Home News Briefs Incentive bonuses, night work, missed periop opportunities, more

Incentive bonuses, night work, missed periop opportunities, more

January 2008

Published in the January 2008 issue of Today’s Hospitalist

How do incentives affect hospitalist pay?

According to a Today’s Hospitalist online survey, a significant amount of hospitalists’ pay is being affected by a wide range of incentives. Here’s a look at what our survey found:

Is your compensation affected by an incentive or bonus?
Yes: 68.4%
No: 31.6%

If you answered yes, what type of incentives do you have?
Productivity: 21.1%
Quality improvement: 36.8%
Satisfaction scores/citizenship: 10.5%
Other: 31.6%

How much of your pay comes from incentives?
0%-25%: 57.1%
26%-50%: 35.7%
51%-75%: 7.1%
76%-100%: 0%

What type of incentive most appropriately rewards your work as a hospitalist?
Productivity: 26.3%
Quality improvement: 47.4%
Satisfaction scores/citizenship: 0%
Other: 26.3%

For this month’s survey, go online to www.todayshospitalist.com.

Working nights: hazardous to your health?

An arm of the World Health Organization (WHO) has deemed that working nights is “probably carcinogenic.” At press time, the International Agency for Research on Cancer, the WHO’s cancer arm, announced that it would add overnight shift work to a list of probable carcinogens, a move that the American Cancer Society said it would likely follow.

In press reports of the announcement, experts pointed out that alcoholic beverages and oral contraceptives are also considered carcinogens. According to research, experts said, lower melatonin levels, which are caused by the disruption in circadian rhythms, may raise cancer risks. As many as 20% of workers in developed countries “and 30% of those in health care “work nights.

One of the agency’s working group members said that flipping between night and day shifts, instead of steadily working only at night, is considered even more disruptive. Companies are experimenting with different types of lighting that won’t affect melatonin production.

The agency’s policy watch was published in the December 2007 issue of
The Lancet Oncology

Fellowship grants for academic hospitalists
The hospital medicine fellowship program at the University of Chicago is holding a seven-week intensive program on outcomes research his summer for academic hospitalists.

The program will run from July 7 to Aug. 22, 2008. Course fees and a housing stipend are available for four hospitalists.

The program will include biostatistics, clinical epidemiology and health services research, as well as a workshop to help physicians develop research proposals. Small-group and one-on-one mentoring are also part of the program.

The deadline for applications is Jan. 15, 2008. Initial inquiries should be sent to jbarrera@medicine.bsd.uchicago.edu.

Physicians raise concerns about computer-spread infections

A new survey of tech-savvy physicians finds that physicians are increasingly concerned about the role that mobile computing devices play in spreading infections.

This fall, Spyglass Consulting Group, a California-based company that targets the use of wireless and mobile technologies in health care, released a report stating that 65% of physicians surveyed said they were concerned that mobile computers increased infection risk. That figure is up from just 25% of physicians surveyed two years before.

Those concerns may translate into policies about the use of mobile devices at the point-of-care, including the use of infection barriers such as “keyboard condoms,” the report said.

The report also said that new computing devices should be water-resistant and made from antimicrobial plastics. The report also signaled a move away from mobile to fixed computing devices. While tablet PCs are making inroads in office-based practices, the report noted, fewer physicians in hospital settings want to tote one of the tablets around.

As for PDAs and smart phones for bedside charting and charge capture, the report claimed that physicians found those screens too small for clinical work. Instead, physicians are using handheld devices for communications.

Periop consult study finds “missed opportunity” on quality, costs

A study led by hospitalists at the University of California, San Francisco found that perioperative consults with internists did not result in higher quality care. Consults also led to higher costs and longer lengths of stay.

The observational study looked at data collected between May 1, 2004, and May 30, 2006, with 9.1% of patients who underwent surgery having a periop consult on either the day before, day of or day after surgery. Results showed that patients who received periop consults from internists did not have higher quality care as measured by indicators like glycemic control and administration of venous thromboembolism prophylaxis and perioperative beta-blockers.

When adjusted for severity of illness, patients who had periop consults had higher costs (24.3%) and longer lengths of stay (12.98%). Findings were published in the Nov. 26, 2007, Archives of Internal Medicine.

The authors claimed that the “inconsistent effects” they found for internal medicine periop consults may have been due to consultation patterns or biases related to unmeasured patient factors.

They also said that consultants’ orders may not have been followed and that preprinted orders for such interventions as perioperative beta-blockers may have been seen as surgeons’ responsibility alone.

They called for more studies and for “a robust consultative model” in which internists and surgeons would share periop order writing and clinical assessment.

Pediatric rapid response teams cut number of deaths, arrests

A children’s hospital that added a rapid response team for patients who were not in the ICU found significant reductions in both inpatient mortality and the number of cardiac and respiratory arrests.

Researchers evaluated the effect of implementing such a team in an academic children’s hospital. More than 22,000 admissions were evaluated before implementation of the team, while more than 7,000 admissions were evaluated post-implementation.

The rapid response team consisted of a pediatric ICU’trained fellow or attending physician, ICU nurse, ICU respiratory therapist and nursing supervisor. After the team was implemented, the inpatient death rate dropped by 18%, while the number of arrests declined by 70%.

Authors said that this was the first published study to demonstrate a mortality benefit to implementing a pediatric rapid response team.

Results appeared in the Nov. 21, 2007, Journal of the American Medical Association.