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Westergaard S, Bowden K, Astik GJ, Bowling G, Keniston A, Linker A, Sakumoto M, Schwatka N, Auerbach A, Burden M. Impact of billing reforms on academic hospitalist physician and advanced practice provider collaboration: A qualitative study. J Hosp Med 2024; 19:486-494. [PMID: 38598752 DOI: 10.1002/jhm.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Medicare previously announced plans for new billing reforms for inpatient visits that are shared by physicians and advanced practice providers (APPs) whereby the clinician spending the most time on the patient visit would bill for the visit. OBJECTIVE To understand how inpatient hospital medicine teams utilize APPs in patient care and how the proposed billing policies might impact future APP utilization. DESIGN, SETTING AND PARTICIPANTS We conducted focus groups with hospitalist physicians, APPs, and other leaders from 21 academic hospitals across the United States. Utilizing rapid qualitative methods, focus groups were analyzed using a mixed inductive and deductive method at the semantic level with templated summaries and matrix analysis. Thirty-three individuals (physicians [n = 21], APPs [n = 10], practice manager [n = 1], and patient representative [n = 1]) participated in six focus groups. RESULTS Four themes emerged from the analysis of the focus groups, including: (1) staffing models with APPs are rapidly evolving, (2) these changes were felt to be driven by staffing shortages, financial models, and governance with minimal consideration to teamwork and relationships, (3) time-based billing was perceived to value tasks over cognitive workload, and (4) that the proposed billing changes may create unintended consequences impacting collaboration and professional satisfaction. CONCLUSIONS Physician and APP collaborative care models are increasingly evolving to independent visits often driven by workloads, financial drivers, and local regulations such as medical staff rules and hospital bylaws. Understanding which staffing models produce optimal patient, clinician, and organizational outcomes should inform billing policies rather than the reverse.
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Affiliation(s)
- Sara Westergaard
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Greg Bowling
- University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anne Linker
- Division of Hospital Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Matthew Sakumoto
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Natalie Schwatka
- Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Andrew Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Boyer L, Fond G, Auquier P, Khouani J, Boussat B, Wu AW. Enhancing healthcare worker resilience and health in underserved communities and rural areas: Lessons and strategies for global health. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202529. [PMID: 38632932 DOI: 10.1016/j.jeph.2024.202529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Laurent Boyer
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France.
| | - Guillaume Fond
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
| | - Pascal Auquier
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
| | - Jeremy Khouani
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Department of General Practice, Aix-Marseille University, Marseille, France
| | - Bastien Boussat
- Department of Clinical Epidemiology, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Albert W Wu
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lally RM, Schmidt R, Kupzyk K, Wengel SP, Cordts KP, Mills AC, Richards SE. Implementing Longitudinal Wellbeing Interventions and Evaluation Among Midwestern Healthcare Workers During COVID-19. West J Nurs Res 2024; 46:296-306. [PMID: 38465618 DOI: 10.1177/01939459241237663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the mental health of healthcare workers throughout the world has been reported, but most studies have been cross-sectional and excluded the Midwestern U.S. healthcare workforce. OBJECTIVE This study aimed to longitudinally assess the psychological wellbeing and wellness strategies used by a Midwestern academic health system's workforce at multiple points throughout waves of the COVID-19 pandemic to inform ongoing implementation of appropriate wellness activities. METHODS An anonymous REDCap survey linked within our team-developed wellness education was posted in the employee online newsletter in April (T1), July (T2), October 2020 (T3), and May 2021 (T4). Surveys were open to all employees (approx. 9000) for approximately 12 days at each time point. Anxiety, depressive symptoms, stress, self-efficacy, and self-care activities were assessed. Following each data collection, team members discussed findings and planned wellness education implementation. RESULTS Response ranged from n = 731 (T1) to n = 172 (T4). Moderate to severe stress was reported by 29.5% (n = 203) of respondents at T1 and 34.0% (n = 108) at T2. At T3, all psychological symptoms significantly increased (p < .001) as COVID-19 surged, with 48.5% (n = 141) of respondents reporting moderate to severe stress. At T4, stress significantly declined (p < .001). Exercise was the most frequently reported coping strategy. CONCLUSIONS Mental health symptoms reported by a Midwestern healthcare workforce increased during surges of COVID-19 hospitalizations. Individuals in non-patient contact roles experienced symptom levels similar to and at times with greater severity than healthcare personnel with patient contact roles.
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Affiliation(s)
- Robin M Lally
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachael Schmidt
- Fred & Pamela Buffett Cancer Center, Nebraska Medicine, Omaha, NE, USA
| | - Kevin Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven P Wengel
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Adam C Mills
- Department of Psychology, Nebraska Medicine, Omaha, NE, USA
| | - Sarah E Richards
- Nebraska Medicine, Omaha, NE, USA
- Division of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Schwatka NV, Keniston A, Astik G, Linker A, Sakumoto M, Bowling G, Auerbach A, Burden M. Hospitalist Shared Leadership for Safety, Health, and Well-Being at Work: United States, 2022‒2023. Am J Public Health 2024; 114:162-166. [PMID: 38354355 PMCID: PMC10916734 DOI: 10.2105/ajph.2024.307573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
We assessed how hospitalists frame workplace safety, health, and well-being (SHW); their perception of hospital supports for SHW; and whether and how they are sharing leadership responsibility for each other's SHW. Our findings highlight the important role of local support for hospitalist SHW and reveal the systemic, hospital-wide problems that may impede their SHW. We believe that positioning hospitalists as leaders for SHW will result in systems-wide changes in practices to support the SHW of all care team members. (Am J Public Health. 2024;114(S2):S162-S166. https://doi.org/10.2105/AJPH.2024.307573).
