Comprehensive Hospital Medicine represents a major step in the journey to provide hospital-based practitioners with an inclusive, practical reference that covers all the diverse aspects of hospital medicine. The desire for a comprehensive resource for the field of hospital medicine drove the contributors to generate what we hope is a useful, frequently utilized tool.
Comprehensive Hospital Medicine is separated into three major parts. The first part (General Hospital Medicine Care) addresses common clinical issues that hospitalists encounter in the care of hospitalized patients, while the second (Consultative Hospital Medicine) focuses on the increasingly important role of hospitalists in perioperative care and providing consultative services. This reference text finishes with an entire part (System Issues) of 20 chapters devoted to explaining how best to organize and operate hospitalist programs, conduct hospital performance improvement projects, and address legal and ethical concerns.
We begin the approach to general hospital medicine care with chapters on applying evidence-based principles, communication and cultural competence, nutritional assessment and support, optimizing care of the frail elderly (typically our most frequent patients), and hospital discharge. Following a section devoted to preventive care in the hospital, subsequent chapters cover medical conditions and situations hospitalists commonly encounter, ranging from cardiovascular disorders to infectious, oncologic, and critical-care conditions. Chapters employ liberal use of tables, diagrams, algorithms, and pictures to distill information into readily accessible formats. We standardized chapters on common medical conditions so you can access the information when you need it. A Background section includes basics of epidemiology and pathophysiology when appropriate, but the primary focus is on Assessment of patients' clinical presentation and Management. Chapters in this part typically finish with discharge and follow-up plans with primary care providers. This structure will assist clinicians in quickly finding relevant information for diagnosis and treatment.
The second major part, Consultative Hospital Medicine, covers both preoperative evaluation and care of postoperative complications. The part is complemented with chapters on management of the medical complications of pregnancy and medical consultation for patients with psychiatric disorders necessitating hospitalization. The third and final part, System Issues, emphasizes the importance of attending to nonclinical issues to optimize the operations of a hospitalist program and the system of hospital care delivery. Topics covered include scheduling, compensation, coding and billing, leadership, managing patient transitions of care, staff performance improvement, establishing a team-work model with hospital staff, patient safety, and quality improvement.
All of the authors and editors sought to make Comprehensive Hospital Medicine useful to clinicians caring for hospitalized patients. In undertaking such a complex endeavor, we recognize that improvements in subsequent editions will be made. The patient-safety movement sweeping the medical world accepts that humans are not infallible, and though we tried our best to ensure the accuracy of the content of this reference, we certainly accept this axiom. Additionally, new scientific advances in diagnosis and treatment are reported every day. So we encourage and appreciate your feedback on how we may improve Comprehensive Hospital Medicine. The entire content of the book will also be on the web (hospitalisttext.com), and all the footnoted references are located there. We placed only suggested readings in the textbook version. The web-based version of Comprehensive Hospital Medicine will be updated regularly, so we can respond quickly to your feedback and new advances in hospital care.
We hope this reference will serve as an authoritative resource for hospitalists and members of the hospital team seeking to improve the overall delivery of hospital care. It was developed for you, and we look forward to continuing to enhance it so you can optimize care for your patients needing hospital care.
FOREWORD
By now hospital medicine is no longer an interesting sideline in medical practice but an established part of health care. The Society of Hospital Medicine (SHM), as the professional medical society for hospitalists, has been involved in defining hospital medicine. There is enormous promise for what this new specialty can do as part of the evolution of health care.
At the forefront of the change is a reordering of medical practice to a system that is patient centered and emphasizes measurable quality delivered by true teams. The themes of Comprehensive Hospital Medicine further define the elements that will be crucial to this transition.
Hospitalists have been portrayed by some as simply replacing internists, family practitioners, and pediatricians in the inpatient setting. While this is true on the face of it, hospitalists bring much more to the table. Certainly, hospitalists need to be experts in the common medical conditions that acutely ill patients bring to the hospital. These illnesses (e.g., heart failure, pneumonia, stroke, deep vein thrombosis) are delineated in the table of contents of this book, and the thorough chapters in this reference provide content to the SHM's Core Competences for Hospital Medicine.[1]
Because hospitalists devote most if not all of their professional focus to inpatient care, they will certainly be called upon to see greater numbers of all of these clinical conditions. Practice does make perfect, but more to the point, hospitalists can and must be experts in the nuances of acute care.
In my medical career as a busy internist in the “old days” it was enough to make the right diagnosis and order the correct therapy. Today's hospitalists must be aware of disease-specific performance standards and must even participate locally in implementation strategies to define what will be measured. The third part of Comprehensive Hospital Medicine, System Issues, covers essential nonclinical aspects of the hospitalist's role and provides tools for their measurement. In addition to helping measure the effectiveness of current hospital care, hospitalists are critical team members who will work with nurses, pharmacists, case managers, and other physicians, as well as the hospital administration, to develop changes in health care work flow to improve performance.
Hospitalists will also need to be prepared to look at how the hospital functions. When is the antibiotic actually received by the patient? How can we improve the way patients move through the emergency department (ED) to allow the ED physicians to do their job more efficiently? How can we work with the intensivists and the ICU staff to transition patients out of crowded ICUs when there is so much demand to create available ICU capacity? Providing comprehensive information and guidance, Comprehensive Hospital Medicine can be a resource for hospitalists wanting to know how best to manage patient flow.
