Year 5. September 28. Hospital Admission: When Patients Need Us the Most, Our Teams Are There
Each day our faculty care for thousands of patients across Southern California. Most of the care provided by our faculty in the UCLA Department of Medicine (DoM), occurs in the ambulatory setting. These efforts promote health and wellness, with the goal of ensuring that individuals lead productive and fulfilling lives. However, each day hundreds of patients develop significant health care challenges that require inpatient hospitalizations. For many, these are challenging and scary episodes during which it is essential to provide exquisite care of the highest caliber, helping individuals return home to their families and communities whenever possible, or when that is not possible, transition to end of life care in a dignified way. For this reason, I shine the spotlight this week on our colleagues in hospital medicine who are on the frontline of inpatient and hospital-based care in our hospitals, and who play a large role in the education of the next generation of physicians in our training programs. This was exemplified last week in the Master Clinician Grand Rounds that presented an incredibly complex and challenging case, where our hospital medicine team, in collaboration with subspeciality services treated, diagnosed and “rescued” a patient who presented with a rare manifestation of an uncommon condition.
As I reflected on framing this week’s note, it is important to convey, that one of things that I value most about our department, is the tremendous contributions that our faculty make towards our missions. The depth and strength of that work is particularly notable in the work led by our hospitalists. Hospital medicine asks a great deal of our faculty, trainees and staff. Hospitalists lead with clinical excellence, thoughtful communication and demonstrate extraordinary teamwork. We are fortunate to count on our hospitalist community who cares deeply for our patients, while also supporting their colleagues, our learners and the continued improvement of how we deliver care. Below, I share a few of the many ways our hospitalists contribute to our department, but more importantly, the culture that they help create in the DoM; one in which people support one another, share what they know and always look for ways to make a difference.
Aram A. Namavar, MD, MS: Building Trust When Patients Need It Most
For Aram A. Namavar, MD, MS, caring for patients at UCLA West Valley is personal. He grew up in the San Fernando Valley and expressed that UCLA has always felt like home. As a hospitalist, he wants to help build the kind of medical center his community can trust and that sense of responsibility shapes the way he approaches patients and families, many of whom he meets for the first time during some of the most difficult moments of their lives.
“I try to start by listening,” he said. “Understanding what the patient and family are worried about, what matters most to them and what they need from us. Sometimes that means sitting down, slowing the conversation and simply being present.” Recently, one family experienced that approach firsthand.
Their loved one was hospitalized at UCLA West Valley while struggling with addiction. In a message shared afterwards, the family described how Dr. Namavar, nurses and social workers treated their loved one with dignity and respect at a time when they feared his addiction would result in judgment. The family noted how Dr. Namavar shared his personal experiences with loss related to addiction because he wanted the patient to understand that he saw him as a person, not a diagnosis. They described how their care team listened, treated them as partners and helped coordinate their loved one’s transition from the hospital to a rehabilitation facility.
“What meant the most to me was hearing that the patient and his family felt seen, respected and cared for as people,” Dr. Namavar said. “Patients struggling with addiction often encounter stigma in healthcare, and no one should feel defined by a diagnosis or by the circumstances that brought them to the hospital.” The family's experience also speaks to the breadth of a hospitalist's role.
Dr. Namavar describes hospitalists as physicians who often bring together the many pieces of a hospitalization. They manage acute and complex medical problems, coordinate with specialists, work closely with nurses and other members of the interdisciplinary team, communicate with families and begin planning for the patient's safe transition from the hospital. But for him, some of the most challenging and rewarding work lies in the relationships built along the way. Those relationships extend to colleagues, too.
Left to right, bottom row: Dr. Aram Namavar, PAC therapy dog Henry, and Dr. Joey Tu.
In reflecting on the family's praise, Dr. Namavar noted the nurses, social workers, case managers, therapists, dietitians, physicians and leaders whose contributions make coordinated hospital care possible.
“I was especially proud that the family recognized the entire team,” he said, “because compassionate care is never the work of one person.” That teamwork becomes particularly important when hospitalization is only one step in a patient's journey.