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Affiliation(s)
- Natalie V Schwatka
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Angela Keniston
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Gopi Astik
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Anne Linker
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Matthew Sakumoto
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Gregory Bowling
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Andrew Auerbach
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Marisha Burden
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
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Chua IS, Khinkar RM, Wien M, Kerrissey M, Lipsitz S, Cheung YY, Mort EA, Desai S, Morris CA, Pearson M, Eappen S, Rozenblum R, Mendu M. What Went Right? A Mixed-Methods Study of Positive Feedback Data in a Hospital-Wide Mortality Review Survey. J Gen Intern Med 2024; 39:263-271. [PMID: 37725228 PMCID: PMC10853134 DOI: 10.1007/s11606-023-08393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality. OBJECTIVE To analyze peer-to-peer positive feedback collected as part of a systematized mortality review survey to identify themes and recognition dynamics that can inform positive organizational culture change. DESIGN Convergent mixed-methods study design. PARTICIPANTS A total of 388 physicians, 212 registered nurses, 64 advanced practice providers, and 1 respiratory therapist at four non-profit hospitals (2 academic and 2 community). INTERVENTION Providing optional positive feedback in the mortality review survey. MAIN MEASURES Key themes and subthemes that emerged from positive feedback data, associations between key themes and positive feedback respondent characteristics, and recognition dynamics between positive feedback respondents and recipients. KEY RESULTS Approximately 20% of healthcare workers provided positive feedback. Three key themes emerged among responses with free text comments: (1) providing extraordinary patient and family-centered care; (2) demonstrating self-possession and mastery; and (3) exhibiting empathic peer support and effective team collaboration. Compared to other specialties, most positive feedback from medicine (70.2%), neurology (65.2%), hospice and palliative medicine (64.3%), and surgery (58.8%) focused on providing extraordinary patient and family-centered care (p = 0.02), whereas emergency medicine (59.1%) comments predominantly focused on demonstrating self-possession and mastery (p = 0.06). Registered nurses (40.2%) provided multidirectional positive feedback more often than other clinician types in the hospital hierarchy (p < 0.001). CONCLUSIONS Analysis of positive feedback from a mortality review survey provided meaningful insights into a health system's culture of teamwork and values related to civility and collegiality when providing end-of-life care. Systematic collection and sharing of positive feedback is feasible and has the potential to promote positive culture change and improve healthcare worker well-being.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Roaa M Khinkar
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matthew Wien
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Stuart Lipsitz
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yvonne Y Cheung
- Department of Quality and Safety, Newton Wellesley Hospital, Newton, MA, USA
- Department of Anesthesia, Newton Wellesley Hospital, Newton, MA, USA
| | - Elizabeth A Mort
- Harvard Medical School, Boston, MA, USA
- Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sonali Desai
- Harvard Medical School, Boston, MA, USA
- Office of the Chief Quality Officer, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles A Morris
- Harvard Medical School, Boston, MA, USA
- Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, MA, USA
| | - Madelyn Pearson
- Office of the Chief Nursing Officer, Brigham and Women's Hospital, Boston, MA, USA
| | - Sunil Eappen
- University of Vermont Health Network, Burlington, VA, USA
| | - Ronen Rozenblum
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mallika Mendu
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, MA, USA
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Kulkarni SA, Wachter RM. The Hospitalist Movement 25 Years Later. Annu Rev Med 2024; 75:381-390. [PMID: 37802086 DOI: 10.1146/annurev-med-051022-043301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Hospitalists are generalists who specialize in the care of hospitalized patients. In the 25 years since the term hospitalist was coined, the field of hospital medicine has grown exponentially and established a substantial footprint in the medical community. There are now more hospitalists than practicing physicians in any other internal medicine subspecialty. Several key forces catalyzed the growth in the field of hospital medicine, including the quality, safety, and value movements; residency duty hour restrictions; the emergence of electronic health records; and the COVID-19 pandemic. Looking ahead, we see new opportunities in the realms of technology and telemedicine, and challenges persist in regard to balancing financial considerations with increasing workload and burnout. Hospitalists must remain nimble and seize emerging opportunities to continue supporting the field's prominence and growth.
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Affiliation(s)
- Shradha A Kulkarni
- Department of Medicine, University of California, San Francisco, California, USA; ,
| | - Robert M Wachter
- Department of Medicine, University of California, San Francisco, California, USA; ,
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Monahan K, Gould E, Rice T, Wright P, Vasilevskis E, Harrell F, Drago M, Mitchell S. Impact of the COVID-19 Pandemic on Medical Grand Rounds Attendance: Comparison of In-Person and Remote Conferences. JMIR MEDICAL EDUCATION 2024; 10:e43705. [PMID: 38029287 PMCID: PMC10766009 DOI: 10.2196/43705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/23/2023] [Accepted: 07/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Many academic medical centers transitioned from in-person to remote conferences due to the COVID-19 pandemic, but the impact on faculty attendance is unknown. OBJECTIVE This study aims to evaluate changes in attendance at medical grand rounds (MGR) following the transition from an in-person to remote format and as a function of the COVID-19 census at Vanderbilt Medical Center. METHODS We obtained the faculty attendee characteristics from Department of Medicine records. Attendance was recorded using a SMS text message-based system. The daily COVID-19 census was recorded independently by hospital administration. The main attendance metric was the proportion of eligible faculty that attended each MGR. Comparisons were made for the entire cohort and for individual faculty. RESULTS The observation period was from March 2019 to June 2021 and included 101 MGR conferences with more than 600 eligible faculty. Overall attendance was unchanged during the in-person and remote formats (12,536/25,808, 48.6% vs 16,727/32,680, 51.2%; P=.44) and did not change significantly during a surge in the COVID-19 census. Individual faculty members attendance rates varied widely. Absolute differences between formats were less than -20% or greater than 20% for one-third (160/476, 33.6%) of faculty. Pulmonary or critical care faculty attendance increased during the remote format compared to in person (1450/2616, 55.4% vs 1004/2045, 49.1%; P<.001). A cloud-based digital archive of MGR lectures was accessed by <1% of faculty per conference. CONCLUSIONS Overall faculty attendance at MGR did not change following the transition to a remote format, regardless of the COVID-19 census, but individual attendance habits fluctuated in a bidirectional manner. Incentivizing the use of a digital archive may represent an opportunity to increase faculty consumption of MGR.