Because hospitals are concerned with both effectiveness and efficiency, hospitalists need to maximize the skills of the entire inpatient team. Working with pharmacists, hospitalists need to be well versed in pharmacoeconomics, using not necessarily the least expensive therapeutic agent, but the one that has the best chance of getting the patient better quicker and keeping them out of the hospital. Working with the nurses and the case managers, hospitalists need to fashion the ideal hospitalization for each inpatient they see. Where do diagnosis and therapy intersect with patient education and the important transition from inpatient to outpatient, especially in today's health care world where patients are often discharged not fully cured, but well enough to leave the hospital and the expense of inpatient care?
Hospitalists are also bringing their new and improved vision of health care to many other parts of the hospital. Surgeons and medical subspecialists now routinely rely on hospitalists to co-manage their patients, freeing them up to concentrate on their specialty expertise. Hospitalists need to be experts in perioperative care and palliative and end-of-life care as well as certain aspects of critical care.
We have moved from the lone-ranger physician, operating individually to cure his or her patients, to health care delivered by teams, as well described in Comprehensive Hospital Medicine's chapter on teamwork. Because of this, hospitalists need information and training to manage groups of hospitalists and provide leadership for other health professionals. Unfortunately, most of these skills are not taught in medical schools or residency programs. Yet they are essential if hospital medicine is to realize the promise of this new specialty.
This textbook takes a giant step toward bringing together the current body of knowledge to help hospitalists succeed in this challenging environment. It complements web-based tools developed by SHM for education and to improve quality as well as SHM courses on practice management and leadership to train the next generation of physician leaders. This combination of a comprehensive reference textbook written by leaders in hospital medicine and interactive resources developed by SHM can allow us to close the knowledge gap.
We are entering a new day in health care where there are increased expectations for better quality outcomes, delivered in an efficient hospital setting. We want more for our health care dollar. No physician specialty has ever been asked both to improve measurable quality and save the system money while they do it.
Soon there will be hospitalists at most if not all hospitals. They will be called upon to play a significant role in improving the health of their patients and leading their institutions into the future. Hospitalists bring the enthusiasm and energy to take this on. Hospitalists need to rely on textbooks like this one for comprehensive information designed to help them succeed. SHM will do our part to provide additional resources specific to hospitalists. Together we will meet the challenge and take health care to a new level.
Laurence D. Wellikson, M.D., F.A.C.P.
Chief Executive Officer, Society of Hospital Medicine
Chief Executive Officer, Society of Hospital Medicine
Features
- Access to the entire contents of this Expert Consult title online permits speedy consultation from any computer with an Internet connection.
- The Premium Edition includes regular online updates reflecting the latest clinical developments ... all of the artwork from the text, downloadable for use in PowerPoint® presentations ... evidence-based admitting orders for over 100 conditions ... and the ability to load all of the admitting orders from the web site onto your handheld device.
- State-of-the-art, evidence-based, hospital-focused guidelines on clinical assessment, diagnosis, prognosis, treatment, and discharge/follow-up planning help you to effectively manage all of the key disorders in every body system.
- 20 chapters focused on peri-operative care assist you in navigating this increasingly important component of hospital medicine practice.
- Expert advice on systems issues explores how to establish and enhance a hospitalist program, provide leadership, manage patient transitions of care, establish a teamwork model with hospital staff, promote patient safety and staff performance improvement, standardize care, and navigate legal and ethical concerns.
PART ONE - GENERAL HOSPITAL MEDICINE CARE
- Section 1 - General Approach to a Hospitalized Patient
- Section 2 - Preventive Services in the Hospitalized Patient
- Section 3 - Cardiovascular
- Section 4 - Infectious Diseases
- Section 5 - Pulmonary
- Section 6 - Nephrology
- Section 7 - Gastroenterology
- Section 8 - Endocrinology
- Section 9 - Oncology
- Section 10 - Hematology
- Section 11 - Rheumatology, Immunology, and Dermatology
- Section 12 - Critical Care
- Section 13 - Neurology
PART TWO - CONSULTATIVE HOSPITAL MEDICINE
- Section 14 - Consultative Hospital Medicine
- Section 15 - Preoperative Assessments and Preparation
- Section 16 - Postoperative Evaluation and Care
- Section 17 - Medical Complications of Pregnancy
- Section 18 - Consultation for the Psychiatric Patient
PART THREE - SYSTEM ISSUES
- Section 19 - Hospitalist Program Operations
- Section 20 - Hospital Performance Improvement
- Section 21 - Legal and Ethical Issues
- APPENDIX ONE: NIH Stroke Scale
- APPENDIX TWO: Eligibility Criteria Indications for tPA Administration/Treatment
- APPENDIX THREE: RASS and CAM–ICU Worksheet
Product Details
- Hardcover: 1072 pages
- Publisher: Saunders; 1 Har/Psc edition (September 28, 2007)
- Language: English
- ISBN-10: 1416002979
- ISBN-13: 978-1416002970
- Product Dimensions: 11.2 x 8.9 x 1.9 inches