Message from Section Head, Amber Inofuentes, MD
2023 proved to be a challenging year for Hospital Medicine. Greater than usual faculty turnover resulted in significant short-staffing, yet recruiting efforts to restore full staffing unfortunately fell short of expectations. To maintain clinical operations, the group worked well over 250 extra shifts and continues to do so this year through the creation of a daylighting model. Despite these challenges, we have continued to advance our strategic aims in clinical innovation and excellence, medical education, and faculty development. We have also focused on ways to cultivate community and connection through exercise groups, annual family-friendly gatherings, and a light-hearted amateur baking competition.
In continuing education and faculty development, we implemented a high-yield conference series to integrate better and prepare new faculty for clinical and educational roles in academic hospital medicine. We began a Writing Accountability Group to promote scholarship. Three more of our faculty (Rahul Mehta, Alex Millard, and Glenn Moulder) were also successfully promoted to Associate Professor.
In the clinical arena, our Night 2 hospitalist service was launched last September and has proven a successful model for improving clinical capacity, patient safety, and housestaff teaching and supervision. Nocturnists frequently help avoid unnecessary admissions by developing collaborative plans for outpatient management or direct admission to a skilled nursing facility as an alternative to hospitalization. In recognition of their unique and valuable work, the Nocturnist team received this year’s DOM Award for Outstanding Team Contribution. We have recently implemented a new Advanced Practice Provider service to expand our clinical capabilities.
Our group also remained active in various quality improvement and patient safety initiatives, including lab and telemetry stewardship, medication reconciliation, and clinical documentation. In addition to these projects, many hospitalists devoted their time mentoring IM resident longitudinal QI projects. We also developed individual performance scorecards provided to faculty each quarter, allowing for personal review and reflection on key quality metrics.
Despite the challenges of recruiting and staffing, I am proud of all we have accomplished this year, none of which would be possible without the vital work of the section’s leadership team. I encourage you to read articles throughout the Newsletter highlighting their efforts. New to the leadership team this year are Ryan Wiggins, Assistant Director of Clinical Operations, and Rob Becker, Director of the Hospitalist APP Program.
This year’s recruiting class boasts an outstanding cohort of physicians and APPs, several of whom were internal candidates from our residency program or other departments. We were fortunate to recruit others from across the region with experience in diverse clinical settings. We have also grown in other ways. The portfolio of research and quality improvement accomplishments, educational leadership roles, and Department/Medical Center roles continues to expand, and our extended family has grown with four more babies already in 2023 and two due for arrival on November 1st.
Looking into early 2024, we are excited to welcome two additional faculty and an APP who come with extensive experience in community hospital medicine. We will also work to further optimize clinical operations through a new ATC Nurse Coordinator role and continue quality improvement efforts focusing on patient progression, clinical documentation, and high-value care.
As a group, we’d like to extend our gratitude to the rest of the Department for its continued support of our endeavors.
~ Amber Inofuentes MD, Section Head
CLINICAL HIGHLIGHTS
Advanced Practice Provider Service Launches
By Rob Becker, MD, Director of Hospitalist APP Program
Last year, the hospitalist program experienced higher-than-usual faculty turnover, including three off-cycle departures. This presented a unique opportunity to expand the breadth and expertise of our clinical workforce by incorporating Advanced Practice Providers (APPs). According to a 2023 Society of Hospital Medicine Survey, 87% of all academic medicine hospitalist groups utilize APPs in various clinical roles, including observation units, direct care services, specialty services, and consultative care. This spring, we recruited three APP team members: Mary Hardy, Deborah Okyere, and Colleen Vadia. Mary has spent much of her career at the University of Virginia with extensive critical care nursing experience with the MICU and MET team before becoming a nurse practitioner and working for several years as a cardiology NP. Before joining our team, Deborah worked as an NP with the Orthopedics Department. During that time, she has worked closely with the hospitalist team as part of the Orthopedics Co-management service. Colleen comes to us from Atlanta, George, with nearly a decade of PA experience with an inpatient pulmonary service and, more recently, an educational role for Pfizer. APPs manage direct care ‘Float’ service of general medicine patients and rotate through admitter shifts. We are very excited about this addition to our team, and have received tremendous positive feedback from clinical staff. In addition to supporting clinical care services, hospitalist APPs will participate in quality improvement initiatives and clinical research to help enhance patient care outcomes. The program will continue to evolve as we add an NP in early 2024 and explore the development of a Hospital Medicine Nurse Practitioner Fellowship Program.
