The Iowa ACP Chapter meeting was one of two professional society meetings that coincided with the annual Progress event. Compared to the ACP group, what the Iowa Chapter of the Society of Hospital Medicine (SHM) lacks in longevity they more than make up in enthusiasm.

As Progress in the Graduate Hotel broke for lunch, attendees were invited to the nearby Vetro for the SHM-sponsored buffet and poster session. A variety of work was on display from undergraduates, residents from multiple programs around the state, nurse practitioners, and pharmacists. Judges and other guests moved from board to board after helping themselves to a buffet lunch provided by SHM.

After a little less than an hour, the judges submitted their scorecards for the final tally, declaring MercyOne resident Allie Ladd, MD, the winner for her poster “A ‘Loopy’ Pancreas.” Three others received special recognition for their posters:

Colton Jensen
Fourth-year medical student, Carver College of Medicine
Membranous Glomerulonephritis as an Immune-Related Adverse Effect of Checkpoint Blockade Therapy

Iaswarya Ganapathiraju, DO
Resident, Unity Point Health – Des Moines
Treatment of Uncomplicated, Mild-to-Moderate Diabetic Ketoacidosis in Adults with Rapid-Acting Subcutaneous Insulin on the General Medical Ward

Katharine Lasley, DO
Resident, Mercy Medical Center – Mason City
Can You Clear a Cervical Spine with a CT Scan? Are you Sure?

Special thanks to the judges, who worked quickly and efficiently through the couple dozen entries.
Dale Bieber, MD
Rachael Dirksen, MD
Wendy Fiordellisi, MD
Kevin Glenn, MD
Carly Kuehn, MD
Ethan Kuperman, MD
Brad Manning, MD

Lunch concluded, attendees returned to close out the first day of Progress before some returned to the Vetro for the ACP chapter meeting. After that, some made their way across the Pedestrian Mall in downtown Iowa City to the second floor of the restaurant, 126, the same location SHM held its event each of the previous two years.

Former SHM chapter president Melinda Johnson, MD, filled in for Dianna Edwards, MD, the current chapter president. She re-introduced guests to Jeffrey Wiese, MD, professor of medicine at Tulane University. Wiese had delivered one of the keynotes at Progress earlier that day. Johnson offered Wiese and Ray Johnson, an SHM representative, tokens of appreciation from the chapter, reminding them of their visit to Iowa.

Wiese spoke briefly as well, congratulating attendees for their commitment to building hospital medicine into a recognized and critical subspecialty. He reminded them that to keep an eye on what is most important, why they first entered the profession in the first place and to try to hang onto that passion.

After Wiese spoke, guests enjoyed a meal together and then Johnson presented chapter awards before the evening drew to a close. Remarks presenting those awards are reproduced below.

2019 Iowa Chapter Awards of Excellence

Excellence in Research: Ethan Kuperman, MD
Dr. Kuperman has demonstrated a strong passion for forward-looking Quality Improvement projects. He reaches all groups of providers from medical students to seasoned colleagues within the Department of Internal Medicine. He does not shy away from sharing his vast QI knowledge, superb data analysis skills and makes all providers realize that “QI is everybody’s job.” Ethan has been a significant contributor to multiple peer-reviewed publications, poster and oral presentations at national meetings and is the director of Quality Improvement and Patient Safety for the Iowa Chapter of Society of Hospital Medicine. Congratulations, Dr. Ethan Kuperman.

Excellence in Teaching:  Justin Smock, MD
Dr. Smock has demonstrated his commitment to a role as a ‘teaching hospitalist’ in many domains. He has participated in multiple training activities to improve his teaching abilities, including the College of Medicine Teaching Scholars Program. He has received multiple awards in education for medical students. Since 2014 he has served as one of the Associate Program Directors for the Iowa Internal Medicine Residency Program, dedicating great time and effort to the excellence of our state’s largest internal medicine residency program. He has developed formal curriculum to teach residents the basics of POC ultrasound, and is currently working on the development of a curriculum to teach patient handoffs and transitions in care across the continuum of medical education, including medical students, residents, and faculty. He also provides a vital link between our hospitalists and the internal medicine residency program, facilitating teaching opportunities and ensuring professional and productive collaboration.

