ACP Hospitalist A monthly publication for hospitalists and other hospital-based physicians. Find tools, tips, and up-to-date information to help you through virtual interviews and more. Hospital medicine is a type of practice within internal medicine in which the clinical focus is caring for hospitalized patients. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Match season is complex—especially this year. The hospitalist should be readily available to discuss the patient's medical problems and hospital course with the family and should provide timely updates to the primary care physician designated by the patient. The following guidelines are intended to support quality, cost effective care to patients and their families, and to clarify expectations for communication between hospitalists and primary care physicians. Using a case-based format, lecturers distill recent evidence, guidelines, and expert opinion to offer “bottom line” recommendations. Focused Education for Hospitalists Whether you’re trying to stay current or preparing for the FPHM exam, ACP has a number of educational opportunities focused on hospital medicine. Not all studies included in the guideline contain exclusively hospitalized patients, but much of the guideline content is applicable to hospitalized patients. Various regimens have been tried and found to be effective. Hospital Medicine Clinical Practice Guidelines - 2019 Year in Review : Stay current with new guidelines and recommendations. With so few coders specializing in hospitalist coding, it is difficult to find and hire experienced hospital medicine … With FMX On Demand, you can access recorded FMX sessions led by family medicine experts, and earn up to 155 enduring CME credits. As a member, you'll receive a variety of exclusive products, programs, services, and discounts totaling more than $3,800 in member savings. Internists practicing hospital medicine are frequently called hospitalists. GUIDELINE TITLE: 2018 Infectious Disease Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) Clostridium difficile infection (CDI) clinical practice guidelineRELEASE DATE: February 15, 2018PRIOR VERSION: 2010 Infectious Disease Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) Clostridium difficile infection (CDI) clinical practice guidelineDEVELOPER: A panel of 14 multidisciplinary expertsFUNDING SOURCE: IDSA and SHEATARGET POPULATION: Adult and pediatric patients at risk for or diagnosed with Clostridium difficile infection based on a literature review with a defined search period of 2009–2016. JAMA. The evidence allows physicians to avoid expending scarce resources on ineffective clinical services. Recommendation 3. ISSN 1553-5606, for Clinical Guideline Highlights for the Hospitalist: Clostridium difficile Infections in Children, for The Association of Inpatient Occupancy with Hospital-Acquired Clostridium difficile Infection, Clinical Guideline Highlights for the Hospitalist: Clostridium difficile Infections in Children, The Association of Inpatient Occupancy with Hospital-Acquired Clostridium difficile Infection, https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(19)30048-5/fulltext, https://clinicaltrials.gov/ct2/show/NCT03223415, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2516765, https://www.nih.gov/news-events/news-releases/clinical-trial-testing-fecal-microbiota-transplant-recurrent-diarrheal-disease-begins, Choosing Wisely: Things We Do For No Reason, Grading of Recommendations Assessment, Development, and Evaluation system (, Universal Screening for C. difficile in a Tertiary Hospital: risk factors for carriage and clinical disease (Color/Black, Effectiveness of Isolating Clostridium Difficile Asymptomatic Carriers on the Incidence of Infections (Color/Black, Effect of Detecting and Isolating Clostridium difficile Carriers at Hospital Admission on the Incidence of C difficile Infections (Color/Black, Clinical Trial Testing Fecal Microbiota Transplant for Recurrent Diarrheal Disease Begins (Color/Black. Society of Hospital Medicine (SHM): Hospital Medicine (SHM Annual Meeting) The Hospitalist. Crook DW, Walker AS, Kean Y, et al. Referring physicians can reach a hospitalist at … MKSAP® 18 for Hospitalists – Hospitalist … A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. David M. Gallagher, Chief. Can I stop, narrow, or switch to oral agents? Two recent randomized, placebo-controlled trials, however, have found oral vancomycin to be superior to metronidazole for producing a clinical cure and resolution of diarrhea without recurrence.5,6 Oral vancomycin remains the treatment of choice for severe C. difficile infection. These guidelines contain 53 recommendations across 35 sections based on a systematic weighting of the strength of recommendation and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. N Engl J Med. Faculty of the Division of Hospital Medicine conduct research that improves the safety and quality of care for the hospitalized patient. 