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Affiliation(s)
- Ken Monahan
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Edward Gould
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Todd Rice
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Patty Wright
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Frank Harrell
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Monique Drago
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah Mitchell
- Vanderbilt University Medical Center, Nashville, TN, United States
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Burt L, Clark L, Park C. Stronger together: learner reactions on a team-based, interprofessional first death simulation experience. J Interprof Care 2024; 38:95-103. [PMID: 37422861 DOI: 10.1080/13561820.2023.2232408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.
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Affiliation(s)
- Leah Burt
- College of Nursing Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lou Clark
- M Simulation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christine Park
- College of Medicine, Simulation and Integrative Learning (SAIL) Institute, University of Illinois, Chicago, Illinois, USA
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Hydoub YM, Walker AP, Kirchoff RW, Alzu'bi HM, Chipi PY, Gerberi DJ, Burton MC, Murad MH, Dugani SB. Risk Prediction Models for Hospital Mortality in General Medical Patients: A Systematic Review. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100044. [PMID: 38090393 PMCID: PMC10715621 DOI: 10.1016/j.ajmo.2023.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 03/20/2023] [Accepted: 05/27/2023] [Indexed: 07/20/2024]
Abstract
Objective To systematically review contemporary prediction models for hospital mortality developed or validated in general medical patients. Methods We screened articles in five databases, from January 1, 2010, through April 7, 2022, and the bibliography of articles selected for final inclusion. We assessed the quality for risk of bias and applicability using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and extracted data using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist. Two investigators independently screened each article, assessed quality, and extracted data. Results From 20,424 unique articles, we identified 15 models in 8 studies across 10 countries. The studies included 280,793 general medical patients and 19,923 hospital deaths. Models included 7 early warning scores, 2 comorbidities indices, and 6 combination models. Ten models were studied in all general medical patients (general models) and 7 in general medical patients with infection (infection models). Of the 15 models, 13 were developed using logistic or Poisson regression and 2 using machine learning methods. Also, 4 of 15 models reported on handling of missing values. None of the infection models had high discrimination, whereas 4 of 10 general models had high discrimination (area under curve >0.8). Only 1 model appropriately assessed calibration. All models had high risk of bias; 4 of 10 general models and 5 of 7 infection models had low concern for applicability for general medical patients. Conclusion Mortality prediction models for general medical patients were sparse and differed in quality, applicability, and discrimination. These models require hospital-level validation and/or recalibration in general medical patients to guide mortality reduction interventions.
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Affiliation(s)
- Yousif M. Hydoub
- Division of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Andrew P. Walker
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, Ariz
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, Ariz
| | - Robert W. Kirchoff
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, Ariz
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minn
| | | | - Patricia Y. Chipi
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Fla
| | | | | | - M. Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn
| | - Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minn
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
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Morawa E, Adler W, Schug C, Geiser F, Beschoner P, Jerg-Bretzke L, Albus C, Weidner K, Baranowski AM, Erim Y. Depressive and anxiety symptoms in the course of the COVID-19 pandemic among physicians in hospitals: results of the longitudinal, multicenter VOICE-EgePan survey over two years. BMC Psychol 2023; 11:327. [PMID: 37817222 PMCID: PMC10566070 DOI: 10.1186/s40359-023-01354-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years. METHODS At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported. RESULTS The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p < .001) and of anxiety symptoms from T1 (M = 1.35, SD = 1.42) to T2 (M = 1.59, SD = 1.43) (p = .024). The main effect of gender was only significant for anxiety symptoms (p = .001): women demonstrated higher scores than men. A significant age class difference was observed only for depressive symptoms: the youngest age group (18-40 years) revealed higher values than the oldest group (> 50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively. CONCLUSIONS Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established. TRIAL REGISTRATION The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020.
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Affiliation(s)
- Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany.
