Mentoring of physicians at a community-based health system: preliminary findings.

BACKGROUND: Mentoring has been suggested as 1 way to reduce physician stress and improve professional satisfaction, yet mentoring programs for physicians have focused principally on faculties of academic medical centers. Recently, a formal mentoring program for physicians in full-time clinical practice was created at a regional health system in western Connecticut. We describe the results of a survey of mentees' impressions of the program after its first year. METHODS: We surveyed hospitalists and other physicians who had participated in the mentoring program to determine their reasons for participation, whether the program was helpful (and if so in what ways), and their recommendations for improvement. RESULTS: Twenty-seven of the 39 participants responded to the survey (69%). Hospitalists were the most likely to participate in the mentoring program (18 of 24) and to respond to the survey. Career planning (52%), balance among personal and professional life (43%), and leadership development (38%) were the most common reasons given for meeting with a mentor. All but 1 respondent felt the mentoring program met their expectations by setting goals (62%), planning next steps in their career(60%), and gaining new insights (52%). CONCLUSIONS: Community-based health systems that seek to improve the professional satisfaction of their physicians should be interested in this description of the physician mentoring program of the Western Connecticut Health Network.

The use of transthoracic echocardiography and adherence to appropriate use criteria at a regional hospital.

BACKGROUND: The sharp increase in health care costs over the past decade has prompted health care providers to reevaluate how diagnostic imaging is utilized. In response to the need for more rational use of imaging services, the American College of Cardiology Foundation and the American Society of Echocardiography have developed appropriate use criteria (AUC) for transthoracic echocardiography to guide its utilization. Although community and regional hospitals, such as Danbury Hospital, account for 85% of registered hospitals in the United States, very little is known about adherence to the AUC at these institutions. METHODS: The electronic medical records of 1,205 patients who underwent inpatient transthoracic echocardiography from January 1 to June 30, 2008, were retrospectively examined to determine the reasons for ordering the studies. The 2007 and 2011 AUC were used to classify indications as appropriate, inappropriate, or uncertain. RESULTS: Using the 2007 AUC, 86% of echocardiographic examinations were classified as appropriate. One percent had indications that were inappropriate, and there were no uncertain indications. Thirteen percent of studies were ordered for reasons not defined by the 2007 AUC. The most common appropriate indications were symptoms due to suspected cardiac etiology, initial evaluation after acute myocardial infarction, and acute chest pain with suspected myocardial ischemia. When evaluated using the 2011 AUC, appropriate and inappropriate indications increased to 97% and 2%, respectively. Ninety-three percent of undefined studies, using the 2007 AUC, could be classified using the 2011 guidelines. CONCLUSIONS: Consistent with studies conducted at university hospitals, Danbury Hospital, a regional hospital, showed good adherence to the AUC. This suggests that the AUC are valuable across a large continuum of inpatient settings and can serve as an excellent guide for utilization and appropriateness.

Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care.

OBJECTIVE: To evaluate the role of continuous lateral rotational therapy on the development of ventilator-associated pneumonia in patients requiring long-term mechanical ventilation. DESIGN: Prospective control study. SETTING: Chronic ventilator unit in tertiary care hospital. METHODS: Thirty-seven patients requiring long-term mechanical ventilation were assigned to receive either continuous lateral rotational therapy or conventional therapy. RESULTS: Patients receiving continuous lateral rotational therapy had a significantly lower prevalence of pneumonia (17.6%) as compared with control patients (50%, p<.05). The development of pneumonia after being entered into the study was also significantly delayed in continuous lateral rotational therapy patients, 29 +/- 8 days vs. 12 +/- 2 days in controls (p <.05). However, unit mortality, total ventilator days, and the number of patients successfully weaned were not significantly different between groups. CONCLUSION: In patients requiring long-term ventilator care, continuous lateral rotational therapy reduced the prevalence of pneumonia but did not seem to affect mortality or the period of mechanical ventilation.