Hospitalists don't need the media to tell them about medication shortages. Many of the drugs at issue—like epinephrine injections—are commonly used in the hospital, and a June survey indicated nearly every hospital in the country has experienced a recent shortage. Unfortunately, there is no impending resolution to the problem, which is only getting worse over time: The number of shortages increased 42% between 2008 and 2010, and the shortages are lasting longer, experts say. As a result, hospitals have been devising strategies to deal with the shortfalls, from alternate treatment protocols to restrictions on the way coveted drugs are used. Our cover story examines the tactics that facilities and physicians are using to handle shortages, and offers factors to consider when making contingency treatment plans at your own hospital.
Another area where hospitalists need to exercise flexibility is in their relations with emergency department physicians. ED doctors and hospitalists often have different communication styles, due in part to different work environments and training. The unfortunate result, however, can be sloppy handoffs. Read about ways to bridge the gap between the hospital and emergency medicine departments for the good of your patients (and your sanity).
If you think getting along with colleagues in another department is difficult, imagine the challenge of applying for clinical rotations at U.S. hospitals as a non-U.S. citizen. In our student hospitalist column, Chi Tang explains just how much work can go into sending an application fee from China, not to mention securing an immunization test report written in English. Meanwhile, Jamie Newman, FACP, exhibits how practicing internal medicine in his household is truly a family affair, especially when it comes to the vestigial organs. Finally, coding guru Richard Pinson, FACP, tells you everything you need to know about the documentation requirements of prolonged evaluation and management (E/M) services, a challenging concept that is often misunderstood and underused. Don't forget to email him your coding questions.
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Editor, ACP Hospitalist