“A successful hospitalization should not end at discharge,” he said. “Our responsibility is not only to stabilize the acute illness, but to make sure there is a safe and thoughtful plan for what happens afterward.” For Dr. Namavar, the family's message was meaningful not simply because they praised the care they received. They left UCLA West Valley feeling supported and hopeful, with confidence in a team and a hospital serving the community he calls home.
“I feel most fulfilled when I know that our patients received the same kind of care I would want for my own family,” Dr. Namavar said, “not only excellent medical care, but compassion, communication and dignity.”
Hospitalists Bring Procedural Expertise to the Bedside
When a hospitalized patient needs a procedure, timely access can shape what happens next. A central line may be necessary to begin treatment. A lumbar puncture may provide information needed to guide care. For some patients, completing a procedure efficiently can also help them avoid an emergency department visit or hospital admission.
At Ronald Reagan UCLA Medical Center, the Internal Medicine Procedure Service helps make that care available at the bedside. The service brings together a select group of hospitalists who perform ultrasound-guided procedures, including central venous catheter placement, ultrasound-guided peripheral IV placement, paracentesis and lumbar puncture.
The service began in 2015 through a collaboration between hospital medicine and the UCLA Internal Medicine Residency Program. At the time, fewer procedures were being performed at the bedside, and there were fewer experienced clinicians available to perform and supervise them. The team was created to help meet that need while preserving opportunities for residents to develop procedural skills.
Today, the service reflects what its leaders, Gary S. Feigenbaum, MD, and Alexandra M. Glaeser, MD describe as two of the team’s greatest strengths: collaboration and adaptability.
“Our backgrounds as hospitalists enable us to uniquely contextualize a lot of the factors that go into patient care,” they shared.
That hospitalist perspective means considering the procedure within the patient’s larger care plan. The team works closely with inpatient and outpatient care teams, including transplant services, nurses, medical students, trainees and other physicians. By bringing procedures to the bedside, the service aims to provide care in a comfortable setting and at the time patients need it.
Colleagues have seen the difference that responsiveness can make. One clinician recalled caring for a patient with progressive lymphoma, liver failure and a fungal bloodstream infection who urgently needed both a temporary central line and dialysis access. The Procedure Service responded proactively.
“This wasn’t the first time they have gone out of their way for our patients,” the colleague shared. “We’ve seen this kind of responsiveness and thoughtfulness from them multiple times, and it really highlights how much they care, not just about the procedures, but about our patients and the team as a whole.”
The procedure service has also studied its own impact. The team has published findings showing decreased wait times for patients receiving intrathecal chemotherapy and more timely outpatient care for CAR T-cell therapy patients who need central lines. Team members also travel to nearby outpatient clinics to perform procedures that might otherwise require patients to visit the emergency department or be admitted to the hospital.
I should note that in addition to being senior authored by Drs. Feigenbaum and Glaeser, both publications had Ghadi Ghanem, MD, one of our UCLA internal medicine residents, as their first author, underscoring the important role that the hospitalists play in the education of trainees. Ghadi will be joining us as a hospitalist next year, a fitting example of the impact of mentorship in his career development.
As recognition of the service’s value grew, and with continued support from the department of medicine, its coverage expanded to every day of the year. The team now includes 10 practitioners supporting inpatient care at Ronald Reagan UCLA Medical Center and several outpatient practices. Its leaders remain focused on refining the service and responding thoughtfully as new needs emerge.
Education continues to be central to that work. Interns and residents rotate with the team, gaining experience in bedside procedures while learning from hospitalists who understand how each procedure fits into a patient’s broader course of care.
Nearly a dozen years after the service began, its growth reflects the commitment of hospitalists who saw an opportunity to improve care and stepped forward to meet it. Drs. Feigenbaum and Glaeser are proud of what their colleagues have built and of a team that continues to be guided by a practical question: What do our patients, learners and clinical partners need from us now?
Hospitalist Educators: Shaping the Next Generation of Physician Leaders
As illustrated by Dr. Namavar and the procedure service team, hospital medicine asks physicians to bring together many parts of patient care at once. While our hospitalists are managing acute illness, they are also responding to rapidly changing clinical situations, communicating with worried families and preparing for a patient’s transition from the hospital, often from the moment they first meet.
