PASHA in Argentina

By Matias Tisi Baña, MD, and Daniel Grassi, MD, and Juan Carlos Morales, MD, and Sebastian Sevilla, MD

ACP Hospitalist - December 2011

Strategies to Prevent Catheter-Associated Urinary Tract Infections: What Are You and Your Hospital Doing?

This is what hospitalists from Chile are doing in their hospital:

Inpatient Hyperglycemia: What Are You and Your Hospital Doing?

This is what hospitalists from Argentina are doing in their hospital:

VTE: What Are You and Your Hospital Doing?

VTE is the No. 1 preventable cause of hospital-associated death for medical inpatients. Most hospitals are struggling to decrease the number of DVTs and PEs in their patient population by teaching or reminding staff to check for risk factors in each patient and, if necessary, provide VTE prophylaxis. While this seems like a simple solution, anyone who’s currently struggling to turn the numbers around this way can assure you that it is an uphill battle. What Are You and Your Hospital Doing?

PASHA comprises an independent network of physicians from across the Americas. By fostering a professional culture of collaboration and knowledge sharing, our goal is to promote the dissemination of ideas and the improvement of Hospital Medicine practice.

This is what hospitalists from Chile are doing in their hospital:

Let’s share experiences and results! You could write in English or in Spanish.

We are looking for internists from Uruguay interested in the movement of Hospital Medicine...

 

Contact us: medicinahospitalar@gmail.com

Perioperative Management of the Morbid Obese Children

Obesity is the plague of our days. It takes years of life away in an instant. However, despite the knowledge and awareness of its terrible consequences, it seems that parents are blind to the devastating effects of it.

I presented a workshop on perioperative management of the pediatric patient in Kansas City, at the 2011 Pediatric Hospital Medicine meeting, sponsored by the American Academy of Pediatrics and the Society of Hospital Medicine.

A section I focused on, and brought special attention was the management of children with morbid obesity. You can read in further detail here.

HM group at Facebook

I created a group called Hospital Medicine at Facebook. You are invited to join.

Do hospitalists increase costs?

I wrote a post in my blog addressing this very issue. I titled it Do hospitalists boost costs? - a reality or fiction? This is based on a fresh-from-the-oven article written in Annals of Internal Medicine where it was shown in a large cohort of Medicare patients that care associated with hospitalists yielded a shift in the healthcare expenditure from inpatient to outpatient.

Nobody can deny the impressive statistical methodology behind this article, however, not because I want to be irrationally defensive or be the devil's advocate, I do think there are multiple limitations in the study that should make the general reader cautious and avoid taking precipitous assumptions and conclusions.

It is important to acknowledge the value of this article in the current state of USA economy - a substantial amount (~40%) of the budget goes into insurance (which includes Medicare and Medicaid). Therefore when the authors conclude that Medicare admissions cared by hospitalists may represent and additional 1.1 billions in Medicare costs per year, it is a very serious and frightening statement.

In the search for the perfect model of healthcare, so far it has been assumed that hospitalists decrease costs; but if this is proven otherwise, it may be a hard bite to swallow.

I have several thoughts in my blog post. First of all, the study period is quite far away, and practices have shifted and evolved. In addition, there are more and newer markers of quality of care that are definitely not included in this article. Third, the healthcare system ion USA is living a paradigm shift where the evolution toward a Patient-centered medical home is an ongoing process and where bundled payments may in fact become the standard of cost containment methods and create very different situation than the one which the article concludes.

I think that in the search of transparency and accountability, and search for self-improvement, this article is a breath of fresh air - it should give place to reflection and careful analysis - we can show our value and newer studies may need to be done including newer metrics of quality and patient outcomes. This should not trigger a defensive attitude, but rather an analytical and philosophical one. We can in fact, appreciate it as an opportunity to look into newer ventures for improvement. This is how this movement was created, and this is what drives our movement - the continuous insight to become better and add increased value to healthcare and society.

Do hospitalists increase costs?