| | - Werner Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany
- Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Bonn, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas M Baranowski
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Bonn, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany
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11
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Dugani SB, Fischer KM, Schroeder DR, Geyer HL, Maniaci MJ, Paulson M, Croghan IT, Burton MC. Global well-being, anxiety, social isolation, and emotional support among hospitalists during COVID-19 and Mpox outbreaks. Hosp Pract (1995) 2023; 51:211-218. [PMID: 37491767 PMCID: PMC10775116 DOI: 10.1080/21548331.2023.2241342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The Coronavirus Disease-19 (COVID-19) pandemic caused a decline in hospitalist wellness. The COVID-19 pandemic has evolved, and new outbreaks (i.e. Mpox) have challenged healthcare systems. The objective of the study was to assess changes in hospitalist wellness and guide interventions. METHODS We surveyed hospitalists (physicians and advanced practice providers [APPs]), in May 2021 and September 2022, at a healthcare system's 16 hospitals in four US states using PROMIS® measures for global well-being, anxiety, social isolation, and emotional support. We compared wellness score between survey periods; in the September 2022 survey, we compared wellness scores between APPs and physicians and evaluated the associations of demographic and hospital characteristics with wellness using logistic (global well-being) and linear (anxiety, social isolation, emotional support) regression models. RESULTS In May 2021 vs. September 2022, respondents showed no statistical difference in top global well-being for mental health (68.4% vs. 57.4%) and social activities and relationships (43.8% vs. 44.3%), anxiety (mean difference: +0.8), social isolation (mean difference: +0.5), and emotional support (mean difference: -1.0) (all, p ≥ 0.05). In September 2022, in logistic regression models, APPs, compared with physicians, had lower odds for top (excellent or very good) global well-being mental health (odds ratio [95% CI], 0.31 [0.13-0.76]; p < 0.05). In linear regression models, age <40 vs. ≥40 years was associated with higher anxiety (estimate ± standard error, 2.43 ± 1.05; p < 0.05), and concern about contracting COVID-19 at work was associated with higher anxiety (3.74 ± 1.10; p < 0.01) and social isolation (3.82 ± 1.21; p < 0.01). None of the characteristics showed association with change in emotional support. In September 2022, there was low concern for contracting Mpox in the community (4.6%) or at work (10.0%). CONCLUSION In hospitalists, concern about contracting COVID-19 at work was associated with higher anxiety and social isolation. The unchanged wellness scores between survey periods identified opportunities for intervention. Mpox had apparently minor impact on wellness.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Holly L. Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Ivana T. Croghan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Research Hub, Mayo Clinic, Rochester, MN, USA
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12
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Tago M, Hirata R, Katsuki NE, Otsuka Y, Shimizu T, Sasaki Y, Shikino K, Watari T, Takahashi H, Une K, Naito T, Otsuka F, Thompson R, Tazuma S. Contributions of Japanese Hospitalists During the COVID-19 Pandemic and the Need for Infectious Disease Crisis Management Education for Hospitalists: An Online Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:1645-1651. [PMID: 37635697 PMCID: PMC10455781 DOI: 10.2147/rmhp.s422412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Hospitalists in Japan have been at the forefront of the COVID-19 pandemic. However, contributions of Japanese hospitalists during the COVID-19 pandemic and hospitalists' awareness of crisis management education remain unclear. Material and Methods We conducted a questionnaire survey to investigate the role of Japanese hospitalists during the COVID-19 pandemic. The questionnaire was conducted using email and Google Forms targeting the chairpersons of facilities certified by the Japanese Society of Hospital General Medicine (JSHGM). Members of the academic committee of the JSHGM and several hospitals conducted a narrative review and determined the questions for the survey in a discussion. Results We conducted descriptive statistics based on the responses of 97 hospitals that agreed to participate in this survey. In total, 91.8% of general medicine departments in the included hospitals were involved in the medical care of COVID-19 patients. Furthermore, in 73.2% of hospitals, hospitalists were involved in infection control for COVID-19 inside or outside the hospital. Our survey revealed that Japanese hospitalists were responsible for COVID-19 treatment in over 60% of hospitals and contributed to hospital management, infection control, and vaccination. In total, 79.4% of hospitals answered that "training of personnel who can provide practical care for emerging infectious diseases is necessary", 78.4% indicated that "the establishment of an infection control system in advance to prepare emerging infectious diseases in the hospital is necessary", and 74.2% stated that "the establishment of an educational system for responding to emerging infectious diseases is necessary.". Conclusion In conclusion, during the pandemic, in addition to inpatient care, Japanese hospitalists provided outpatient care for COVID-19, which is the role of primary care physicians in other countries. Furthermore, Japanese hospitalists who experienced the COVID-19 pandemic expressed the need for personnel development and education to prepare for future emerging infectious disease pandemics.
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Affiliation(s)
- Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Sasaki
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, Japan
| | - Hiromizu Takahashi
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazunobu Une
- Department of Critical Care and General Medicine, Onomichi General Hospital, Hiroshima, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rachel Thompson
- Executive Team, Snoqualmie Valley Hospital, Snoqualmie, WA, USA
| | - Susumu Tazuma
- Department of Critical Care and General Medicine, Onomichi General Hospital, Hiroshima, Japan
- JR Hiroshima Hospital, Hiroshima, Japan
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13
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James TT, Hudon R, Merrick T, Olson L, Hanes D, Scanlan JM. Creating a Comprehensive Pandemic Response to Decrease Hospitalist Burnout During COVID-19: Intervention vs Control Results in 2 Comparable Hospitals (HOSP-CPR). J Gen Intern Med 2023; 38:1256-1263. [PMID: 36764984 PMCID: PMC9918339 DOI: 10.1007/s11606-023-08041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Physician burnout increased during the COVID-19 pandemic. OBJECTIVE To evaluate the effectiveness of a multimodal workplace intervention designed to reduce hospitalist burnout. DESIGN Participants and setting: Our intervention group was composed of internal medicine hospitalists at Providence Portland Medical Center (64 providers including 58 physicians and 6 nurse practitioners). Our control was composed of internal medicine hospitalists at Providence St Vincent's Hospital (59 physicians and 6 nurse practitioners). MEASUREMENTS Two surveys were given during, before, and after a 12-month intervention period (October 2020 and again in October 2021). Surveys included demographics, job satisfaction, the Maslach Burnout Inventory, the Pandemic Experiences Survey, and 2 questions about leaving the job. INTERVENTIONS Three hospitalists designated as wellness warriors created weekly COVID group meetings, providing up-to-date information about COVID-19 infection rates, treatments, and work-flow changes. Discussions included coping and vaccine hesitancy, difficult case debriefs, and intensive care unit updates. Individual coaching was also offered. Meeting minutes were taken and sessions were recorded for asynchronous access. RESULTS No site differences in burnout or job satisfaction were evident pre-intervention. Post-intervention, the intervention group reported 32% burnout while controls reported 56% (p = .024). Forty-eight percent of the intervention group reported high wellness support vs. 0% of the controls (< .001). Intervention participants attributed 44% of wellness support to Providence alone, vs. controls at 12% (< .001). Regressions controlling sex, work hours, experience, race, and children in the home showed the intervention's positive effects on burnout and job satisfaction remained significant (all p < .02). LIMITATIONS For privacy reasons, all survey responses were anonymous, meaning that individual pre-post changes could not be tracked. CONCLUSION We believe the intervention resulted in substantial burnout prevention and is feasible for adoption in most hospitals and clinics.
