Hospitalist mentorship, heart failure prediction

Summaries from ACP Hospitalist Weekly.

Junior hospitalists report improved career and research skills from formal mentorship program

Early-career hospitalists reported increased satisfaction within several career domains after completing a structured mentorship program at a large academic medical center, a recent pilot study found.

The hospital medicine unit implemented the program from October 2015 to June 2016. As part of the program, mentors and mentees participated in three training sessions that focused on best practices in mentoring over a period of nine months. Eligible mentees were hired at more than 0.5 full-time equivalents and had three or fewer years of experience as hospitalists. Mentors, who were invited to participate on a voluntary basis, were hospital medicine unit faculty members with at least seven years of hospital medicine experience.

Using participants' areas of interest and history of mentorship, study authors matched mentors and mentees with the aim of maximizing similarities. They paired four mentors with two mentees each and 12 mentors with one mentee each.

During the first mentorship-training lunch session, mentees and mentors met to discuss expectations and challenges and develop action plans with individualized goals. A mid-program training session included progress evaluations and discussions about optimizing the mentoring relationship. At a final session, participants reflected on their relationships, set future expectations, and identified their extended mentoring support network. In addition to attending the sessions, pairs were expected to meet at least twice during the program.

Researchers studied the impact of the program by administering anonymous surveys to participants prior to the first training session and after completion of the program. Participants reported satisfaction scores on a scale of 1 to 5 (with 5 being very satisfied) within 18 domains of career skills. Results were published online on Oct. 4, 2017, by the Journal of Hospital Medicine.

Overall, 14 mentees and nine mentors completed the pre-intervention survey, and 10 mentees and eight mentors completed the postintervention survey. At baseline, mentees ranked the following career domains as very important: career planning, professional connectedness, producing scholarly work, finding an area of expertise, balancing work and family life, and job satisfaction.

After completion of the program, composite satisfaction scores improved from 54.5 ± 6.2 to 65 ± 14.9 (P=0.02). Five of the 18 domains showed significant improvement in mentee satisfaction: career planning, professional connectedness, self-reflection, research skills, and mentoring skills. In addition, 43% of mentees reported feeling supported by the hospital medicine unit before the program, compared to 90% after the program, and all agreed that future faculty should participate in a similar program.

The authors noted limitations of the study, such as its small sample size, single-center design, short study period, and reliance on self-reporting. They added that the observational study's results suggest that mentorship is associated with, not necessarily the cause of, the improvements in mentee satisfaction.

Simple tool accurately predicts 30-day mortality for heart failure

A simple tool using readily available data can accurately estimate the 30-day mortality risk for patients admitted to the ED with acute heart failure, a study found.

Researchers for the Spanish Ministry of Health used data from an established registry of 34 Spanish EDs with diverse patient and facility characteristics to create the prediction tool model. They identified 88 variables and tested them against outcomes in a cohort of 4,867 consecutive ED patients admitted from 2009 to 2011. Within 30 days of ED admission, 500 patients (10.3%) died. The findings were published on Oct. 3, 2017, by Annals of Internal Medicine and appeared in the Nov. 21, 2017, issue.

Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score: Barthel index score at admission, systolic blood pressure, age, N-terminal pro B-type natriuretic peptide level, potassium level, troponin level, New York Heart Association class at admission, respiratory rate, low-output symptoms, oxygen saturation, episode association with acute coronary syndrome, hypertrophy on electrocardiography, and creatinine level.

The variables were tested in an independent validation population of 3,229 patients gathered three years later from the same EDs. In this validation cohort, 299 (9.26%) patients died within 30 days of ED admission. The score had excellent discrimination and calibration for predicting 30-day mortality, the researchers found. Thirty-day mortality risk was dramatically different across groups defined by the score (<2% for patients in the two lowest risk quintiles and 45% in the highest risk decile). Multiple sensitivity analyses did not find substantial confounding or bias.

“Identification of both groups [high- and low-risk] has important management implications,” the authors wrote. “For a patient with very high risk, attention should be focused on ensuring that the patient and their relatives are aware of the severity of the situation. In addition, the patient should receive prompt and aggressive treatment if appropriate, with an emphasis on early admission to an intensive care unit. For a patient with low risk, attention should be focused on treatment that will lead to early discharge from the ED to home, which is consistent with a recent consensus opinion about patients with less than 2% all-cause mortality who undergo sufficient observation in the ED.”

An editorial noted that this is the fourth major study aiming to define prognosis of heart failure patients in the ED, all of which claimed excellent discrimination. “If any of these models are to gain acceptance, they will need to be prospectively tested in diverse populations. That is the easy part; the next steps are more challenging. If 40% of ED patients with [heart failure] are truly at very low risk, we must find commonalities among them. This information may guide development of an alternate infrastructure to successfully treat these patients out of the hospital,” the editorialist wrote.