At the 2006 SHM Annual Meeting Geriatrics Special Interest Forum, participants asked, “Can we create an area on the SHM Web site focused on our unique interests and needs?” Last month, SHM answered with a resounding “Yes!” as we launched the Geriatrics Special Interest Group on www.hospitalmedicine.org.

The SHM Geriatrics Special Interest Group provides a portal for SHM members to access relevant, timely information about and resources for geriatric medicine. The Community Forums provide a mechanism for participants to communicate with each other about issues in geriatric medicine and other areas of interest. In particular, the Geriatrics Special Interest Group allows users to post information about training and career development opportunities, professional meetings and forums, and funding opportunities. Users can access a wealth of geriatric-medicine resources, including breaking medical news, clinical and quality improvement tools, key publications, and archived SHM Annual Meeting presentations. The Geriatrics Special Interest Group will serve as a template for future member-requested special interest groups, including palliative care, pediatrics, and others.

The Geriatrics Special Interest Group allows users to post information about training and career development opportunities, professional meetings and forums, and funding opportunities.

The Geriatrics Special Interest Group was developed by SHM members, other experts from the community of geriatric medicine, and a team of SHM staffers. SHM member Melissa Mattison, MD, (Beth Israel Deaconess) serves as medical editor for the site and helped shape its vision, along with members Param Dedhia, MD, (Johns Hopkins, Bayview) and Jason Stein, MD (Emory University). The group also benefited from reviews and contributions made by John Degelau, MD, at HealthPartners Medical Group, Gavin W. Hougham, MD, PhD, at The John A. Hartford Foundation, Nancy Lundebjerg, MPA, and Jane Potter, MD, at the American Geriatrics Society, Odette van der Willik at the American Federation for Aging Research, and Paula M. Podrazik, MD, at the Case Management Society of America. The internal SHM development team was led by Shannon Roach and included Bruce Hanson, Travis Kamps, and Tina Budnitz.

To view the Geriatrics Special Interest Group, go to SHM’s Web site or type the address into your browser: www.hospitalmedicine.org/AM/Template.cfm?Section=Home&Template=/CM/HTMLDisplay.cfm&ContentID=12369.

We hope SHM members will utilize the Geriatrics Special Interest Group to share ideas and resources, to network, and to improve inpatient geriatric medicine. Let us know if the site meets your needs by sending your comments and suggestions to Shannon Roach at sroach@hospitalmedicine.org. Have an idea for another special interest group? E-mail us that suggestion, too.

SHM: BEHIND THE SCENES

Education and quality improvement: Reflections of a New Staff Member

By Kristin Beck

It’s nice to come to work every day and focus on education and quality improvement. Ensuring that hospitalists have the most up to date information as well as support and encouragement for implementing positive change are good reasons for leaving the house in the morning.

Only three weeks into my role as senior project manager, I have had the sincere pleasure of being involved with updating quality improvement resource rooms (common Web site areas that house tools for implementing quality improvement programs) by initiating a grant-supported program for examining observation units as they relate to treating the number one reason people are hospitalized. I have also accomplished writing and submitting a grant for the Quality Improvement Pre-Course, as well as, working with a committee that looks at patient quality care and projects to enhance it.

Our work here focuses on examining what has been done, how we can improve it, and how we can institute best practices. Not bad for three weeks’ work!

Conversations in our department focus on whether members get what they need and want. People meet regularly to discuss how we can refine and improve the services we offer. Strategies for securing funding and developing programs are reviewed, not for this calendar or fiscal year but for years to come. In one of my final interviews for this job, I was reminded that we don’t deliver here—we over-deliver. Looking through The Hospitalist, titles that stand out include the words unforgettable, safety, expert, leader, admire, and smart.

When people ask what I do in my new job, I tell them that hospital medicine looks at the total experience of being a doctor. It focuses not only on medical care but also on the complete experience of being a working professional: the arts of research, negotiation, best practices, team-focused care, conflict resolution, and systems change. I explain that we do life-saving work, for it is far more than the practice of just day-to-day medicine that improves all of our lives. I tell people that it is work that makes sense.

