Hospital Medicine: The Handbook

By Ramegowda Belakere and Jayanthi Ramu

After 2O years of successful experimentation, Hospital Medicine has now become a part of the established medical landscape. While core competences in medicine can be attained through innumerable books, journals, etc., there is a dearth for literature aimed at enhancing Hospital Medicine practitioners' capacity to perform their day-to-day roles effectively. This lacuna, and the demand to fill it, has led us to publish an abridged version of this handbook. This indispensable resource is loaded with many not-to-be missed tricks of the trade, allowing practitioners to optimize their everyday performance. Hospital Medicine is addressed from many angles, including quality of patient care, safety, cost, efficiency, communication, leadership roles of hospitalists, and healthcare economics. Also featured are critical issues such as delivering a death message, determining brain death, withdrawing life support, discharging un-dischargeable, hospice care, patients leaving against medical advice, etc. The authors have gone to great effort to put together these useful materials in a handy book format that can be slipped into the pocket of a white coat. This handbook is intended for Hospitalists, Internists, Family Practitioners, Internal/Family Medicine Residents, Medical Students, Physician Assistants, Nurse Practitioners, Case Management workers and Hospital Administrative staff.

• Language: English
• Publisher: BookBaby
• Release date: Mar 31, 2018
• ISBN: 9781543929621

Book preview

Hospital Medicine:

The Handbook

A Short Compendium of Effective and Efficient Patient-centered Care

Ramegowda Belakere, MD, PhD

Medical Director/Associate Regional Director, Hospital Medicine, (Envision-EMCARE)

Chief of Staff, Houston Northwest Medical Center, Houston, TX 77090.

Jayanthi Ramu, MD, PhD

Emergency Physician, Jackson Memorial Hospital, Edna, TX 77957.

Former Physician Advisor, Executive Health Resources, PA

Hospital Medicine: The Handbook

Copyright © 2018 by Ramegowda Belakere

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

ISBN (eBook Edition): 978-1-54392-962-1

Disclaimer

The information provided in this handbook represents concise, practical, and evidence-based knowledge. The authors are clinicians who see patients regularly. They have made concentrated and careful efforts to collect reliable information from published literature and documents to include in this handbook. However, they make no guarantee concerning the contents herein and specifically disclaim any implied guarantee of suitability for any specific purpose. Neither the authors nor any other party involved in the preparation or publication of this handbook shall be liable for any special, consequential, or exemplary damages resulting in all or part of any user’s use of or reliance on this material. The users must check with their coder/hospital for suitability of ideas expressed here for a specific location, region, or state. The suggestions provided in this handbook are not a substitute for clinical judgment. The content of this handbook is covered by copyright laws. The reproduction of any of the information without prior permission in any form is prohibited.

Akash Jayram, Sky Unlimited Publications 2018,

Sugar Land, Texas 77479.

Preface

After 2O years of successful experimentation, Hospital Medicine has now become a part of the established medical landscape. While core competences in medicine can be attained through innumerable books, journals, etc., there is a dearth for literature aimed at enhancing Hospital Medicine practitioners’ capacity to perform their day-to-day roles effectively. This lacuna, and the demand to fill it, has led us to publish an abridged version of this handbook. Its aim is to help the drivers of inpatient care to understand the goals and roles of Hospital Medicine, and to become efficient ambassadors of the profession.

This indispensable resource is loaded with many not-to-be missed tricks of the trade, allowing practitioners to optimize their everyday performance. Hospital Medicine is addressed from many angles, including quality of patient care, safety, cost, efficiency, communication with primary care physicians, nurses, administrators, and other medical staff, leadership roles of hospitalists, and healthcare economics. Also featured are critical issues such as delivering a death message, determining brain death, withdrawing life support, discharging un-dischargeable, hospice care, patients leaving against medical advice, etc.

The authors have gone to great effort to put together these useful materials in a handy book format that can be slipped into the pocket of a white coat. This handbook is intended for Hospitalists, Internists, Family Practitioners, Internal/Family Medicine Residents, Medical Students, Physician Assistants, Nurse Practitioners, Case Management workers and Hospital Administrative staff.

Hospital medicine is the fastest growing specialty in the United States. We believe that the addition of our handbook with many useful information required for daily rounds will have positive impact on the job performance of hospitalists. We also believe that the book will create awareness among the physician communities about the roles of hospitalists.