2018;321(2):139-140. https://doi.org/10.1001/jama.2018.19509. Below are brief descriptions of ACP Hospitalist sections written by physician or medical student writers. The Society of Hospital Medicine (SHM) exists to promote exceptional care for hospitalized patients. Some estimate there will be 50,000 hospitalists needed in the next 10 years. Representing the fastest growing specialty in modern healthcare, the Society of Hospital Medicine (SHM) is the leading medical society for more than 34,000 hospitalists and their patients. More. 2015;110(3):381-90; quiz 391. https://doi.org/10.1038/ajg.2015.22.5. [clinical guideline … Describe common clinical questions and dilemmas for hospitalists and apply current Guideline standards to the clinical practice of inpatient medicine. Knowledge of these areas has progressed since the publication of the previous C. difficile guidelines in 2010. 2011;365(18):1693-703. https://doi.org/10.1056/NEJMoa1012413.3. Do not perform repeat testing (within seven days) during the same episode of diarrhea and do not test stool from asymptomatic patients (strong recommendation, moderate quality of evidence). 2012;55(2):S93-S103. Significant topics include reducing … Today's Hospitalist is a monthly magazine that reports on practice management issues, quality improvement initiatives, and clinical updates for the growing field of hospital medicine. 2. With constant clinical difficulties and questioning on how hospitalists should be incorporating emerging clinical data into daily patient interactions, SHM’s COVID Rapid Clinical Updates for Hospitalists … This is an educational document with an overview of care. Loo VG, Bourgault AM, Poirier L, et al. Either vancomycin (125 mg orally four times per day for 10 days) or fidaxomicin (200 mg twice daily for 10 days) is recommended over metronidazole for an initial episode of nonsevere or severe C. difficile infection (strong recommendation, high quality of evidence). Their importance is magnified by the current urgency given to value-based purchasing in healthcare reform. Clin Infect Dis. Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice. View Abstract for Clinical Guideline Highlights for the Hospitalist: Management of Acute Pancreatitis in the Pediatric Population; Case Reports A Veteran … Family physicians possess the education and training necessary to be a hospitalist, and are eligible to sit for the Focused Practice in Hospital Medicine examination administered by the American Board of Family Medicine. Recommendation 4. For a second recurrence, providers can consider addition of rifaximin following oral vancomycin. A hospitalist is defined as a physician “whose primary professional focus is the general medical care of hospitalized patients. However, inconsistencies remain with regard to the appropriate threshold for testing, the type of diagnostic tests used, and treatment. Hospitalist Skills: Covers the interpretation of common, low-tech tests that are routinely accessible on admission, how to optimize the use of radiology services, and the standardization of the execution of procedures routinely performed by some hospitalists. Faculty include both hospitalists and specialists, and rank among the … For several decades now, metronidazole has been the primary antibiotic agent for initial treatment of nonsevere C. difficile infection. COVID-19 outcomes post-hospitalization. FMX may have ended, but the learning doesn't stop! Some authors received funding for work outside of this guideline by companies that manufacture diagnostic assays, vancomycin, and fidaxomicin. Recommendation 1. Hospital Medicine If a patient needs to stay at UK Hospital for the specialized care that only UK physicians can provide, our hospitalist will work to coordinate the best, most advanced care possible … Despite the improved treatment response with oral vancomycin, one in four patients will experience recurrence. Dec. 2019, Volume 14, Issue Number 12. The guideline committee consisted of an interdisciplinary team of healthcare providers with extensive experience in the diagnosis, infection control, treatment, and management of C. difficile. View Abstract for Clinical Guideline Highlights for the Hospitalist: 2019 American Thoracic Society/Infectious Diseases Society of America Update on … Our aim is to have one evidence based universal CPG that is not site specific. HOSPITALIST AND EMERGENCY PROCEDURES COURSE. Updates, new guidelines, and best practices to optimize inpatient care Register at HospitalMedicine.HMSCME.com Update in HOSPITAL MEDICINE 2020 September 30 – October 2 … The Society of Hospital Medicine’s (SHM’s) Quality 101 resources draw from the knowledge and experience of renowned national experts in the field of quality and patient safety. The Hospital Medicine 10 year MOC exam or the Hospital Medicine Knowledge Check-In (once it launches in 2020) satisfies the assessment requirement for the FPHM MOC program. The committee reviewed over 14,000 pieces of literature and performed a detailed analysis of each one to determine the quality of evidence in support of each recommendation. 