Group Title: DoHM newsletter
Title: DoHM newsletter. August 2008.
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 Material Information
Title: DoHM newsletter. August 2008.
Series Title: DoHM newsletter
Physical Description: Serial
Creator: Division of Hospital Medicine, College of Medicine, University of Florida
Publisher: Division of Hospital Medicine, College of Medicine, University of Florida
Publication Date: August 2008
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Bibliographic ID: UF00088874
Volume ID: VID00003
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.

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Special points of
interest:

* How low can we go?
* We're goingGREEN
* Summer Babies
* Hospitalist Humor


CHF Core Measures

Centers for Medicare and Medicaid Services have
implemented a method to standardize quality core
measures when discharging patients. Congestive
Heart Failure (CHF), is on the top of the list of core
measure documentation Shands hospital is trying to
standardize. Dr. House will be individually address-
ing any fallouts regarding discharge instructions for
patients with a CHF diagnosis. Listed below are
quick references mandated by CMS when discharg-
ing CHF patients:


1. DOCUMENTATION OF A LEFT VEN-
TRICULAR SYSTOLIC ASSESSMENT.

2.ACEI AND ARB ORDERED AT DIS-
CHARGE FOR LEFT VENTRICULAR
SYSTOLIC DYSFUNCTION.


4.DISCHARGE INSTRUCTIONS INDI-
CATORS:

5. ADDITIONAL DOCUMENTATION
NEEDED ONLY IF APPLICABLE:
For a copy of the quick reference list, please access
our Division of Hospital Medicine folder on the
common drive.


3. ADULT SMOKING


Inside this issue:


CHF Core Measures
We're going Green
This Month's events
Ask Dr House
Journal Club


How low can we go?


2 Throughout the hospital and the city of Jacksonville, daily hospital census is on the decline. Specifically for our
2 hospital, it could be due to the partnership between case management and the Division of Hospital Medicine.
Our daily average length of stay (ALOS) is less than 5 days for both the clinical center and the pavilion. Since
3 our census is so low, adjustments have been made to our August schedule to increase the number of patients
I I each physician sees. At mid-month, we will reassess our average
3 daily census and make adjustments as necessary.


Getting to know you 3


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We're going Green


In our ongoing effort to make the world a better place to live, we will be transitioning some of our
paper reports to electronic reports. Starting for the month of August, we will be distributing your
individual financial and production report cards via email. The division's monthly admission data
and monthly newsletter will be displayed in the office rather than a hard copy distributed to every-
one in our division meetings. We will be copying and printing on recycled paper and begin to limit
our usage of Styrofoam cups and utensils. Once our batch of Styrofoam cups have been depleted,
Felixia Colon will distribute individual ceramic coffee cups to be used. If you can suggest any other
"going green" ideas, please send an email to Felixia Colon, felixia.colonkjax.ufl.edu.


August Ward Team

coverage:

August 1-15th:

Dr. Garg, Team C

August 16th-31st:

Dr. Mughal, Team C

August 13-15th:

Dr. Konda, Team D


Summer Babies


Now that summer draws to an
end (except in Florida), the
Division of Hospital Medicine
would like to acknowledge its
summertime babies.

May Babies:

Dr. Ayvazyan-May 5

Dr. Gupta-May 14

Dr. Konda-May 24

Dr. Kharrazi-May 26


Dr. Mughal-May 29

June Babies:

Dr. Michel-June 15

Dr. Po-June 21

July Babies: Not Applicable

August Babies:

Dr. Garg-August 20

Dr. Vazquez-August 28


This Month's Events


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Ask Dr. House


What is the policy for
transferring unstable pa-
tients from the Pavilion to
the Clinical Center? Patients
who are unstable at the Pavilion
may be transferred to the clinical
center at the Pavilion clinicians
discretion. If the patient is truly
unstable or "crashing", then
there is an ICU bed that is avail-
able for immediate transfer. The
on-callMICU resident should be
contacted to alert them that this
patient is on the way. When the
patient arrives to the floor, the
resident will consult the patient
to make a final disposition
(either accept this patient onto


their service or transfer back to
Hospital Medicine at the Clinical
Center.
If the Pavilion clinician has a pa-
tient who they feel does not need
ICU care but may just need closer
monitoring or a higher level of
care, then they should transfer the
patient to the Clinical Center under
Hospital Medicine's care. This
process involves first calling the
unit secretary to arrange the
transfer followed by calling the on-
call hospitalist to inform them of
the transfer.

Are we the only division that
accepts direct admissions or
does medicine also accept until


they cap? Direct admissions from
outside the hospital are exclusively
handled by Hospital Medicine. The
only exception to this is the General
Internal Medicine patients from the
ACC or Faculty clinic. These will go
to the teaching services unless they
are capped.

Will our hours for the ER offi-
cially change from 7-5p to 7-3p,
now that we have 2 evening ER
physicians? At the present time
there are no plans to shorten the ER
day shift to 7-3. This is subject to
change depending on the success of
the new 4-12 shift.


Dr. Jeff House, Division
Chief Hospital Medicine


July Journal Club


Presenter:


Sann Htoo, M.D.

Topic: Characterization of resis-
tant hypertension

Article: Association Between
Resistant Hypertension, Aldoster-
one and Persistent Intravasular
Volume Expansion. ARCH Inter-
nal Med/ vol 168 (NO. 11), June
6,2008.

Summary: The present study
adds to the body of literature
relating to Aldosterone excess to


the pathogenesis of resistant hy-
pertension by demonstrating that:

* PAC and 24-hour UAldo
excretion are significantly
higher in patients with resis-
tant hypertension vs. control
subjects

* Aldosterone levels are higher
in men than in women with
resistant hypertension

* BMP and ANP levels are
higher in patients with resis-
tant hypertension, irrespec-


tive of Aldosterone levels, sug-
gesting that increased intravascu-
lar volume is a common charac-
teristic of resistant hypertension

24 hour excretion of UAldo and
UCort is positively correlated in
patients with resistant hyperten-
sion, suggesting a stimulus com-
mon to both as the underlying
cause of the excessive Aldoster-
one secretion.


Getting to know you...Viiav


Full Name: Vijay Kumar Konda

Place of Birth: Hyberabab, India

Favorite Color: Blue

Favorite Food: Red Chilling

Something Unique about you: I can speak 6 languages fluently.

Place you would like to visit: Alaska


Vijay Konda, MD


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Division of Hospital Medicine The Division of Hospital Medicine has an established team of highly
655 West 8th Street qualified, specially trained, experienced providers. Our team works in
cc262
Jacksonville FL 32209 partnership with various entities within the hospital including special-
Phone 904-244-7024 ists and case management.
Fax 904-244-4799
E-mail hospital medicine@jax ufl edu






"Hospital Medicine is a service that allows the physicians '
to optimize and provide seamless patient coverage"
-Dr. House, Division Chief Hospital Medicine


We're on the web!
httlp://WWW.hsci.ull.edu im/hosp ]


Hospitalist Humor


1996 Randy Glasbergen. www.glasbergen.com E-mail: randy@giasbergen cor


Because of his ongoing ability
to increase office productivity,
the "Employee Of The Month" award
again goes to Mr. Coffee.


http://www.glasbergen.com


.., GASSampF44


(71




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