on postoperative outcomes is unknown. OBJECTIVE: To determine the impact of providing a collaborative, Hospitalist-led model of care on postoperative outcomes and costs among patients having hip or knee arthroplasty. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: 526 patients having elective orthopedic surgery who are at elevated risk for postoperative morbidity. MEASUREMENTS: Length of stay, inpatient postoperative medical complications, health care provider satisfaction, and inpatient costs. INTERVENTIONS: A comanagement medical Hospitalist-Orthopedic Team compared with standard postoperative care by orthopedic surgeons with medical consultation. RESULTS: More patients in the Hospitalist group were discharged from the hospital with no complications (61.6% vs. 49.8%; difference, 11.8 percentage points [95% CI, 2.8 to 20.7 percentage points]). Fewer minor complications were observed among Hospitalist patients (30.2% vs. 44.3%; difference, -14.1 percentage points [CI, -22.7 to -5.3 percentage points]). Observed length of stay was not statistically different between treatment groups. However, when adjusted for discharge delays, mean length of stay for patients in the Hospitalist model of care was shorter (5.1 days vs. 5.6 days; difference, -0.5 day [CI, -0.8 to -0.1 day]). Total costs did not differ between groups. Orthopedic surgeons and nurses preferred the Hospitalist model. LIMITATIONS: Care providers and patients were aware of intervention assignments, and the study could not capture all costs associated with the Hospitalist model. CONCLUSIONS: The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement Hospitalist model. Additional research on the clinical and economic impact of the Hospitalist model in other surgical populations is warranted.
Andrew D Auerbach - One of the best experts on this subject based on the ideXlab platform.
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Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes
Journal of Hospital Medicine, 2012Co-Authors: Kate Goodrich, Peter K Lindenauer, Harlan M Krumholz, Patrick H Conway, Andrew D AuerbachAbstract:BACKGROUND: The increase in Hospitalist-provided inpatient care may be accompanied by an expectation of improvement on patient outcomes. To date, the association between utilization of Hospitalists and the publicly reported patient outcomes is unknown. OBJECTIVE: Assess the relationship between Hospitalist utilization and performance on 6 publicly reported patient outcomes. DESIGN: Cross-sectional study. PARTICIPANTS: Representatives of 598 hospitals in the United States with direct knowledge of inpatient service models. INTERVENTION: Survey of hospital personnel with knowledge of Hospitalist use and Hospitalist programs. MEASUREMENTS: Six publicly reported quality outcome measures across 3 medical conditions: acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia. Using multivariable regression models, we assessed the relationship between presence of Hospitalists and performance on each outcome measure; we further assessed the relationship between the percentage of patients admitted by Hospitalists and each outcome measure. RESULTS: Of 598 respondents, 429 (72%) reported the use of Hospitalist services. In the comparison of hospitals with and without Hospitalists, there was no statistically significant difference on any of the mortality or readmissions measures with the exception of the risk-stratified readmission rate for heart failure. For hospitals that used Hospitalists, there was no significant change in any of the outcome measures with increasing percentage of patients admitted by Hospitalists. CONCLUSIONS: The presence of Hospitalists is not an independent predictor of performance on publicly reported mortality and readmissions measures for AMI, HF, or pneumonia. It is likely that broader system or organizational interventions are required to improve performance on patient outcomes. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine
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survey of us academic Hospitalist leaders about mentorship and academic activities in Hospitalist groups
Journal of Hospital Medicine, 2011Co-Authors: Rebecca A Harrison, Bradley A Sharpe, Alan J Hunter, Andrew D AuerbachAbstract:BACKGROUND: Few data describe the structure, activities, and goals of academic hospital medicine groups. METHODS: We carried out a cross sectional email survey of academic Hospitalist leaders. Our survey asked about group resources, services, recruitment and growth, as well as mentoring of faculty, future priorities, and general impressions of group stability. RESULTS: A total of 57 of 142 (40%) potential Hospitalist leaders responded to our email survey. Hospitalist groups were generally young (<5 years old). Hospitalist group leaders worried about adequate mentorship and burnout while placing a high priority on avoiding physician turnover. However, most groups also placed a high priority on expanding nonclinical activities (teaching, research, etc.). Leaders felt financially and philosophically unsupported, a sentiment which seemed to stem from being viewed primarily as a clinical rather than an academic service. CONCLUSION: Academic hospital medicine groups have an acute need for mentoring and career development programs. These programs should target both individual Hospitalists and their leaders while also helping to enhance scholarly work. Journal of Hospital Medicine 2011;6:5–9. © 2011 Society of Hospital Medicine.
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effect of Hospitalist attending physicians on trainee educational experiences a systematic review
Journal of Hospital Medicine, 2009Co-Authors: Pradeep Natarajan, Andrew D Auerbach, Sumant R Ranji, Karen E HauerAbstract:BACKGROUND: Trainees receive much of their inpatient education from Hospitalists. PURPOSE: To characterize the effects of Hospitalists on trainee education. DATA SOURCES: MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term “Hospitalist”, and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION: Original English language research studies meeting all of the following: involvement of Hospitalists; comparison to nonHospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION: Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS: Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing Hospitalists to nonHospitalists, trainees were more satisfied with Hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonHospitalist general internists from specialists showed that trainees preferred Hospitalists, but the other did not demonstrate a Hospitalist advantage over general internists. CONCLUSIONS: Trainees are more satisfied with inpatient education from Hospitalists. Whether the increased satisfaction translates to improved learning is unclear. Journal of Hospital Medicine 2009;4:490–498. © 2009 Society of Hospital Medicine.
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effects of Hospitalist attending physicians on trainee satisfaction with teaching and with internal medicine rotations
JAMA Internal Medicine, 2004Co-Authors: Karen E Hauer, Robert M. Wachter, Charles E Mcculloch, Garmen A Woo, Andrew D AuerbachAbstract:Background Hospitalists are increasingly serving as inpatient attendings at teaching hospitals. The educational impact of this new model is unclear. We evaluated the relationship between type of attending (Hospitalist vs traditional) and trainees' ratings of attending teaching and the overall ward rotation. Methods We analyzed data from a Web-based evaluation system containing all house staff and student evaluations of their attendings and internal medicine ward rotations at 2 university-affiliated teaching hospitals over a 2-year period (1999-2001). Results The overall evaluation completion rate was 91% (1587 of 1742 evaluations) by trainees working with 17 Hospitalists and 52 traditional attendings. Trainees reported significantly more overall satisfaction with Hospitalists than traditional attendings (8.3 vs 8.0 on a 9-point scale; P P P = .04). Trainees evaluated Hospitalists' knowledge, teaching, and feedback as superior to that of traditional attendings. There were no significant differences in reports of attendings' interest in teaching or patients, availability, or emphasis on cost-effectiveness. Conclusions Trainees reported more effective teaching and more satisfying inpatient rotations when supervised by Hospitalists. This analysis suggests that Hospitalists may possess or accrue a specific inpatient knowledge base and teaching skill that distinguishes them from nonHospitalists.
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physician attitudes toward and prevalence of the Hospitalist model of care results of a national survey
The American Journal of Medicine, 2000Co-Authors: Andrew D Auerbach, Steven Z Pantilat, Peter K Lindenauer, Patricia P Katz, Elizabeth A Nelson, Robert M. WachterAbstract:Abstract PURPOSE: We sought to determine the availability and utilization of, as well as physician attitudes toward, the Hospitalist model in the United States. SUBJECTS AND METHODS: Using a telephone survey, we asked physicians who were board certified in internal medicine about their inpatient practice arrangements, the availability of Hospitalist services, and their attitudes toward the Hospitalist model. All physicians were generalists in active clinical practice. Using multivariable methods, we determined factors associated with attitudes toward the Hospitalist model. RESULTS: We were able to contact 787 of 2,829 physicians who were randomly selected from a national list of board-certified internists, of whom 400 agreed to participate. Most respondents were familiar with the term "Hospitalist" and had Hospitalist services available in their community, and 28% used Hospitalists for their inpatients. Few (2%) reported the presence of the "mandatory" Hospitalist model. Physicians reported that the model was more commonly available in Western states (84% vs 55% to 63% in other regions, P CONCLUSIONS: Although agreeing that quality of care and efficiency might be improved, physicians were concerned about patient–doctor relationships and patient satisfaction in a Hospitalist model. Future studies should determine the effect of the Hospitalist model on these outcomes.
Wendy Levinson - One of the best experts on this subject based on the ideXlab platform.
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effects of physician experience on costs and outcomes on an academic general medicine service results of a trial of Hospitalists
Annals of Internal Medicine, 2002Co-Authors: David O Meltzer, Jeanette Morrison, Todd Guth, Willard G. Manning, Manish N. Shah, Lei Jin, Wendy LevinsonAbstract:Background: Hospitalists may decrease costs and improve outcomes in hospitalized patients, but existing evidence is limited and has not identified mechanisms for such effects. Objective: To study the costs and outcomes for patients on an academic general medicine service assigned to teams led by Hospitalists and nonHospitalists. Design: Cohort study. Setting: Academic general medicine service. Patients: 6511 patients admitted to the hospital from July 1997 through June 1999. Intervention: All patients admitted every fourth day were assigned to 1 of 2 Hospitalists caring for inpatients 6 months each year or 1 of 58 nonHospitalists caring for inpatients 1 to 2 months each year. Measurements: Length of stay; inpatient costs; and 30-, 60-, and 365-day mortality. Results: Patients assigned to Hospitalists (24.8%) and nonHospitalists (75.2%) did not differ in age, race, sex, diagnosis mix, or Charison index score. In year 1, average adjusted length of stay was 0.29 day shorter for patients cared for by Hospitalists than by nonHospitalists (95% Cl, -0.66 to 0.06 day; P = 0.06); in year 2, average adjusted length of stay was 0.49 day shorter for patients cared for by Hospitalists (Cl, -0.79 to -0.15 day; P = 0.01). Average adjusted costs were not significantly reduced for Hospitalists compared with nonHospitalists in year 1 but were reduced by $782 in year 2 (CI, -$1313 to -$187; P = 0.01). When years 1 and 2 were combined or when year 1 was analyzed alone, 30-day mortality was not significantly different for Hospitalists and nonHospitalists; however, 30-day mortality was 4.2% for Hospitalists compared with 6.0% for nonHospitalists in year 2 (Cl for difference, 1.8 percentage points [-3.6 to -0.1 percentage points]; P = 0.04) and the adjusted relative risk was 0.65 (Cl, 0.44 to 0.96; P = 0.03). In multivariate analyses, resource use decreased with the physician's cumulative experience in caring for a patient's primary diagnosis. Mortality showed a similar pattern. Conclusions: Hospitalist care was associated with lower costs and short-term mortality in the second but not the first year of Hospitalists' experience. Disease-specific physician experience may reduce resource use and improve patient outcomes; in addition, it may be an important determinant of the effectiveness of Hospitalists.
