PHM 2005 Presentations

Pediatric Hospital Medicine 2005

July 28 - 31
Denver, Colorado

Sponsored by the Ambulatory Pediatric
Association, The American Academy of Pediatrics
Section on Hospital Care and the Society on
Hospital Medicine

The following is an outline of the topics covered at the Conference and a brief summary of each.

Click on the title of the workshop to view the information covered in the session.

KEYNOTE ADDRESS - LARRY WELLIKSON

PLENARIES

FUTURE DIRECTIONS - Becoming a Sub-board vs. Pursuing Competencies
FUTURE DIRECTIONS - Steve Ludwig
Steve Ludwig, Larry Wellikson, Doug Carlson and Mark Joffe. Moderator: Dan Rauch.
Pediatric hospital medicine has changed significantly in the last five years. Several key organizations have started to respond to their members needs, fellowships are being developed, research is becoming established and the number of pediatric hospitalists is rapidly growing. Many questions remain: Is pediatric hospital medicine a new specialty? Is there a distinct difference in the knowledge base between outpatient and inpatient pediatrics? Should pediatric hospital medicine be a board-certified specialty or one with an added qualification? What needs to happen in the short- and long-term for this to be a viable career/specialty option? These questions were addressed during this session.

PRIS AND NETWORKING - Chris Landrigan
Moving the field of inpatient pediatrics forward will require generating new evidence on how best to treat inpatients with various conditions (evidence-based medicine) and how to translate those findings quickly into the practice of hospital medicine. This session described how the Pediatric Research in Inpatient Settings (PRIS) network functions. Key issues, an agenda on how to accomplish these goals and information on how to become involved will be presented by Dr. Chris Landrigan, Chair of PRIS, Research Director of Inpatient Services at Children's Hospital, Boston and a practicing Hospitalist/health services researcher focusing on medical errors in inpatient settings among other things.

WORKSHOPS

CLINICAL ISSUES

1.	Hospitalist Run Sedation Services - Doug Carlson This workshop focused on the systems necessary to develop, implement, sustain and maintain a hospitalist run sedation service. The session emphasized training requirements for hospitalists as well as the systems and safeguards necessary for an effective program. Clinical aspects and billing aspects of a sedation service were also discussed.

2.	Pathways: A Critical Tool for Hospitalist Success - Steve Muething Examples were presented of the lessons learned at Cincinnati Children's Hospital with their exemplary development of inpatient pediatric pathways (available on-line at www.guidelines.gov). The workshop focused on the processes of developing consensus, buy-in, overcoming obstacles, gaining support of all members of the healthcare team, implementing systems change, monitoring progress, and conducting on-going quality improvement.

3.	Troubleshooting Lines, Tubes and Catheters - Mark Joffe Part 2 This workshop provided nuts and bolts information that hospitalists need to manage the range of access and egress devices encountered on the pediatric ward. Areas appropriate and inappropriate for hospitalist intervention were discussed and demonstrated. Topics included repair of PICC lines and broviac catheters, thrombolytic therapy for catheter occlusion, G-tube management, VP shunt assessment and trach tubes.

4.	Hospital Care of the Technologically Dependent Child - Raj Srivastava This workshop focused on clinical aspects involved in the care of the technologically dependent, hospitalized child. Items covered were respiratory status and pulmonary toilet, feeding and nutrition, physical therapy, psychosocial considerations and emotional well being. Integration with the medical home and transitions of care was emphasized. New technologies and therapeutic modalities that the hospitalist can expect to encounter were reviewed.

5.	Top 10 Topics in Pediatric Hospital Medicine 2005 - Erin Stucky This workshop provided an overview of advances in the clinical and systems practice of pediatric hospital medicine in the year 2005. Topics were selected from an extensive review of the literature, identification of hot topics from the LISTSERV, and on-going surveillance of the activities of professional organizations impacting pediatric hospitalist practice.

