Intro to hospital med Flashcards
What is a hospitalist work week?
7 days on and 7 days off 12 hours each day
Difference between hospitalist and family care
Admitted by family care and has clinic all day (leads to delayed patient care)
Hospitalist allows to keep people in house
Difference between outpatient and inpatient
Outpatient takes longer and does not move fast
Inpatient everything gets done fast, meds readily available
Patient-centered care definition
Patient values guide clinical decision
Used to be where patients did not have a say.
Patient is the center of the team
Cycling of nurses
Discuss plan
Doctor has an entourage
Repeat info
How is patient-centered care graded?
Through patient satisfaction surveys
What are the two patient models?
Hospital/clinical centric (VA centers - at the mercy of the insurance, lots of mental health issues, same patient treatment)
Patient/centric model (what we strive for, shared decision making, patient portal)
Two components of patient centered care
Patient experience (measured through patient surveys - HCAHPS tied through reimburcement of provider)
Patient engagement
7 components of HCAHPS
- Discharge info
- responsiveness of hospital staff
- cleanliness and quietness of hospital environment
- communication w/ nurses
- communication about medicines
- communication with doctors
- pain management (subjective)
Define patient engagement
Actions taken by individuals to obtain the greatest benefit from the health care services available to them.
Occurs when patients feel empowered to move to a state of active participation and self-efficacy in managing their health.
Engaged patients have better health outcomes, incur less costs, and enjoy greatest value (quality/cost) from health care system.
How Can We Improve Patient Engagement through customizing care plan development by considering.
Literacy Level
Readiness to Learn
Readiness to Change (most difficult)
Learning Style
Family Dynamics
What is a hospitalists?
“Primary Care Provider” of the Hospital Setting
What is a consultant?
Anybody can be a consultant
The role of the consultant is to give recommendations, not to become the primary provider
What are the principles of ethical consultation?
Indicated In Complex Cases to Enhance the Quality of Medical Care
Case Summary should be provided to Consultant
1 physician in Charge of Patient/Attending Has Overall Responsibility
Consultation Should Be Completed Punctually
How do you perform an effective consultation?
Determine The Question
Look For Yourself
Establish Urgency
Be As Brief As Appropriate
Be Specific and Concise
Provide Contingency Plans
Honor Thy Turf
Teach With Tact
Talk Is Cheap And Effective
Follow-Up
What is co-management
SHARED responsibility of a hospitalized patient
leads to decreased length of stay
What are the two models of co-management?
The first model assigns the hospitalist as the patient’s primary attending, utilizing the subspecialist as a consultant.
The second model assigns the hospitalist to serve as a consultant to the patient while the subspecialist is the patient’s primary attending.
Traditional consult vs comanagement
TRADITIONAL
Requesting physician in charge
Requesting physician treats primary medical problems
Specific question addressed
Consultant does not write orders
Limited follow-up….as needed
CO-MANAGEMENT
Shared responsibility
Medical/Surgical consultant treats primary medical problems
Broader issues – other conditions
Consultant writes orders
Daily follow-up until discharge
What are the 4 keys to success of team based care
mutual respect
accountability
effective communication
common goals and plans
A 24-year old male presents to the Emergency Department complaining of chest pain. He states that is it worse with swallowing and taking a deep breath. It is improved by sitting up and leaning forward. He denies trauma, a cough, or shortness of breath. Which of the following tests would be most compatible with your suspected diagnosis?
Hiatal Hernia visualized on chest x-ray
Normal Erythrocyte Sedimentation Rate
Calcified “Popcorn” lesions in the lung fields bilaterally
Diffuse ST segment elevation on the ECG
A Widened A-a gradient on his Arterial Blood Gas
Pericarditis = diffuse ST segment elevation
What does ESR show?
Inflammation
What causes a widened A-a gradient?
Poor oxygenation
Which of the following viruses is the most common cause of the presumed diagnosis?
Coxsackievirus