Daylighting Opportunities Support Clinical Operations
This year, hospitalist operations needed to adapt to significant staffing shortages due to four faculty vacancies. Adjustments have primarily led to reliance on daylighting to fill many Admitter shifts. This daylighting has been done mainly through internal daylighting by hospitalist faculty picking up extra shifts for pay, though chief residents have also picked up many weekend shifts. We welcome any interested independently licensed fellows and faculty to join our team of daylighters. Day shifts not for you? We also have night-shift moonlighting opportunities. Shift rates start at $1,250 for daytime shifts with an escalation for evenings and nights. Please contact Amber Inofuentes at ANT4P@uvahealth.org if you’d like more information.
RESEARCH HIGHLIGHTS
Hospital Medicine Innovations in Physiological Monitoring Earn Recognition
By Shrirang Gadrey MBBS MPH, Division Director for Research
A) Modelling the impact of occult hypoxemia
In 2019, Dr. Gadrey and colleagues developed a new model for the oxygen-hemoglobin dissociation curve1. The goal was to estimate the partial arterial oxygen (PaO2) pressures using non-invasive pulse oximetric saturation data (SpO2). The newer model worked better in hospitalized patients than the classical models from healthy subjects1. This year, Drs. Gadrey and Dreicer applied the new model to study racial disparities in occult hypoxemia2.
Occult hypoxemia occurs when the pulse oximeter reports a falsely normal oxygen saturation in a hypoxemic patient. Such a misleading observation can adversely affect outcomes. This error occurs more frequently in patients with darker skin and contributes to racial disparities in outcomes. However, to directly quantify occult hypoxemia, arterial blood gas, and a pulse oximetric saturation has to be recorded simultaneously. Such an invasive approach cannot be applied on a hospital-wide scale. The exact relationship between occult hypoxemia and outcomes remained a mystery. We used our oxygen dissociation curve model to indirectly estimate the impact of occult hypoxemia and externally validated our findings at the Emory University Hospital2. Our novel approach can enable research into occult hypoxemia on a larger scale than previously possible.
The Society of Critical Care Medicine recognized our work’s importance and invited us to present the findings at the Critical Care Congress 2023 in San Francisco.
B) Developing technology to monitor for labored breathing patterns
Breathing patterns (or respiratory kinematics) contain vital diagnostic and prognostic information. Yet, conventional vital signs do not report respiratory kinematics beyond the average respiratory rate. Clinicians have to rely on qualitative visual inspections for a complete assessment. Such assessments lack sensitivity and inter-rater reliability and are manual effort intensive. This leads to delays in detecting high-risk labored breathing patterns and missed opportunities for early life-saving intervention.
To tackle this gap in patient monitoring, Dr. Gadrey and colleagues previously developed time-series methods to detect breath intervals and characterize respiratory kinematics using motion sensors in healthy adults in an exercise physiology laboratory3. This year, we studied the breathing motion patterns of 108 hospital patients with active respiratory symptoms. Our findings confirmed that (a) breathing motion patterns are a rich source of physiological information, with more complexity than is adequately represented by the respiratory rate alone, and (b) high-risk breathing phenotypes can be identified in an everyday clinical context through multi-dimensional analysis of respiratory kinematics.
Recognizing the success of our proof-of-concept studies, the Virginia Innovation Partnership Corporation awarded us $100,000 from the Commonwealth Commercialization Fund. This support will allow us to establish the infrastructure needed for home monitoring of breathing patterns. Our work can potentially improve care in a wide range of clinical areas, like the early detection of asthma attacks in children or the prevention of heart failure readmissions in the elderly.
A more detailed description of these innovations can be found in Dr. Gadrey’s Medicine Grand Rounds presentation (password: medmovies).
References:
1) Gadrey SM, Lau CE, Clay R, Rhodes GT, Lake DE, Moore CC, Voss J, Moorman JR. Imputation of partial pressures of arterial oxygen using oximetry and its impact on sepsis diagnosis. Physiological Measurement 2019 Oct 25;
2) Gadrey SM, Mohanty P, Haughey SP, Jacobsen BA, Dubester KJ, Webb KM, Kowalski RL, Dreicer JJ, Andris RT, Clark MT, Moore CC, Holder A, Kamaleswaran R, Ratcliffe SJ, Moorman JR. Overt and occult hypoxemia in patients hospitalized with COVID-19. Critical Care Explorations 5(1):p e0825, January 2023.
3) Ashe WB, Innis SE, Shanno JN, Hochheimer CJ, Williams RD, Ratcliffe SJ, Moorman J R, & Gadrey SM (2022). Analysis of Respiratory Kinematics: A method to characterize breaths from motion signals. Physiological Measurement 43 015007.