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Affiliation(s)
- Tricia T James
- Department of Medical Education, Providence Portland Medical Center, 5050 NE Hoyt Suite 540, Portland, OR, 97213, USA.
| | - Robert Hudon
- Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - Todd Merrick
- Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - Lisa Olson
- Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - Douglas Hanes
- Center for Cardiovascular Analytics, Research + Data Science, Providence Research Network, Portland, OR, USA
| | - James M Scanlan
- Providence Health Research Accelerator (HRA), Seattle, WA, USA
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14
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Kulkarni SA, Keniston A, Linker AS, Astik GJ, Kangelaris KN, Leykum LK, Sakumoto M, Auerbach A, Burden M. Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field. J Hosp Med 2023; 18:329-336. [PMID: 36876949 DOI: 10.1002/jhm.13074] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/14/2023] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The hospitalist workforce has been at the forefront of the pandemic and has been stretched in both clinical and nonclinical domains. We aimed to understand current and future workforce concerns, as well as strategies to cultivate a thriving hospital medicine workforce. DESIGN, SETTING, AND PARTICIPANTS We conducted qualitative, semistructured focus groups with practicing hospitalists via video conferencing (Zoom). Utilizing components from the Brainwriting Premortem Approach, attendees were split into small focus groups and listed their thoughts about workforce issues that hospitalists may encounter in the next 3 years, identifying the highest priority workforce issues for the hospital medicine community. Each small group discussed the most pressing workforce issues. These ideas were then shared across the entire group and ranked. We used rapid qualitative analysis to guide a structured exploration of themes and subthemes. RESULTS Five focus groups were held with 18 participants from 13 academic institutions. We identified five key areas: (1) support for workforce wellness; (2) staffing and pipeline development to maintain an adequate workforce to match clinical growth; (3) scope of work, including how hospitalist work is defined and whether the clinical skillset should be expanded; (4) commitment to the academic mission in the setting of rapid and unpredictable clinical growth; and (5) alignment between the duties of hospitalists and resources of hospitals. Hospitalists voiced numerous concerns about the future of our workforce. Several domains were identified as high-priority areas of focus to address current and future challenges.
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Affiliation(s)
- Shradha A Kulkarni
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anne S Linker
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, Division of Hospital Medicine, New York, New York, USA
| | - Gopi J Astik
- Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois, USA
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Luci K Leykum
- Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Matthew Sakumoto
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Andrew Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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15
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Hydoub YM, Fischer KM, Hanson KT, Coons TJ, Wilshusen LL, Vista TL, Colbenson GA, Burton MC, Habermann EB, Dugani SB. Multisite analysis of patient experience scores and risk of hospital admission: a retrospective cohort study. Hosp Pract (1995) 2023; 51:35-43. [PMID: 36326005 PMCID: PMC9928911 DOI: 10.1080/21548331.2022.2144055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routinely collected patient experience scores may inform risk of patient outcomes. The objective of the study was to evaluate the risk of hospital admission within 30-days following third-party receipt of the patient experience survey and guide interventions. METHODS In this retrospective cohort study, we analyzed Hospital Consumer Assessment of Healthcare Providers and Systems surveys, January 2016-July 2019, from an institution's 20 hospitals in four U.S. states. Surveys were routinely sent to patients using census sampling. We analyzed surveys received ≤60 days following discharge from patients living ≤60 miles of any of the institution's hospitals. The exposures were 19 survey items. The outcome was hospital admission within 30 days after third-party receipt of the survey. We evaluated the association of favorable (top-box) vs unfavorable (non-top-box) score for survey items with risk of 30-day hospital admission in models including patient and hospitalization characteristics and reported adjusted odds ratios (aOR [95% confidence interval]). RESULTS Among 40,162 respondents (mean age ± standard deviation: 68.1 ± 14.0 years), 49.8% were women and 4.3% had 30-day hospital admission. Patients with 30-day hospital admission, compared to those not admitted, were more likely to be discharged from a medical service line (62.9% vs 42.3%; P < 0.001) and have a higher Elixhauser index. Favorable vs unfavorable score for hospital rating was associated with lower odds of 30-day hospital admission in the overall cohort (0.88 [0.77-0.99]; P = 0.04), medical service line (0.81 [0.70-0.94]; P = 0.007), and upper tertile of Elixhauser index (0.79 [0.67-0.92]; P = 0.003). Favorable score for recommend hospital was associated with lower odds of 30-day hospital admission in the medical service line (0.83 [0.71-0.97]; P = 0.02) but for others (e.g. cleanliness of hospital environment) showed no association. CONCLUSION In routinely collected patient experience scores, favorable hospital rating was associated with lower odds of 30-day hospital admission and may inform risk stratification and interventions. Evidence-based survey items linked to patient outcomes may also inform future surveys.
