Feasibility of implementing antimicrobial stewardship programs in acute-care hospitals: A nationwide survey in Thailand

A nationwide survey was conducted in 399 acute-care hospitals in Thailand. Most had a designated antimicrobial stewardship program (ASP), but <20% had an infectious disease physician on the team. The most frequently cited challenges in ASP implementation were the increased workload, followed by a lack of antimicrobial stewardship knowledge and a lack of hospital administrator concern.

The Overlap Between Rural Hospital Needs and Medical Student Goals in Texas

Introduction: The rural health workforce in the United States is difficult to maintain and harder to increase. This may contribute to worse health outcomes in rural areas and threaten the sustainability of rural hospitals. Previous studies have attempted to identify medical student characteristics and strategies to help grow this workforce. In this study, we aimed to understand the needs of medical students and hospital administrators to identify potential strategies to improve the rural health workforce. Methods: We conducted medical student and hospital administrator focus groups. We analyzed focus group data separately to identify themes, and reviewed these themes for overlap between groups and potential actionable areas. We calculated Cohen 𝜅 statistics. Results: We identified 26 themes in the medical student focus groups, and 14 themes in the hospital administrator focus group. Of these themes, three were identical between groups (scope of practice, loan repayment and financial concerns, and exposure to rural health in training), and two were similar between the groups (family and leadership). Conclusion: The identification of two themes that are similar but not identical between medical students and hospital administrators may serve as part of future strategies to improving rural physician recruitment. Future studies should determine if a shift in language or focus in these areas specifically help to improve the rural health workforce.

With quality and safety for all: Risking optimal care with VIP patients.

142 Background: The person deemed a VIP is generally considered differentiated from the average person by virtue of fame, notoriety (positive or negative), or success through talent, tenacity or simple luck. Because society often views VIPs as special, this can generate strong feelings ranging from excitement and awe to resentment in those who encounter a VIP. VIPs and/or their entourage may request or demand special attention. The unique factors associated with caring for a VIP can jeopardize patient safety and optimal care of the VIP patient. Methods: Typology associated with the labeling of VIP patients will be used as a framework. For example, an objective VIP patient is someone who is indisputably famous or notorious. These individuals are typically in the public eye such as a famous actress, professional athlete, elected official or rock star. Persons who are subjectively designated as a VIP are usually labeled by a person of power or authority such as a hospital administrator or the Development office and they are largely unknown until they are so designed as a VIP in a specific facility. They may be the brother-in-law of the hospital CEO or a major benefactor who has a low or unknown public profile. Both objective and subjective VIPs pose problems because of the expectations placed on staff whether implied or explicit. Results: This presentation will review typical operational problems and named syndromes that are associated with the medical care of the VIP patient. These syndromes typically outline how the whirlwind of activity and expectations surrounding a VIP patient can cause a flummoxed staff to make decisions that can lead to worse care for the patient. Conclusions: For example, ‘Chief Syndrome’ is a demand, request, or intentional substitution for the “top person” in a department to provide care to the VIP patient. Problems can result if the top person, or chief, has been behind an administrative desk for the past five years and they are not as practiced as a usual provider who sees patients daily. Other cautionary notes and preventable actions that can lead to sub-optimal care of the VIP patient will be presented.

Article Commentary: Perils, Pitfalls, and Benefits of a Surgeon as a Health System Employee: The Contracting Process

One would be hard pressed today to find a general surgeon or subspecialty-trained general surgeon who has not been approached by a health system to discuss employment. The majority of physicians find these initial discussions with a hospital administrator daunting at best regardless of whether they are just finishing residency or fellowship training or have had many successful years of private practice under their belt. Just as real estate has the mantra of “location, location, location,” I would suggest that physician employment by a health system should have the mantra of “relationship, relationship, relationship.” The following tips provide guidance on how to better understand the potential perils, pitfalls, and benefits of specific content sections of a standard template employment agreement between a health system and a physician. Physicians should review, understand, and be ready to engage in dialogue with the hospital administrator before involving attorneys. My experience is that if the dialogue begins with the attorneys representing each party, the opportunity to fully develop a partnership relationship between the parties is either lost or at minimum severely delayed in its development.