2007;45(3):302-307. https://doi.org/10.1086/519265.7. Because recurrent C. difficile infection is relatively common, repeat testing is appropriate only for recurrence of symptoms following successful treatment and should focus on detection of C. difficile toxin because the persistence of the organism itself can occur after successful treatment.4. Fidaxomicin versus vancomycin for Clostridium difficile infection: meta-analysis of pivotal randomized controlled trials. Clin Infect Dis. Many hospitalists are incorporating point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or guide performance of invasive bedside procedures. Articles focus on topics such as advances in health care technology, clinical controversies, staffing and … As a result, the vast majority of hospitalists are trained in internal medicine, usually general internal medicine. Timely and direct communication between the hospitalist and patient/caregivers concerning change in status, test results or new diagnosis, and any complications is extremely important. Clostridium difficile, now referred to as Clostridioides difficile (C. difficile), is the most commonly identified cause of healthcare-associated infection among adults in the United States.1 Because C. difficile infection results in significant mortality and inpatient costs, its persistence threatens to undermine patient safety and the value of healthcare delivery.1 A standardized, evidence-based approach to diagnosis and management is crucial. “What is a Hospitalist?” Society of Hospital Medicine. The hospitalist should communicate the treatment plan and follow-up recommendations to the patient's primary care physician or the covering physician on the day of discharge. Quality 101 … Tube feeding, the microbiota, and Clostridium difficile infection. An important attribute of the hospitalist is the ability to collaborate and communicate with other physicians in the inpatient setting as well as to ensure continuity between the inpatient and the outpatient setting. Submissions are accepted on a rolling basis. No studies demonstrating a benefit to further extending contact precautions beyond 48 hours after resolution of diarrhea are yet available. Activities include patient care, teaching, research, and leadership related to hospital medicine.”1 Hospitalists may be employed by medical institutions or a large group practice to provide inpatient services to children and/or adults. Fecal microbiota transplantation is recommended for patients with multiple recurrences of C. difficile infection who have failed these antibiotic treatments. A brief, targeted review of recently published clinical guidelines, distilling the major recommendations relevant to hospital medicine and placing them in context of the available evidence. Hospital Pediatrics® is the first journal dedicated to pediatric hospital medicine and offers the tools to help provide quick, correct, and targeted medical interventions. Johnson S, Louie TJ, Gerding DN, et al. A major strength of these guidelines is the extensive work that went into their preparation. Coding guidelines for hospital inpatient services are complex, change often and errors can be costly to the practice or create major compliance audit exposure. Get information to help you prepare your practice, counsel your patients and administer the vaccine. Although not all hospitalists are required to be internists, the nature of internal medicine training uniquely prepares internists for hospital medicine practice. Recommendation 2. Consultative medicine is a service provided by many hospitalists, and a future in which almost all surgical patients are co-managed by hospitalists … Dubberke ER, Olsen MA. Our guideline goals include: 1. Consultation with an intensivist, medical, or surgical subspecialist does not preclude the need for the continuing, comprehensive, and personal care provided by the hospitalist. Point-of-Care Ultrasound for Hospitalists. Additionally, we are deeply committed to the education and mentorship of medical students, Internal Medicine … Hospitalists are most commonly trained as family physicians, pediatricians, or internal medicine physicians. Patients with unexplained and new-onset ≥3 unformed stools within 24 hours are the preferred target population for testing for C. difficile infection (weak recommendation, very low quality of evidence). 1. Antibiotic stewardship programs, which are now commonplace in US hospitals, largely rely on educational initiatives or committee-based order review. The overarching objective is optimal care for the patient. Zacharioudakis IM, Zervou FN, Pliakos EE, Ziakas PD, Mylonakis E. Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: a systematic review and meta-analysis. Am J Gastroenterol. If you withdraw from the FPHM program after successfully passing the Hospital Medicine … Clin Infect Dis. Treat a first recurrence of C. difficile infection with oral vancomycin as a tapered and pulsed regimen rather than a second standard 10-day course of vancomycin or metronidazole (weak recommendation, low quality of evidence). Fidaxomicin, a recently FDA-approved antibiotic, can also be used as initial treatment in place of oral vancomycin. ACP offerings devoted to hospitalists and their career path. O’Keefe SJ. Timely communication supports successful transitions of care and care coordination of any necessary follow-up treatment. 