For hospitalists who teach, that complexity makes the inpatient setting an especially meaningful classroom.
Hospitalist education LEADERS Edward Lee, MD, Wendy M. Simon, MD, Rachel P. Brook, MD, Michael F. Ayoub, MD, Casey Kaneshiro, MD, and Kelley Chuang, MD, bring a generalist’s perspective to residency education. Collectively, they describe hospitalists as specialists in the full arc of inpatient care, from the clinical reasoning that guides a diagnosis to the communication and coordination that helps patients move safely through hospitalization and into the next stage of care.
Some of those lessons unfold during urgent clinical decisions. Others emerge through the quieter and sometimes overlooked work of medicine such as reconciling medications, coordinating equipment, navigating social circumstances and making sure a safe plan is in place after discharge. Together, these experiences allow residents to see excellent care not as a single decision or intervention, but as a sustained commitment to the whole patient.
Through their work with residents, our hospitalist educators encourage learners to look beyond simply focusing on finding the right answer, but to always seek to understand the why behind clinical decisions, to communicate it clearly to our team members and patients and remain open when the path forward is not entirely clear. Hospitalists also try to model the willingness to say I don't know, because honest uncertainty not only prevents premature closure, but can build more trust than false confidence ever will.
Their teaching also emphasizes the importance of assuming good intent. A frustrated page or an unclear handoff can be approached with curiosity rather than defensiveness, grounded in the understanding that everyone involved is working toward the same goal. Residents learn to advocate for their patients while respecting the knowledge and contributions of colleagues across nursing, pharmacy, social work, case management and other disciplines. The educators recognize how easily one difficult interaction, or unexpected outcome can overshadow everything that went well during a day. “One of the things we can do for each other and for our residents is make sure no one goes home carrying that alone,” they shared.
This generosity is reflected throughout the hospitalist group. Hospitalists lead noon conferences and simulation sessions, teach procedures and point-of-care ultrasound, and serve as mentors and coaches at every stage of training. Many make these contributions without holding a formal educational title. They show up because they believe in medical education and in the responsibility of preparing the physicians who will follow them.
These six leaders are proud of that collective commitment. They are also grateful for the direct-care hospitalist teams whose work helps sustain a strong learning environment on the teaching services. Education, like hospital medicine itself, depends on colleagues contributing in different but complementary ways.
Their work with residents has enriched these hospitalist educators in return, challenging them to remain curious, reconsider familiar approaches and reconnect with the purpose that drew them to medicine.
“Our residents show up every day and night and inspire us with their dedication to our patients,” the educators shared. “They ask sharp questions, bring in the latest literature, quote the newest guidelines and push us to articulate why we do things the way we do. Learning flows in every direction when the environment is right. We believe the attending’s role is to cultivate that environment, not simply to occupy the top of it. Their enthusiasm and accountability remind us, what drew us to this work in the first place.”
Ultimately, these educators hope residents leave prepared to approach patients thoughtfully, work alongside colleagues with humility and respect, communicate uncertainty honestly and remain curious throughout their careers.
Through their leadership and the collective contributions of hospitalists across the DoM, they have a critical role in shaping the future of medicine, one learner, one lesson and one act of support at a time.
Transforming Inpatient Care Through Quality and Collaboration
Physicians train for years to care for the patient in front of them. Quality improvement asks them to widen that view and consider how the systems surrounding each clinical encounter can help every care team deliver its best.
For Erin P. Dowling, MD, and Wendy M. Simon, MD, co-directors of UCLA Department of Medicine Inpatient Quality, that broader perspective strengthens the conditions in which bedside care takes place.
“Quality improvement allows us to think more broadly about putting systems in place that help physicians and teams show up each day and give their best,” they shared.
One recent initiative focused on documenting conversations about patients’ goals of care. Hospitalists identified this as an important area they could influence, helping ensure that care aligns with patients’ wishes. Because these conversations may occur at different points during a hospitalization, a group measure was incorporated into the hospitalist quality incentive program to reflect their shared responsibility.
