Tertiary Care Hospital In Boston Research Articles

How physicians perceive hospitalist services after implementation: anticipation vs reality.

To determine whether internists' attitudes toward the hospitalist model change after implementation of a new inpatient service. Cross-sectional surveys performed in 1998 and 2000. Tertiary care hospital in Boston, Mass. A total of 236 internal medicine board-certified physicians affiliated with Beth Israel Deaconess Medical Center. Responses to survey items regarding attitude toward inpatient care and the hospitalist model. We used multivariable models to determine factors associated with physician responses. Of physicians surveyed in 2000, 236 (69%) responded; 145 (61%) had also responded in 1998. The mean (SD) age of respondents was 46.4 (10.8) years; 157 (66.5%) were male; and 146 (61.9%) were primary care providers. In 2000, more physicians agreed that "caring for inpatients is an inefficient use of my time" (P<.001), and that "use of a hospitalist service improves quality of care" (P =.002). In 2000, more physicians disagreed that "use of a hospitalist service diminishes physician career satisfaction" (P<.001), and that "use of the hospitalist service adversely affects the physician-patient relationship" (P<.001). No differences were detected in responses to questions regarding patient satisfaction or overall career satisfaction. In multivariable models, older physicians were more likely to favor the hospitalist model; those with busier inpatient practices were more negative (P<.05 for each). Physician specialty or being a primary care provider was not associated with attitudes toward the hospitalist model. Following experience with a hospitalist system, physician attitude, including concerns regarding career satisfaction and relationships with patients, toward a voluntary hospitalist model improved. Future research should investigate whether the hospitalist model affects patient satisfaction and quality of care.

Lightening the burden for preceptors: consider adding a "Faculty Model" week to orientation.

The physical and emotional stress on preceptors creates a conundrum as hospitals expand and/or experience higher rates of nursing staff turnover. When chosen well, preceptors are an excellent way to integrate and teach new nurses. However, being a preceptor can often be an added burden in a busy hospital climate. Creating innovative systems, within new nurse orientation, that respect the preceptor role and provide some relief have much merit in today's bustling hospital environment. The creation of such a system in a large tertiary care hospital in Boston, MA, entitled the Faculty Model Pilot Program, seems to be both supporting the overworked preceptors and providing a comprehensive standardized practice week for newly hired medical/surgical nurses. The pilot program appeared to increase not only their knowledge of the hospital itself but also the standards of patient care throughout the hospital. This added week seemed to provide a good understanding of general nursing practice prior to the acquisition of the unit-based, specific knowledge; thus, lightening the burden for unit preceptors.

The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment

The Brigham integrated computing system (BICS) provides nearly all clinical, administrative, and financial computing services to Brigham and Women’s Hospital, an academic tertiary-care hospital in Boston. The BICS clinical information system includes a very wide range of data and applications, including results review, longitudinal medical records, provider order entry, critical pathway management, operating-room dynamic scheduling, critical-event detection and altering, dynamic coverage lists, automated inpatient sumaries, and an online reference library. BICS design emphasizes direct physician interaction and extensive clinical decision support. Impact studies have demonstrated significant value of the system in preventing adverse events and in saving costs, particularly for medications.

Prevalence of Deep Venous Thrombosis Among Patients in Medical Intensive Care

OBJECTIVE--To determine the frequency of deep venous thrombosis (DVT) in medical intensive care unit (MICU) patients. DESIGN--Prospective ultrasound case series. SETTING--An MICU in a large tertiary care hospital in Boston, Mass. SUBJECTS--Patients older than 18 years of age admitted to the MICU with an anticipated stay of more than 48 hours. MAIN OUTCOME MEASURE--Deep venous thrombosis as detected by ultrasonography with color Doppler imaging performed twice weekly in the MICU and once within 1 week of discharge from the MICU. RESULTS--Deep venous thrombosis was detected in 33% (95% confidence interval, 24% to 43%) of 100 eligible patients during the 8-month study period. Forty-eight percent (16/33) were proximal lower extremity DVT, and 15% (5/33) were upper extremity DVT associated with central venous catheters, with one patient having both upper and proximal lower extremity DVT. Ultrasound examination results led to inferior vena cava filter placement in three patients, initiation of full-dose anticoagulation in four patients, initiation or continuation of low-dose subcutaneous heparin in 10 patients, follow-up ultrasound studies in three patients, central line removal in one patient, and no intervention in 10 patients due to active bleeding, prior filter, or heparin-induced thrombocytopenia. Two patients remained anticoagulated for other reasons. In this series, there was no difference in age, gender, body mass index, diagnosis of cancer, recent surgery, duration of hospitalization prior to DVT detection, and DVT prophylaxis between patients with DVT and those without. CONCLUSIONS--An unexpectedly high rate of DVT was detected by ultrasound in these MICU patients despite prophylaxis in 61%. Traditionally recognized DVT risk factors failed to identify patients who developed DVT. Routine ultrasound surveillance or more intensive prophylaxis regimens may be warranted in this patient population if these DVT rates are confirmed in other settings.