STAT looks at five ways in which some hospitals are trying to relieve employees’ stress:
“At Hennepin County Medical Center, in Minneapolis, administrators created a ‘reset room’ where employees can grab a quiet moment to themselves or take a quick nap.”
Tapping the spiritual
“At M.D. Anderson Cancer Center, in Houston, physicians and nurses visit a prayer labyrinth to recover from a sad or stressful episode in the facility….”
Arts, craft, and live music“Hospital arts programs are going beyond pinning a few colorful paintings on the walls.
“At MedStar Georgetown University Hospital, in Washington, D.C., nurses and doctors listen to live music, dance, and work on a wide range of projects, from bracelet making to creative writing. Julia Langley, director of the hospital’s Lombardi Arts & Humanities Program, said it is crucial for front-line caregivers to have a creative outlet.”
Taking a deep breath
“Hospitals are also placing a greater emphasis on physical activity for staff members. Instead of just opening a gym in the basement, many administrators are finding ways to incorporate exercise into the work day.”
Relieving information overload
“Cleveland Clinic administrators are targeting a primary source of stress for physicians: the electronic medical records system.
Record-keeping requirements force most physicians to spend more time working on computers than treating patients, which is not why they joined the profession, said Dr. Sumita Khatri, of the Cleveland Clinic Pathobiology Department.
“Dr. Khatri is working with a panel of physicians to redesign daily workflow to help relieve the burden of record-keeping requirements. The effort involves creating customized software and delegating some EMR work to physician’s assistants, among others. ”
To read the STAT story, please hit this link.
A new computer program helps calculate the odds of a patient having an illness. The Wall Street Journal says the predictive tool, “which pops up on a screen of electronic medical records, prompts the doctor to answer a short series of questions about the patient’s condition. Based on that information, a calculator predicts the probability that the person has the suspected ailment. It may also recommend a course of action.”
The hope is that the technology can cut the number of expensive tests and antibiotics ordered by allowing the early ruling out of some diseases as causing the symptoms a patient shows up with, thus speeding appropriate care.
Text and video: Cheryl Pegus, M.D., director of the Division of General Internal Medicine and Clinical Innovation at New York University Langone Medical Center, discusses how to improve the relationship between primary-care physicians and hospitalists; the latter are the fastest growing specialty physicians in the U.S.
She notes that with that growth, “Over the past 5 or 10 years, we’ve also seen another trend. Academic medical centers, hospitals, and community health systems have been purchasing outpatient practices of ambulatory physicians. Today, about 58 percent of family medicine physicians and 50 percent of internal medicine physicians are employed by health systems. We also see this with multi-specialty practices, where about 40 percent of them are associated with health systems and about 20 percent are associated with single-specialty hospitals. Today, we have a number of our physicians who are employed in both the inpatient and outpatient settings.”
Among her other remarks:
“There are many advantages to having outpatient ambulatory sites and inpatient physicians having patients’ care on the same patient portal where the patients also have access to the system. Some of the benefits include that there is a patient history readily available. You actually know who the physicians are the patient has seen from a specialty, and from a primary care perspective, and you have their results. You’re aware of the different community resources that a patient has had. This allows beginning an easy communication between physicians, even if they’ve met only once or twice, allowing for easier diagnosis, easier treatment protocols, and transitions back into the community.”
“Because these physicians all work within the same health systems, it’s extremely important that there are great communication modalities set up so that all of the physicians within a health system are hearing the same message. ”
“Electronic medical records form a basis for improving communications between inpatient and outpatient physicians. Putting training into place so that physicians are aware of the tools and how to use them is very important.”
Murray Epstein, M.D., writes that it’s time to restore continuity of care in U.S. hospitals.
“I wish to unfurl a red flag, a challenge to the legions of bureaucrats who hover under the umbrella of the Centers for Medicare & Medicaid Services and other agencies governed by the Department of Health and Human Services. Rather than focusing on electronic medical records, and expending hundreds of hours honing and refining penalties and dictums for physicians who have transgressed for slight ‘errors,’ I recommend that you expend time and energy developing a viable algorithm that is readily comprehended for ensuring continuity of clinical care.
“When a patient is asked to name his or her physician in charge, and the response is a blank stare, a deafening silence, or a long list of names, we must recognize that the patient care model currently espoused is broken, and no ACGME dictate will resolve this problem. I suggest that we reach out to the Institute of Medicine, which I regard with great esteem, to become involved and prioritize this problem as one of the key issues to solve in an accelerated timeline.”
The American Board of Internal Medicine’s Choosing Wisely campaign aimed at reducing the incidence of unneeded and sometimes clinically dangerous care has not had much of an impact so far.
A study in JAMA Internal Medicine found that, for seven treatment and testing services listed by the Choosing Wisely campaign as usually unnecessary, use of only two had declined, but use of the other five either didn’t change or increased.
A possible caveat: All the investigators in the study are affiliated with Anthem, the big health insurer, and led by Alan Rosenberg, M.D., the firm’s vice president for clinical pharmacy and medical policy .
The researchers recommended new measures to achieve substantial change in physician knowledge and behavior.
Many, though not all, of the services covered by Choosing Wisely are related to diagnostic imaging.
The study said: “The relatively small use changes suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations in general practice. Some of the additional interventions needed include data feedback, physician communication training, systems interventions (e.g., clinical decision support in electronic medical records), clinician scorecards, patient-focused strategies, and financial incentives.”
TytoCare, an Israeli telehealth device company, has attracted the interest of some pediatric practices and children’s hospitals who want to see how if and how they can use the company’s device (above) that tests for mouth, ear, heart, throat, skin, heart and lung issues.
The company said the device could be used with a remote clinician in a video interaction. The user could transmit data from the device to the physician. The device allows for integration into electronic medical records.
Sounds neat, but would it oversimplify information compared to what a clinician would get via a regular physical exam? Just how much of medicine can be made “virtual”?
Sleepy downtown Danville, Pa., where Geisinger is based.
This interview with David Feinberg, M.D., the chief executive of Geisinger Health System, which serves a largely rural clientele in Pennsylvania’s coal country, gives a pretty good idea of why, as The Wall Street Journal notes, it has “become a national poster child for the kind of carefully coordinated, data-driven healthcare that experts say one day could right the nation’s troubled medical system, providing better care at lower costs.”
Among other things, the system has long been a pioneer in the use of electronic medical records and other data, which helps it to avoid unnecessary procedures. That the company also runs an insurance company gives it an unusual incentives to reduce the number of many procedures.
And look for Geisinger to keep expanding:
“WSJ: Geisinger has been growing in size and scope, in part through merger-and-acquisition activity such as the deal with AtlantiCare health system in New Jersey. What are your plans for future mergers and acquisitions?
“DR. FEINBERG: Our M&A activity is wild. As far as our growth goes, I’m really looking for people that are culturally aligned with where we’re going. I want people or organizations—and AtlantiCare is a great example—that may be at a different place in the journey but believe in the journey around population health, innovation.”