Letter from the Editor


Until recently, sepsis care was fairly clear-cut, with most physicians feeling confident that early goal-directed therapy (EGDT) was the preferred route to best care. Then 2 studies found that EGDT might not be superior after all, causing some turmoil in the field. But there was some good news, too, experts said: The studies also showed that although there may be some confusion about protocols, sepsis care overall is very effective. In our cover story, Stacey Butterfield looks at the new research on EGDT and on other areas of sepsis care, such as fluid resuscitation, and talks to experts about how it might lead hospitalists to modify their practice.

Comanagement has become a bigger and bigger part of hospitalists' work, making good relationships with specialist and subspecialist colleagues more important than ever. A formal comanagement agreement can help avoid problems by spelling out expectations in advance. Our story offers expert advice on how to establish a comanagement program, how to handle conflicts, and how to make sure lines of communication stay open.

Providing high-value care in the hospital, as elsewhere, involves balancing the benefits of an intervention against its harms and costs. And it's important to introduce these concepts at the beginning, with doctors-in-training. In our story in this issue, leading academic hospitalists and educators discuss how they teach high-value care to students, interns, and residents, as well the importance of modeling this behavior themselves. Read our story to learn more.

Initiatives to improve nursing home care, especially in patients with dementia, have taken off in recent years, with more of a focus on reducing medication use and promoting patient-centered care. We look at some ways physicians can make sure that patients' goals are being met in long-term care and skilled nursing facilities, such as taking age and cognitive status into account when applying treatment plans and taking time to learn what a patient was like before he or she developed dementia.

Questions about smoking are fairly standard for cardiac patients, but questions about secondhand smoke exposure should also be on the table, according to a recent study. Researchers found that although almost one-quarter of nonsmoking cardiac patients had been exposed to secondhand smoke in the 30 days before admission, around 17% said they had been asked about such exposure and fewer than 2% said they had been told that their environments should be smoke-free. In our Q&A, the study's lead author explains the significance of the findings.

Has sepsis care changed in your hospital? How do you make comanagement work? Let us know.

Sincerely,
Stacey Butterfield
Editor-in-Chief, ACP Hospitalist