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Hospitalist Happenings¶
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UNC Division of Hospital Medicine Newsletter¶
Volume 26, Issue 15¶
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| | | Quality Improvement and ResearchUNC Institute for Healthcare Quality Improvement (IHQI) Concept Letters. Congratulations to Nelly Bellamy and Nick Piazza for having their IHQI concept letters accepted for full grant proposals. Nelly’s proposal involves a project to increase SAFE reporting among attendings and house staff. The goal of Nick’s proposed project is to improve early recognition and prevention of hospital-acquired pressure injuries. Final proposals are due March 13th and award decisions are usually released in early June.¶
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Final proposals are due March 13th and award decisions are usually released in early June.Good luck Nelly and Nick!
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| | | | | | | | | | | | SHM Converge will be Here Soon (March 29th to April 1st)! Don’t wait until the last minute to register and make travel arrangements.We have several research and innovation abstracts from our division that were selected for poster presentations.¶
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| | | Hospital Medicine Support for Scholarly Activity Escher Howard-Williams has protected time to help folks write manuscripts and abstracts for their projects. Over the past year, Escher has worked with faculty to support and publish several manuscripts and abstracts. Escher is amazing and has been a great resource for the HM Division. Let me or Escher know if you have a project you’re considering for publication. We can discuss how best to utilize Escher’s time to get your work published. Please see below for information that’s helpful for Escher to know for her to speed up the process.¶
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| | | | | | | | | | | | -Carlton Moore, MD, MS , Associate Chief for Research and Quality Improvement¶
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CDI Corner: Hospital Acquired Pressure Injuries (HAPI) / Acute Skin Failure
In the spirit of keeping everyone HAPI (sorry, mandatory dad joke), here are a few quick documentation tips:
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1.) Capture POA status - If a wound is present on D1 of the hospitalization, please explicitly document that it is present on admission (POA) and clearly state the anatomic location. When this isn’t clearly written and there is disambiguate later in the admission on when exactly the wound popped up, wounds can unintentionally be classified as hospital-acquired. This is especially critical for patients who may transfer in from outside hospitals where wounds may have developed.
2.) Get a photo uploaded to media tab ASAP - Early photography is incredibly helpful. Every nursing unit has a unit iPhone (they are called “Rovers”) that can be used to photograph wounds and upload them directly into the chart. It is within the scope of admitting nursing to do this. Getting a photo early — even before a WOCN consult — can prevent a lot of downstream uncertainty.
3.) Device Related? It’s also helpful to document whether a wound is device-related (nasal cannula, ET tube, cervical collar, tubing, etc.), as this meaningfully affects how the wound is classified.
Finally, a quick plug for acute skin failure. Many of us weren’t formally taught about this diagnosis - I know I wasn’t - and it’s not something that gets talked about a lot, but it is probably more common than we are documenting it.
In patients with sepsis, shock, or other hypoperfusion states — especially when other organs are failing — the skin can fail as well. Just as we see shock liver or ATN in sepsis, skin failure is a real entity. These wounds often appear in dependent areas like the sacrum and can look indistinguishable to pressure injuries, so thoughtful clinical assessment and documentation matter. It is a clinical diagnosis - If you suspect Acute Skin Failure as the etiology / partial etiology of a wound, please document so.
Thanks for helping ensure that what we’re seeing clinically is accurately reflected in the chart — it truly makes a difference!Side note, if I haven’t lost you at this point, and you might be interested in QI work around HAPI / Skin Failure, let me know - we’ve got something in the works!
-Nicholas Piazza, MD , Associate Professor of Medicine
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| | | View from the Ninth Floor February 26, 2026 Exactly a year ago, in my February contribution to the newsletter, I highlighted several Throughput efforts all in a pilot stage or just starting: the change back to team-based care management, the Enteral Access Specialist, the revamped TPN team and Throughput Specialist. Shortly after, the GIP Inpatient Hospice program also expanded from the ICU to all locations. All of these were built to address barriers identified by the Physician Advisor team as frequent roadblocks to discharge.¶
| | | | | | | | | | | | Fast forward to 2026 and all of these investments driven by the Forward Together 2030 strategic plan have matured or even expanded. In my new role as sponsor for Throughput work across the Medical Center, I have gotten to see both the data showing how these efforts are working and the ongoing efforts to improve the other pain points for our providers that I wanted to highlight here.¶
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| DOM (exc C/E/I) | 2023 | 2024 | 2025
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Average LOSi | 1.20 | 1.19 | 1.09
Discharges | 7595 | 8682 | 9553
| | | | | | | | | | | | Let’s start with the successes. If you look at quarterly data for all DOM services excluding Cardiology, ICU and Hematology/Oncology, you see a significant sustained drop in LOSI and steady increase in total number of discharges over the past year. In the last quarter, UNC rose nearly 20 spots into the 3rd quartile amongst the 120 Comprehensive Academic Medical Centers in the Vizient LOS benchmark. The work on our outliers has been particularly noticeable, with a marked reduction in the very long-term patients we used to collect on our teams.¶
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On MDH yesterday, there were only 2 patients with a LOS > 1 month and including MDX only added 4 more. This number used to be consistently between 10-20 across the 2 services (despite a lower total census).
