The fantasy hospitalist league

With the ongoing success of fantasy leagues in sports from football to badminton, a talented group of hospitalists decided to organize the first annual Fantasy Hospitalist League (FHL)*. Players were blinded to each other and themselves using false identities. In a mock “draft,” players got to choose which hospitalists, allied health providers, surgeons, specialists, nurses, therapists, administrators and facilities they wanted on their teams. We used our patented FHL technology to generate all the statistics and vital practice information we'd need to play, like length of stay, quality indices, sentinel events and patient satisfaction.

In the first three weeks, all players participated independently for a total score by compiling data on hospital admissions, adverse events, and other activities of daily hospital life. At the end of three weeks, the eight highest-scoring players were chosen and matched in an elimination tournament, one-on-one, in duels of hospital service management skill. To the winner went the title of Dr. Fantasy.

Here are the results from our first full season of the FHL. Twelve top-ranking hospitalists, toe to toe, jowl to jowl, faced off in a hospital free-for-all. The players were:

HTM—HoldtheMayo—Rochester

GUD—GUDischarge—Chicago

BIG—BigDaddy—San Francisco

DRL—DrLean—New Orleans

MRP—MyRunningPartner—Atlanta

WOL—WinorLose—Atlanta

CAD—CaliforniaDreaming—San Diego

TAB—TaBom—Brazil

CMP—Cardiomyopathy—Cleveland

BLU—BlueBoy—Tahiti

TRP—TripleA—Chile

HOG—HouseO’God—Boston

Week 1: GUD and DRL started out strong. Their teams had brief lengths of stay and impressive quality indicators, but GUD's service dropped in the stats after a needlestick injury. MRP's team was dogged by a low percentage of staff washing their hands. CMP and TRP were the top scorers.

Week 2: Continued safety issues impacted the teams managed by MRP and TAB, with several near-miss sentinel events and a patient elopement. CAD's team scored perfectly in quality this week, but this was counterbalanced by extensive length-of-stay issues.

Week 3: The competition got fierce with elimination on the horizon. It was a disastrous week with new house staff. Lengths of stay were up across the board and quality was down, except for TRP's team; he had selected all private hospitals. HTM's score was second highest this week, on the heels of a series of publications and a teaching award to team members. At the end of these weeks of preliminary play, BIG, MRP, GUD and CMP were dropped. MRP has filed suit against the FHL in protest.

Week 4: HTM vs. DRL. In a grueling contest, DRL was strongly in the lead with outstanding utilization of resources and patient satisfaction by his team. However, a nurses' strike and a transfusion mismatch knocked DRL out of the tournament.

WOL vs. CAD. CAD was behind after his inpatient service had several delays in treatment and a low DVT prevention compliance rate. WOL coasted to victory.

TAB vs. HOG. HOG was eliminated after a series of mysterious postoperative complications.

TRP vs. BLU. BLU had good numbers early in the week, but after an outbreak of Campylobacter in the hospital cafeteria, his team's run ended with the runs.

Week 5, Semi-finals: HTM vs. TAB. Entering the semi-finals, all of the players were ramped up for the hospital services to see some action. Census numbers were high and so was the pressure on the contestants. TAB's team zoomed out early with a run of short stays, tricky diagnoses, high-risk procedures without complications, and high patient satisfaction scores. Just as things looked hopeless for HTM, the surgical services for TAB collapsed. A retained foreign object compounded a wrong-site surgery (the wrong leg was amputated, again) and TAB was blown out of the water. Então, desculpe.

WOL vs. TRP. WOL was leading TRP easily going into the last day. Quality indicators were solid, costs were low, and satisfaction was high… and then, disaster. It started with a minor medication error. A patient was incontinent due to an inadvertent furosemide dose, and his roommate slipped in a urine puddle, fracturing his humerus. When the nurse ran in the room, she tripped over the IV tubing and fractured her femur. The consultant then ran to the room and developed chest pain; he was rushed to heart catheterization, where he developed a contrast reaction and renal failure. WOL was history.

Week 6, Finals: HTM vs. TRP. It seemed like HTM's team was the favorite. Outstanding numbers, incredible quality, satisfaction supreme, resource redux, a perfect lineup of multidisciplinary staff, even an endowment. TRP was doing his best, though, and still in the running. By the end of the week HTM had a commanding lead, but with victory in hand, his team let down their guard. A surprise Joint Commission survey, followed by an RAC audit and work hour violations! HTM was tanked; TRP strode to victory! Felicitaciones!