Finally, we would like to extend our appreciation and thanks to our colleagues, Dr. Srilakshmi Konidala, Dr. Rajeev Ramadugu, and others who took time to review our draft and made many useful suggestions to improve the quality of this publication.

Ram Belakere, MD, PhD

Jay Ramu, MD, PhD

Contents

Preface

SECTION 1: Vitals of Hospital Medicine

Compassionate Care: The Driver

Communication: The Game Changer

Efficiency: The Difference Maker

Rounding Efficiently

Safety: The Basic Premise

Quality: The Central Element

Conditions Present on Admission (POA)/ Hospital Acquired Conditions

Leadership: The Key Player

SECTION 2: Healthcare Performance: The Validator

Healthcare Performance

Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS)

Hospital Readmissions Reduction Program (HRRP)

Hospital Acquired Conditions Reduction Program (HACRP)

SECTION 3: Healthcare Economics: The Primer

Healthcare Economics

Diagnosis Related Group (DRG)

APR-DRG: All Patients Refined Diagnosis-Related Group

Case Mix Index (CMI)

An Overview of Health Plans for Elderly

SECTION 4: Documentation: The Basic Tenet

Documentation Basics

Inpatient Visits Documentation

Progress Notes for Follow-up

Consultation – Initial visit

Discharge Summary

Complications and Comorbidities (CCs) and Major Complications and Comorbidities (MCCs)

Current Procedural Terminology (CPT): Coding for Professional Service

Flow Diagram of Hospital Service CPT Codes (except Critical Care)

Coding Critical Care

Coding Prolonged Inpatient Care

Coding Discharges

Coding Same Day Admit and Discharge

Relative Value Units and Professional Fees reimbursement by CMS

SECTION 5: Hospital Admission

Outpatient Admission with Observation

Outpatient Admission without Observation Status

Inpatient Admission

SECTION 6: Critical Issues and Solutions

Breaking Bad News to Patient

Delivering A Death Message

Determining Brain Death

Withdrawing or Withholding Life Support

Dealing with Difficult Patients

Discharging the Un-dischargeable

Hospice/Comfort care

Against Medical Advice (AMA)

Pain Management and Opioids Use

SECTION 7: Selected References

Hospital Medicine

The goal is to provide Compassionate and Efficient Care to Every Patient, Every Day

Vitals of Hospital Medicine

•Compassion

•Communication

•Efficiency

•Safety

•Quality

•Leadership

Compassionate Care:

The Driver

Compassionate Care

•Compassionate care is an essential part of patient-centered care.

•Compassionate care is affected by care efficiency, effective communication, quality, and safety.

•The presence or absence of compassionate care directly affects hospital experience of patients and their satisfaction.

•Compassionate care often creates lasting and vivid memories for patients and their families. It helps them retain the overall experience of care in the hospital.

•Compassionate care starts with good basic timely care including pain management, meeting feeding requirements, etc., with the participation of the patient or their family members.

•Compassion encompasses patient care with sympathy, empathy, respect, and responsiveness to the individual patient’s preferences and needs.

•Compassion is seeing the person in the patient at all time.

Pointers for Effective Compassionate Care

•Involve patients and their families actively in their care planning.

•Manipulate the environment, have good lighting, have less noise etc., to enhance the comfort of care.

•Acknowledge their concerns and address them appropriately.

•Show respect for patients, their families, and those important to them.

•Communicate verbally and non-verbally. Make eye contact, and turn your body toward the person speaking. Communication should be human to human instead of physician to patient.

•Touch is important, and shaking or holding hands of patients is appropriate.

•Talk respectfully, and use words that are understandable to patients and their family members.

•Match your facial expression to your heartfelt emotions.

•Listen actively.

•Spend enough time with the patients for their disease and beyond.

•Strive to understand patients’ emotional needs and assists to resolve them if possible.

•Give patients hope, even when their health news is bad. For example, discussion about relieving pain of a terminal cancer patient gives hope for comfortable end of life care.

•Show understanding of patients’ cultural and religious beliefs.

•The measure of compassion includes how quickly the nurse or doctor respond to patients’ care needs, how well the pain, etc., is managed.

•Compassionate care may be lost in a situation of continuous calls from patients for pain medications or other