Comprehensive Hospital Medicine

I. Evidence Based Clinical Practice

A. Principles of evidence-based clinical practice

B. Real time application

II. Clinical Care Delivery

A. General Approach to a Hospitalized Patient


1) Communication

2) Symptom Management
a) Insomnia and anxiety
b) Nausea
c) Constipation and Diarrhea

3) Nutrition

4) Maintaining Skin Integrity

5) Pain Management

B. Cardiovascular


1) Chest Pain

2) Acute Coronary Syndromes

3) Heart Failure

4) Arrhythmias

5) Cardiac Arrest

6) Syncope

7) Venous Thromboembolism

8) Aortic Dissection

9) Valvular Heart Disease

10) Peripheral Arterial Disease

C. Infectious Diseases


1) Pneumonia
a) Community Acquired
b) Nosocomial

2) Urinary Tract Infections
a) Community Acquired
b) Nosocomial

3) Cellulitis

4) Meningitis

5) Endocarditis

6) Vascular Catheter-related infections

7) HIV – related infections

8) Fever in a hospitalized patient
Pulmonary

9) COPD

10) Asthma

11) Pleural Disease

12) Interstitial Lung Disease

13) Pulmonary Hypertension

D. Nephrology


1) Acute Renal Failure

2) Chronic Renal Failure

3) Electrolyte Disorders

4) Acid-Base Disorders

E. Gastroenterology


1) Acute GI Bleeding
a) Upper
b) Lower

2) Acute Hepatitis

3) Cirrhosis and Liver Failure
a) Spontaneous Bacterial Peritonitis

4) Acute Abdominal Emergencies
a) Appendicitis
b) Cholecystitis
c) Diverticulitis
d) Bowel Obstruction and ileus
e) Ischemic Bowel

5) Inflammatory Bowel Disease

6) Gastroenteritis

F. Endocrinology


1) Diabetes Mellitus
a) DKA
b) Managing DM in hospitalized patients

2) Thyroid Disorders

3) Adrenal Disorders

4) Parathyroid Disorders

G. Oncology


1) Chemotherapy

2) Paraneoplastic Syndromes

3) Oncologic Emergencies
a) Neutropenia / Fever
b) Hypercalcemia
c) Tumor Lysis Syndrome

H. Hematology


1) Anemia
a) Transfusion Medicine

2) Sickle Cell Disease

3) Hemorrhagic and Thrombotic Disorders

4) Leukemia

5) Lymphoma

I. Rheumatology


1) Acute Arthritis

2) Vasculitis

J. Critical Care


1) Sepsis and Shock

2) Acute Respiratory Failure
a) Sedation and Ventilator Weaning

3) Drug Overdose / Poisoning

K. Neurology


1) Stroke

2) Intracranial Hemorrhage
a) Subarachnoid hemorrhage
b) Subdural, Epidural, and intracerebral hemorrhage

3) Altered Mental Status
a) Coma
b) Delirium

4) Dementia

5) Pain Management

L. Psychiatry


1) Depression

2) Anxiety

3) Mania

M. Peri-Operative Care


1) Hospitalist as Consultant

2) Pre-op Assessment and Preparation

3) Post-op Evaluation and Care

4) General Wound Care

5) Orthopedics
a) Hip Fracture
b) Total Joint Replacement
a. Hip, Knee, Shoulder
c) Spinal Surgery

6) Urology
a) Nephrolithiasis
b) Transurethral Prostatectomy (TURP)
c) Radical Prostatectomy

7) Obstetrics/Gynecology
a) Medical Complications of Pregnancy
b) Hysterectomy
c) Mastectomy / Mammoplasty

8) Cardiothoracic
a) CABG
b) Lung Resection

9) Otolaryngology
a) Tracheostomy
b) Neck

10) Neurosurgery

N. Approach to Special Patient Populations


1) Geriatrics

2) End-of-Life

3) Psychiatric illness

4) Pregnant patients

5) Patients with cancer

6) Immunocompromised patients
a) HIV
b) Transplantation

O. Preventive Services in the Hospitalized Patient


1) Vaccination

2) Smoking Cessation

3) Dietary Counseling

III. System Issues

A. Establishing a Hospitalist Program

B. Enhancing a Hospitalist Program

C. Managing Patient Transitions of Care


1) Admission

2) Transfers

3) Discharge and Follow-up

D. Establishing a Teamwork Model with Hospital Staff

E. Patient Safety and Performance Improvement


1) Continuous Quality Improvement

2) Cost Effectiveness

3) Patient Satisfaction

4) Hospital Staff Feedback Analysis

5) Risk Management

F. Guidelines for Standardizing Care


1) Development of Guidelines and Order Sets

2) Implementation

3) Evaluation

4) Disseminating Innovation

G. Ethics