Over two years, rates of goals-of-care documentation improved significantly for patients at UCLA-affiliated hospitals and those cared for by DoM hospitalists in community hospitals, while maintaining the quality and content of the note. The experience reinforced the importance of aligning improvement efforts with frontline values, communicating transparently and using shared measures to support change.
That frontline perspective guides the team’s broader work, which includes physician engagement and performance feedback, transitions of care, clinical pathways, mortality and safety, and patient flow. Before designing an intervention, the team works to understand why the current state exists, gather hospitalist input and identify measures that can show whether the work is making a difference.
Effective improvement also requires teams to look beyond traditional boundaries.
“The patient experience does not consider department org charts or the physical walls of buildings,” Drs. Dowling and Simon said. “In order to design improvement projects that will truly be impactful, we must consider the patient journey of care and build teams that reflect that experience.”
That includes engaging interprofessional colleagues and incorporating the patient voice early in the process.
Quality also encompasses the experience of those providing inpatient care. Drs. Dowling and Simon participate in multicenter studies examining how hospitalist workloads and work design affect patient and provider outcomes. Studying factors such as hospital census, shift structures, staffing models and time spent on different tasks can help inform systems that support high-quality care and a healthier work experience.
“The people delivering inpatient care drive all the other quality outcomes,” they shared.
Drs. Dowling and Simon are particularly grateful for the hospitalists who listen to new ideas, participate in surveys and provide candid feedback about what is working and what needs to change. They describe our hospitalist colleagues as committed to excellent patient care and open to new ways of making that care safer, more efficient, equitable and patient-centered and I couldn’t agree more.
New Hospitalist Onboarding Program: Building Community on Day One
Before a new hospitalist begins their first shift with the DoM, Michael F. Ayoub, MD, William P. Cope, MD, Khushboo Akkad, MD, and Jiyeon M. Jeong, MD, want them to be secure in two things. First, they are prepared for the work ahead, and second, they have colleagues ready to support them.
That sense of welcome is central to the UCLA Hospital Medicine Onboarding Program they are leading. More than 40 hospitalists join the DoM each year and are assigned across multiple cohorts and hospitals throughout Southern California. Each location has its own services, schedules and workflows, making preparation essential.
Under the leadership of Drs. Ayoub and Cope, the program begins with an intensive two-day, in-person introduction to hospitalist practice. New faculty meet physician leaders, administrative staff and one another while learning the foundations of their new roles. Virtual sessions provide detailed introductions to individual service lines, followed by hospital tours and practical guidance closer to each hospitalist’s start date.
In the department, we recognize the importance of ongoing support throughout the year. Through the UCLA Department of Medicine Professional Group (DMPG) onboarding curriculum, new hospitalists connect with faculty from across the department, learn about available resources and participate in hospitalist-specific sessions addressing the challenges of inpatient practice. At Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center, each new hospitalist is paired with a peer practice partner who is available during their first shift to help answer clinical or logistical questions. Other cohorts similarly connect new faculty with experienced colleagues.
In addition, new hospitalists are provided with peer coaching sessions through the UCLA Department of Medicine Peer Coaching Program. Drs. Akkad and Jeong are hospitalist peer coaches who meet individually with hospitalists to help them meet their career goals, whatever those may be.
After welcoming more than 40 hospitalists each year, the onboarding leaders recognize that no curriculum can anticipate every question. What matters is ensuring new colleagues know that they can ask.
“New faculty need to feel welcome and comfortable reaching out to colleagues and mentors when questions arise,” they shared.
Ultimately, the team hopes new hospitalists understand that our culture centers on excellent patient care, teamwork, education and service. They also want each person to find opportunities to contribute their own interests and passions to a career in academic hospital medicine.
By helping new hospitalists feel prepared, connected and valued from the beginning, Drs. Ayoub, Cope, Akkad, and Jeong are doing more than introducing colleagues to a new workplace. They are welcoming them into our community and helping them discover how they can contribute to its future.