Dr. Smock is also a co-director of our 6RC undergraduate student assistant program, providing both essential assistance to our resident internal medicine resident teams in their daily work, and an invaluable healthcare learning experience to University of Iowa undergraduate students. For this he received first place award at the GME Leadership Symposium for Educational Incentives Poster Session. He is also an excellent career mentor to junior hospitalists, in both their academic and professional pursuits. Thank you, Justin, for these and many other teaching contributions.

Leadership for Practice Managers:  Gregory Hamilton, JD
Greg Hamilton is the Administrative Director of the Adult Hospitalist Program and Adult Supportive and Palliative Care Program. He creates, defends, and oversees the $10 million hospitalist budget and manages the supportive staff in hospitalist and supportive and palliative care programs. He started in February 2018 and oversaw the tremendous growth of the hospitalist program from approximately 48 FTE to approximately 57 FTE by January of 2020.

Working closely with our CMO, Teri Brennan, he has obtained preemptive financial support to make sure the hospitalist program has the resources needed to support projected growth in the hospital. It is somewhat unique in healthcare to receive financial support for projected growth in advance of that growth. Greg is able to achieve this remarkable goal because of his diligent work ethic, remarkable integrity, and his success in delivering the hospitalist program under budget every year.

Despite reduction in departmental support services and explosive growth of the hospitalist program, Greg has managed the support services staff to ensure an equitable distribution of an increased workload without overwhelming the support staff.  He provides thoughtful leadership of his support staff and has established a high functioning supportive team based on meritocracy. He actively seeks out resources to reward high performing members with bonuses and raises.

Finally, he leads by example, modeling integrity, persistence, strong work ethic, and stoicism combined with compassion.

Outstanding Service in Hospital Medicine:  Friederike Fischer, MD
Dr. Fischer has indeed delivered outstanding service in hospital medicine in her role as hospitalist at the University of Iowa. She has demonstrated dedication to hospital medicine by receiving her Designation of Focused Practice in Hospital Medicine.

She has served as New Faculty Leader of our program since May of 2018, assisting with on boarding and support of our new hospitalist hires yearly.  She also makes herself available as a resource (at all hours) to our new, and not-so-new hospitalists, regarding questions about hospital policy, delivery of care, logistics, and other essential information.

Dr. Fischer has newly assumed responsibility as Medical Director for our Observation Unit, already making great strides in improving the efficiency and quality of that unit, including a current QI project involving more timely and accurate medication delivery on the unit. She also serves on the Clinical Communication and Paging Committee for safer and more effective communication throughout the hospital. In addition to these more formal roles, Friederike frequently makes herself available to help clinically when census is critically high or to otherwise support her colleagues. She has been acknowledged, by vote, in UIHC’s informal hospitalist awards as our ‘MVP,’ and her performance and commitment support that title. 

Clinical Leadership for Physicians: Niyati Sharma, MD
Dr. Sharma joined UnityPoint St. Luke’s Hospitalist program in 2012. Over the years, Dr. Sharma has been a vital contributor to many aspects of our program. She has made outstanding contributions and shown dedication to improving the health and quality of care for patient’s in need of wound management. Through additional specialized training, Dr. Sharma now serves as the medical director of UnityPoint St. Luke’s Wound and Hyperbaric Center in Cedar Rapids. She and her team specialize in management of diabetic foot ulcers, stasis ulcers, vascular ulcers, among other complex wounds through the continuum of care both inpatient and outpatient. Without specialized treatment these patients are at high risk for secondary infections, repeat hospitalizations, and amputations however through their aggressive efforts the wound care team has achieved a greater than 90% wound healing rate. Her leadership has not only improved the quality of patient care but also has expanded fellow clinician’s clinical knowledge in wound prevention and management. Thank you, Dr. Sharma, for leading this effort to improve quality and excellence in care.