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Burden of Clostridium difficile on the healthcare system. Edited By: Samir S. Shah, MD, MSCE Impact Factor: 2.331 Online ISSN: 1553-5606 Print ISSN: 1553-5992 The hospitalist will assess the patient at admission and determine the best course of treatment and coordinate care during the hospitalization. SHM is dedicated to promoting the highest quality care for all hospitalized patients and overall excellence in the practice of hospital medicine … World J Gastroenterol. These are broad guidelines … In the recent past, healthcare facilities employed C. difficile tests with limited sensitivity, leading to frequent and repeat testing of hospitalized patients. Please note that articles are unpaid, that ACP Hospitalist is not a peer-reviewed publication, and that articles published in ACP Hospitalist … One study found fidaxomicin to be superior to oral vancomycin for producing a sustained clinical response, that is, resolution of diarrhea at the end of treatment without recurrence 25 days later.7 Fulminant disease, which is characterized by hypotension or shock, ileus, or megacolon, requires a higher dose of oral vancomycin (or vancomycin enema if with ileus) in addition to intravenous metronidazole. Herein, we have chosen to highlight five of these recommendations most relevant to hospitalists. Guidelines are separate from any order sets. SHM is a medical society comprised of over 15,000 hospitalists, including physicians, nurse … The hospitalist should request from the primary care physician information on the pre-admission treatment and testing, co-morbidities, ongoing specialty consultations, family and social concerns, advance directives, etc., to assume management of the patient’s care. Andrew S. Parsons, MD, MPH; E-mail: [email protected]; Telephone: 434-0243-0763; Twitter: @andrewparsonsMD. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. Quizzes. When a patient presents to the emergency department (ED) and the ED physician determines an inpatient admission is necessary, the following should occur: Verification of the primary care physician name and address by the patient, family, or care giver. Hospitalists should take a structured approach emphasizing the four critical questions of antibiotic prescribing: Does this infection require antibiotics? https://doi.org/10.1093/cid/cis499.8. 2010;16(2):139-142. https://doi.org/10.3748/wjg.v16.i2.1394. Prepare for the ABFM exam with the AAFP’s Family Medicine Board Review Express Livestream, February 18-21 and get the same in-depth Board review but with all the conveniences of your home or office. Stay Dialed In on the Fight for Family Medicine, AAFP Digital Assistant Pilot Opportunities Available. Tamma, PD, Miller MA, Cosgrove SE. SHM is at the forefront of how hospitalists are using POCUS and is here to help guide hospitalists by leading the conversation and driving POCUS integration into hospital medicine. Duration of hospitalization and antibiotic exposure are the most significant modifiable risk factors for C. difficile infection in adult inpatients.2 Laxative use within the previous 48 hours, enteral tube feeding, and underlying medical conditions, such as inflammatory bowel disease (IBD), are common causes of improper testing.3 This decision may be difficult, as some underlying causes of diarrhea, such as IBD and enteral tube feeding, also increase the risk of C. difficile infection.3 Laboratories can help by rejecting specimens that are not liquid or soft and employing a multistep algorithm using a combination of nucleic acid testing, antigen testing, and toxin detection to maximize sensitivity and specificity. Identify, critically appraise and incorporate into current hospitalist care the top Clinical Practice Guidelines relevant to inpatient practice. The impact of COVID-19 on the practice of hospital medicine continues to change daily. In … ACP Hospitalist provides news and information for hospitalists and other hospital-based physicians, including subspecialists, third-year internal medicine residents, and residency program directors. Although C. difficile is undetectable in stool samples from most patients by the time diarrhea has resolved, skin and environmental contaminations remain high. For fulminant C. difficile infection, the regimen of choice is a vancomycin dosage of 500 mg orally four times per day (per rectum every six hours if with ileus) in addition to intravenous metronidazole (strong recommendation, moderate quality of evidence). Herein, we have chosen to highlight five of these recommendations most relevant to hospitalists. Contact precautions should be maintained for at least 48 hours after diarrhea has resolved (weak recommendation, low quality of evidence). All rights Reserved. 2012;55(2):S88-S92. Host and pathogen factors for Clostridium difficile infection and colonization. During the period of hospitalization, decisions regarding care, consultation, admission, transfer, and discharge should be the sole responsibility of the hospitalist in consultation with the patient and, as appropriate, family members and the patient's primary care physician. These potential conflicts were listed at the end of the article. 3. These guidelines contain 53 recommendations across 35 sections based on a systematic weighting of the strength of recommendation and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. 2014;59(3):345-354. https://doi.org/10.1093/cid/ciu313.6. Recommendation 5. Have I ordered appropriate cultures and the correct empiric therapy? This review will focus on adult patients. Communication between the hospitalist and the primary care physician ensures optimal patient outcomes and reduces hospital readmissions. 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