Nichani S

Quality improvement (QI) is the process of continually evaluating existing processes of care and implementing/disseminating best practice. QI is influenced by objective data and focuses on systems change to optimize institutional performance and appropriate resource use. Since the Institute of Medicine released its report “To Err is Human” in 1999, the then fledgling field of hospital medicine and the QI movement have simultaneously evolved and worked synergistically. Hospitalists are uniquely positioned to improve the quality of inpatient care. Hospitalists should strive to lead or participate in QI efforts to optimize management of common inpatient conditions and improve clinical outcomes on the basis of standardized evidence-based practices.  

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Hospitalists should be able to: 

• Describe the roles of quality and peer review committees in facilitating continuous QI processes. 

• Identify structure, process, and outcome measures appropriate for specific QI projects.

• List the characteristics of high-reliability organizations and learning healthcare systems.

• Describe the elements of effective teams and teamwork.

• Describe the relationships among value, quality, and cost.

• Explain different philosophies and techniques for thorough analysis of complex systems, such as root cause analysis, failure mode and effects analysis, Lean, Six-Sigma, Plan-Do-Study-Act, etc.

• Identify and categorize adverse outcomes including sentinel events, medical errors, and near-misses.

• Describe QI outcome measurements currently used by stakeholders and regulatory agencies.

• Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.

• Identify the relative strengths and limitations of proposed interventions to address hospital-based QI concerns.

• Identify appropriate institutional systems used to report medical errors, patient safety events, and near-misses.

Hospitalists should be able to: 

• Use quality data to inform hospitalist practice and improve patient care at the individual and system levels. 

• Distinguish outcome measurements from process measurements. 

• Interpret patient satisfaction metrics.  

• Incorporate patient preference and satisfaction into the optimization of healthcare quality.

• Identify key stakeholders within individual institutions and work collaboratively in QI endeavors.

• Use common methods to understand, describe, and analyze QI initiatives such as the fishbone diagram and the 5 why’s.

• Apply the results of validated outcome studies to improve the quality of inpatient practice. 

• Structure QI initiatives that reflect evidence-based literature and high-quality outcomes data. 

Hospitalists should be able to:

• Practice patient-centered care and recognize its value in improving patient safety and satisfaction.

• Promote the adoption of new practices, guidelines, and technology as supported by best available evidence. 

• Engage in a collaborative multidisciplinary team approach to lead, coordinate, and/or participate in the design and implementation of QI initiatives at individual, practice, and system levels. 

• Appreciate the importance and need to align quality goals with institutional and system goals.

• Advocate for and foster a Just Culture around patient safety and QI.

Quality improvement (QI) is the process of continually evaluating existing processes of care and implementing/disseminating best practice. QI is influenced by objective data and focuses on systems change to optimize institutional performance and appropriate resource use. Since the Institute of Medicine released its report “To Err is Human” in 1999, the then fledgling field of hospital medicine and the QI movement have simultaneously evolved and worked synergistically. Hospitalists are uniquely positioned to improve the quality of inpatient care. Hospitalists should strive to lead or participate in QI efforts to optimize management of common inpatient conditions and improve clinical outcomes on the basis of standardized evidence-based practices.  

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Describe the roles of quality and peer review committees in facilitating continuous QI processes. 

• Identify structure, process, and outcome measures appropriate for specific QI projects.

• List the characteristics of high-reliability organizations and learning healthcare systems.

• Describe the elements of effective teams and teamwork.

• Describe the relationships among value, quality, and cost.

• Explain different philosophies and techniques for thorough analysis of complex systems, such as root cause analysis, failure mode and effects analysis, Lean, Six-Sigma, Plan-Do-Study-Act, etc.

• Identify and categorize adverse outcomes including sentinel events, medical errors, and near-misses.

• Describe QI outcome measurements currently used by stakeholders and regulatory agencies.

• Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.

• Identify the relative strengths and limitations of proposed interventions to address hospital-based QI concerns.

• Identify appropriate institutional systems used to report medical errors, patient safety events, and near-misses.

Hospitalists should be able to: 

• Use quality data to inform hospitalist practice and improve patient care at the individual and system levels. 

• Distinguish outcome measurements from process measurements. 

• Interpret patient satisfaction metrics.  

• Incorporate patient preference and satisfaction into the optimization of healthcare quality.

• Identify key stakeholders within individual institutions and work collaboratively in QI endeavors.

• Use common methods to understand, describe, and analyze QI initiatives such as the fishbone diagram and the 5 why’s.

• Apply the results of validated outcome studies to improve the quality of inpatient practice. 

• Structure QI initiatives that reflect evidence-based literature and high-quality outcomes data. 

Hospitalists should be able to:

• Practice patient-centered care and recognize its value in improving patient safety and satisfaction.

• Promote the adoption of new practices, guidelines, and technology as supported by best available evidence. 

• Engage in a collaborative multidisciplinary team approach to lead, coordinate, and/or participate in the design and implementation of QI initiatives at individual, practice, and system levels. 

• Appreciate the importance and need to align quality goals with institutional and system goals.

• Advocate for and foster a Just Culture around patient safety and QI.

Quality improvement (QI) is the process of continually evaluating existing processes of care and implementing/disseminating best practice. QI is influenced by objective data and focuses on systems change to optimize institutional performance and appropriate resource use. Since the Institute of Medicine released its report “To Err is Human” in 1999, the then fledgling field of hospital medicine and the QI movement have simultaneously evolved and worked synergistically. Hospitalists are uniquely positioned to improve the quality of inpatient care. Hospitalists should strive to lead or participate in QI efforts to optimize management of common inpatient conditions and improve clinical outcomes on the basis of standardized evidence-based practices.  

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Describe the roles of quality and peer review committees in facilitating continuous QI processes. 

• Identify structure, process, and outcome measures appropriate for specific QI projects.

• List the characteristics of high-reliability organizations and learning healthcare systems.

• Describe the elements of effective teams and teamwork.

• Describe the relationships among value, quality, and cost.

• Explain different philosophies and techniques for thorough analysis of complex systems, such as root cause analysis, failure mode and effects analysis, Lean, Six-Sigma, Plan-Do-Study-Act, etc.

• Identify and categorize adverse outcomes including sentinel events, medical errors, and near-misses.

• Describe QI outcome measurements currently used by stakeholders and regulatory agencies.

• Identify guidelines and protocols supported by outcomes data to shape and standardize clinical practice.

• Identify the relative strengths and limitations of proposed interventions to address hospital-based QI concerns.

• Identify appropriate institutional systems used to report medical errors, patient safety events, and near-misses.

Hospitalists should be able to: 

• Use quality data to inform hospitalist practice and improve patient care at the individual and system levels. 

• Distinguish outcome measurements from process measurements. 

• Interpret patient satisfaction metrics.  

• Incorporate patient preference and satisfaction into the optimization of healthcare quality.

• Identify key stakeholders within individual institutions and work collaboratively in QI endeavors.

• Use common methods to understand, describe, and analyze QI initiatives such as the fishbone diagram and the 5 why’s.

• Apply the results of validated outcome studies to improve the quality of inpatient practice. 

• Structure QI initiatives that reflect evidence-based literature and high-quality outcomes data. 

Hospitalists should be able to:

• Practice patient-centered care and recognize its value in improving patient safety and satisfaction.

• Promote the adoption of new practices, guidelines, and technology as supported by best available evidence. 

• Engage in a collaborative multidisciplinary team approach to lead, coordinate, and/or participate in the design and implementation of QI initiatives at individual, practice, and system levels. 

• Appreciate the importance and need to align quality goals with institutional and system goals.

• Advocate for and foster a Just Culture around patient safety and QI.

Risk management seeks to reduce hazards to patients through a process of identification, evaluation, and analysis of potential or actual adverse events. Hospitalists should strive to comply with applicable laws and regulations, avoid conflicts of interest, and conduct the practice of medicine with integrity and ethics. Hospitalists should also take a collaborative and proactive role in risk management to improve safety and satisfaction in the hospital setting. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the legal definition of negligence and the concept of standard of care. 

• Describe the components of informed consent.

• Describe Health Insurance Portability and Accountability Act (HIPAA) regulations related to patient confidentiality.

• Explain requirements for billing compliance.  

• Describe laws and regulations relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing. 

• Explain how ethical principles can be applied to risk management.

Hospitalists should be able to:

• Ensure patient confidentiality and comply with HIPAA regulations in day-to-day practice.

• Conduct medical practice and complete chart documentation to meet patient care needs and billing compliance.

• Reduce risks through effective communication with all involved parties on the healthcare team. 

• Elicit and appropriately document informed consent from patients or surrogates for treatment plans and procedures when indicated.

• Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents, or medical students.

• Apply guidelines of clinical ethics to patient care and risk management.

• Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.

• Use appropriate systems to identify and report potential areas of risk to patients, families, or healthcare providers. 

Hospitalists should be able to:

• Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient-centered care.   

• Recognize the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.

• Respect patient wishes for treatment decisions and plans, including those that may not resonate with personal beliefs.

• Respect patient confidentiality.

• Collaborate with risk management specialists to review and/or address adverse events.

Risk management seeks to reduce hazards to patients through a process of identification, evaluation, and analysis of potential or actual adverse events. Hospitalists should strive to comply with applicable laws and regulations, avoid conflicts of interest, and conduct the practice of medicine with integrity and ethics. Hospitalists should also take a collaborative and proactive role in risk management to improve safety and satisfaction in the hospital setting. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the legal definition of negligence and the concept of standard of care. 

• Describe the components of informed consent.

• Describe Health Insurance Portability and Accountability Act (HIPAA) regulations related to patient confidentiality.

• Explain requirements for billing compliance.  

• Describe laws and regulations relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing. 

• Explain how ethical principles can be applied to risk management.

Hospitalists should be able to:

• Ensure patient confidentiality and comply with HIPAA regulations in day-to-day practice.

• Conduct medical practice and complete chart documentation to meet patient care needs and billing compliance.

• Reduce risks through effective communication with all involved parties on the healthcare team. 

• Elicit and appropriately document informed consent from patients or surrogates for treatment plans and procedures when indicated.

• Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents, or medical students.

• Apply guidelines of clinical ethics to patient care and risk management.

• Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.

• Use appropriate systems to identify and report potential areas of risk to patients, families, or healthcare providers. 

Hospitalists should be able to:

• Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient-centered care.   

• Recognize the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.

• Respect patient wishes for treatment decisions and plans, including those that may not resonate with personal beliefs.

• Respect patient confidentiality.

• Collaborate with risk management specialists to review and/or address adverse events.

Risk management seeks to reduce hazards to patients through a process of identification, evaluation, and analysis of potential or actual adverse events. Hospitalists should strive to comply with applicable laws and regulations, avoid conflicts of interest, and conduct the practice of medicine with integrity and ethics. Hospitalists should also take a collaborative and proactive role in risk management to improve safety and satisfaction in the hospital setting. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Explain the legal definition of negligence and the concept of standard of care. 

• Describe the components of informed consent.

• Describe Health Insurance Portability and Accountability Act (HIPAA) regulations related to patient confidentiality.

• Explain requirements for billing compliance.  

• Describe laws and regulations relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing. 

• Explain how ethical principles can be applied to risk management.

Hospitalists should be able to:

• Ensure patient confidentiality and comply with HIPAA regulations in day-to-day practice.

• Conduct medical practice and complete chart documentation to meet patient care needs and billing compliance.

• Reduce risks through effective communication with all involved parties on the healthcare team. 

• Elicit and appropriately document informed consent from patients or surrogates for treatment plans and procedures when indicated.

• Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents, or medical students.

• Apply guidelines of clinical ethics to patient care and risk management.

• Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.

• Use appropriate systems to identify and report potential areas of risk to patients, families, or healthcare providers. 

Hospitalists should be able to:

• Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient-centered care.   

• Recognize the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.

• Respect patient wishes for treatment decisions and plans, including those that may not resonate with personal beliefs.

• Respect patient confidentiality.

• Collaborate with risk management specialists to review and/or address adverse events.

Multidisciplinary care refers to active collaboration among various members of the healthcare team to develop and deliver optimal care plans for hospitalized patients. In an era of healthcare delivery reform, team-based care delivery is an integral strategy for enhancing care quality, improving patient safety, decreasing length of stay, lowering costs, and improving health outcomes.^1,2 It is well documented that communication and teamwork failures are the root cause of many preventable adverse events.^3-5 In addition, patients’ rating of nurse-physician coordination correlates with their perception of the quality of care they have received.^6,7 Hospitalists often lead multidisciplinary teams to coordinate complex inpatient medical care to address these and other issues and to improve care processes. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the important elements of teamwork including mutual respect, effective communication techniques, establishing common goals and plans, and individual and team accountability.
• List behaviors and skills that contribute to effective and ineffective interactions, which may also influence team performance.
• Describe factors within an institution, including its local organizational culture, that may influence the structure and function of multidisciplinary teams.
• Recognize the complexity of healthcare systems and the myriad factors involved in patient care.

Hospitalists should be able to:

• Determine an effective team composition and work collaboratively to designate individual responsibilities within the group. 
• Demonstrate skills necessary to lead a team, including effective communication, negotiation, conflict resolution, delegation, and time management. 
• Assess individual team member abilities to identify areas of strength and improvement such that each member is incorporated effectively and productively into the team. 
• Assess and reassess group dynamics as needed and make necessary changes to optimize team function. 
• Use active listening techniques during interactions with team members and engage team participation. 
• Communicate effectively with all members of the multidisciplinary team. 
• Conduct effective multidisciplinary team rounds, which may include patients and their families. 
• Appropriately integrate and balance the assessments and recommendations from all contributing team members into a cohesive care plan.
• Assess performance of all team members, including self-assessment, and identify opportunities for improvement.
• Provide meaningful, behavior-based feedback to improve individual performance. 

Hospitalists should be able to:

• Emphasize the importance of mutual respect among team members. 
• Role model in professional conflict resolution and discussion of disagreements. 
• Within appropriate scopes of practice, share decision-making responsibilities with care team members. 
• Create an environment of shared responsibility with patients and caregivers and provide opportunities for patients and/or caregivers to participate in medical decision-making. 
• Encourage interactive education among team members. 
• Encourage team members to educate patients and families using effective techniques. 

Multidisciplinary care refers to active collaboration among various members of the healthcare team to develop and deliver optimal care plans for hospitalized patients. In an era of healthcare delivery reform, team-based care delivery is an integral strategy for enhancing care quality, improving patient safety, decreasing length of stay, lowering costs, and improving health outcomes.^1,2 It is well documented that communication and teamwork failures are the root cause of many preventable adverse events.^3-5 In addition, patients’ rating of nurse-physician coordination correlates with their perception of the quality of care they have received.^6,7 Hospitalists often lead multidisciplinary teams to coordinate complex inpatient medical care to address these and other issues and to improve care processes. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the important elements of teamwork including mutual respect, effective communication techniques, establishing common goals and plans, and individual and team accountability.
• List behaviors and skills that contribute to effective and ineffective interactions, which may also influence team performance.
• Describe factors within an institution, including its local organizational culture, that may influence the structure and function of multidisciplinary teams.
• Recognize the complexity of healthcare systems and the myriad factors involved in patient care.

Hospitalists should be able to:

• Determine an effective team composition and work collaboratively to designate individual responsibilities within the group. 
• Demonstrate skills necessary to lead a team, including effective communication, negotiation, conflict resolution, delegation, and time management. 
• Assess individual team member abilities to identify areas of strength and improvement such that each member is incorporated effectively and productively into the team. 
• Assess and reassess group dynamics as needed and make necessary changes to optimize team function. 
• Use active listening techniques during interactions with team members and engage team participation. 
• Communicate effectively with all members of the multidisciplinary team. 
• Conduct effective multidisciplinary team rounds, which may include patients and their families. 
• Appropriately integrate and balance the assessments and recommendations from all contributing team members into a cohesive care plan.
• Assess performance of all team members, including self-assessment, and identify opportunities for improvement.
• Provide meaningful, behavior-based feedback to improve individual performance. 

Hospitalists should be able to:

• Emphasize the importance of mutual respect among team members. 
• Role model in professional conflict resolution and discussion of disagreements. 
• Within appropriate scopes of practice, share decision-making responsibilities with care team members. 
• Create an environment of shared responsibility with patients and caregivers and provide opportunities for patients and/or caregivers to participate in medical decision-making. 
• Encourage interactive education among team members. 
• Encourage team members to educate patients and families using effective techniques. 

Multidisciplinary care refers to active collaboration among various members of the healthcare team to develop and deliver optimal care plans for hospitalized patients. In an era of healthcare delivery reform, team-based care delivery is an integral strategy for enhancing care quality, improving patient safety, decreasing length of stay, lowering costs, and improving health outcomes.^1,2 It is well documented that communication and teamwork failures are the root cause of many preventable adverse events.^3-5 In addition, patients’ rating of nurse-physician coordination correlates with their perception of the quality of care they have received.^6,7 Hospitalists often lead multidisciplinary teams to coordinate complex inpatient medical care to address these and other issues and to improve care processes. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to:

• Describe the important elements of teamwork including mutual respect, effective communication techniques, establishing common goals and plans, and individual and team accountability.
• List behaviors and skills that contribute to effective and ineffective interactions, which may also influence team performance.
• Describe factors within an institution, including its local organizational culture, that may influence the structure and function of multidisciplinary teams.
• Recognize the complexity of healthcare systems and the myriad factors involved in patient care.

Hospitalists should be able to:

• Determine an effective team composition and work collaboratively to designate individual responsibilities within the group. 
• Demonstrate skills necessary to lead a team, including effective communication, negotiation, conflict resolution, delegation, and time management. 
• Assess individual team member abilities to identify areas of strength and improvement such that each member is incorporated effectively and productively into the team. 
• Assess and reassess group dynamics as needed and make necessary changes to optimize team function. 
• Use active listening techniques during interactions with team members and engage team participation. 
• Communicate effectively with all members of the multidisciplinary team. 
• Conduct effective multidisciplinary team rounds, which may include patients and their families. 
• Appropriately integrate and balance the assessments and recommendations from all contributing team members into a cohesive care plan.
• Assess performance of all team members, including self-assessment, and identify opportunities for improvement.
• Provide meaningful, behavior-based feedback to improve individual performance. 

Hospitalists should be able to:

• Emphasize the importance of mutual respect among team members. 
• Role model in professional conflict resolution and discussion of disagreements. 
• Within appropriate scopes of practice, share decision-making responsibilities with care team members. 
• Create an environment of shared responsibility with patients and caregivers and provide opportunities for patients and/or caregivers to participate in medical decision-making. 
• Encourage interactive education among team members. 
• Encourage team members to educate patients and families using effective techniques. 

The term “transitions of care” refers to specific interactions, communication, and planning required for patients to safely move from one care setting to another. These transitions apply not only to transfers of care between the inpatient and outpatient settings but also to handoffs that occur within facilities (eg, service to service) and communities (eg, inpatient to subacute rehabilitation). Ineffective transitions of care are associated with adverse events, and nearly 20% of patients experience adverse events (many of which are preventable) within 3 weeks of hospital discharge.^1,2 Hospitalists should promote efficient, safe transitions of care to ensure patient safety, reduce loss of information, and maintain the continuum of high-quality care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Describe the relevant parts of the medical record that should be retrieved and communicated during each care transition to ensure patient safety and maintain the continuum of care.  
• Describe the importance and limitations of patient transition processes. 
• Describe ancillary services that are available to facilitate patient transitions.
• Compare postacute care options for patients.
• Explain the strengths and limitations of different communication modalities and their role in patient transitions. 
• Explain elements of a high-quality patient handoff. 
• Recognize the value of real-time interactive dialogue among clinicians during care transitions. 
• Describe the characteristics of a high-quality discharge summary document.
• Recognize the impact of care transitions on patient outcomes and satisfaction.

Hospitalists should be able to:

• Use the most efficient, effective, reliable, and expeditious communication modalities appropriate for a patient’s care transition.
• Communicate and synthesize relevant medical information to and from referring healthcare providers into a cohesive care plan.
• Develop a care plan early during hospitalization that anticipates care needs beyond the inpatient care setting.  
• Prepare patients and families early in the hospitalization for anticipated care transitions. 
• Access available ancillary services that can facilitate patient transitions. 
• Expeditiously inform the primary care provider about significant changes in patient clinical status. 
• Inform receiving healthcare providers of pending tests and determine responsibility for the follow-up of pending results.
• Select an appropriate level of postacute care that is best suited to the patient’s needs.
• Incorporate patient preferences and use shared decision-making in the selection of postacute care. 
• Anticipate and address language and/or literacy barriers to patient education. 
• Communicate with patients and families to explain the patient’s condition, ongoing medical regimens and therapies, follow-up care, and available support services.
• Communicate with patients and families to explain clinical symptomatology that may require medical attention before scheduled follow-up.  
• Coordinate multidisciplinary teams early during hospitalization to facilitate patient education, optimize patient function, and improve discharge planning.
• Lead, coordinate, and/or participate in initiatives to develop and implement new protocols to improve or optimize transitions of care. 
• Lead, coordinate, and/or participate in the evaluation of new strategies or information systems designed to improve care transitions. 

Hospitalists should be able to:

• Engage in a multidisciplinary approach to care transitions, including nursing, rehabilitation, nutrition, pharmaceutical, and social services. 
• Engage stakeholders in hospital initiatives to continuously assess the quality of care transitions. 
• Maintain availability to discharged patients for questions during discharge and between discharge and the follow-up visit with the receiving physician. 

The term “transitions of care” refers to specific interactions, communication, and planning required for patients to safely move from one care setting to another. These transitions apply not only to transfers of care between the inpatient and outpatient settings but also to handoffs that occur within facilities (eg, service to service) and communities (eg, inpatient to subacute rehabilitation). Ineffective transitions of care are associated with adverse events, and nearly 20% of patients experience adverse events (many of which are preventable) within 3 weeks of hospital discharge.^1,2 Hospitalists should promote efficient, safe transitions of care to ensure patient safety, reduce loss of information, and maintain the continuum of high-quality care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Describe the relevant parts of the medical record that should be retrieved and communicated during each care transition to ensure patient safety and maintain the continuum of care.  
• Describe the importance and limitations of patient transition processes. 
• Describe ancillary services that are available to facilitate patient transitions.
• Compare postacute care options for patients.
• Explain the strengths and limitations of different communication modalities and their role in patient transitions. 
• Explain elements of a high-quality patient handoff. 
• Recognize the value of real-time interactive dialogue among clinicians during care transitions. 
• Describe the characteristics of a high-quality discharge summary document.
• Recognize the impact of care transitions on patient outcomes and satisfaction.

Hospitalists should be able to:

• Use the most efficient, effective, reliable, and expeditious communication modalities appropriate for a patient’s care transition.
• Communicate and synthesize relevant medical information to and from referring healthcare providers into a cohesive care plan.
• Develop a care plan early during hospitalization that anticipates care needs beyond the inpatient care setting.  
• Prepare patients and families early in the hospitalization for anticipated care transitions. 
• Access available ancillary services that can facilitate patient transitions. 
• Expeditiously inform the primary care provider about significant changes in patient clinical status. 
• Inform receiving healthcare providers of pending tests and determine responsibility for the follow-up of pending results.
• Select an appropriate level of postacute care that is best suited to the patient’s needs.
• Incorporate patient preferences and use shared decision-making in the selection of postacute care. 
• Anticipate and address language and/or literacy barriers to patient education. 
• Communicate with patients and families to explain the patient’s condition, ongoing medical regimens and therapies, follow-up care, and available support services.
• Communicate with patients and families to explain clinical symptomatology that may require medical attention before scheduled follow-up.  
• Coordinate multidisciplinary teams early during hospitalization to facilitate patient education, optimize patient function, and improve discharge planning.
• Lead, coordinate, and/or participate in initiatives to develop and implement new protocols to improve or optimize transitions of care. 
• Lead, coordinate, and/or participate in the evaluation of new strategies or information systems designed to improve care transitions. 

Hospitalists should be able to:

• Engage in a multidisciplinary approach to care transitions, including nursing, rehabilitation, nutrition, pharmaceutical, and social services. 
• Engage stakeholders in hospital initiatives to continuously assess the quality of care transitions. 
• Maintain availability to discharged patients for questions during discharge and between discharge and the follow-up visit with the receiving physician. 

The term “transitions of care” refers to specific interactions, communication, and planning required for patients to safely move from one care setting to another. These transitions apply not only to transfers of care between the inpatient and outpatient settings but also to handoffs that occur within facilities (eg, service to service) and communities (eg, inpatient to subacute rehabilitation). Ineffective transitions of care are associated with adverse events, and nearly 20% of patients experience adverse events (many of which are preventable) within 3 weeks of hospital discharge.^1,2 Hospitalists should promote efficient, safe transitions of care to ensure patient safety, reduce loss of information, and maintain the continuum of high-quality care. 

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Describe the relevant parts of the medical record that should be retrieved and communicated during each care transition to ensure patient safety and maintain the continuum of care.  
• Describe the importance and limitations of patient transition processes. 
• Describe ancillary services that are available to facilitate patient transitions.
• Compare postacute care options for patients.
• Explain the strengths and limitations of different communication modalities and their role in patient transitions. 
• Explain elements of a high-quality patient handoff. 
• Recognize the value of real-time interactive dialogue among clinicians during care transitions. 
• Describe the characteristics of a high-quality discharge summary document.
• Recognize the impact of care transitions on patient outcomes and satisfaction.

Hospitalists should be able to:

• Use the most efficient, effective, reliable, and expeditious communication modalities appropriate for a patient’s care transition.
• Communicate and synthesize relevant medical information to and from referring healthcare providers into a cohesive care plan.
• Develop a care plan early during hospitalization that anticipates care needs beyond the inpatient care setting.  
• Prepare patients and families early in the hospitalization for anticipated care transitions. 
• Access available ancillary services that can facilitate patient transitions. 
• Expeditiously inform the primary care provider about significant changes in patient clinical status. 
• Inform receiving healthcare providers of pending tests and determine responsibility for the follow-up of pending results.
• Select an appropriate level of postacute care that is best suited to the patient’s needs.
• Incorporate patient preferences and use shared decision-making in the selection of postacute care. 
• Anticipate and address language and/or literacy barriers to patient education. 
• Communicate with patients and families to explain the patient’s condition, ongoing medical regimens and therapies, follow-up care, and available support services.
• Communicate with patients and families to explain clinical symptomatology that may require medical attention before scheduled follow-up.  
• Coordinate multidisciplinary teams early during hospitalization to facilitate patient education, optimize patient function, and improve discharge planning.
• Lead, coordinate, and/or participate in initiatives to develop and implement new protocols to improve or optimize transitions of care. 
• Lead, coordinate, and/or participate in the evaluation of new strategies or information systems designed to improve care transitions. 

Hospitalists should be able to:

• Engage in a multidisciplinary approach to care transitions, including nursing, rehabilitation, nutrition, pharmaceutical, and social services. 
• Engage stakeholders in hospital initiatives to continuously assess the quality of care transitions. 
• Maintain availability to discharged patients for questions during discharge and between discharge and the follow-up visit with the receiving physician. 

Acute coronary syndrome (ACS) encompasses a spectrum of ischemic heart disease that may include unstable angina (UA), non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Coronary artery disease (CAD) is the leading cause of mortality in the United States and accounts for 1 in 6 deaths annually. Each year, approximately 635,000 Americans have ACS and 300,000 have a recurrent event.¹ Of persons who experience a coronary event or myocardial infarction, approximately 34% and 15%, respectively, will die.¹ More than 45% of patients with symptoms of acute myocardial infarction arrive at the hospital 4 or more hours after symptom onset, and the mortality rate increases for every 30 minutes that elapse before a patient with ACS is diagnosed and treated.^2,3 A shorter time to intervention leads to improved outcomes.^4,5 If the acute stage of a myocardial infarction is survived, patients have a risk of illness and mortality that is 1.5 to 15 times higher than that of the general population.^1,6 Annually in the United States, the number of hospital discharges with a primary or secondary diagnosis of ACS approaches 1.2 million.¹ Hospitalists diagnose, risk stratify, and initiate early management of patients with ACS. Hospitalists provide leadership for multidisciplinary teams that optimize the quality of inpatient care, maximize opportunities for patient education, and efficiently use resources. In addition, hospitalists initiate secondary preventive measures and facilitate adherence to outpatient medical regimens.  

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Define and differentiate UA, NSTEMI, and STEMI.
• Describe the pathophysiologic processes and variable clinical presentations of patients with ACS.  
• Distinguish ACS from other cardiac and noncardiac conditions that may mimic this disease process.
• Describe the use of cardiac biomarkers in the diagnosis of ACS, including timing of testing and the effects of renal disease and other conditions (such as pulmonary embolism or sepsis) on cardiac biomarker levels.  
• Describe the role of noninvasive cardiac tests in the diagnosis and management of ACS.
• Explain indications for and risks associated with cardiac catheterization. 
• Recognize indications for early specialty consultation, which may include cardiology and cardiothoracic surgery. 
• List the major and minor risk factors predisposing patients to CAD.
• Explain the value and use of validated risk stratification tools.  
• Explain indications for hospitalization of patients with chest pain.
• Explain indications and contraindications for fibrinolytic therapy. 
• Explain indications, contraindications, and mechanisms of action of pharmacologic agents that are used both upstream and downstream to treat ACS.   
• Describe factors that indicate the need for early invasive interventions, including angiography, percutaneous coronary intervention, and/or coronary artery bypass grafting. 
• Describe the optimal timeframe for coronary reperfusion when indicated.
• Identify clinical, laboratory, and imaging studies that indicate severity of disease.
• Recognize appropriate timing and thresholds for hospital discharge, including specific measures of clinical stability for safe transition of care.

Hospitalists should be able to: 

• Elicit a thorough and relevant medical history with emphasis on presenting symptoms and patient risk factors for CAD.  
• Perform a physical examination with emphasis on the cardiovascular and pulmonary systems and recognize clinical signs of ACS and disease severity.   
• Diagnose ACS through interpretation of expedited testing, including history, physical examination, electrocardiogram, chest radiograph, and biomarkers.
• Perform early risk stratification using validated risk stratification tools. 
• Synthesize results of history, physical examination, electrocardiography, laboratory and imaging studies, and risk stratification tools to determine therapeutic options, formulate an evidence-based treatment plan, and determine level of care required.
• Identify patients who may benefit from fibrinolytic therapy and/or early revascularization in a timely manner, and activate appropriate teams accordingly.
• Treat patients’ symptoms of chest pain, anxiety, and other discomfort associated with ACS.
• Initiate immediate indicated therapies when patients display symptoms and signs of decompensation.
• Anticipate and address factors that may complicate ACS or its management, which may include inadequate response to therapies, hemodynamic and cardiopulmonary compromise, life-threatening cardiac arrhythmias, or bleeding.
• Assess patients with suspected ACS in a timely manner, identify the level of care required, and manage or comanage the patient with the primary requesting service.
• Communicate with patients and families to explain the history and prognosis of their cardiac disease. 
• Communicate with patients and families to explain tests and procedures and their indications and to obtain informed consent. 
• Communicate with patients and families to explain the use and potential adverse effects of pharmacologic agents. 
• Facilitate discharge planning early during hospitalization. 
• Communicate with patients and families to explain the goals of care, discharge instructions, and management after hospital discharge to ensure safe follow-up and transition of care. 
• Initiate secondary preventive measures before discharge, which may include smoking cessation, dietary modification, and evidence-based medical therapies. 
• Communicate to outpatient providers the notable events of the hospitalization and postdischarge needs including outpatient cardiac rehabilitation. 
• Provide and coordinate resources to ensure safe transition from the hospital to arranged follow-up care. 

Hospitalists should be able to: 

• Employ a multidisciplinary approach, which may include nursing, nutrition, rehabilitation, and social services, in the care of patients with ACS that begins at admission and continues through all care transitions. 
• Follow evidence-based recommendations, protocols, and risk-stratification tools for the treatment of ACS. 

To improve efficiency and quality within their organizations, hospitalists should:

• Lead, coordinate, and/or participate in efforts to develop protocols to rapidly identify patients with ACS and minimize time to intervention.
• Lead, coordinate, and/or participate in efforts among institutions to develop protocols for the rapid identification and transfer of patients with ACS to appropriate facilities.
• Implement systems to ensure hospital-wide adherence to national standards and document those measures as specified by recognized organizations (eg, The Joint Commission, American Heart Association, American College of Cardiology, Agency for Healthcare Research and Quality).  
• Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety and optimize resource use, which may include order sets for ACS and chest pain.
• Lead, coordinate, and/or participate in efforts to educate staff on the importance of smoking cessation counseling and other preventive measures.
• Integrate outcomes research, institution-specific laboratory policies, and hospital formulary to create indicated and cost-effective diagnostic and management strategies for patients with ACS.  

Acute coronary syndrome (ACS) encompasses a spectrum of ischemic heart disease that may include unstable angina (UA), non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Coronary artery disease (CAD) is the leading cause of mortality in the United States and accounts for 1 in 6 deaths annually. Each year, approximately 635,000 Americans have ACS and 300,000 have a recurrent event.¹ Of persons who experience a coronary event or myocardial infarction, approximately 34% and 15%, respectively, will die.¹ More than 45% of patients with symptoms of acute myocardial infarction arrive at the hospital 4 or more hours after symptom onset, and the mortality rate increases for every 30 minutes that elapse before a patient with ACS is diagnosed and treated.^2,3 A shorter time to intervention leads to improved outcomes.^4,5 If the acute stage of a myocardial infarction is survived, patients have a risk of illness and mortality that is 1.5 to 15 times higher than that of the general population.^1,6 Annually in the United States, the number of hospital discharges with a primary or secondary diagnosis of ACS approaches 1.2 million.¹ Hospitalists diagnose, risk stratify, and initiate early management of patients with ACS. Hospitalists provide leadership for multidisciplinary teams that optimize the quality of inpatient care, maximize opportunities for patient education, and efficiently use resources. In addition, hospitalists initiate secondary preventive measures and facilitate adherence to outpatient medical regimens.  

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Define and differentiate UA, NSTEMI, and STEMI.
• Describe the pathophysiologic processes and variable clinical presentations of patients with ACS.  
• Distinguish ACS from other cardiac and noncardiac conditions that may mimic this disease process.
• Describe the use of cardiac biomarkers in the diagnosis of ACS, including timing of testing and the effects of renal disease and other conditions (such as pulmonary embolism or sepsis) on cardiac biomarker levels.  
• Describe the role of noninvasive cardiac tests in the diagnosis and management of ACS.
• Explain indications for and risks associated with cardiac catheterization. 
• Recognize indications for early specialty consultation, which may include cardiology and cardiothoracic surgery. 
• List the major and minor risk factors predisposing patients to CAD.
• Explain the value and use of validated risk stratification tools.  
• Explain indications for hospitalization of patients with chest pain.
• Explain indications and contraindications for fibrinolytic therapy. 
• Explain indications, contraindications, and mechanisms of action of pharmacologic agents that are used both upstream and downstream to treat ACS.   
• Describe factors that indicate the need for early invasive interventions, including angiography, percutaneous coronary intervention, and/or coronary artery bypass grafting. 
• Describe the optimal timeframe for coronary reperfusion when indicated.
• Identify clinical, laboratory, and imaging studies that indicate severity of disease.
• Recognize appropriate timing and thresholds for hospital discharge, including specific measures of clinical stability for safe transition of care.

Hospitalists should be able to: 

• Elicit a thorough and relevant medical history with emphasis on presenting symptoms and patient risk factors for CAD.  
• Perform a physical examination with emphasis on the cardiovascular and pulmonary systems and recognize clinical signs of ACS and disease severity.   
• Diagnose ACS through interpretation of expedited testing, including history, physical examination, electrocardiogram, chest radiograph, and biomarkers.
• Perform early risk stratification using validated risk stratification tools. 
• Synthesize results of history, physical examination, electrocardiography, laboratory and imaging studies, and risk stratification tools to determine therapeutic options, formulate an evidence-based treatment plan, and determine level of care required.
• Identify patients who may benefit from fibrinolytic therapy and/or early revascularization in a timely manner, and activate appropriate teams accordingly.
• Treat patients’ symptoms of chest pain, anxiety, and other discomfort associated with ACS.
• Initiate immediate indicated therapies when patients display symptoms and signs of decompensation.
• Anticipate and address factors that may complicate ACS or its management, which may include inadequate response to therapies, hemodynamic and cardiopulmonary compromise, life-threatening cardiac arrhythmias, or bleeding.
• Assess patients with suspected ACS in a timely manner, identify the level of care required, and manage or comanage the patient with the primary requesting service.
• Communicate with patients and families to explain the history and prognosis of their cardiac disease. 
• Communicate with patients and families to explain tests and procedures and their indications and to obtain informed consent. 
• Communicate with patients and families to explain the use and potential adverse effects of pharmacologic agents. 
• Facilitate discharge planning early during hospitalization. 
• Communicate with patients and families to explain the goals of care, discharge instructions, and management after hospital discharge to ensure safe follow-up and transition of care. 
• Initiate secondary preventive measures before discharge, which may include smoking cessation, dietary modification, and evidence-based medical therapies. 
• Communicate to outpatient providers the notable events of the hospitalization and postdischarge needs including outpatient cardiac rehabilitation. 
• Provide and coordinate resources to ensure safe transition from the hospital to arranged follow-up care. 

Hospitalists should be able to: 

• Employ a multidisciplinary approach, which may include nursing, nutrition, rehabilitation, and social services, in the care of patients with ACS that begins at admission and continues through all care transitions. 
• Follow evidence-based recommendations, protocols, and risk-stratification tools for the treatment of ACS. 

To improve efficiency and quality within their organizations, hospitalists should:

• Lead, coordinate, and/or participate in efforts to develop protocols to rapidly identify patients with ACS and minimize time to intervention.
• Lead, coordinate, and/or participate in efforts among institutions to develop protocols for the rapid identification and transfer of patients with ACS to appropriate facilities.
• Implement systems to ensure hospital-wide adherence to national standards and document those measures as specified by recognized organizations (eg, The Joint Commission, American Heart Association, American College of Cardiology, Agency for Healthcare Research and Quality).  
• Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety and optimize resource use, which may include order sets for ACS and chest pain.
• Lead, coordinate, and/or participate in efforts to educate staff on the importance of smoking cessation counseling and other preventive measures.
• Integrate outcomes research, institution-specific laboratory policies, and hospital formulary to create indicated and cost-effective diagnostic and management strategies for patients with ACS.  