But UNC Medical Center aspires to be better than current state and is targeting a LOS index in the top decile of our peers by the target date. It won’t be easy, and to make those next leaps, we need to get all areas of our operations thinking about and working on patient flow as much as we have been. It has been exciting to see the work coming in the next wave of initiatives. To hit that level of achievement will require good data and our operational leaders can now easily see real-time turnaround times for VIR, GI procedures, Radiology, ECHO, SNF and home health placements, new patient and follow up appointments. Once you have the data, you can create plans to address the gaps.
You may have already noticed the work from Operational Efficiency partnering with the lab to have more reliable phlebotomy morning draws. Radiology has set ambitious targets for turnaround times for studies and is actively working to achieve them, increasing support to help avoid failed MRI studies due to inadequate sedation, purchasing software to speed MRI acquisition times by half, and improving scheduling to minimize downtime and move non-urgent studies to the outpatient setting. Similar work in VIR is ongoing.
Care management has engaged support to re-evaluate our IDR process to improve the efficiency and efficacy of those meetings and to ensure all teammates are following standard processes and best practices to identify discharge needs earlier, create parallel planning and use available resources to mitigate barriers. I noted the changes at IDR last week on Dogwood as the CM had already arranged Bipap at the SNF days before the patient was medically ready.
The revamped Access Center now has the ability to schedule patients into many primary care and specialty clinics across UNC Health. This means that referrals no longer need to be targeted to a clinic to hit a scheduler’s work queue and we should be placing discharge referrals as soon as we know we will need them. A referral order with new radio buttons (i.e Urology) means the specialty has created heuristics to allow appropriate patients to self-schedule and this feature will be spreading across other specialties in the months to come. The Access Center will be part of a coming project to readily identify patients who need hospital follow-up and have that information hit a shared work queue to ensure the patient gets scheduled for a time within 7 DAYS! We have talked about efforts to get patients reliably scheduled for post-hospital follow up for years, but I am starting to believe this one may stick.
At the same time, I have also been involved in numerous conversations about the difficulty of hospital medicine work in general and of the “Trees”, our MDH direct care teams at the Medical Center, in particular. We’ll talk more that challenge in my next installment, but I will say for now that I remain hopeful that improvements like these that make it easier each day to provide top quality care will go a long way to keeping hospital medicine a sustainable, meaningful practice.
| | | | | | | | | | | | Congratulations to Jon Heath! He won the MSPEC Award for Physician Excellence in Clinical Care this year, an incredible honor recognizing 3 physicians across the entire medical staff for unwavering commitment to compassionate, high-quality patient care, leadership in clinical education, and dedication to service across the UNC Health system and beyond. He will be recognized at Medicine Grand Rounds on March 5th and I hope you all can be there to support him.¶
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| | | | | | | | | | | | -David Hemsey, MD, Division Chief, Hospital Medicine¶
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| | | Taylor’s Updates and Reminders
Please see the information below regarding upcoming fit testing opportunities. This is an annual requirement for all patient facing staff and providers, so now is a great time to make sure you’re up to date and compliant. I’m also advocating for additional slots and locations (including Hillsborough). In the meantime, please review and take advantage of the options listed below.
| | | | | | | | | | | | Current Fit Testing Options - More pop-up clinic options are coming soon! We are awaiting further train-the-trainer dates and will have a lot more options available beginning the weeks of March 9th and 16th.
- University (School of Medicine) Faculty
- Healthcare System Providers and Staff
You should NOT be asked for payment, but if you are for some reason, please let them know to charge the expense to CFS:¶
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| | Let us know if you have any questions or need any help with getting signed up!¶
| | | | | | | | | | | | Remember to complete your TeamSTEPPS training if you haven’t already. This should be done by June 2026. You can click the button to register. Let someone from our admin team know if you’re having any issues completing it.¶
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| | I am sure you have all received the email notifications but want to make sure everyone is aware that surveyors from both Joint Commission (2/24-2/25) and DHSR are onsite. Both Main Campus and Hillsborough.
Surveyors from the Division of Health Service Regulations (DHSR) have returned to our Chapel Hill campus as part of an unannounced survey Monday, Feb. 24 and will likely stay through the remainder of the week. Updates will be added to this page as they become available.To my understanding DHSR Surveyors are requesting to interview UNC teammates. If you are asked to interview, please make sure to loop both Dave and me in so we are aware of any requests to interview. We are here to support you in any way that we can!
-Taylor Herndon, MHA , Associate Chief of Administration, Divisions of Hospital Medicine and Geriatrics
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| | | | | | Please email Sharon Baker ([email protected]) if you would like to recognize a fellow peer, share a personal work achievement, family/coworkers photos, or submit an announcement to be featured in future newsletters.¶
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| | Copyright (C) 2026 UNC Division of Hospital Medicine. All rights reserved.
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