Medical volunteerism abroad is popular with U.S. physicians, and for good reason: these experiences are invariably energizing and eye-opening. Often, however, they are also short-lived, comprising a few weeks at a small outpatient clinic. A new kind of overseas medical experience is emerging that's specifically geared for hospitalists, however. Institutions like the University of San Francisco and University of Chicago are offering global-hospital medicine fellowships in which doctors take several weeks to assess the needs of a host hospital, then propose and implement solutions. The work aims to make systemic, long-term improvements to inpatient care in foreign hospitals. To read more about these inspiring programs, read our cover story by Charlotte Huff.
Catheter-related infections are a persistent problem in hospitals, but the results of a new study may help change that. In September, a study in The Lancet showed that replacing peripheral vascular catheters when clinically indicated did not result in an increase in phlebitis compared with replacing them every 72 to 96 hours. Most hospitals still do the latter, and switching policies could spare patients pain and save hospitals money, as long as there is a system for monitoring for infections. Janet Colwell writes about how to change catheter protocol safely.
Speaking of improving policies, many hospitals would like to have better post-discharge transitions but are concerned about overtaxing their existing staff. One option is to hire a call service, which can handle common issues such as barriers to medication compliance and transfer of information to outpatient physicians. Stacey Butterfield outlines how these services work, and whether or not one might be of benefit in your hospital.
Also in this issue are a collection of perioperative care pointers from the Rocky Mountain Hospital Medicine Symposium last fall, and the final installation of our three-part series on documentation of medical necessity.
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Editor, ACP Hospitalist