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effects of physician experience on costs and outcomes on an academic general medicine service results of a trial of Hospitalists
Annals of Internal Medicine, 2002Co-Authors: David O Meltzer, Jeanette Morrison, Todd Guth, Willard G. Manning, Manish N. Shah, Lei Jin, Wendy LevinsonAbstract:Hospitalist care was associated with lower costs and short-term mortality in the second but not the first year of Hospitalists' experience. Disease-specific physician experience may be an important...
Sarah L Krein - One of the best experts on this subject based on the ideXlab platform.
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Hospitalist experiences practice opinions and knowledge regarding peripherally inserted central catheters results of a national survey
Journal of Hospital Medicine, 2013Co-Authors: Vineet Chopra, Latoya Kuhn, Sarah L Krein, Scott A Flanders, Sanjay SaintAbstract:BACKGROUND A Michigan survey found variation in Hospitalist-reported experience, practice, opinions, and knowledge related to peripherally inserted central catheters (PICCs). Whether these findings reflect a national trend is unknown. OBJECTIVE To investigate self-reported PICC practice among adult Hospitalists in the United States. METHODS Society of Hospital Medicine-administered, anonymous, Web-based survey of practicing, adult, non-Michigan Hospitalists. RESULTS Of the 2112 Hospitalists who were sent an electronic invitation, 381 completed the online survey (18%). Eighty-six percent of Hospitalists reported having placed a PICC solely for venous access (vs specific indications such as long-term antibiotics or parenteral nutrition). Eighty-two percent reported having cared for a patient who specifically requested a PICC. Only 25% of Hospitalists reported examining PICCs for evidence of external problems, whereas 57% admitted to having, at least once, forgotten about the presence of a PICC. Only 9% of respondents knew that PICC tip verification was performed primarily to prevent venous thromboembolism. Finally, 42% of participants indicated that 10% to 25% of PICCs placed in their hospitals might be inappropriately placed and/or avoidable. CONCLUSIONS This national survey highlights several potential opportunities to improve Hospitalist PICC practices. A research agenda dedicated to this issue is necessary to improve patient safety and hospital-based practice. Journal of Hospital Medicine 2013;8:635–638. © 2013 Society of Hospital Medicine
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Hospitalist experiences practice opinions and knowledge regarding peripherally inserted central catheters a michigan survey
Journal of Hospital Medicine, 2013Co-Authors: Vineet Chopra, Latoya Kuhn, Charles E Coffey, Mohammad Salameh, Jim Barron, Sarah L Krein, Scott A Flanders, Sanjay SaintAbstract:BACKGROUND Peripherally inserted central catheters (PICCs) are commonly inserted during hospitalization for a variety of clinical indications. OBJECTIVE To understand Hospitalist experience, practice, knowledge, and opinions as they relate to PICCs. DESIGN AND SETTING Web-based survey of Hospitalists in 5 healthcare systems (representing a total of 10 hospitals) across Michigan. RESULTS The overall response rate was 63% (227 Hospitalists received invitations; 144 responded). Compared with central venous catheters, Hospitalists felt that PICCs were safer to insert (81%) and preferred by patients (74%). Although 84% of respondents reported that placing a PICC solely to obtain venous access was appropriate, 47% also indicated that 10%–25% of PICCs inserted in their hospitals might represent inappropriate placement. Hospitalist knowledge regarding PICC-related venous thromboembolism was poor, with only 4% recognizing that PICC-tip verification was performed principally to prevent thrombosis. Furthermore, several potential practice-related concerns were identified: one-third of Hospitalists indicated that they never examine PICCs for externally evident problems, such as exit-site infection; 48% responded that once inserted, they did not remove PICCs until a patient was ready for discharge; and 51% admitted that, at least once, they had “forgotten” that their patient had a PICC. CONCLUSIONS Hospitalist experiences, practice, opinions, and knowledge related to PICCs appear to be variable. Because PICC use is growing and is often associated with complications, examining the impact of such variation is necessary. Hospitals and health systems should consider developing and implementing mechanisms to monitor PICC use and adverse events. Journal of Hospital Medicine 2013;8:309–314. © 2013 Society of Hospital Medicine.