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The structured handoff program improved the participating interns' perceptions of their knowledge of the handoff process and their ability to transfer the care of their patients effectively. The formal program for teaching handoffs, that included attendings' supervision of the process, was well received.

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BACKGROUND: Admitted patients boarding in the emergency department (ED) leads to hospital diversion. Active bed management and care for boarded patients can improve throughput. We developed a hospital medicine ED (HMED) team to participate in active bed management, and to care for boarded patients, to decrease diversion and improve throughput.

Despite the rapid growth of academic hospital medicine, scholarly productivity remains poorly characterized. In this cross-sectional study, distribution of academic rank and scholarly output of academic hospital medicine faculty are described. We extracted data for 1,554 hospitalists on faculty at the top 25 internal medicine residency programs. Only 11.7% of faculty had reached associate (9.0%) or full professor (2.7%). The median number of publications was 0.0 (interquartile range [IQR], 0.0-4.0), with 51.4% without a single publication. Faculty 6 to 10 years post residency had a median of 1.0 (IQR, 0.0-4.0) publication, with 46.8% of these faculty without a publication. Among men, 54.3% had published at least one manuscript, compared to 42.7% of women (P < .0001). Predictors of promotion included H-index, number of years post residency graduation, completion of chief residency, and graduation from a top 25 medical school. Promotion remains uncommon in academic hospital medicine, which may be partially due to low rates of scholarly productivity.

BackgroundThe first Multicenter Medication Reconciliation Quality Improvement (QI) Study (MARQUIS1) demonstrated that mentored implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The objective of this study was to determine the effects of a refined toolkit on a larger group of hospitals.MethodsWe conducted a pragmatic quality improvement study (MARQUIS2) at 18 North American hospitals or hospital systems from 2016 to 2018. Incorporating lessons learnt from MARQUIS1, we implemented a refined toolkit, offering 17 system-level and 6 patient-level interventions. One of eight physician mentors coached each site via monthly calls and performed one to two site visits. The primary outcome was number of unintentional medication discrepancies in admission or discharge orders per patient. Time series analysis used multivariable Poisson regression.ResultsA total of 4947 patients were sampled, including 1229 patients preimplementation and 3718 patients postimplementation. Both the number of system-level interventions adopted per site and the proportion of patients receiving patient-level interventions increased over time. During the intervention, patients experienced a steady decline in their medication discrepancy rate from 2.85 discrepancies per patient to 0.98 discrepancies per patient. An interrupted time series analysis of the 17 sites with sufficient data for analysis showed the intervention was associated with a 5% relative decrease in discrepancies per month over baseline temporal trends (adjusted incidence rate ratio: 0.95, 95% CI 0.93 to 0.97, p<0.001). Receipt of patient-level interventions was associated with decreased discrepancy rates, and these associations increased over time as sites adopted more system-level interventions.ConclusionA multicentre medication reconciliation QI initiative using mentored implementation of a refined best practices toolkit, including patient-level and system-level interventions, was associated with a substantial decrease in unintentional medication discrepancies over time. Future efforts should focus on sustainability and spread.

INTRODUCTION: Handoffs of patient care are increasingly common and are known to contribute to medical errors. A significant number, if not the large majority, of first‐year Internal Medicine residents have not received formal education pertaining to handoffs during medical school. AIM: To develop a program designed to teach handoffs to medical students entering their fourth year of training. SETTING: University of Colorado Denver School of Medicine. PROGRAM DESCRIPTION: Our Handoff Selective was first offered in April 2007 as part of a 2‐week Integrated Clinician's Course conducted once yearly between the third and fourth years of medical school. The Selective consisted of a didactic session in which communication theory and elements were discussed and a practicum in which students used faculty‐developed case scenarios to practice both giving and receiving handoffs. PROGRAM EVALUATION: Sixty (the maximum number of spots available) out of 150 students participated in the course, although many more students chose the course than spots available. Prior to taking the Selective, medical students' confidence in performing handoffs was poor, but it improved after the course (P < 0.001); 92% of students felt the Handoff Selective was “useful” or “extremely useful.” While both components of the course were thought to be useful to the large majority of students, the practicum portion was thought to be more useful (P < 0.001). DISCUSSION: Formal education on handoffs is well received by medical students and improves their self‐perceived understanding and performance of handoffs. Journal of Hospital Medicine 2010;5:344–348. © 2010 Society of Hospital Medicine.

BACKGROUND:While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs.METHODS:We developed the ACUTE Center at Denver Health Medical Center to medically stabilize adults with the medical complications of severe malnutrition due to an eating disorder. The first 2 years of patient characteristics and outcomes are reported.RESULTS:From October 2008 through December 2010, the ACUTE unit had 76 admissions of which 62 were for medical stabilization, comprising 54 patients. Eighty‐nine percent of patients were female. The mean age was 27 years old (range 17–65). The mean body mass index on admission was 12.9 kg/m2 (standard deviation [SD] 2.0). At admission, patients were hyponatremic, anemic, and leukopenic, with low bone density, but had normal albumin levels. The mean body mass index on discharge was 13.1 ± 1.9 kg/m2. Median length of stay was 16 days (interquartile range [IQR] 9–29 days). Eighteen percent were discharged to home and eighty‐two percent were discharged to inpatient psychiatric eating disorder units. Inpatient mortality was zero.DISCUSSION:Patients with this degree of severe malnutrition due to eating disorders are medically complex and relatively uncommon. Regionalized subspecialty centers of excellence, in which a multidisciplinary team is led by practitioners of hospital medicine who have developed expertise in a rare condition, may improve clinical outcomes, optimize healthcare resources, and provide unique professional and academic opportunities for the clinicians involved. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine