scholarly journals “Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center

2021 ◽  
Vol 22 (6) ◽  
pp. 1227-1239
Author(s):  
Zahir Kanjee ◽  
Christine Beltran ◽  
C. Christopher Smith ◽  
Jason Lewis ◽  
Matthew Hall ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Focus Groups ◽  
Medical Center ◽  
Contextual Factors ◽  
Academic Medical Center ◽  
Adverse Outcomes ◽  
Theory Approach ◽  
Academic Medical ◽  
Patient Handoffs ◽  
Patient Handover

Introduction: Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. Methods: We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method. Results: From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). Conclusions: Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.

scholarly journals 864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
Genevieve Allen ◽  
Jamie Riddell
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Hiv Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Academic Medical ◽  
Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

Holiday Discharges Are Associated with Higher 30-Day General Internal Medicine Hospital Readmissions at an Academic Medical Center

2019 ◽  
Vol 112 (6) ◽  
pp. 338-343
Author(s):  
Ajay Dharod ◽  
Brian J. Wells ◽  
Kristin Lenoir ◽  
Wesley G. Willeford ◽  
Michael W. Milks ◽  
...  
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
General Internal ◽  
Academic Medical

Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center

2019 ◽  
Vol 112 (6) ◽  
pp. 310-314
Author(s):  
Becky Lowry ◽  
Leigh M. Eck ◽  
Erica E. Howe ◽  
JoHanna Peterson ◽  
Cheryl A. Gibson
Keyword(s):  
Internal Medicine ◽  
Workplace Violence ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

scholarly journals Effect of Obesity on Complications in Short-Scar Breast Reduction: A Retrospective Study of 236 Consecutive Patients

2018 ◽  
Vol 26 (4) ◽  
pp. 238-243
Author(s):  
Eleanor Rose Goldwasser Tomczyk ◽  
Ava Chappell ◽  
Nathaniel Erskine ◽  
Mustafa Akyurek
Keyword(s):  
Adverse Outcome ◽  
Medical Center ◽  
Reduction Mammaplasty ◽  
Academic Medical Center ◽  
Adverse Outcomes ◽  
Positive Trend ◽  
Academic Medical ◽  
Significant Difference ◽  
Short Scar

Background: Prior studies have examined the relationship between obesity and adverse outcomes after reduction mammaplasty, suggesting a correlation between increasing body mass index (BMI) and postoperative complications. However, there is little data published regarding such correlation with respect to short-scar technique. Methods: A total of 236 patients underwent short-scar mammaplasty with a superomedial pedicle from 2008 to 2014. The procedure was performed by a single surgeon at an academic medical center. Adverse outcomes included delayed healing, major wounds, nipple necrosis, fat necrosis, seroma, hematoma, infection, revision, and dog ear deformities. Univariate and multivariate logistic regression analyses were used to calculate crude and adjusted odds ratios for the association of BMI category with the development of any adverse outcome. Results: Patients were grouped by the following BMI categories: <25 kg/m2 (n = 27), 25 to <30 kg/m2 (n = 71), 30 to <35 kg/m2 (n = 73), 35 to <40 kg/m2 (n = 45), and >40 kg/m2 (n = 20). The mean follow-up period was 260 days. The total complication rate in each group was 22.2%, 23.9%, 27.4%, 33.3%, and 45.0%, respectively. Although the proportion of patients experiencing at least 1 adverse outcome increased across the ascending BMI categories ( P trend = .145), there was no statistically significant difference between the groups. Conclusion: This study of 236 patients who underwent short-scar reduction mammaplasty found a positive trend in the incidence of adverse outcomes as BMI increased. However, this was not statistically significant.

scholarly journals A Strategy to Reduce Interruptions at Hospital Morning Report

2010 ◽  
Vol 2 (1) ◽  
pp. 83-84 ◽  
Author(s):  
Mark L. Wieland ◽  
Laura L. Loertscher ◽  
Darlene R. Nelson ◽  
Jason H. Szostek ◽  
Robert D. Ficalora
Keyword(s):  
Internal Medicine ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nursing Personnel ◽  
Simple System ◽  
House Staff ◽  
Dramatic Reduction ◽  
Morning Report ◽  
Academic Medical ◽  
Observation Period

Abstract Background The learning atmosphere of hospital morning report is frequently interrupted by nonurgent beeper pages to participating residents. Intervention During 176 consecutive internal medicine morning reports, 1 of the 4 chief residents at a single academic medical center collected and answered house staff pages during the 30-minute conference. Results A total of 884 pages were answered during this period. Of these, 743 could wait until after the end of morning report, resulting in more than 4 interruptions averted per session. Over half of the pages were from nursing personnel. There was no significant decrease in the total number of pages or nurse pages during the observation period. Discussion In summary, our simple system of holding intern pages resulted in a dramatic reduction in interruptions during hospital morning report.

scholarly journals A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

2010 ◽  
Vol 2 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Suraj Kapa ◽  
Thomas J. Beckman ◽  
Stephen S. Cha ◽  
Joyce A. Meyer ◽  
Charlotte A. Robinet ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Interrater Reliability ◽  
Medical Center ◽  
Academic Medical Center ◽  
Internal Medicine Resident ◽  
Educational Interventions ◽  
Medicine Resident ◽  
Academic Medical ◽  
Outpatient Practice ◽  
Financial Losses

Abstract Background The financial success of academic medical centers depends largely on appropriate billing for resident-patient encounters. Objectives of this study were to develop an instrument for billing in internal medicine resident clinics, to compare billing practices among junior versus senior residents, and to estimate financial losses from inappropriate resident billing. Methods For this analysis, we randomly selected 100 patient visit notes from a resident outpatient practice. Three coding specialists used an instrument structured on Medicare billing standards to determine appropriate codes, and interrater reliability was assessed. Billing codes were converted to US dollars based on the national Medicare reimbursement list. Inappropriate billing, based on comparisons with coding specialists, was then determined for residents across years of training. Results Interrater reliability of Current Procedural Terminology components was excellent, with κ ranging from 0.76 for examination to 0.94 for diagnosis. Of the encounters in the study, 55% were underbilled by an average of $45.26 per encounter, and 18% were overbilled by an average of $51.29 per encounter. The percentages of appropriately coded notes were 16.1% for postgraduate year (PGY) 1, 26.8% for PGY-2, and 39.3% for PGY-3 residents (P &lt; .05). Underbilling was 74.2% for PGY-1, 48.8% for PGY-2, and 42.9% for PGY-3 residents (P &lt; .01). There was significantly less overbilling among PGY-1 residents compared with PGY-2 and PGY-3 residents (9.7% versus 24.4% and 17.9%, respectively; P &lt; .05). Conclusions Our study reports a reliable method for assessing billing in internal medicine resident clinics. It exposed large financial losses, which were attributable to junior residents more than senior residents. The findings highlight the need for educational interventions to improve resident coding and billing.

Sign in / Sign up

Export Citation Format

Share Document