October 2009


Code status discussions sometimes difficult, but necessary

Understanding individual preferences about code status is critical to delivering the care patients want. Still, code discussions between doctors and patients don't always happen when they should, or at all. A 2008 study in the Journal of Hospital Medicine found that only 10% of patients in six university-based hospitals had documented code discussions within 24 hours of admission.

Not a time for modesty

With the economy shaky and hospital budgets tight, hospitalists are being asked more and more to prove their worth. Value may be the word that hospital administrators and consultants use to describe what hospitalists are being expected to demonstrate, but what it boils down to is this: Are hospitalists earning their keep?

I-MOVE gets elderly patients on the move

The I-MOVE sounds like a state-of-the-art electronic gadget, but it's actually the simplest of medical tools. Developed by clinicians at Mercy Hospital of Pittsburgh and the Mayo Clinic in Minnesota, the Independent Mobility Validation Examination, or I-MOVE, is a 12-point scale that could help hospitalists assess their patients' mobility.

Man meets dog

In the hospital for a series of tests, Mary C. looks forward to a visitor, Casey. When he arrives, Mary's face lights up in anticipation of his warm greeting. But first he has to go through the required alcohol gel routine: one paw at a time.

Letter from the Editor

Once you've recruited a few great hospitalists to your program, you might be tempted to think you've solved your staffing woes. But recruitment is only half the battle. You also need to worry about that other "R" word: retention.

Locum terror

Here I was pulling into the staff parking lot of a funky old private sanitarium in the middle of stinking nowhere. I rang the bell and the creaky door swung open. A very pale and dusty nurse pointed to the staff lounge, but said nothing, though I seemed to detect the ghost of a smile.

How trustworthy is automated noninvasive blood pressure monitoring?

Most vital signs are now obtained using automated techniques. We put a lot of stock in these numbers. Just how accurate are they?

CMS updates payments, quality measures for 2010

October 1 is an important time to evaluate coding changes because it's when CMS' annual update to the inpatient prospective payment system (MS-DRGs) takes effect.

Surviving seven on/seven off

Love it or loathe it, the seven days on/seven days off schedule is gaining traction among hospitalist programs. Experts discuss its pluses and pitfalls and share some strategies for success.

Managing acute opiate withdrawal in hospitalized patients

The case of a 48-year-old man who presented to the hospital seeking treatment for acute heroin withdrawal is discussed.

Test yourself: Opioid therapy

The following cases and commentary, which address opioid therapy, are excerpted from ACP's Medical Knowledge Self-Assessment Program (MKSAP14).

Hospital admissions and costs for potentially preventable conditions in adults, 2006

Hospital costs for potentially preventable hospitalizations were about one of every 10 dollars of total hospital expenditures in 2006.

Journal watch: Recent studies of note

Recent studies about predicting surgical outcomes, abdominal CTs for C. diff patients, and other topics

In the News

Varied times to debrillation after in-hospital cardiac arrest, and more.