Towards better understanding of workplace factors contributing to hospitalist burden and burnout prior to COVID-19 pandemic

Background: Hospitalists are physicians trained in internal medicine and play a critical role in delivering care in in-patient settings. They work across and interact with a variety of sub-systems of the hospital, collaborate with various specialties, and spend their time exclusively in hospitals. Research shows that hospitalists report burnout rates above the national average for physicians and thus, it is important to understand the key factors contributing to hospitalists' burnout and identify key priorities for improving hospitalists' workplace. Methods: Hospitalists at an academic medical center and a community hospital were recruited to complete a survey that included demographics, rating the extent to which socio-technical (S-T) factors contributed to burnout, and 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Twelve contextual inquiries (CIs) involving shadowing hospitalists for ~60 h were conducted varied by shift type, length of tenure, age, sex, and location. Using data from the survey and CIs, an affinity diagram was developed and presented during focus groups to 12 hospitalists to validate the model and prioritize improvement efforts. Results: The overall survey participation rate was 68%. 76% of hospitalists reported elevated levels on at least one sub-component within the MBI. During CIs, key breakdowns were reported in relationships, communication, coordination of care, work processes in electronic healthcare records (EHR), and physical space. Using data from CIs, an affinity diagram was developed. Hospitalists voted the following as key priorities for targeted improvement: improve relationships with other care team members, improve communication systems and prevent interruptions and disruptions, facilitate coordination of care, improve workflows in EHR, and improve physical space. Conclusions: This mixed-method study utilizes participatory and data-driven approaches to provide evidence-based prioritization of key factors contributing to hospitalists' burnout. Healthcare systems may utilize this approach to identify workplace factors contributing to provider burnout and consider targeting the factors identified by providers to best optimize scarce resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Gearing Up For Digital Transformation

Prisma Health is working to deploy customer relationship management technology so that everyone in the organization knows which patients need, for example, a chatbot nudge to schedule a mammogram or a telephone call to check on their status. Adopting a single electronic medical record system for the entire system in 2017 set the foundation needed to be an early adopter of technology that moves care delivery closer to patients where they live says Pankaj Jandwani, MD, regional vice president for medical affairs and chief innovation officer. [...]experience, MidMichigan is currently working to implement a systemwide tele-ICU model to serve its smaller hospitals. In early 2022, the Centers for Medicare & Medicaid Services (CMS) certified that MyMichigan's Hospital at Home program met its stringent requirement for treating a specific subset of patients for an acute illness in their homes.

Towards better understanding of workplace factors contributing to hospitalist burden and burnout prior to COVID-19 pandemic

Background Hospitalists are physicians trained in internal medicine and play a critical role in delivering care in in-patient settings. They work across and interact with a variety of sub-systems of the hospital, collaborate with various specialties, and spend their time exclusively in hospitals. Research shows that hospitalists report burnout rates above the national average for physicians and thus, it is important to understand the key factors contributing to hospitalists' burnout and identify key priorities for improving hospitalists’ workplace. Methods Hospitalists at an academic medical center and a community hospital were recruited to complete a survey that included demographics, rating the extent to which socio-technical (S-T) factors contributed to burnout, and 22-item Maslach Burnout Inventory – Human Services Survey (MBI-HSS). Twelve contextual inquiries (CIs) involving shadowing hospitalists for ∼60 hours were conducted varied by shift type, length of tenure, age, sex, and location. Using data from the survey and CIs, an affinity diagram was developed and presented during focus groups to 12 hospitalists to validate the model and prioritize improvement efforts. Results The overall survey participation rate was 68%. 76% of hospitalists reported elevated levels on at least one sub-component within the MBI. During CIs, key breakdowns were reported in relationships, communication, coordination of care, work processes in electronic healthcare records (EHR), and physical space. Using data from CIs, an affinity diagram was developed. Hospitalists voted the following as key priorities for targeted improvement: improve relationships with other care team members, improve communication systems and prevent interruptions and disruptions, facilitate coordination of care, improve workflows in EHR, and improve physical space. Conclusions This mixed-method study utilizes participatory and data-driven approaches to provide evidence-based prioritization of key factors contributing to hospitalists’ burnout. Healthcare systems may utilize this approach to identify workplace factors contributing to provider burnout and consider targeting the factors identified by providers to best optimize scarce resources.