Hospitalist care associated with higher costs, more medical utilization after discharge

Can this make sense for you? What could cause this result?

These are my speculations (by Dr. Robert M. Centor)

Suggestions and comments are welcome!

Resident Duty Hours

by Neil Winawer, PASHA's director:

As those of you in the medical profession know, July 1st was a symbolic date, as now interns can no longer work more than 16 hours in a row. Residency training programs have scrambled to fill this void and make it work. While these new rules were bound to happen given the current climate, the real question is whether these changes make patients any safer. With that in mind I was asked to reflect upon the old days when we use to routinely work 80+ hour weeks. My colleague and close friend, Dr. Kimberly Manning has a medical blog called, Reflections of a Grady Doctor. It was voted one of the top literary medical blogs of the year by Oprah Mag and was in the running for top medical web blogs of 2010. Check it out if you have time. 

Anyway, she asked me to post my story about the time about a time during my internship when I was overworked and blacked out (she did a part I & I’m part II). I can see those of you who know the story chuckle, but for those of who do not, please take a trip down memory lane and read the post and even make a comment should you see fit. 

http://www.gradydoctor.com/2011/07/duty-hours-pre-form-part-2-no-sleep-til.html

Hospital Medicine in Argentina – First Official Meeting

Hospital Universitario Austral

The first official meeting is scheduled for 8:00 am, September 23, 2011 at Hospital Universitario Austral, Pilar, Argentina (next to Buenos Aires).






Daniel Gonzalo Grassi and Roberto Martinez are in charge of the organization and they would like to invite you invite to participate. 

Friday, September 23, 2011

08:00 am - 08:45 am
Registration

08:45 am - 09:00 am
Opening Greetings
Eduardo Schnitzler (Director of the Hospital Universitario Austral, Argentina)
Guillherme Barcellos (President of the PASHA, Brazil)

09:00 am - 09:45 am
Hospital and hospitalist
James Newman (USA)

09:45 am -10:45 am
DVT prevencion
Fernando Rivera (USA)
Eduardo Abbott (Chile)
Magdalena Princz (Argentina)

10:45 am - 11:00 am
Break

11:00 am - 12:05 pm
Palliative care
Sergio Carlini (Argentina)
Daniel Weissbrod (Argentina)
Alejandra Juliarena (Argentina)

12:05 pm - 12:30 pm
Bullous diseases for the hospitalist
Cathy Newman (USA)

12:30 pm - 01:00 pm
Patient safety in the emergency room
Lucas Santos Zambon (Brasil)

01:00 pm - 02:00 pm
Break

02:00 pm - 03:00 pm
Patient safety
James Newman (USA)
Ariel Palacios (Argentina)

03:00 pm - 04:00 pm
Acute renal failure in the hospital: How to avoid it and how to manage it
Eddie Greene (USA)

04:00 pm - 04:15 pm
Break

04:15 pm - 05:15 pm
Transitions of care
Fernando Rivera (USA)
Eduardo Abbot (Chile)
Matías Tisi Baña (Argentina)

05:15 pm - 05:45 pm
Blood transfusion in the hospitalized patient
Tiago Daltoé (Brasil)

Saturday, September 24, 2011

09:00 am - 09:45 am
Update in Hospital Medicine
Neil Winawer (USA)

09:45 am - 10:45 am
The Pharmacist as team member on partient care
Ana Fajreldines (Argentina)
Magdalena Princz (Argentina)
Cristián Ortíz (Argentina)

10:45 am - 11:00 am
Break

11:00 am - 12:05 pm
Inpatient hyperglycemia
Matías Re (Argentina)
Sebastian Sevilla (Argentina)
Juan Carlos Rodriguez (Chile)

12:05 pm - 12:35 pm
Delirium in the hospitalized patient
Neil Winawer (USA)

12:35 pm - 02:00 pm
Break

02:00 pm - 03:00 pm
Cardiac evaluation before non cardiac surgery
Guillherme Barcellos (Brazil)