4) Ashe WB, McNamara BD, Patel SM, Shanno JN, Innis SE, Hochheimer CJ, Barros AJ, Williams RD, Ratcliffe SJ, Moorman JR, Gadrey SM, Kinematic signature of high-risk labored breathing revealed by novel signal analysis, medRxiv 2023.06.08.23291170.
Clinical Reasoning Research Collaborative (CRRC)
By Andrew Parsons MD
The University of Virginia’s Clinical Reasoning Research Collaborative (CRRC) is a research team housed within the Section of Hospital Medicine. The CRRC’s mission is to further our understanding of clinical reasoning (how clinicians think through medical problems, including diagnosis, management, and prognosis) to improve medical education and positively impact patient care. To achieve this aim, the CRRC seeks internal and external collaboration with patients, clinicians, educators, and scholars interested in conducting high-quality research on clinical reasoning. The CRRC was launched in the fall of 2022 by co-founding PIs: Dr. Andrew Parsons and Dr. Jessica Dreicer. As internal medicine hospitalists, Dr. Parsons and Dr. Dreicer are committed to improving patient safety by reducing diagnostic and management errors. Central to this goal is an improved understanding and practice of clinical reasoning. Collaborative members include Dr. Greg Young, Dr. Rebecca Clemo, Dr. Ian Crane, and Dr. Brian Peterson. You can learn more here.
EDUCATION AND FACULTY DEVELOPMENT HIGHLIGHTS
Early Career Scholar (ECS) Program Success
By Andrew Parsons MD
Intending to provide structure and support to foster academic achievement, the Section of Hospital Medicine launched the ECS Program in early 2022. The two-year ECS Program provides protected non-clinical time for selected faculty hospitalists to complete a mentored project focused on clinical research, medical education, hospital or section operations, development of a new clinical program, or quality improvement in alignment with departmental and institutional priorities. Dr. Ian Crane was selected for the inaugural cohort and has found early success with his project, “Deconstructing Pre-rounding: Applying Observations from Cognitive Task Analysis to an EMR Simulation.” Dr. Crane has completed a national training course in Cognitive Task Analysis and built clinical cases within Epic for research purposes. He was recently awarded a $27,000 grant through the UVA Center for Excellence in Education, providing ongoing FTE support, Epic assistance, and funding participant incentives.
SGIM’s MedEd Scholarship Faculty Development Program
By Andrew Parsons
Congratulations to Dr. Ivonne Lollett on her selection to the inaugural Society for General Internal Medicine (SGIM) MedEd Scholarship Faculty Development Program, designed to foster the development of scholarship skills for the clinician-educator. This one-year faculty development certificate program began in September 2023 and includes monthly seminars and group and one-on-one mentoring for a scholarly project. Dr. Lollett aims to create a formalized night curriculum for interns and residents on their general medicine night float rotation, focusing on developing management reasoning skills utilizing common cross-cover patient scenarios. She works closely with project mentors, including residency program leadership, to implement and study this innovation.
Hospital Medicine Launches Writing Accountability Group
By Jess Dreicer MD
Inspired by Writing Accountability Groups (WAGs) started at Johns Hopkins, several hospitalists began meeting in August of 2022 to increase academic productivity by dedicating an hour a week to scholarship and increasing accountability by setting a meeting time. We are currently halfway through our third, ten-week session. Multiple publications and abstracts that were fostered during these meetings have been published. We are always open to new members; contact Jess Dreicer jd3nd@uvahealth.org if you want to join!
FACULTY DEVELOPMENT PROGRAM HIGHLIGHT
New Hospitalist Faculty Development
By George Hoke MD
The Section of Hospital Medicine continues to grow and welcomed four new faculty members and three advanced practice providers to our team in 2023. The transition from resident to faculty and from one institution to another can be quite complex. To smooth this transition and ensure our new Hospitalists start their UVA careers on solid ground, Alex Millard and George Hoke created an early career faculty development program in 2022. The components of this program include mentorship and a Professional Development Conference Series. Each participating Hospitalist is assigned a primary mentor from the Section of Hospital Medicine. This senior Hospitalist will serve as a guide for exploring the opportunities within Hospital Medicine at the University of Virginia. Additional mentors with expertise in the faculty member’s area of interest will be added to the mentorship team as needed. The mentorship team may include faculty from outside the Section of Hospital Medicine. After the first year, each faculty member will work with their mentorship team to create goals for year two. In its inaugural year, the Professional Development Conference Series was delivered in evening sessions scheduled monthly. In 2023, we have transitioned to two half-day seminars to ensure faculty availability. The first seminar, delivered in September, included onboarding topics and laying the groundwork for faculty development. The second seminar is scheduled for December and focuses on educational skills. See the full schedule below. The Section of Hospital Medicine would welcome the participation of new faculty from other Sections within the Division. Please reach out to George or Alex if interested.