Connection and Resilience: Using Interviews to Support Hospitalist Well-Being During COVID-19

Like all healthcare professionals, hospitalists are at risk for burnout, and COVID-19 has made burnout symptoms worse, according to survey data of hospitalists at Mayo Clinic sites.1 Burnout is destructive;it is associated with shorter lifespan, depression, staff turnover, medical errors, and high costs to healthcare systems.2-6 Hospitalists, as leaders of healthcare teams in the hospital setting, also face personal risk in caring for hospitalized patients during the pandemic. At one New York City health system, hospital leaders fostered the emotional well-being of staff with individual and group counseling sessions, respite rooms, wellness rounds, assistance with transportation, childcare, and temporary lodging.7 A culture committee at Stanford University created several initiatives to address the needs of healthcare workers, including obtaining donations of masks and gift cards, providing snacks, and creating safe social interactions through podcasts and virtual gatherings.8 Others have offered workshops on mind-body practices.9 We report on a simple, low-cost effort led by wellness physician champions to directly support the well-being of frontline hospitalists at a large academic medical center: the personal interview. With the backing of the larger Health System Wellness Committee, which had identified wellness champion leaders early in the pandemic, we embarked on a variety of hospital medicine wellness activities. Hospitalists are accustomed to talking on the phone;they respond to pages by contacting patient care nurses and other staff by phone;they discuss patient care with consultants via phone;they update patients' families by phone;and, importantly, they sign out to oncoming teammates by phone. Because of the severe restrictions placed on social interactions, these essential exchanges with hospitalist teammates were now, at times, taking place between teammates who had never met.

Goals-of-care conversations and COVID-19: Using a brief educational module to empower generalist clinicians at the southern AZ VA health care system

Purpose: To evaluate the effect of a brief educational module on the self-reported knowledge, confidence, and intent of generalist clinicians to conduct goals-of-care conversations with hospitalized COVID-19 patients at the Southern Arizona Veterans Affairs Health Care System (SAVAHCS) in Tucson, Arizona.Background: The COVID-19 pandemic has led to an influx of seriously ill hospitalized patients who need their goals of care rapidly established to guide medical treatment decisions. Generalist clinicians have had to conduct these conversations more frequently due to large patient volumes and a shortage of palliative care specialists. However, generalists often report feeling underprepared due to limited formal goals-of-care communication training. Several recent studies have shown that educational interventions can improve goals-of-care-related knowledge, confidence, and skill levels. The Reframe, Expect emotion, Map outpatient goals, Align with goals, and Propose a plan (REMAP) communication framework is a structured, evidence-based approach to goals-of-care conversations that has been shown to increase the knowledge, confidence, and skill levels of generalists across multiple disciplines.Methods: Generalists at the SAVAHCS completed a web-based educational module that demonstrated the application of the REMAP framework to a COVID-specific case scenario. Participants completed pre- and post-intervention questionaries. Primary outcomes were changes in self-reported knowledge and confidence levels. Secondary outcomes included post-intervention feelings of preparedness and intention to conduct goals-of-care conversations.Results: Three participants completed the pre- and post-intervention questionnaires. All three participants reported an increase in their knowledge levels, and two out of three reported an increase in their confidence levels. Neither of the differences in means was statistically significant. All three participants strongly agreed that they felt more prepared and had a stronger intention to conduct goals-of-care conversations after completing the module. All participants agreed that participation in the project would change or improve their practice.Conclusions: The results of this project suggest that a brief online educational module that demonstrates the application of an evidence-based goals-of-care communication framework can improve generalists' knowledge, confidence, and intent to conduct goals-of-care conversations with hospitalized COVID-19 patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-19: PEER-TO- PEER, REAL-TIME LEARNING