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Affiliation(s)
- Yousif M. Hydoub
- Division of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States
| | - Kristine T. Hanson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Trevor J. Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Tafi L. Vista
- Office of Patient Experience, Mayo Clinic, Rochester, MN, United States
| | | | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Elizabeth B. Habermann
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Sagar B. Dugani
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
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16
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Anand U, Rea M, Kirshnit C, Dias S, Molla M. Checking in through the zoom window: Reducing barriers to seeking mental health care for hospitalists. J Hosp Med 2022. [PMID: 36537361 DOI: 10.1002/jhm.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Uma Anand
- Academic and Staff Assistance Program, University of California Davis Health, Sacramento, California, USA
| | - Margaret Rea
- Graduate Medical Education, University of California Davis Health, Sacramento, California, USA
| | - Carol Kirshnit
- Academic and Staff Assistance Program, University of California Davis Health, Sacramento, California, USA
| | - Sabrina Dias
- Division of Hospital Medicine, University of California Davis Health, Sacramento, California, USA
| | - Mithu Molla
- Division of Hospital Medicine, University of California Davis Health, Sacramento, California, USA
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Smith EM, Keniston A, Welles CC, Vukovic N, McBeth L, Harnke B, Burden M. Inpatient clinician workload: a scoping review protocol to understand the definition, measurement and impact of non-procedural clinician workloads. BMJ Open 2022; 12:e062878. [PMID: 36523243 PMCID: PMC9748947 DOI: 10.1136/bmjopen-2022-062878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Clinicians that care for hospitalised patients face unprecedented work conditions with exposure to highly infectious disease, exceedingly high patient numbers, and unpredictable work demands, all of which have resulted in increases in stress and burnout. Preliminary studies suggest that increasing workloads negatively affect inpatient clinician well-being and may negatively affect job performance; yet high workloads may be prioritised secondary to financial drivers or from workforce shortages. Despite this, the correlation between workload and these negative outcomes has not been fully quantified. Additionally, there are no clear measures for inpatient clinician workload and no standards to define ideal workloads. Using the protocol described here, we will perform a scoping review of the literature to generate a comprehensive understanding of how clinician workload of medical patients is currently defined, measured in clinical settings and its impact on the workforce, patients and institutional outcomes. METHODS AND ANALYSIS We will follow the methodology outlined by Joanna Briggs Institute and Arksey and O'Malley to conduct a comprehensive search of major electronic databases including Ovid Medline (PubMed), Embase (Embase.com), PsycINFO, ProQuest Dissertations and Google Scholar. All relevant published peer-reviewed and dissertaion grey literature will be included. Data will be extracted using a standardised form to capture key article information. Results will be presented in a descriptive narrative format. ETHICS AND DISSEMINATION This review does not require ethics approval though all included studies will be screened to ensure appropriate approval. The synthesis of this literature will provide a better understanding of the current state of work for inpatient clinicians, associated outcomes, and will identify gaps in the literature. These findings will be used in conjunction with an expert Delphi panel to identify measures of inpatient clinician workload to then guide the development of a novel workforce mobile application to actively track clinician work. We aim to lay the groundwork for future workforce studies to understand the optimal workloads that drive key outcomes for clinicians, patients and institutions.
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Affiliation(s)
- Erica Mitchell Smith
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Cara Welles
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nemanja Vukovic
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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Singh A, Panek T, Tackett S, Paranji S, Gundareddy V, Kauffman R, Wright S, Bowling G, Torok H, Patel H, Alhadeff I, Nogi M, McIlraith T, Robertson T, Kisuule F. Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study. J Gen Intern Med 2022; 37:3925-3930. [PMID: 35657465 PMCID: PMC9165541 DOI: 10.1007/s11606-022-07680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials. OBJECTIVE To understand what elements influence millennial hospitalists' recruitment and retention. DESIGN We developed a survey that asked participants to rate the level of importance of 18 elements (4-point Likert scale) in their decision to choose or remain at an HMG. PARTICIPANTS The survey was electronically distributed to hospitalists born in or after 1982 across 7 HMGs in the USA. MAIN MEASURES Elements were grouped into four major categories: culture of practice, work-life balance, financial considerations, and career advancement. We calculated the means for all 18 elements reported as important across the sample. We then calculated means by averaging elements within each category. We used unpaired t-tests to compare differences in means for categories for choosing vs. remaining at an HMG. KEY RESULTS One hundred forty-four of 235 hospitalists (61%) responded to the survey. 49.6% were females. Culture of practice category was the most frequently rated as important for choosing (mean 96%, SD 12%) and remaining (mean 96%, SD 13%) at an HMG. The category least frequently rated as important for both choosing (mean 69%, SD 35%) and remaining (mean 76%, SD 32%) at an HMG was career advancement. There were no significant differences between respondent gender, race, or parental status and ratings of elements for choosing or remaining with HMGs. CONCLUSION Culture of practice at an HMG may be highly important in influencing millennial hospitalists' decision to choose and stay at an HMG. HMGs can implement strategies to create a millennial-friendly culture which may help improve recruitment and retention.
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Affiliation(s)
- Amteshwar Singh
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA.