September
The Mission and Culture of Hospital Medicine at UVA
UVA Organizational Structure
Understanding Your Benefits
CME and MOC
The Business of Medicine
Documentation and Coding
Quality Improvement and Patient Safety
Care Transitions
December
Perioperative Medicine
Effective Hand-off of Care
Teaching Residents and Students on the General Medicine Service
Teaching Students on the Hospital Medicine ACE
Learner Evaluation and Feedback
Exploring Opportunities for Professional Development and Mentorship
HONORS AND AWARDS
Awards
Andrew Parsons – 2023 ACP Waxman Award for Outstanding Contribution to Medical Education
Jess Dreicer – 2023 Inpatient Attending of the Year Award
Andrew Parsons – 2023 Department of Medicine Award for Excellence in Research
Ben Martin – 2023 Department of Medicine Award for Excellence in Education
Val Lollett, Angel Morvant, Joe Kerley, Brian Peterson – 2023 Department of Medicine Award for Outstanding Team Contribution
Promotions
Glenn Moulder – Associate Professor
Alexander Millard – Associate Professor
Rahul Mehta – Associate Professor
QUALITY HIGHLIGHT
Medical Director Profile – Rebecca Corey MD
Dr. Rebecca Corey is a 3rd-year hospitalist at the University of Virginia (and a quadruple Hoo!) who has continued to develop a focus on quality improvement and patient safety that began during her residency training when she participated in a high-value care project that resulted in decreased utilization of multi-lumen PICC lines. This past year, she collaborated with the clinical pharmacy to improve the accuracy of discharge medication reconciliation for patients discharged home deemed high risk for medication errors or 30-day readmission. She and the team implemented several iterations of pharmacy-led medication reconciliation for patients discharged with cirrhosis, heart failure, and insulin-dependent diabetes. They demonstrated a reduction in discharge medication errors. Dr. Corey has also served as a faculty mentor for resident quality improvement projects and was recently selected as the new medical director for 3 West Acute Care as Dr. Charlie Magee pivoted to fill a vacancy on 5 South. In alignment with medical center priorities, Dr. Corey has joined the CAUTI coalition and is leading a project to improve testing and antibiotic stewardship of suspected urinary tract infections. She is passionate about quality improvement and patient safety and is eager to partner with 3 West and the CAUTI coalition this year.
MEET THE NEW MEDICAL DIRECTORS
Rebecca Corey MD, 3 West
Dr. Rebecca Corey is a 3rd-year hospitalist at the University of Virginia (and a quadruple Hoo!) who has continued to develop a focus on quality improvement and patient safety that began during her residency training when she participated in a high-value care project that resulted in decreased utilization of multi-lumen PICC lines. This past year, she collaborated with the clinical pharmacy to improve the accuracy of discharge medication reconciliation for patients discharged home deemed high risk for medication errors or 30-day readmission. She and the team implemented several iterations of pharmacy-led medication reconciliation for patients discharged with cirrhosis, heart failure, and insulin-dependent diabetes. They demonstrated a reduction in discharge medication errors. Dr. Corey has also served as a faculty mentor for resident quality improvement projects and was recently selected as the new medical director for 3 West Acute Care as Dr. Charlie Magee pivoted to fill a vacancy on 5 South. In alignment with medical center priorities, Dr. Corey has joined the CAUTI coalition and is leading a project to improve testing and antibiotic stewardship of suspected urinary tract infections. She is passionate about quality improvement and patient safety and is eager to partner with 3 West and the CAUTI coalition this year.
Robert Becker MD, 3N Acute
After completing his internal medicine residency at the University of Virginia in 2011, Dr. Robert Becker joined the hospitalist faculty, where he has been an integral section member for over a decade. Throughout his tenure, he has developed interests in quality improvement, value-based care, and multidisciplinary program development. Dr. Becker has served for several years as a physician champion for clinical documentation and, more recently, co-led a high-value care project focused on reducing costs associated with IV iron usage in hospitalized patients and participated in creating a multidisciplinary Limb Preservation Workgroup. This past year, he expanded his interests to clinical operations. He took an active role in the vision, development, & implementation of the successful new Hospitalist APP service, where he now serves as director. Given Rob’s significant experience in clinical medicine and emerging leadership in quality and clinical operations, he has been selected as the new medical director of the 3N Acute unit. He is excited to partner with local nursing leadership toward institutional quality priorities.