03:00 pm - 04:00 pm
Hospital Infection
Rodolfo Quirós (Argentina)
Alberto Cremona (Argentina)
Juan Carlos Rodríguez (Chile)

04:00 pm - 04:15 pm
Break

04:15 pm - 06:15 pm
Hospital Medicine in South America
Guillherme Barcellos (Brazil)
Juan Carlos Rodriguez (Chile)
Manuel Klein (Argentina)
Roberto Martinez (Argentina)
Daniel Grassi (Argentina)
Gibran Avelino Frandoloso (Brazil)

SHM Leadership Academy

The Hospitalist Field Turns 15: What The Past Says About The Future

By 2000, when I assumed SHM’s presidency, I worried terribly about our field being branded as being all about saving money for hospitals – not a particularly satisfying self-identify for a professional, and highly vulnerable to caricature (think “death panels” and you’ll know what I mean).

Luckily, in 2000 the Institute of Medicine published To Err is Human. After that seminal publication, I strongly suspected that the field of patient safety would take off, and it didn’t take a genius to realize that a parallel healthcare quality movement would follow closely behind. We recognized that hospitalists had a once-in-a-lifetime opportunity to brand ourselves as being about quality improvement and patient safety, not just cost-savings.

[READ FULL ARTICLE]

This is how it shouldn't be done...

"Hospitalist" Opportunity in Jabaquara/Brazil

  

Job opportunities as a "hospitalist"

"We are looking for doctors to work in a hospital at the region of Jabaquara. Very calm work as a hospitalist, you would only take care of the emergency needs of the patients we have on the wards and fulfill institutional protocols. Free parking on the parking lot! During the work period, we will cover your meals! Internal Medicine certification is recommendable or at least you should be an Internal Medicine resident, ok?"

This is true! Read more

Constructive criticism is welcome.

An increased insight perspective into quality and safety - Musings of a hospitalist

In the current era of Medicine, hospitalists are in the front line of improvement and innovation in quality of patient care and safety. I'm unsure whether this is an unwanted privilege or honor; however, certainly, our job in the extremely complex environment that a Hospital pose, make us witnesses and actors in this fascinating and challenging journey that is the patient safety.

Hospitals by definition are dangerous places. The patients are very sick, the healthcare providers are overworked, the duty hours are demanding, but in addition there are multiple levels at which errors can occur. It is our responsibility to identify those errors and pursue a proactive role in attempting to minimize any preventable error. We need to be humble. Knowledge can easily overpower us. It is impossible to master all knowledge, and in pursuit of the best of patient care, sometimes it is not knowledge, but organization, time to think, good documentation practices, and evidence-based simple practices (such as using checklists, washing hands, etc.) which will allow patient care to be safer.

In this blog post, I discuss on some thoughts that my recent ventures into patient quality and safety have inspired me.

As I concluded in the blog post, "we all need to be on board of the train of safety and quality, as this journey will be the most exciting ever, and as a hospitalist, we are passengers in the First class coach."

Day-log Internal Medicine 2011 Hospital Medicine Precouse will track one patient´s journey

There must be a way to tie the bread-and-butter topics of hospital medicine together so they are relevant yet fun, thought James S. Newman, FACP, director of the new hospital medicine precourse at Internal Medicine 2011, as he planned the course agenda last year.

“Instead of disparate lectures on this and that, I thought, ‘The course should follow a hospitalization from admission to discharge.’ Then I thought of the fact that so much of our testing and lectures in medicine is case-based, which is how I got the idea to make the course about the sequence of one patient's hospitalization,” said Dr. Newman, a hospitalist at the Mayo Clinic in Rochester, Minn. and the editorial advisor for ACP Hospitalist.

The precourse, which runs from 8 a.m. to 5 p.m. on Wednesday, April 6, starts with the admission of fictional patient Francis Xavier, a 78-year-old man admitted directly to the hospital service from a nursing home with fever and myalgias. The admission scenario is a springboard for a short introductory talk on the administrative and historical aspects of admission, including utilization review, Dr. Newman said.

