Whether or not to admit a patient to the ICU is, in many cases, a judgment call. Uniform standards for such admissions don't really exist, which leaves the decision in the hands of individual hospitalists and other clinicians. The result is that a portion of the patients in the ICU are either too sick or too well to be there, and are racking up hospital costs with no apparent benefit to their health, as Stacey Butterfield reports in our cover story. Solutions are at hand, however, as studies suggest that having discussions with family about care preferences, training clinicians in critical care, and having closed ICUs may influence the number of patients in intensive care. Read about these and other solutions, and learn what hospitalists in particular can do.
In other clinical coverage, our feature story looks at the increasing role hospitalists play in perioperative care of cancer patients. These patients present unique issues related to their diagnosis, including the lingering effects of cancer treatments, complications from comorbidities, and different preoperative testing needs. Meanwhile, our Q&A with hospitalist Marisha Burden, MD, ACP Member, debates the merit of curbsides consults, while our Success Story details how creative scheduling helped solve concerns created by resident work-hour limits. And speaking of residents, our feature examines how some internal medicine programs are getting serious about teaching business, management and leadership skills to residents to help them advance their careers.
Last but not least, our second installment of The Brief Case reviews patient cases from Montefiore Medical Center in New York City. Please email us if you are interested in contributing your own cases to this quarterly column.
Editor, ACP Hospitalist