| | - Tiffani Panek
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Suchitra Paranji
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Venkat Gundareddy
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Regina Kauffman
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Scott Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory Bowling
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Haruka Torok
- Division of General Internal Medicine, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Ilan Alhadeff
- Hospitalist Services, Team Health, Hollywood, FL, USA
| | - Masayuki Nogi
- Division of Hospital Medicine, The Queen's Medical Center, Honolulu, HI, USA
| | - Thomas McIlraith
- Department of Hospital Medicine, Mercy Medical Group, Sacramento, CA, USA
| | - Thomas Robertson
- Division of Academic Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Flora Kisuule
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
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19
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Chandrabhatla T, Asgedom H, Gaudiano ZP, de Avila L, Roach KL, Venkatesan C, Weinstein AA, Younossi ZM. Second victim experiences and moral injury as predictors of hospitalist burnout before and during the COVID-19 pandemic. PLoS One 2022; 17:e0275494. [PMID: 36194588 PMCID: PMC9531782 DOI: 10.1371/journal.pone.0275494] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background The increasing number of physicians leaving practice, especially hospitalists, has been well-documented. The most commonly examined factor associated with this exodus has been burnout. The COVID-19 pandemic has put a unique and unprecedented stress on hospitalists who have been at the front lines of patient care. Therefore, the investigation of burnout and its related factors in hospitalists is essential to preventing future physician shortages. Objective This study examined the relationship between burnout, second victim, and moral injury experiences before and during the COVID-19 pandemic among hospitalists. Methods Two anonymous cross-sectional surveys of hospitalists from a community hospital in the metropolitan Washington, DC area were conducted. One was conducted pre-COVID-19 (September-November 2019) and one was conducted during COVID-19 (July-August 2020). The surveys were sent to all full-time hospitalists via an online survey platform. A variety of areas were assessed including demographic (e.g., age, gender), work information (e.g., hours per week, years of experience), burnout, second victim experiences, well-being, and moral injury. Results Burnout rates among providers during these two time periods were similar. Second victim experiences remained prevalent in those who experienced burnout both pre and during COVID-19, but interestingly the prevalence increased in those without burnout during COVID-19. Moral injury was predictive of burnout during COVID-19. Conclusion While there were some factors that predicted burnout that were similar both pre- and during-pandemic, moral injury was unique to predicting burnout during COVID-19. With burnout as a contributing factor to future physician shortages, it is imperative that predictive factors in a variety of different environments are well understood to prevent future shortages. Hospitalists may be an excellent barometer of these factors given their presence on the front line during the pandemic, and their experiences need to be further explored so that targeted interventions aimed at addressing those factors may be created.
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Affiliation(s)
- Tejasri Chandrabhatla
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Henok Asgedom
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States of America
| | - Zehra P. Gaudiano
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
| | - Kenneth L. Roach
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Chapy Venkatesan
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Ali A. Weinstein
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States of America
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
- Center for the Advancement of Well-Being, George Mason University, Fairfax, VA, United States of America
- * E-mail:
| | - Zobair M. Younossi
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
- Center for the Advancement of Well-Being, George Mason University, Fairfax, VA, United States of America
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20
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Burden M, Patel M, Kissler M, Harry E, Keniston A. Measuring and driving hospitalist value: Expanding beyond wRVUs. J Hosp Med 2022; 17:760-764. [PMID: 35652672 PMCID: PMC9545401 DOI: 10.1002/jhm.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/17/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Marisha Burden
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Moksha Patel
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Mark Kissler
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Elizabeth Harry
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Angela Keniston
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
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21
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Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting. J Gen Intern Med 2022; 37:3162-3165. [PMID: 35415791 PMCID: PMC9005021 DOI: 10.1007/s11606-022-07560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Geographic "cohorting," "co-location," "regionalization," or "localization" refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. Cohorting may also be associated with unintended consequences such as increased interruptions and increased indirect care time. Institutions may increase patient loads in anticipation of the efficiency gained by cohorting-leading to further increases in interruptions and time away from the bedside. Fragmented attention and increases in indirect care may lead to a perception of increased workload, errors, and burnout. As hospital medicine evolves, there are lessons to be learned by studying cohorting. Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes-and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.
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22
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Kara A, Wright C, Funches L, Williamson F, Hicks RA, Sutton TA, Nabhan Z. Serving on a Graduate Medical Education Diversity, Equity, Inclusion, and Justice Committee: Lessons Learned From a Journey of Growth and Healing. Front Public Health 2022; 10:867035. [PMID: 35570954 PMCID: PMC9091374 DOI: 10.3389/fpubh.2022.867035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Efforts toward achieving diversity, equity, inclusion, and justice (DEIJ) within graduate medical education (GME) often begin with the formation of a DEIJ committee that steers the work. Little is known about the experiences and the challenges faced by those serving on such committees. We sought to describe the experiences of members of our institutional GME DEIJ committee to gain knowledge that would propel this work forward. An open-ended survey was electronically administered to members of our institutional GME DEIJ committee. Responses were analyzed using a rapid qualitative analytical approach. Eighteen members (58%) responded. Of these, (67%) were women and five (28%) were Black. Six domains emerged: “motivation,” “challenges,” “emotional response,” “highs,” “facilitators,” and “advice.” Black respondents more often cited the need to increase diversity as a motivator to join this work. Women and Black respondents more often identified time constraints as a challenge to participation. Some members found the work emotionally draining; others described it as uplifting. Two themes emerged as high points of participation-pride and achievement around the work completed and the personal benefits of building a community with a shared purpose. Three themes emerged as facilitators: effective leadership, support, and establishing psychological safety during the meetings. Many arrived at the realization that change would take time and advocated for patience and perseverance. Protected time and DEIJ expertise were identified as integral to successful committee work. Our findings provide novel insights into the experience of serving on a GME DEIJ committee and highlights infrastructural and institutional prerequisites for success.
