Since its inception, the HMG has embarked on a variety of new initiatives. Below are some recent innovations by members of our group that are impacting the field of hospital medicine in tremendous ways.
The Health Innovations Scholars Program (HISP) - part of the HMG's Young Hospitalist Academy - was started in 2013 to provide preclinical medical students from across the country with skills necessary to transform health systems. A one-of-a kind program in the US, HISP is an intensive summer training program that emphasizes mastery of advanced skills from improvement science, policy, finance, business, engineering, and leadership. Participating students complete a team-based QI project with close mentorship from HMG faculty. Since its inception, HISP has trained 14 medical students from across the country, and program graduates have gone on to pursue QI initiatives and create related educational programs at their home institutions.
Electronic Clinical Decision Support Intervention: IV Haloperidol
Using quality methods and the EPIC electronic health record, a team of HMG faculty worked with the information technology and pharmacy departments at University of Colorado Hospital (UCH) to reduce the frequency that high risk patients would inappropriately receive intravenous (IV) haloperidol. The team developed a focused, electronic clinical decision support intervention—an “alert” in EPIC—to help providers avoid ordering IV haloperidol when patients had a corrected QT interval greater than 500msec on their EKGs. In this patient population, the intervention decreased the rate of inappropriate IV haloperidol ordering from 50% to 14%, while simultaneously reducing the number of erroneous alerts.
Innovations Collaborative: Visiting Professorship in Hospital Medicine
The HMG created the Innovations Collaborative in 2012 to address a number of essential scholarship and mentoring needs for HMG faculty. The Innovations Collaborative re-conceptualizes the traditional visiting professorship by pairing with a leading academic program nationally to exchange a visiting professor to spread hospitalist innovation and create opportunities for career mentorship. During their visit each visiting professor delivers Grand Rounds to disseminate an innovation and meets with five to six junior faculty members to develop external mentorship relationships and provide career advice. By providing a forum for cross-pollination between academic medical centers it facilitates networking and collaborations for future scholarship. It also raises the visibility of our Hospital Medicine Group nationally and enhances the career of the visiting hospitalist. The program is being rigorously studied and itself represents IRB approved multi-institutional research. Now in its third year, the Innovations Collaborative has created four visiting professor exchanges between the University of Colorado, the University of New Mexico, and Johns Hopkins University. This has provided 13 of our faculty an opportunity for external mentorship, resulting in external letters for promotion, and generation of two inter-institutional research projects.
Pioneers In Stroke Care: Telestroke Service
Late in academic year 2014 the neurohospitalist group commenced the first telehealth initiative within the University of Colorado Health System - Telestroke. The group began with a pilot that provides 24/7 stroke coverage to Memorial Hospital in Colorado Springs. The group employs a robotic camera in the Emergency Department that is controlled from their home or office to interview patients, complete physical exam maneuvers and review images. The early results have been incredibly positive with numerous stroke alert consults resulting in several significant alterations in the patient care due to their involvement. The group is looking to aggressively build this program as an important means to further cement their recognition as the premier stroke program in the region.
On the CUHSP of Greatness
The University of Colorado Hospitalist Scholars Program (CUHSP) is a first-of-its-kind longitudinal program for undergraduate students focused on mentorship, career development, and service within hospital medicine. As part of this two-year program, students participate in monthly didactic and shadowing sessions designed to prepare them for careers in medicine. Students are also exposed to specific areas of hospital medicine, including Quality Improvement (QI), transitions of care and patient safety. Over 80 students applied for CUHSP in 2011, 2012 and 2013. Out of six students accepted, three are in the second program year and three have completed the program and are currently enrolled in medical school. Upon completion of the program, all students reported feeling more prepared to apply to medical school and more knowledgeable about careers in medicine, particularly hospital medicine. Additionally, all students participated in a QI project. Given the growing interest and outstanding candidate base, the program will increase the number of students accepted into the next cohort. In addition, CUHSP is planning an intensive QI summer program for interested undergraduate students, with a special focus on health care disparities.
In 2009 the HMG developed the nation’s first Advanced Practice Fellowship (APF) in Hospital Medicine. This year-long training program is dedicated to training early-career nurse practitioners (NPs) and physician assistants (PAs) in the art of inpatient medicine. The APF continues to evolve in design and curriculum. This past year, the APF expanded to accommodate seven fellows allowing participants to train in a number of clinical settings including general medicine, inpatient oncology, neurology, consultative medicine and the care of elderly inpatients. Our fellows also rotate on evening and overnight teams, providing them exposure to patient cross coverage and a more intensive admitting environment. The true strength of the program rests in the four dedicated and talented NP and PA faculty that serve as role models and primary educators for the fellows. The success of the program can be measured in many ways but the best is the success of its graduates. Many former fellows populate jobs as Emergency Department (ED) providers, hospitalists and nocturnists while others provide care for inpatient bone marrow transplant, infectious disease and neurosurgical patients.
Pioneering Pathways: Holistic High-Value Care
For the last several years, HMG Associate Professor Gregory Misky, MD, has led a broad group of stakeholders in an effort to standardize care and reduce unnecessary hospital and Emergency Department (ED) utilization for venous thromboembolism (VTE) among under- and un-insured patients. Historically, this population has struggled to acquire necessary medications and obtain timely lab monitoring for VTE treatment outside the hospital, resulting in longer inpatient length of stay (LOS) and more frequent return visits to the ED. Through development of VTE care pathways, collaboration with local primary care clinics serving underinsured patients, and sustained inter-departmental leadership at University of Colorado Hospital, Dr. Misky and his colleagues have helped underinsured patients receive high quality, evidence-based VTE care in the outpatient setting by arranging more timely follow-up. In the process, they have reduced inpatient LOS for this population from 5.9 to 3.1 days, producing cost savings of over $500,000 over the past 1.5 years. The HMG is proud to support and lead such work, which focuses on holistic value: better implementation of practice guidelines, safe and timely treatment, creation of a system more responsive to patient needs, and avoidance of unnecessary costs.
Timely Stroke Care: Innovation and Leadership
For the last few years, a group of HMG internal medicine and neurology hospitalists have been hard at work enhancing stroke care at University of Colorado Hospital (UCH). Through the formation of an inter-professional, inter-departmental team, our faculty have led dramatic improvements in outcomes for acute stroke patients. Along the way UCH has received multiple national awards and certifications, including the Target Stroke Honor Roll, Society of Hospital Medicine's 2012 Award for Excellence in Team-Based Quality Improvement, and Joint Commission designation as a "Comprehensive Stroke Center"— the highest level of stroke certification available for hospitals. Not content to be among the best hospitals in the U.S. for stroke care, our neurohospitalist faculty have continued their improvement work, most recently focusing on timely thrombolytic administration (in < 60 minutes) in the Emergency Department (improvement from 33% to 86%) and decreasing the time required to administer intra-arterial (IA) thrombolytics in the Interventional Radiology suite for selected stroke patients. The results of the latter are impressive: 42% of patients treated more quickly via the improved process leave the hospital with higher functional status (modified Rankin score of 2 or less), compared to only 16% previously. We are proud to champion a culture where innovative care models, such as our neurohospitalists, can combine leadership opportunities and a focus on continuous improvement to enhance patient outcomes.