Gregory Cooper, MD, PhD, CPE Regional president (East Region), Baptist Health Medical Group, based in Kentucky The biggest challenge has been the initial need to rapidly assimilate a great deal of information about the disease, including the potential public health impact and most appropriate responses to mitigate this impact. Amin Hakim, MD, CPE, FIDSA, FACPE Vice president of clinical operations for United Healthcare, based in New York As a physician on the COVID-19 Task Force of a national healthcare organization and as an infectious disease specialist, it was hard to stay on top of the flood of science and to sort through what is relevant, hype, or misleading. Scott Ransom, DO, MBA, MPH, CPE Partner, Health Industries Advisory, PricewaterhouseCoopers LLP ;Strategy&, in Dallas, Texas Balancing and effectively communicating the very real business, public health, clinical, and psychological issues associated with the COVID-19 crisis has required strong and insightful physician leadership. More personally, be sure to repeatedly thank everyone on your team: the nurses, patient care techs, and housekeepers braving COVID-19 exposure;the case managers keeping patient flow moving;the cafeteria staff delivering much-needed food to teams who are too busy to take lunch;administrative staff handing out masks;and security keeping everyone safe

Web Exclusive. Annals for Hospitalists Inpatient Notes - Preparing for Battle: How Hospitalists Can Manage the Stress of COVID-19.

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Expanding the Differential During the COVID-19 Pandemic: Fatal West Nile Virus Neuroinvasive Disease.

The ever-evolving pandemic of Coronavirus disease 2019 (COVID-19) has the potential to drown out other viruses continuing to infect communities. To highlight this, we present 2 cases of fatal West Nile virus neuroinvasive disease that occurred within 2 weeks of each other. Since the first positive case of West Nile virus in the United States, there have been 2 epidemics in the past 2 decades, most often occurring in regions of North Texas and Southern California, which have been areas of high-incidence for COVID-19. It is important for the health care provider to recognize diagnostic biases and maintain broad differentials for the patient presenting with fever and other symptoms associated with COVID-19.

Clinical Redeployment of an Academic Family Medicine Department in an Early, Severe COVID-19 Pandemic in the Bronx, NY.

INTRODUCTION: A severe surge of the COVID-19 pandemic in spring 2020 infected 33% of the population and caused more than 7000 deaths in the Bronx, NY. The Department of Family and Social Medicine at Montefiore Medical Center rapidly and strategically reconfigured clinical services to meet the needs of patients, communities, and the health system. CLINICAL RECONFIGURATION: Family medicine hospitalist services tripled in size within 2 weeks to cover 71 beds and cared for 447 patients between March 24 and June 10, 2020, of whom 279 (62.4%) had COVID-19. Community health centers reorganized to maintain primary care services, shifting abruptly to telemedicine while maintaining 95% of the previous year's visit volume, and address intensified patient needs related to viral infection and mental health impacts. Core principles for redeployment included role flexibility, communication, responsiveness, and safety and wellness. DISCUSSION: During a pandemic surge, academic family medicine departments have an important role in expanding hospitalist services and redesigning primary care services. The ability to reconfigure work to meet unprecedented demands on health care was facilitated by family medicine's broad scope of practice including training in hospital medicine, interpersonal communication, behavioral health, care across settings, collaborative partnerships with specialists, and adaptability to communities' needs.

The fine line of defensive medicine.

Defensive medicine is a practice that has been utilized by clinicians in efforts of preventing patient dissatisfaction and malpractice claims and may be done through either omission or commission. As much as 57% of physicians have disclosed that they practice defensive medicine. However, this practice does not necessarily prevent malpractice claims and more importantly, neither does it equate to good medical practice, with some leading to poor outcomes. Unfortunately, there is a high percentage of malpractice claims lodged against clinicians in both primary care and hospital settings. Specialists such as surgeons, obstetricians, and gynecologists face the highest claims. In particular, during the SARS CoV-2 pandemic, with new challenges and limited treatment algorithms, there is an even greater concern for possible bourgeoning claims. Counteracting defensive medicine can be accomplished through decriminalizing malpractice claims, leaving physician oversight up to state medical boards and hospital claims management committees. Additional tort reform measures must also be taken such as caps on noneconomic damages to ensure emphasis on beneficence and nonmaleficence. Once these are in place, it may well serve to increase clinician-patient trust and improve patient independence in the shared decision-making process of their treatment, allowing clinicians to practice their full scope of practice without feeling wary of potential malpractice claims.