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Affiliation(s)
- Areeba Kara
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Curtis Wright
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Levi Funches
- Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Ralph A Hicks
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Timothy A Sutton
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Zeina Nabhan
- Indiana University School of Medicine, Indianapolis, IN, United States
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23
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Dugani SB, Fischer KM, Geyer HL, Maniaci MJ, Croghan IT, Burton MC. Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 pandemic. JAAPA 2022; 35:45-53. [PMID: 35421872 PMCID: PMC9129920 DOI: 10.1097/01.jaa.0000824964.37126.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hospitalists, comprising PAs, NPs, and physicians, manage patients hospitalized with COVID-19. To guide the development of support programs, this study compared the psychologic wellness of hospitalist PAs, NPs, and physicians during the COVID-19 pandemic. METHODS We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 25, 2020. We used PROMIS surveys for self-reported global well-being (two single-item measures), anxiety, social isolation, and emotional support, before and during the pandemic. Linear and logistic regression models were adjusted for personal and professional factors. RESULTS The response rate was 52.2% (N = 154/295). In adjusted linear regression models, the change in scores (before minus during pandemic) for anxiety, social isolation, and emotional support was similar for PAs and NPs compared with physicians. In adjusted logistic regression models, physicians, compared with PAs and NPs, had a higher odds of top global well-being for mental health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = .03) and top global well-being for social activities and relationships (adjusted odds ratio 4.08 [1.38, 12.08]; P = .01). CONCLUSIONS During the COVID-19 pandemic, global well-being was lower for PAs and NPs compared with physician hospitalists. These results can guide support programs for hospitalists.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Holly L. Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | | | - Ivana T. Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN
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24
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Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey. J Gen Intern Med 2022; 37:1169-1176. [PMID: 34993856 PMCID: PMC8734540 DOI: 10.1007/s11606-021-07251-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020. OBJECTIVE To determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns. DESIGN Cross-sectional survey in an urban medical center (September-November 2020) in Baltimore, MD, in the United States. PARTICIPANTS A total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers). MAIN MEASURES Measures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns. KEY RESULTS Fifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3-11.7), anxiety (aOR, 3.0; 95% CI, 1.4-6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1-5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1-6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8). CONCLUSIONS US HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health.
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25
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Cunningham JM, Persoff J, Piper C, Burger A, Shinnar E, Cunnius P, Stella SA, Frank MG. A Framework for Hospital Medicine's Involvement in Disaster Preparedness and Response. Health Secur 2022; 20:172-176. [PMID: 35333614 DOI: 10.1089/hs.2021.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John M Cunningham
- John M. Cunningham, MD, are Hospitalists and Medical Director of the Biocontainment Unit, Department of Medicine, Division of Hospital Medicine, Denver Health Hospital Authority and University of Colorado, School of Medicine
| | - Jason Persoff
- Jason Persoff, MD, is a Hospitalist, Department of Medicine, Division of Hospital Medicine, University of Colorado, School of Medicine; all in Aurora, CO
| | - Christi Piper
- Christi Piper, MLIS, is a Medical Librarian, Strauss Health Sciences Library, University of Colorado, Anschutz Medical Campus; all in Aurora, CO
| | - Alfred Burger
- Alfred Burger, MD, is a Hospitalist and Senior Associate Program Director for the Internal Medicine Residency Program, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eliezer Shinnar
- Eliezer Shinnar, MD, is a Hospitalist, Department of Medicine, Phoenix Indian Medical Center, Indian Health Service, Phoenix, AZ
| | - Peter Cunnius
- Peter Cunnius, CRNP, is an Advanced Practice Provider, Division of Hospital Medicine, Penn State Health-St. Joseph Medical Center, Reading, PA
| | - Sarah A Stella
- Sarah A. Stella, MD, are Hospitalists and Medical Director of the Biocontainment Unit, Department of Medicine, Division of Hospital Medicine, Denver Health Hospital Authority and University of Colorado, School of Medicine
| | - Maria G Frank
- Maria G. Frank, MD, is a Hospitalist and Medical Director of the Biocontainment Unit, Department of Medicine, Division of Hospital Medicine, Denver Health Hospital Authority and University of Colorado, School of Medicine
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26
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Carlson KJ, Matthias TH, Birge JR, Bulian BP, Richards SE, Shiffermiller JF. The effect of geographic rounding on hospitalist work experience: A mixed-methods study. Hosp Pract (1995) 2022; 50:124-131. [PMID: 35253585 DOI: 10.1080/21548331.2022.2050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as "geographic rounding," and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. METHODS The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. RESULTS Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p<0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p<0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p<0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p=0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. CONCLUSION Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.
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Affiliation(s)
- Kristy J Carlson
- Univeristy of Nebraska Medical Center, Department of Otolaryngology Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, NE 68198-1225
| | - Tabatha H Matthias
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Justin R Birge
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Brady P Bulian
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Sarah E Richards
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Jason F Shiffermiller
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
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27
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Hodo LN, Douglas LC, Lee DS, Bhadriraju S, Wilson KM. Deployed: One Pediatric Department's Experience of Adult Care During COVID-19. Hosp Pediatr 2021; 11:e235-e243. [PMID: 34117092 DOI: 10.1542/hpeds.2020-005799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Laura Nell Hodo
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital, New York, NY;
| | - Lindsey C Douglas
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital, New York, NY
| | - Diana S Lee
- Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Srividya Bhadriraju
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital, New York, NY.,Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karen M Wilson
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital, New York, NY
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28
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Dugani SB, Geyer HL, Maniaci MJ, Fischer KM, Croghan IT, Coons TJ, Canan EL, Burton MC. Hospitalist perspectives on barriers to recommend and potential benefit of the COVID-19 vaccine. Hosp Pract (1995) 2021; 49:245-251. [PMID: 33826433 DOI: 10.1080/21548331.2021.1914465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients.Methods: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from 14 December 2020 through 4 January 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians.Results: The overall response rate was 42.7% (n = 128/300) and comprised of 53.9% women (n = 69/128) and 41.4% APPs (n = 53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n = 119/128) and influenza (97.7%; n = 125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and coworkers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32-6.59]; P< .008), whereas hospitalist age, gender, and profession showed no association.Conclusion: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Robert D. And Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN, USA
| | - Trevor J Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth L Canan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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