[READ FULL ARTICLE]

It's official: Patients like hospitalis​ts

Survey results published by Press Ganey indicate that facilities with hospitalists may have higher patient satisfaction scores. The company, which specializes in measuring health care performance, found that hospitals with hospitalists score better in terms of patient satisfaction with nursing and personal issues, which include privacy and facility response to complaints. According to survey results, the advantages that hospitalists bring in scoring were particularly marked in teaching hospitals and large facilities. Survey results were published in the American Journal of Medical Quality. Read more in the American Journal Medical Quality.

Save the Date: PASHA Meeting with Bob Wachter - WAITING FOR A NEW DATE

Reflections on the Hospitalist Field on its 15th Birthday with...

the 'father' of hospitalist medicine

Robert M. Wachter, MD, professor and associate chair of the Department of Medicine at UCSF, was recently named the tenth most influential physician-executive in the United States by Modern Physician magazine.

Readers voted for one of 100 physician executives who made up the final ballot, with the 50 physicians who received the most votes making the final list. The ranking was determined by the number of votes received.

Wachter’s tenth-place ranking puts him in good company. Others in the top ten include the national coordinator of the health information technology office, the directors of the Food and Drug Administration, Agency for Healthcare Research and Quality, National Institutes of Health, Centers for Disease Control and Prevention and Joint Commission and the US Surgeon General – all individuals controlling large national organizations. In fact, Wachter’s ranking at number 10 marks him as the most influential academic physician in the country for the third consecutive year.

A national leader in the fields of patient safety and health care quality, Wachter wears many hats at UCSF. He is professor and chief of the Division of Hospital Medicine at UCSF, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine and serves as chief of the Medical Service at UCSF Medical Center.

This is Wachter’s fourth time in the top 50 of the nation’s top physician executives. His previous high point was No. 19 in 2008.

Wacther has published more than 200 articles and six books in the fields of quality, safety, and health policy. He coined the term “hospitalist” in a 1996 New England Journal of Medicine article, and is past president of the Society of Hospital Medicine. He is generally considered the “father” of the hospitalist field, the fastest growing specialty in the history of modern medicine.

Wachter is editor of AHRQ WebM&M, a case-based patient safety journal on the web, and AHRQ Patient Safety Network (PSNet), the leading federal patient safety portal. Together, the sites receive nearly two million visitors a year.

He has written two bestselling books on patient safety: Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (Rugged Land, 2004), and Understanding Patient Safety (McGraw-Hill, 2008).

Wachter is widely sought out by the media. He has discussed patient safety and quality on “Good Morning America”, PBS’s “NewsHour,” and NPR’s “Talk of the Nation,” and has been quoted in virtually every major newspaper and newsmagazine.

He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety. Wachter is a member of the Board of Directors of the American Board of Internal Medicine and has served on the health care advisory boards of several companies, including Google and Epocrates. His blog, Wachter’s World, is one of the nation’s most popular health care blogs.

PASHA Meeting with Phil Wells - April 7, 2011

We will connect with colleagues around the world and we wait at least 200 people togheter, learning and sharing experiences.




Web-meeting with Phil Wells, Professor of Medicine and Canada Research Chair who has been performing research in venous thromboembolic diseases for over a decade now. His most significant contributions have been in the areas of (a) diagnosis of pulmonary embolism and deep vein thrombosis, (b) treatment and (c) meta-analysis.

We are going to discuss the following topics:
What clinical rule to diagnose PE in hospitalized patients?
Is there any role for D-dimer?
CT scan or V/Q scan which one is better?
Sub-segmental PE, is it a false positive? What should we do?
Thrombolysis to whom? Do we need troponin and echocardiogram?
Outpatient treatment, what does he hospitalist need to know?
New drugs, the end of warfarin?

Coordination: Esteban Gandara (Canada), Jamie Newman (USA) and Guilherme Brauner Barcellos (Brazil)

Support: Ottawa Hospital-Ottawa Hospital Research Institute

Where to be togheter and watch the expert online? Select the place next to you and join us:

Phil Weels will be in Ottawa, Canada with Esteban Gandara - 3:00pm (Ottawa time)

Vancouver. Contact: David Wilton, Canadian Society of Hospital Medicine

Hospital Universitario Austral, Buenos Aires, Argentina. Contact: Sebastian Sevilla

Pontificia Universidad Católica de Chile, Hospital Clínico UC, Santiago. Contact: Luis Rojas Orellana

Several places in Brazil will be available. Information at http://www.medicinahospitalar.blogspot.com/

What Time Is It Around The World Right Now?

 

We are preparing a great surprise for the next event. We desire participants of others countries, mainly of those where the Hospital Medicine is starting. Contact:

South American Hospitalist Survey

PASHA members are trying to get information about the reality of Hospitalists in South America.
This kind of information would let us know where we are now and what are the principal needs of Hospitalists in our region.
It would also help us to build a "hospitalist panamerican network" to join our efforts.
The Survey is a "5 minutes questionare" that you can fill in this link:

Brasil: www.hospitalistas.com/2011p

Other Countries: www.hospitalistas.com/2011e

Thanks a lot for your Help.

Andrés Aizman.
PASHA´s Vice President.
Chile.

Patient Safety

Guest: Dr. Robert Wachter, MD, chief of the Medical Service and chair of the Patient Safety Committee at UCSF Medical Center.



Listen and comment!

Pageviews by Countries (2010 November – 2011 March) and Most Popular Posts

Brazil -------------------- 59,8%

United States -------------------- 23,5%

Canada --------------------  6,6%

Argentina -------------------- 4,4%

Australia -------------------- 1,4%

Others* -------------------- 4,3%

* Spain, Chile, Singapore, Germany, France, United Kingdom, Russia, Iran, Indonesia

Hi everyone, let us know what you think. We would like to hear from you!

Top 5 Posts
1. Save de date: April 7, 2011 - PASHA Meeting with Phil Wells
2. Jamie speaks about Pan American Hospital Medicine
3. Must a hospitalist abandon all the ambulatorial practice?
4. Will we be replaced by hospitalist “midlevel” providers?
5. What's a hospitalist?

Outcomes of a hospitalist model in Singapore

The aim of the study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database.

The family medicine hospitalist model was associated with reductions in hospital LOS and cost of care without adversely affecting mortality or 30-day all-cause readmission rate. These findings suggest that the hospitalist care model can be adapted for health systems outside North America and may produce similar beneficial effects in care efficiency and cost savings.

[ABSTRACT]

An interview with the 'father' of hospitalist medicine

Partners: Early on there was clearly some resistance to the concept of hospital medicine from other internists and other specialties. Do you find that is still the case today?

Wachter: Sure, and I actually would have been disappointed in my field had there not been. In order to achieve the advantages of having a hospitalist — and those advantages really are focused practice where this person becomes an expert in the management of sick hospitalized patients, available throughout the day and often the night, with on-site presence, and a level of coordination of hospital care that can’t be achieved by a primary care doctor trying to manage a hospitalized patient — in order to achieve those advantages there is a cost. That cost is a purposeful discontinuity of care, with the primary care doctor no longer maintaining the responsibility to manage a hospitalized patient. If I was a primary care doctor and I was being confronted with a model in which a different doctor would take care of my patient when he or she were very sick, that would bother me too. It’s really the reason why, in the early years of the field, our professional society, and our whole field really, came down very strongly against programs that were mandatory. We really felt that if the model develops and grows organically, and some primary care doctors see why there may be advantages to them and their patients in doing things this way, that over time it would grow of its own momentum. I think that has largely been what has happened.

[READ FULL ARTICLE]

Patient Satisfaction With Hospitalists

Despite concerns and disagreements about the impact of hospitalist models on health care, hospitalists are becoming the dominant means of providing inpatient care, and models continue to diversify. Understanding their impact and the factors that influence their adoption is essential. This study examined hospitalists' impact on patient satisfaction, considering a host of characteristics. [READ FULL ARTICLE]

What's a hospitalist?

