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The Principles and Practice of Hospital Medicine reflects the evolution of the specialty of Hospital Medicine at a time of increasing pressures to address the ills of our health care system and to provide quality patient care that is safe, effective, patient-centered, timely, efficient, and equitable—the six dimensions defined by the Institute of Medicine. Regardless of practice setting, all clinicians will be increasingly called upon to improve the care they provide for populations of patients. This requires optimizing the function of the entire health care team, structuring their programs to better meet demand, and aligning their performance measures with those of their hospital networks.

The first major part of this book, Systems of Care, introduces key issues in Hospital Medicine, patient safety, quality improvement, leadership and practice management, professionalism and medical ethics, medical legal issues and risk management, teaching and development. In general, most physicians have little formal training relating to complex hospital systems or human error. These sections provide a background for improving the hospital setting for patients through system redesign, training, and teamwork.

The second major part of this book, Medical Consultation and Co-Management, reviews core tenets of medical consultation, preoperative assessment, and management of post-operative medical problems. Although hospitalists have already changed the health care system by their presence and up to 85% of hospitalists report that they co-manage surgical patients, most do not have a surgical background. Surgeons present key concepts relating to General Surgery, Neurosurgery, and Orthopedic and Bariatric surgery, and anesthesiologists cover key concepts of Anesthesia. Experts in anticoagulation from McMaster University, Canada, review perioperative anti-thrombotic management and prevention. These sections present a framework for improving the co-management of surgical patients with significant medical illnesses that make them vulnerable to post-operative complications.

The third major part, Clinical Problem-Solving in Hospital Medicine, introduces principles of evidence-based medicine, quality of evidence, interpretation of diagnostic tests, systemic reviews and meta-analysis, and knowledge translations to clinical practice. Each field of medicine challenges clinicians to recommend a course of action for a specific patient at a particular time. To efficiently and safely obtain the right information through examination and testing, physicians need to ask the right questions. Increasingly, physicians must process an enormous amount of data in the care of a single patient and do not have time to critically review the medical literature at each encounter. The purpose of these chapters is to provide a context for evidence-based medicine so that clinicians optimize how they access information tools that facilitate clinical decision-making at the point of care.

The fourth major part, Approach to the Patient at the Bedside, covers the diagnosis, testing, and initial management of common complaints that may either precipitate admission or arise during hospitalization. Hospitalized patients differ from their outpatient counterparts in many respects, including severity of primary systemic illness precipitating admission, multiple co-morbidities that do not fit into one subspecialty, the number and route of administration of prescription drugs, and vulnerability to hospital-acquired complications. Condensed accounts of patient cases presented in these chapters and throughout the book provide examples of asking questions, thinking critically, and diagnosing and assessing problems so that the reader may apply key concepts directly to patient care. As much as possible this approach offers evidence-based strategies that can be employed when clinicians encounter an unfamiliar patient who has developed a new problem that requires urgent evaluation.

The fifth major part, Hospitalist Skills, covers the interpretation of common “low tech” tests that are routinely accessible on admission, how to optimize the use of radiology services, and the standardization of the execution of procedures routinely performed by some hospitalists. Diagnostic testing is rarely without risk or financial cost and almost never completely accurate. The pursuit of diagnostic tests may also delay much needed treatment; thus, physicians cannot pursue every diagnostic avenue, even if patients want all the information. These sections review the process of how to incorporate simple test results into clinical decision-making, how to select imaging tests, and how to safely perform procedures.

The sixth major part, Clinical Conditions, reflects the expanding scope of Hospital Medicine by including sections of Emergency Medicine, Critical Care, Geriatrics, Neurology, Palliative Care, Pregnancy, Psychiatry and Addiction, and Wartime Medicine. Although there have been tremendous strides in the technology relating to the management of many diseases and in proven therapies, performance gaps still remain. The objective of this part of the book is to present current best practices and highlight opportunities for improvement.

The overarching goal of this first edition is to make available a comprehensive resource for trainees, junior and senior clinicians, and other professionals so that they can effectively work together to create opportunities to ensure the delivery of high-quality health care and value.

Sylvia C. McKean, MD, SFHM, FACP

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