Clinical Leadership for Nurse Practitioners/Physician Assistants: Julia Freel, ARNP
Julia has pioneered the APP triage in ED and has been integral in working on an APP discharge facilitator. She has streamlined our scheduling system and is always willing to shift her assigned service based on team needs. In addition, her patient care is outstanding. She is highly respected by her physician and APP colleagues, and by all members of the health care team. When colleagues think of Julia, they think of compassion, strength, wisdom, and integrity. Thank you, Julia, for all of your contributions.

Excellence in Teamwork: UIHC 6RC Team
Team Members 6RC Internal Medicine Hospitalists (Drs. Bashar Abuqayas, Mehul Adhaduk, Neeru Agarwal, Abbas Ali, Asad Ali, Saeed Ali, Saed Alnaimat, Zabu Aung, Hirva Bakeri, Andy Bryant, Mayy Chahla, Sheena CarlLee, Brian Daniel, Yaser Dawod, Friederike Fischer, Kevin Glenn, Jeydith Gutierrez-Perez, Mariko Hagiwara, Russell Hamilton, Katie Harris, Eric Heller, Carolyn Hilliard, Hisham Ibrahim, Melinda Johnson, Rupesh Kshetri, Carly Kuehn, Ethan Kuperman, Hari Mani, Brad Manning, Bryan McConomy, Aditi Reddy, Danish Safi, Dhaval Save, Suchith Shetty, Justin Smock, Tuncay Taskesen, Sathvika Velur, Dinesh Voruganti, Abdul Wahab, James Willey, Mark Wilson, Ying Chi Yang, Hesham Yasin, Myo Zaw) 6RC MAPPS Team (Brittany Frush, Melissa Mohling, Ellie Krueger, Ellie Lingo, Aimee Foster, Julie Lensing, Harmony Tamboura, Susan Shea, Jenna Nielsen, Julia Freel, Matt Hines) 6RC Pharmacist Stuart Pitman 6RC Social Workers Jessi Williams, Whitney Jost, Danielle Schulte 6RC RN Navigators Catherine Graham and Libby Dillon 6RC Charge RNs, UIHC Discharge Pharmacy, Clerk III, Hospitalist Program, Sherrie Cooling

The 6RC Hospitalist services engage a robust interdisciplinary team that works to ensure all aspects of transitions of care are addressed prior to each patient’s discharge. Within this group, teamwork and communication are essential with each team member contributing their particular skills to produce and execute a medically sound, efficient and safe discharge plan.

What started as an interdisciplinary pilot project in 2015 has now evolved into a daily routine for planning and carrying out patient discharges, including but not limited to, pharmacist-pending of discharge medication orders, social workers ensuring that proper disposition orders are in place, and RN Navigators having follow-up appointment times noted in the discharge paperwork. Also, social workers ensure that nurses and physicians have the appropriate contact information to make transition of care verbal handoffs to community providers. Physicians and advanced practice providers take on the responsibility of having discharge orders and summaries completed prior to patient discharge.

These processes are of significant scope due to the volume of patients discharging each day from 6RC and the number of decision-points that are addressed for each patient. These processes are also of significant magnitude as errors on discharge could lead to re-admissions, suboptimal therapy, or patient harm. Further, this team-based discharge process touches on many of the core competencies in hospital medicine such as Transitions of Care, Team Approach and Multidisciplinary Care, Patient Safety, Patient Handoff, Information Management, and Drug Safety and Communications. Data from the 2015 pilot indicated that time of discharge was reduced by one half-hour. Not necessarily captured in the day-to-day processes but important nonetheless is that increased discharge planning communication and teamwork has also nurtured a positive culture change amongst unit staff.