Watch full conference: http://www.unisimers.com.br/videos/index.php?palestra=394

Winawer speaks about Pan American Hospital Medicine

Listen and comment

Jamie speaks about Pan American Hospital Medicine issues. Listen and comment

"It took many years to Hospital Medicine to grow in the USA. It has taken ten years to be a full specialty. At first there was only a few hundred doctors doing it and people thought it wouldn’t last, and now there is tens of thousand hospitalists in the USA, it is a huge growth. But it took five or six to start really growing and in the last three or four to really expand. It is a ten year process!"

Mark Enzler's impression about the PASHA2010

Listen and comment

Eddie Greene, Mayo Clinic nefrologist, speaks about the PASHA2010

Listen and comment

PASHA2010 from a fifth-year medical student from Universidade Positivo, Curitiba, Brazil point of view

The meeting, held in November at a beautiful beach resort in Florianópolis in southern Brazil, was pioneering in several aspects...

[READ FULL ARTICLE]

PASHA2010: An Argentine perspective

Daniel Grassi speaks about the meeting and about the Hospital Medicine in Argentina. Listen and comment.

Aleta Borrud speaks about the PASHA2010

Aleta Borrud, Mayo Clinic hospitalist, speaks about the PASHA2010, about the evolution that she observes between the moment of the first big meeting about HM in Brazil (I Brazilian Congress of Hospital Medicine, 2008) and now. Borrud compares aspects of the North American and the South American movement and speaks about the decision of not having pharmaceutical industry funding for the PASHA2010. Listen and comment.

 

Febrile neutropenia in adults and the experience of the Universitario Austral Hospital (Argentina)

Watch full conference: http://www.unisimers.com.br/videos/index.php?palestra=405

Emergency Departments and Hospitalists

Watch full conference: http://www.unisimers.com.br/videos/index.php?palestra=395

Will we be replaced by hospitalist “midlevel” providers?

Considering the fact that some hospital administrators have a tendency to view hospitalists as floaters who fill in for other physicians.

We know that the role of the hospitalist is more than being on-site as a “super resident” processing patients for other physicians or as a “nurse's doctor of convenience”, but...

Brazil is champion in absolute number of medical schools and we have a profession in crisis: too many doctors - lots of dysfunctional competition - low salaries;

In Brazil we can’t use midlevel providers.

My fear in that [bad] hospitals in Brazil start to use young licensed doctors as “midlevel hospitalists”. A physician assistant in the US is a healthcare professional licensed to practice medicine with supervision of a licensed physician. There is a movement here to have a licensed physician (not medical resident anymore) working for hospitals and attending physicians giving rear to the traditional model. Some hospitalist programs start because of the increasing necessity of around-the-clock doctors at the hospitals, but to be just for the attending physicians’ temporary substitution, what adds another layer of costs, perhaps duplication...

Will we be replaced by hospitalist “midlevel” providers?

Hope comments could help us...

Rapid Response Teams: What do you thing about it?

Rapid Response Teams: Ready for Prime Time?, by Bob Wachter

Rapid response teams saves lives, but is it good medicine?

What do you thing about RRT's?

Cutting down medication mistakes and problems

Watch full conference: http://unisimers.com.br/videos/index.php?palestra=399

When hospitalists stay longer, patients leave sooner

Researchers, led by Kenneth R. Epstein, FACP, now chief medical officer for Hospitalist Consultants, Inc. (HCI), found that as fragmentation increased, length of stay did, too. Dr. Epstein recently spoke with ACP Hospitalist about the study's results, problems with handoffs, and pros and cons of block schedules.

[READ FULL ARTICLE]

Evidense BIASed Medicine

Suggestion of a very good activity that we made in POA and you could see it online: http://www.unisimers.com.br/videos/?palestra=353

Below an interview with the speaker (almost everything in English):

Interview with Bob Wachter

Dr. Robert Wachter: Helping Health Care Get Well

Healthy Lifestyles: Hospitalist 1/5/11