COMMUNITY AND CULTURE HIGHLIGHTS
HAVE YOU RUN WITH G.I.M.?
By Charlie Magee
You may have heard about the University President’s “Run with Jim” initiative to foster community engagement regionally and worldwide. Punning off his idea, we created “Run with G.I.M.,” that is, “Run with General Internal Medicine. In 37 of the last 43 weeks, hospitalists, oncologists, intensivists, and general internists have been seen trotting around grounds, downtown, and all around C’ville! As a simple means to celebrate what we do and who we are, Run with G.I.M. provides an excellent venue for providers to build camaraderie, celebrate our incredible wins, and maybe burn off a little steam! Now more than ever, we recognize the need to focus on our wellness to best care for our patients and loved ones, alleviating strain contributing to provider burnout. Although the exact mileage Run with G.I.M. goes unmeasured, estimates place it close to 500 miles trodden together in this inaugural year.
In the spring and fall, we pivot from morning to evening to maximize comfort, and we just returned to an evening time (5:15 p.m. on Wednesdays; no holidays) to make the most of both the daylight and warmth as we head into our colder months of the year.
As always, ALL ARE WELCOME, and we would love to have YOU join us sometime! Want to walk a couple of miles? I welcome you to join us, and we’ll walk those precious miles together as we share conversations and perspectives. Don’t think of us as runners – we are your General Medicine colleagues who happen to spend time together running.
Please join us on the corner of Crispell and Jeannette Lancaster at the South garage entrance at 5:15 p.m. on Wednesdays! Charlie would be happy to answer any questions you have at cm7ze@uvahealth.org.
Hospital Medicine Volleyball Team
By Miriam Gomez-Sanchez MD
The Hospitalist group sand volleyball team (“Shooting Blanks Miriam Gomez-Sanchez”), comprised of dedicated healthcare professionals and their non-healthcare friends, embodies teamwork on and off the hospital floor. With a shared goal of fostering camaraderie and maintaining a healthy work-life balance, the hospitalist group volleyball team promotes physical wellness and strengthens the bonds between colleagues. If you have limbs and you like to flail them with friends and don’t mind sand in awkward places, join us next season!
Great Hospitalist Bake-Off: On your mark…get set…bake!
In June, the Hospitalist Section hosted a Great Hospitalist Bake-Off to celebrate the end of the year with fun, flour, and sugar. In the Great British Bake-Off style, the contest featured three distinct dessert challenges meant to test our amateur bakers’ abilities. For the signature competition, Brian Peterson presented classic glazed yeasted donuts (made by his husband Patrick) competing against Duck Donuts’ maple bacon donut. Sara Brumfield created uniquely delicious chai caramel rocky road brownies for the technical challenge. Melissa Kehl presented a traditional Swedish ‘Princess Cake’ for the showstopper that went head-to-head against Albemarle Baking Company’s twist on this classic. The bakes were presented to esteemed judges Paul ‘Helgerson’ Hollywood & Hannah ‘Pru’ Moore. Though the competition was fierce, it was a hospitalist sweep, with all three hospitalist bakers winning handily!
-
- The Showstopper – Melissa earning the coveted ‘Hollywood Handshake.’
-
- The technical challenge.
-
- The Signature challenge.
-
- Homemade glazed donuts square off against Duck Donuts’ maple bacon donut.
-
- Princess cake.
-
- Chai-caramel rocky road brownies take on classic rocky road brownies.
Hospitalists Annual Fall Gathering
From left: Joe Hall, Alex Millard, Bennett Milner, Glenn Moulder, Emily Richardson, Jess Dreicer, Brian Peterson, Miriam Gomez-Sanchez, Charlie Magee, Meghan Geraghty, Amber Inofuentes
From left: Joe Hall, Alex Millard, Bennett Milner, Glenn Moulder, Emily Richardson, Jess Dreicer, Brian Peterson, Miriam Gomez-Sanchez, Charlie Magee, Meghan Geraghty, Amber Inofuentes and families
Filed Under: Basic Research, Clinical Research, DOM in the News, Education, In the Know, News and Notes, Notable Achievements, Publications, Research, Top News
Tags: Awards, DOM, Education, faculty, fellows, GENERAL MEDICINE, GMGPC, medicine matters, newsletter, November 2023, November Medicine Matters, November Medicine Matters Newsletter, Palliative Medicine, profile, profiles, Publications, Research, staff