When you come to work every day and are surrounded by a dynamic, positive energy, the work you produce is likely to mirror the hospital medicine movement: You will reflect, revise, and grow stronger. Sincere, well-planned initiatives are infectious. Continually participating in an environment that asks the questions, “Where can we take this?” and “What can we do better?” is a pretty good reason to get out of bed in the morning.

Beck is the senior project manager at SHM.

VTE Prevention Collaborative off to a Great Start

The VTE Prevention Collaborative (VTE PC) is the latest SHM initiative to support hospitalist-led efforts to reduce the incidence of preventable, hospital-acquired VTE. Launched in January 2007, the program offers individualized assistance to hospitalists who want to take the lead on this critical quality and patient safety issue.

Hospital-Acquired Venous Thromboembolism

The problem of hospital-acquired VTE is huge. More than 2 million Americans suffer from VTE each year. Most hospitalized patients have at least one risk factor for VTE. In a large registry trial capturing more than 5,451 patients at 183 sites in a six-month period, 50% (2,726) developed their VTE during hospitalization.1 A 400-bed hospital with an average rate of VTE prophylaxis can expect that 200 patients will suffer from hospital-acquired VTE each year; around half of these cases are potentially preventable.1,2

The good news is that effective and safe measures to prevent hospital-acquired VTE exist. Pharmacologic prophylaxis reduces the incidence of asymptomatic and symptomatic DVT and pulmonary embolism (PE) by 50%-65%.3, 4-11 Prevention of DVT also prevents PE and fatalities from PE. The chief concern of prophylaxis is bleeding, but bleeding risk secondary to pharmacologic prophylaxis is a rare event, as is shown in abundant data from meta-analyses and placebo-controlled, randomized controlled trials.3,4

Close the Gap

Reliably preventing VTE in the hospital is inherently complex. VTE risk and bleeding risks vary within patient populations, and these risks may change for an individual patient several times in the course of the hospital stay. Weight, age, renal function, medication changes, and recent or impending invasive interventions may all influence decisions about the best VTE prevention options. Transitions across care providers and locations translate into multiple opportunities for breakdown in the delivery of optimal VTE prophylaxis. Thoughtful, evidence-based protocols, multidisciplinary system changes, and comprehensive educational efforts are required to achieve optimal VTE prophylaxis in the complex hospital setting.

How the VTE PC Can Help

The VTE PC program builds on and complements the VTE prevention materials and educational resources that SHM has produced in recent years. “Our Quality Improvement Resource Rooms have the information and resources needed to tackle a number of key quality issues,” says SHM CEO Larry Wellikson. “The VTE PC project takes this one step further by providing individualized mentorship. SHM is committed to supporting these forward-thinking, unique strategies that will allow hospitalists to lead their hospitals into a better future.”

VTE PC participants can choose the type of support that best fits their needs: a full year of distance mentoring or a one-day evaluation and consultation visit to their site.

The mentoring program presents a perfect option for individuals interested in ongoing support for their planned or active VTE prevention projects. Through the project, SHM mentors with VTE and QI experts who work with participants during eight telephone calls scheduled throughout a yearlong mentoring period. During the calls, mentors offer individualized assistance on any topics, tasks, and barriers that are encountered in the course of designing, implementing, and evaluating a VTE prevention project. Instruction and assistance are tailored to participant needs and commonly focus on:

Working with medical center administration;

Using practical methods to assess institutional performance in VTE prophylaxis;

Identifying and tracking patients with hospital-acquired VTE;

Constructing a VTE risk-assessment model and integrating it into workflow, order sets, and protocols;

Enhancing selection of appropriate prophylaxis by linking the VTE risk assessment to a corresponding menu of proven options; and

Bolstering your chances of success by utilizing high-reliability design features and effective implementation techniques.

