Intro to hospital med

Question 1

What is a hospitalist work week?

Answer 1

7 days on and 7 days off 12 hours each day

Question 2

Difference between hospitalist and family care

Answer 2

Admitted by family care and has clinic all day (leads to delayed patient care)

Hospitalist allows to keep people in house

Question 3

Difference between outpatient and inpatient

Answer 3

Outpatient takes longer and does not move fast

Inpatient everything gets done fast, meds readily available

Question 4

Patient-centered care definition

Answer 4

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

Question 5

How is patient-centered care graded?

Answer 5

Through patient satisfaction surveys

Question 6

What are the two patient models?

Answer 6

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)

Question 7

Two components of patient centered care

Answer 7

Patient experience (measured through patient surveys - HCAHPS tied through reimburcement of provider)

Patient engagement

Question 8

7 components of HCAHPS

Answer 8

1. Discharge info
2. responsiveness of hospital staff
3. cleanliness and quietness of hospital environment
4. communication w/ nurses
5. communication about medicines
6. communication with doctors
7. pain management (subjective)

Question 9

Define patient engagement

Answer 9

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.

Question 10

How Can We Improve Patient Engagement through customizing care plan development by considering.

Answer 10

Literacy Level
Readiness to Learn
Readiness to Change (most difficult)
Learning Style
Family Dynamics

Question 11

What is a hospitalists?

Answer 11

“Primary Care Provider” of the Hospital Setting

Question 12

What is a consultant?

Answer 12

Anybody can be a consultant

The role of the consultant is to give recommendations, not to become the primary provider

Question 13

What are the principles of ethical consultation?

Answer 13

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

Question 14

How do you perform an effective consultation?

Answer 14

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

Question 15

What is co-management

Answer 15

SHARED responsibility of a hospitalized patient

leads to decreased length of stay

Question 16

What are the two models of co-management?

Answer 16

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.

Question 17

Traditional consult vs comanagement

Answer 17

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

Question 18

What are the 4 keys to success of team based care

Answer 18

mutual respect
accountability
effective communication
common goals and plans

Question 19

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

Answer 19

Pericarditis = diffuse ST segment elevation

Question 20

What does ESR show?

Answer 20

Inflammation

Question 21

What causes a widened A-a gradient?

Answer 21

Poor oxygenation

Question 22

Which of the following viruses is the most common cause of the presumed diagnosis?

Answer 22

Coxsackievirus