Brenda Sanz: Supporting the People Behind Hospital Medicine
Much of what makes a large hospital medicine group work, happens outside the moments patients and families see. Faculty must be recruited and onboarded, appointments and promotions supported, budgets managed, resources allocated and countless operational and administrative questions addressed along the way.
For section administrator Brenda Sanz, that behind-the-scenes work has a clear purpose: creating the structure that allows faculty to focus on patient care, teaching, research and their own professional growth.
“The administrative team plays a central role in connecting people, processes and resources to support the division’s operations and the success of its faculty and staff,” she said. “While much of this work happens behind the scenes, its impact is reflected every day in the care provided to our patients.”
That work depends on close partnership. Brenda and her administrative colleagues work alongside faculty and staff as well as partners across hospital leadership, human resources, finance, quality, IT and academic personnel.
“I enjoy being a resource, finding solutions to challenges and supporting initiatives from start to finish,” she said.
She is particularly proud of the hospital medicine administrative staff and the ways they have grown together as a team. Their support can take many forms, from helping faculty navigate questions to celebrating one another through Cheers for Peers recognition and team-wide messages acknowledging accomplishments.
For Brenda, those gestures are important because they help create a culture in which people feel appreciated and supported.
Her connection to health care is personal, too. Growing up with a physician father, Brenda saw the impact health care professionals could have on patients, families and communities. What has sustained her own career is the opportunity to work alongside people united by a commitment to excellent patient care and to one another.
“Seeing both our faculty and staff thrive through these shared efforts is what makes this work so meaningful to me,” she said.
In closing, I want to acknowledge and thank the directors of our hospitalist section, Linda K. Czypinski, MD and Neveen S. El Farra, MD for their leadership. Their advocacy for patients, their colleagues and commitment to creating a culture of collaboration within their group and across the department contributes importantly to our efforts to strengthen and support the members of the hospital medicine section and their mission critical contributions to our department and health system.
Dale
P.S.
A few weeks ago, I posed a riddle challenge, centered on solving Dr. Brent’s age, based on the Davinci Code.
I promised to take the person who submitted the correct answer to coffee, and this week I had the pleasure of doing so.
I had the privilege of having coffee with Shehan (Shey) DaSilva who works as a member of the DoM’s Research Administration Team. It was fun getting to learn about Shey’s journey to UCLA, his work here and of course, how he solved the puzzle!
Here are some of the things that Shey shared with me:
Shey was born in Sri Lanka and previously worked in airline dispatch in Dubai, before emigrating to the US with his wife. Although he enjoyed working in the travel business, during the pandemic he realized that his analytic skill set could be leveraged in a different career, that was potentially less volatile. He is glad that he received the opportunity to join the DoM and loves his work supporting our research faculty and managing and supporting multiple and complex grant portfolios. It was clear from our conversation how passionate he was about our department’s research mission and the “small” role that he plays in ensuring that it remains robust.
Shey shared the following note with me afterwards.
“Thank you for inviting me for coffee this morning. I truly appreciated the opportunity to spend time with you and enjoyed our conversation.
I also wanted to share my thought process in solving the riddle. The image you shared immediately caught my attention because the location looked very familiar. Once I recognized it was Rosslyn Chapel, I knew the movie referenced was The Da Vinci Code, since the chapel plays a key role in the film’s ending. I had the opportunity to visit Rosslyn Chapel in 2015 during a trip to Scotland. I enjoy visiting filming locations when I travel, which made the clue especially memorable.
Having recognized the location, I decided to answer the riddle a step further. Drawing on my catechism background, I did some additional research and found references indicating that the number most commonly associated with 12 in both the Gospels and rabbinic writings is either 70 or 72. Based on the information I found, I made my best guess and submitted 70 as my final answer.
After submitting the answer, I told myself that even if my answer turned out to be incorrect, I was happy to have participated. Besides, if 72 happens to be the correct answer, perhaps Dr. Brett will be pleased that I made him two years younger! 😊
Thank you again for taking time out of your busy schedule to meet with me. I greatly appreciated the opportunity and enjoyed both the conversation and the riddle.
Best regards,
Shey
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