The on-site consultation program is a good option for individuals interested in securing expert evaluation and input on a VTE prevention program but who don’t need ongoing support. Through the on-site consultation program, SHM consultants with VTE and QI expertise visit applicants’ hospitals to evaluate active or planned VTE prevention programs. The visits are especially helpful to participants with existing VTE prevention programs that they wish to expand or improve upon.

The consultation visits feature a structured evaluation of the site’s strengths and resources, barriers to improvement, and the design and functioning of active or proposed VTE prevention interventions. Specific consultation-visit activities vary according to participant goals and needs but may include meeting with the local project team, QI leaders, hospital administrators, and hospital medicine group leaders, as well as reviewing project documents—order sets, policies, and procedures—data, and data collection/management tools. Following the visits, SHM consultants provide participants with a written report of findings and recommendations. Participants also receive one follow-up telephone consultation.

Collaborative Members

SHM membership has responded enthusiastically to the VTE PC project. Early enrollees have a wide range of experience with VTE prevention and QI in general. Some fill QI leadership roles in their hospitals or hospital medicine groups; for others, the VTE prevention project is their first experience leading a QI effort. Enrollees represent a range of hospital types (academic centers, community teaching hospitals, community hospitals) and sizes (staffed beds range from 135 to 650) and are located in every U.S. geographic region in multiple hospital systems.

Several participants represent hospitals where VTE prevention programs have been implemented, while most have active projects in which no intervention has yet been implemented; a handful are still in the planning/initial exploration phase of work. Nearly half of the enrolled sites have a history of failed QI efforts in VTE prevention.

Many enrollees are looking to their VTE prevention efforts as a means of positioning their hospital medicine group as a local QI force. “This is the first large project the hospitalist group has undertaken since getting up and running,” reports one attendee. “I would really like to make a positive impact on patient care and lay the groundwork with this project that would allow us to be successful with future undertakings.”

Applying to the Programs

Participation in both the mentoring and on-site consultation programs is open to hospitalists who lead proposed or active VTE prevention projects. Participation is free, but enrollment is limited, so interested individuals are encouraged to apply early. SHM members can apply to either program by completing the online application available on the VTE Prevention Collaborative Web site: www.hospitalmedicine.org/vte-pc.

Direct your questions about VTE Prevention Collaborative programs to vtepc@hospitalmedicine.org.

Bibliography

Goldhaber SZ, Tapson VF; DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004 Jan;93(2):259-262.

Maynard G. Workbook for Improvement: optimize prevention of venous thromboembolism at your medical center [SHM Web site, VTE Quality Improvement Resource Room]. Available at: www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_Rooms&Template=/CM/ContentDisplay.cfm&ContentID=6092. Last accessed March 19, 2007.

Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S. Review. Comment in Chest. 2005 Jun;127(6):2297-2298.

Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evidence Report/Technology Assessment No. 43 [Agency for Healthcare Research and Quality Web site]. July 2001;332–346;AHRQ Publication No. 01-E058. Available at: www.ahrq.gov/clinic/ptsafety/. Last accessed March 19, 2007.

Belch JJ, Lowe GD, Ward AG, et al. Prevention of deep vein thrombosis in medical patients by low-dose heparin. Scott Med J. 1981 Apr;26(2):115–117.

Gardlund B. Randomised, controlled trial of low-dose heparin for prevention of fatal pulmonary embolism in patients with infectious diseases. The Heparin Prophylaxis Study Group. Lancet. 1996 May 18;347(9021):1357–1361. Comment in: ACP J Club. 1996 Nov-Dec;125(3):64 & Lancet. 1996 Jul 20; 348(9021):205-206.

Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med. 1999 Sep 9;341(11):793–800.

Leizorovicz A, Cohen AT, Turpie AG, et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004 Aug 17;110(7):874-879.

Kleber FX, Witt C, Vogel G, et al. Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J. 2003 Apr;145(4):614–621.

Lechler E, Schramm W, Flosbach CW. The venous thrombotic risk in non-surgical patients: epidemiological data and efficacy/safety profile of a low-molecular-weight heparin (enoxaparin). The Prime Study Group. Haemostasis. 1996;26(Suppl):49–56.