Acute coronary syndrome (ACS) encompasses a spectrum of ischemic heart disease that may include unstable angina (UA), non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Coronary artery disease (CAD) is the leading cause of mortality in the United States and accounts for 1 in 6 deaths annually. Each year, approximately 635,000 Americans have ACS and 300,000 have a recurrent event.¹ Of persons who experience a coronary event or myocardial infarction, approximately 34% and 15%, respectively, will die.¹ More than 45% of patients with symptoms of acute myocardial infarction arrive at the hospital 4 or more hours after symptom onset, and the mortality rate increases for every 30 minutes that elapse before a patient with ACS is diagnosed and treated.^2,3 A shorter time to intervention leads to improved outcomes.^4,5 If the acute stage of a myocardial infarction is survived, patients have a risk of illness and mortality that is 1.5 to 15 times higher than that of the general population.^1,6 Annually in the United States, the number of hospital discharges with a primary or secondary diagnosis of ACS approaches 1.2 million.¹ Hospitalists diagnose, risk stratify, and initiate early management of patients with ACS. Hospitalists provide leadership for multidisciplinary teams that optimize the quality of inpatient care, maximize opportunities for patient education, and efficiently use resources. In addition, hospitalists initiate secondary preventive measures and facilitate adherence to outpatient medical regimens.  

Want all 52 JHM Core Competency articles in an easy-to-read compendium? Order your copy now from Amazon.com.

Hospitalists should be able to: 

• Define and differentiate UA, NSTEMI, and STEMI.
• Describe the pathophysiologic processes and variable clinical presentations of patients with ACS.  
• Distinguish ACS from other cardiac and noncardiac conditions that may mimic this disease process.
• Describe the use of cardiac biomarkers in the diagnosis of ACS, including timing of testing and the effects of renal disease and other conditions (such as pulmonary embolism or sepsis) on cardiac biomarker levels.  
• Describe the role of noninvasive cardiac tests in the diagnosis and management of ACS.
• Explain indications for and risks associated with cardiac catheterization. 
• Recognize indications for early specialty consultation, which may include cardiology and cardiothoracic surgery. 
• List the major and minor risk factors predisposing patients to CAD.
• Explain the value and use of validated risk stratification tools.  
• Explain indications for hospitalization of patients with chest pain.
• Explain indications and contraindications for fibrinolytic therapy. 
• Explain indications, contraindications, and mechanisms of action of pharmacologic agents that are used both upstream and downstream to treat ACS.   
• Describe factors that indicate the need for early invasive interventions, including angiography, percutaneous coronary intervention, and/or coronary artery bypass grafting. 
• Describe the optimal timeframe for coronary reperfusion when indicated.
• Identify clinical, laboratory, and imaging studies that indicate severity of disease.
• Recognize appropriate timing and thresholds for hospital discharge, including specific measures of clinical stability for safe transition of care.

Hospitalists should be able to: 

• Elicit a thorough and relevant medical history with emphasis on presenting symptoms and patient risk factors for CAD.  
• Perform a physical examination with emphasis on the cardiovascular and pulmonary systems and recognize clinical signs of ACS and disease severity.   
• Diagnose ACS through interpretation of expedited testing, including history, physical examination, electrocardiogram, chest radiograph, and biomarkers.
• Perform early risk stratification using validated risk stratification tools. 
• Synthesize results of history, physical examination, electrocardiography, laboratory and imaging studies, and risk stratification tools to determine therapeutic options, formulate an evidence-based treatment plan, and determine level of care required.
• Identify patients who may benefit from fibrinolytic therapy and/or early revascularization in a timely manner, and activate appropriate teams accordingly.
• Treat patients’ symptoms of chest pain, anxiety, and other discomfort associated with ACS.
• Initiate immediate indicated therapies when patients display symptoms and signs of decompensation.
• Anticipate and address factors that may complicate ACS or its management, which may include inadequate response to therapies, hemodynamic and cardiopulmonary compromise, life-threatening cardiac arrhythmias, or bleeding.
• Assess patients with suspected ACS in a timely manner, identify the level of care required, and manage or comanage the patient with the primary requesting service.
• Communicate with patients and families to explain the history and prognosis of their cardiac disease. 
• Communicate with patients and families to explain tests and procedures and their indications and to obtain informed consent. 
• Communicate with patients and families to explain the use and potential adverse effects of pharmacologic agents. 
• Facilitate discharge planning early during hospitalization. 
• Communicate with patients and families to explain the goals of care, discharge instructions, and management after hospital discharge to ensure safe follow-up and transition of care. 
• Initiate secondary preventive measures before discharge, which may include smoking cessation, dietary modification, and evidence-based medical therapies. 
• Communicate to outpatient providers the notable events of the hospitalization and postdischarge needs including outpatient cardiac rehabilitation. 
• Provide and coordinate resources to ensure safe transition from the hospital to arranged follow-up care. 

Hospitalists should be able to: 

• Employ a multidisciplinary approach, which may include nursing, nutrition, rehabilitation, and social services, in the care of patients with ACS that begins at admission and continues through all care transitions. 
• Follow evidence-based recommendations, protocols, and risk-stratification tools for the treatment of ACS. 

To improve efficiency and quality within their organizations, hospitalists should:

• Lead, coordinate, and/or participate in efforts to develop protocols to rapidly identify patients with ACS and minimize time to intervention.
• Lead, coordinate, and/or participate in efforts among institutions to develop protocols for the rapid identification and transfer of patients with ACS to appropriate facilities.
• Implement systems to ensure hospital-wide adherence to national standards and document those measures as specified by recognized organizations (eg, The Joint Commission, American Heart Association, American College of Cardiology, Agency for Healthcare Research and Quality).  
• Lead, coordinate, and/or participate in multidisciplinary initiatives to promote patient safety and optimize resource use, which may include order sets for ACS and chest pain.
• Lead, coordinate, and/or participate in efforts to educate staff on the importance of smoking cessation counseling and other preventive measures.
• Integrate outcomes research, institution-specific laboratory policies, and hospital formulary to create indicated and cost-effective diagnostic and management strategies for patients with ACS.