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Yokose M, Harada Y, Shimizu T. Visualizing diagnostic "hotspots" in a tertiary hospital. Eur J Intern Med 2024; 120:136-138. [PMID: 37977998 DOI: 10.1016/j.ejim.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi, 321-0293 Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi, 321-0293 Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi, 321-0293 Japan.
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Gilman EA, Aakre C, Meyers A, Collins N, VerNess C, Dougan B, Davis X, Philpot L, Ramar P, Croghan I, Schroeder DR, Pagel E, Ghosh K, Hurt RT. Development of a Visit Facilitator Role to Assist Physicians in an Ambulatory Consultative Medical Practice. Mayo Clin Proc Innov Qual Outcomes 2023; 7:187-193. [PMID: 37213712 PMCID: PMC10196913 DOI: 10.1016/j.mayocpiqo.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Objective To decrease the electronic health record (EHR) clerical burden and improve patient/clinician satisfaction, allied health staff were trained as visit facilitators (VFs) to assist the physician in clinical and administrative tasks. Patients and Methods From December 7, 2020, to October 11, 2021, patients with complex medical conditions were evaluated by an internal medicine physician in an outpatient general internal medicine (GIM) consultative practice at a tertiary care institution. A VF assisted with specific tasks before, during, and after the clinical visit. Presurvey and postsurvey assessments were performed to understand the effect of the VF on clinical tasks as perceived by the physician. Results A total of 57 GIM physicians used a VF, and 41 (82%) physicians and 39 (79%) physicians completed the pre-VF and post-VF surveys, respectively. Physicians reported a significant reduction in time reviewing outside materials, updating pertinent information, and creating/modifying EHR orders (P<.05). Clinicians reported improved interactions with patients and on-time completion of clinical documentation. In the pre-VF survey, "too much time spent" was the most common response for reviewing outside material, placing/modifying orders, completing documentation/clinical notes, resolving in-baskets, completing dismissal letters, and completing tasks outside of work hours. In the post-VF survey, "too much time spent" was not the most common answer to any question. Satisfaction improved in all areas (P<.05). Conclusion VFs significantly reduced the EHR clinical burden and improved GIM physician practice satisfaction. This model can potentially be used in a wide range of medical practices.
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Affiliation(s)
- Elizabeth A. Gilman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Correspondence: Address to Elizabeth Gilman, MD; Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | | | - Adam Meyers
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nerissa Collins
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Chrissy VerNess
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Brian Dougan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Xiomari Davis
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Lindsey Philpot
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Division of Epidemiology, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Priya Ramar
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ivana Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Division of Epidemiology, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Darrell R. Schroeder
- Division of Clinical Trials and Biostatistics, Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Erin Pagel
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Karthik Ghosh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ryan T. Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Kawamura R, Harada Y, Yokose M, Hanai S, Suzuki Y, Shimizu T. Survey of Inpatient Consultations with General Internal Medicine Physicians in a Tertiary Hospital: A Retrospective Observational Study. Int J Gen Med 2023; 16:1295-1302. [PMID: 37081930 PMCID: PMC10112478 DOI: 10.2147/ijgm.s408768] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
Purpose The general internal medicine (GIM) department can be an effective diagnostic coordinator for undiagnosed outpatients. We investigated the contribution of GIM consultations to the diagnosis of patients admitted to specialty departments in hospitals in Japan that have not yet adopted a hospitalist system. Patients and Methods This single-center, retrospective observational study was conducted at a university hospital in Japan. GIM consultations from other departments on inpatients aged ≥20 years, from April 2016 to March 2021, were included. Data were extracted from electronic medical records, and consultation purposes were categorized into diagnosis, treatment, and diagnosis and treatment. The primary outcome was new diagnosis during hospitalization for patients with consultation purpose of diagnosis or diagnosis and treatment. The secondary outcomes were the purposes of consultation with the Diagnostic and Generalist Medicine department. Results In total, 342 patients were included in the analysis. The purpose of the consultations was diagnosis for 253 patients (74%), treatment for 60 (17.5%), and diagnosis and treatment for 29 patients (8.5%). In 282 consultations for diagnosis and diagnosis and treatment, 179 new diagnoses were established for 162 patients (57.5%, 95% confidence interval [CI], 51.5-63.3). Conclusion The GIM department can function as a diagnostic consultant for inpatients with diagnostic problems admitted to other specialty departments in hospitals where hospitalist or other similar systems are not adopted.