6.	Family Centered Rounds - Overcoming Barriers - Steve Muething, Jeff Simmons This workshop featured video vignettes of family-centered rounds and encouraged discussion amongst the attendees. Participants had the chance to share and learn best practices from other sites. Also addressed were barriers to family-centered rounds and possible ways to overcome them.

TEACHING

1.	Evidence Based Medicine - How to Use and Teach - Vinny Chiang, Mary Ottolini How to Use and Teach Web Addresses Education Prescription Education Therapy Comparison of Racemic Albuterol and Levalbuterol Pediatrics This workshop gave a brief review of evidence based medicine and explored how to incorporate evidence based medicine into the practice of hospital medicine and how to teach evidence based medicine to others.

2.	Teaching Techniques: Evaluation, Feedback and Teachable Moments - Vinny Chiang, Dan Rauch This workshop reviewed basic components of evaluation and feedback as well as the necessary skills for teaching within the hospital setting.

3.	Developing a Curriculum - Tim Cornell, Craig DeWolfe, Lisa Zaotis Curriculum Development 2 Workshop Curriculum Development 3 Goals & Objectives Curriculum Development 4 Evaluation Measurement Curriculum Development 5 Application & Implementation Curriculum Development 6 Small Group Products Curriculum Development 7 Goals & Objectives Curriculum Development 8 Children's Hospital of Philadelphia Goals & Objectives Curriculum Development 9 CNM Goals & Objectives This workshop discussed how to develop a hospital medicine focused curriculum with attention to institutional priorities and ACGME competencies.

PRACTICE MANAGEMENT

1.	Coding and Billing Coding Worksheet Critical Care Coding History Page 1 History Page 2 Master Sheet for Coding and Billing Medical Decision Making Patient History Page 1 Patient History Page 2 RTA Admission Note This workshop highlighted common billing, coding and documentation issues dealt with in everyday hospitalist practice including initial and subsequent hospital days, observation codes, common procedure codes and consulting codes. Strategies to safely maximize reimbursement were discussed as well as common pitfalls in appropriate billing and documentation.

2.	Contract Negotiation - Coverage Models and Funding (Support/Subsidy) - Linda Snelling This workshop outlines key principles of powerful and positive negotiation, focusing on negotiation as shared learning, strategic planning and a process to strengthen relationships, in addition to advancing one's own agenda. References and recommendations were given for further self study and development of crucial life long negotiation skills.

3.	Career Advancement/ Preventing Burnout - Dan Rauch, Mike Ruhlen Career Satisfaction This workshop explored the principles in creating longevity and career satisfaction in hospital medicine. Key concepts in physician retention and burnout were described using lessons from other fields and from existing research in the field of hospital medicine. Academic career advancement for the hospitalist was also discussed.

4.	Being a Consultant - Erin Stucky Discussed in this session was the hospitalist as a consultant and covered were the common pitfalls of this role. Effective communication strategies including verbal and written were also discussed, as was the idea of "attending" versus "consultant" and the advantages of each role.

RESEARCH

1.	Opportunities and Mechanisms for Conducting Inpatient Research - Chris Landrigan, Raj Srivastava This workshop discussed the core components needed to conduct quality inpatient research and how to use opportunities locally to pool resources together. Experiences from two large pediatric teaching hospitals were discussed, as were integration with quality departments, statistical analytical resources, career options for hospitalists interested in research and how to work with groups at a national level.

2.	Educational Scholarship: Sharing Resources and Developing Research - Mary Ottolini Part 2 Educational Scholarship Educators Protfolio Larrie W. Greenberg's Article on Bad News This workshop focused on educational scholarship for hospitalists. Scholarship was defined and there was discussion on how hospitalists could advance the field of medical education and their own careers as educators by investigating questions that arise about teaching in the inpatient setting, or sharing educational resources. Also discussed was how to document scholarship using an educator's portfolio.