Cohen AT, Davidson BL, Gallus AS, et al. Fondaparinux for the prevention of VTE in acutely ill medical patients (abstract 42). Blood. 2003;102:15a.

Chapter summaries

Pittsburgh

The Pittsburgh chapter held its meeting Jan. 30, 2007, at Morton’s Steakhouse in Pittsburgh. The speaker for the event was David Lasorda, MD, director of Interventional Cardiology at Allegheny General Hospital. His presentation topic was “Aggressive Lipid Management.” The subject matter generated an excellent discussion. At press time, the next meeting was scheduled for April 2007. For more information on the Pittsburgh chapter, please contact Michael Cratty, MD, PhD, at mcratty@wpahs.org.

Northern Nevada

The inaugural Northern Nevada SHM chapter meeting on Feb. 13 in Reno was attended by 38 physicians, including four specializing in internal medicine, two family practice residents, and two group administrators. The physicians represented the three large groups from the Reno area and the major groups from Carson City and South Lake Tahoe. Phil Goodman, MD, welcomed the group and provided an overview of SHM. A DVD featuring former SHM President Mary Jo Gorman, MD, was then shown.

Following a round of introductions and dinner, a short business meeting was held, at which the following chapter members were elected to office for the current year:

President: Damon Zavala, DO, Renown Regional Hospitalists;

Secretary/VP Logistic: Joel McReynolds, MD, Sierra Hospitalists;

Membership VP: Ned Jaleel, MD, Carson Tahoe Hospitalists; and

Projects VP: Phil Goodman, MD, University Hospitalists.

Rocky Mountain

SHM’s Rocky Mountain chapter met Feb. 8, 2007, at Landry’s Downtown Aquarium in Denver. Attendees spent time networking. Eugene Chu, MD, was announced as president. Other officer nominations followed. An update was then given by Bob Brockmann, MD, on the chapter’s Public Policy Committee; Ken Epstein, MD, gave a report on the status of the chapter’s Research Committee. The guest speakers for the night were Jean Kutner, MD, MSPH, FACP, who gave a presentation on palliative care, and Barry Molk, MD, FACC, who spoke on congestive heart failure.

The meeting was sponsored by Ortho McNeil and Medtronic.

Awards Ceremony Preview

SHM created the Awards of Excellence program to honor members whose contributions to the hospital medicine movement deserve acknowledgment and respect. Award winners will receive complimentary registration and paid airfare to SHM’s Annual Meeting, which is being held this month in Dallas and will be presented during the President’s luncheon. Any physician member whose focus is the general medical care of hospitalized patients is eligible for nomination of the four awards. Award winners have been selected for the following categories: Clinical Excellence, Excellence in Teaching, Outstanding Service, and Research.

The SHM Award for Clinical Excellence will be presented to an individual for recognition of exemplary clinical service in hospital medicine. The Awards Committee has evaluated the candidates according to their outstanding contributions to patient care, their advancement of clinical knowledge, including their leadership and professionalism in medicine, as well as personal excellence in practice management.

The SHM Award for Excellence in Teaching is presented in recognition of outstanding teaching and mentorship in hospital medicine, most specifically within the academic and community practice settings. Consideration was given to those nominees who demonstrated outstanding teaching ability and who served as role models and mentored other hospitalists, residents, medical students, or other healthcare professionals.

The SHM Award for Outstanding Service in Hospital Medicine is presented in recognition of exceptional service to the discipline of hospital medicine. The winning candidate has displayed exemplary organizational and leadership activities within organized medicine and has shown contributing support in public policy.

The SHM Excellence in Research Award is presented in recognition of outstanding achievement by a researcher in the discipline of hospital medicine. The candidate selected presented peer-reviewed publications and continued education with additional research and training that provided for both intra- and extramural funding for research.

For additional information regarding SHM’s Awards Program, please e-mail awards@hospitalmedicine.org. TH

SHM Launches Geriatric Special Interest Group