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Affiliation(s)
- Ren Kawamura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Shogo Hanai
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Yudai Suzuki
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
- Correspondence: Taro Shimizu, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan, Tel +8128286-1111, Email
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Santhosh L, Flores EJ, Bajaj K. A National Leadership Incubator to Promote Equity in Diagnostic Excellence: The National Academy of Medicine DxEx Scholars. JAMA HEALTH FORUM 2022; 3:e224364. [PMID: 36416814 DOI: 10.1001/jamahealthforum.2022.4364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This Viewpoint discusses the structure of the National Academy of Medicine’s Scholars in Diagnostic Excellence program and the lessons learned from this national leadership incubator.
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Affiliation(s)
- Lekshmi Santhosh
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Komal Bajaj
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, New York, New York
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Chao S, Lotfi J, Lin B, Shaw J, Jhandi S, Mahoney M, Singh B, Nguyen L, Halawi H, Geng LN. Diagnostic journeys: characterization of patients and diagnostic outcomes from an academic second opinion clinic. Diagnosis (Berl) 2022; 9:340-347. [PMID: 35596123 DOI: 10.1515/dx-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Diagnostic programs and second opinion clinics have grown and evolved in the recent years to help patients with rare, puzzling, and complex conditions who often suffer prolonged diagnostic journeys, but there is a paucity of literature on the clinical characteristics of these patients and the efficacy of these diagnostic programs. This study aims to characterize the diagnostic journey, case features, and diagnostic outcomes of patients referred to a team-based second opinion clinic at Stanford. METHODS Retrospective chart review was performed for 237 patients evaluated for diagnostic second opinion in the Stanford Consultative Medicine Clinic over a 5 year period. Descriptive case features and diagnostic outcomes were assessed, and correlation between the two was analyzed. RESULTS Sixty-three percent of our patients were women. 49% of patients had a potential precipitating event within about a month prior to the start of their illness, such as medication change, infection, or medical procedure. A single clear diagnosis was determined in 33% of cases, whereas the remaining cases were assessed to have multifactorial contributors/diagnoses (20%) or remained unclear despite extensive evaluation (47%). Shorter duration of illness, fewer prior specialties seen, and single chief symptom were associated with higher likelihood of achieving a single clear diagnosis. CONCLUSIONS A single-site academic consultative service can offer additional diagnostic insights for about half of all patients evaluated for puzzling conditions. Better understanding of the clinical patterns and patient experiences gained from this study helps inform strategies to shorten their diagnostic odysseys.
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Testa S, Joshi M, Lotfi J, Lin B, Artandi M, Chiang KF, Chang K, Singh B, Geng LN. Training Internal Medicine Residents in Difficult Diagnosis: A Novel Diagnostic Second Opinion Clinic Experience. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221091036. [PMID: 35372696 PMCID: PMC8972929 DOI: 10.1177/23821205221091036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In primary care clinics, time constraints and lack of exposure to highly complex cases may limit the breadth and depth of learning for internal medicine residents. To address these issues, we piloted a novel experience for residents to evaluate patients with puzzling symptoms referred by another clinician. OBJECTIVE To increase internal medicine residents' exposure to patients with perplexing presentations and foster a team-based approach to solving diagnostically challenging cases. METHODS During the academic year 2020-2021, residents participating in their 2-week primary care "block" rotation were given protected time to evaluate 1-2 patients from the Stanford Consultative Medicine clinic, an internist-led diagnostic second opinion service, and present their patients at the case conference. We assessed the educational value of the program with resident surveys including 5-point Lickert scale and open-ended questions. RESULTS 21 residents participated in the pilot with a survey response rate of 66.6% (14/21). Both the educational value and overall quality of the experience were rated as 4.8 out of 5 (SD 0.4, range 4-5; 1:"very poor"; 5:"excellent"). Residents learned about new diagnostic tools as well as how to approach complex presentations and diagnostic dilemmas. Residents valued the increased time devoted to patient care, the team-based approach to tackling difficult cases, and the intellectual challenge of these cases. Barriers to implementation include patient case volume, time, and faculty engagement. CONCLUSIONS Evaluation of diagnostically challenging cases in a structured format is a highly valuable experience that offers a framework to enhance outpatient training in internal medicine.
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Affiliation(s)
| | - Mugdha Joshi
- Stanford Department of Medicine, Stanford, CA, USA
| | - Justin Lotfi
- Stanford Department of Medicine, Stanford, CA, USA
| | - Bryant Lin
- Stanford Department of Medicine, Stanford, CA, USA
| | - Maja Artandi
- Stanford Department of Medicine, Stanford, CA, USA
| | | | - Kevin Chang
- Stanford Department of Medicine, Stanford, CA, USA
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