Generation of Functional CLL-Specific Cord Blood CTL Using CD40-Ligated CLL APC

PMCID: PMC3526610This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Hospitalists in Teaching Hospitals: Opportunities but Not Without Danger

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73210/1/j.1525-1497.2004.42002.x.pd

A Prospective Study of Reasons for Prolonged Hospitalizations on a General Medicine Teaching Service

BACKGROUND: Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care. OBJECTIVE: To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients. DESIGN: Prospective survey of senior residents. SETTING: Urban tertiary care university-affiliated teaching hospital. PARTICIPANTS: Sixteen senior residents were surveyed regarding 2,831 patient-days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were collected on 97.6% (2,762) of patient-days eligible for evaluation. Three hundred seventy-three patient-days (13.5% of all hospital days) were judged unnecessary for acute inpatient care, and occurred because of delays in needed services. Sixty-three percent of these unnecessary days were due to nonmedical service delays and 37% were due to medical service delays. The vast majority of nonmedical service delays (84%) were due to difficulty finding a bed in a skilled nursing facility. Medical service delays were most often due to postponement of procedures (54%) and diagnostic test performance (21%) or interpretation (10%), and were significantly more common on weekend days (relative risk [RR], 1.49; P=.02). Indeed, nearly one fourth of unnecessary patient-days (24% overall, 88 patient-days) involved an inability to access medical services on a weekend day (Saturday or Sunday). CONCLUSIONS: At our institution, a substantial number of hospital days were judged unnecessary for acute inpatient care and were attributable to delays in medical and nonmedical services. Future work is needed to develop and investigate measures to decrease delays

The Positive Impact of Initiation of Hospitalist Clinician Educators: Resource Utilization and Medical Resident Education

OBJECTIVE: Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation. DESIGN: Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists’ top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents (N = 36) were given an anonymous written survey to assess the HCEs’ impact on resident education and service. RESULTS: Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents’ roles as teachers and team leaders were largely unchanged. CONCLUSION: Hospitalist clinician educators as inpatient teaching attendings effectively reduce length of stay and resource utilization while improving resident education at community-based teaching hospitals