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As hospitalist roles surge, mastering consultative and perioperative care has become a career essential. Gain the proven frameworks and clinical confidence to navigate complex surgical co-management and specialist consultations, leading to safer patients and smoother workflows.
Bundle
 42.5 CME available  42.5 ABIM-MOC available  42.5 Participation available
Hospitalists are the fastest growing portion of the physician work force. Some estimate there will be 50,000 hospitalists needed in the next 10 years. As the number of hospitalists grows, so too will the clinical settings in which we practice. Consultative medicine is a service provided by many hospitalists, and a future in which almost all surgical patients are co-managed by hospitalists is already a reality for some. For many of us, our training in consultative medicine during residency was limited. We hope this curriculum will help you to feel more confident about your knowledge and skills and will lead to better patient outcomes. We welcome your comments and suggestions for future topics.
Bundle
 26 CME available  26 ABIM-MOC available  26 Participation available
Atrial fibrillation is the most common arrhythmia in the postoperative period. It is important that hospitalists understand the current management of postoperative atrial fibrillation (AF) because it is a frequent reason for consultation. Postoperative AF after noncardiac surgery has been associated with risk of thromboembolism, myocardial infarction, and mortality. The following activity addresses the incidence, natural history, risk factors, prevention, clinical significance, evaluation, and management of newly diagnosed postoperative AF after non-cardiothoracic surgery.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Ensuring optimal nutrition for the hospitalized patient is a complex issue fraught with several pitfalls for clinicians as they asses the patient’s nutritional status and determine the caloric needs and appropriate delivery method. Many factors need to be considered when creating this patient-specific plan. The following activity discusses these issues and outlines the various dietary formulations (ie, oral, enteral nutrition, and parenteral nutrition). Step-by-step guidance for how to implement a nutritional plan for the different types of hospitalized patients that hospitalists encounter also is provided.
On-Demand
 2.5 CME available  2.5 ABIM-MOC available  2.5 Participation available
Although obstetricians play the most critical role in the health of a pregnant woman and her fetus, the internist’s skills are also often needed to assure their health. From caring for chronic medical illnesses during pregnancy to diagnosing and managing acute medical complications of pregnancy, the internist must comfortably practice obstetric medicine. The following activity discusses these important topics and explains how to provide a cost-effective and evidence-based preoperative evaluation of a pregnant patient. In addition, a discussion of the use of appropriate intraoperative and postoperative interventions and methods for employing an evidence-based approach to prescribing medications in pregnant patients is included.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Hip fractures are a frequent cause of hospitalization in the elderly population. As the population continues to age, the incidence is expected to increase. Since many patients with hip fracture suffer from multiple medical comorbidities, hospitalists play a critical role in their care. Management of these patients requires knowledge of multiple consultative medicine topics including preoperative cardiac and pulmonary risk stratification and reduction strategies, venous thromboembolism prevention, and diagnosis and management of common postoperative complications. Open lines of communication between the hospitalist, surgeon, and anesthesiologist are essential to optimize patient care.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Obstructive sleep apnea (OSA) has an increased incidence in the surgical population compared to the general patient population. The link between OSA and cardiac disease has been well established, although sleep apnea has also been associated with several other postoperative complications, the most feared being respiratory arrest. The following activity discusses these aspects of OSA and the different screening tools available to clinicians. A discussion of the logistical barriers to managing OSA and the options for treatment is included to help hospitalists successfully identify and manage these patients during the perioperative period.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Hyponatremia is the most common electrolyte abnormality that occurs in hospitalized patients, and it is recognized as a serious in-hospital complication. It is a complex electrolyte disorder that results mainly from water imbalances and dysregulation of arginine vasopressin. Hyponatremia is associated with increased morbidity and mortality among geriatric patients and patients with heart, liver, or neurologic diseases. The following educational activity discusses the pathophysiology of hyponatremia, outlines methods for differentiating the cause, and provides examples of how to manage hyponatremia in various situations commonly faced by hospitalists.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Therapeutic advances in cancer therapy have led to an increase in the number of patients undergoing surgery as part of their cancer treatment. These patients present several unique challenges, including weighing risks against adverse effects of delaying time-sensitive treatment and taking the patient’s cancer and its treatment into account when determining postoperative management. The following activity discusses these topics, with an emphasis on cardiovascular and pulmonary toxicities of radiation and chemotherapeutic agents as well as common hematologic problems encountered in patients with cancer or a history of cancer treatment.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Successful neurosurgery co-management requires hospitalists to be familiar with the presentations, disease processes, management, and complications of neurosurgical inpatients. The first section of this activity summarizes common inpatient neurosurgical conditions. The second section prepares the reader to recognize and act on neurosurgical emergencies. The remaining four sections of the activity cover blood pressure management in patients with subarachnoid hemorrhage, sodium abnormalities in patients with brain tumors, the use of mannitol vs. dexamethasone, and the perioperative management of anticoagulants, in addition to other topics.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Perioperative fever has multiple possible etiologies, including infections such as pneumonia, fungal infections, central-line associated infections, and urinary infections. By understanding the typical time frame and common risk factors for each etiology, hospitalists and other perioperative consultants can develop a differential diagnosis for perioperative fever. The following activity will provide a general approach for determining the differential diagnosis in patients with a perioperative fever, as well as an outline of the diagnostic and treatment modalities.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Surgery in patients with primary adrenal insufficiency can precipitate acute adrenal insufficiency, a potentially life-threatening complication. Acute adrenal insufficiency, however, can be prevented by the perioperative administration of a short activity of stress dose steroids. Patients with secondary adrenal insufficiency due to exogenous steroid administration may also be at risk for perioperative acute adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal axis. When these patients present for preoperative evaluation, the risk for acute adrenal insufficiency must be weighed against the risk of administering higher steroid doses in the perioperative period. Inconsistencies in the published literature and the widespread use of perioperative dexamethasone can make decisions about perioperative stress dose steroid administration challenging. The following activity suggests a rational strategy for the perioperative management of both patients with known adrenal insufficiency and those at risk for hypothalamic-pituitary-adrenal axis suppression due to exogenous steroid administration.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This activity, which focuses on the noncritically ill patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss which medications are best for controlling blood glucose levels in the hospital. A thorough discussion of how to determine the appropriate insulin dose and develop an insulin regimen for hospitalized patients is provided, as well as strategies for developing a discharge plan for patients on insulin.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This activity, which focuses on the critically ill hospitalized patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss how to formulate preoperative and postoperative intensive care unit plans. In addition, a thorough review of the evidence for intraoperative glycemic control and a discussion of how to transition patients off of an insulin drip are provided.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Although general internists and subspecialists are familiar with prescribing and managing medications in typical outpatient and inpatient venues, the perioperative period represents a challenging and often unfamiliar setting. This activity will outline the principles, available evidence, and expert opinion to be considered when making perioperative management recommendations for some of the most commonly prescribed medications.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Preoperative testing can provide valuable information to identify patients who are at high risk for perioperative complications and reduce perioperative morbidity and mortality; however, there is little benefit from routinely testing patients who are known to be at low risk. The objectives of preoperative testing are to identify patients who are at high risk for perioperative complications, assess the severity or stability of existing medical problems, and evaluate abnormal symptoms or signs detected during the preoperative assessment. This activity discusses the common challenges and pitfalls of preoperative testing, describes how pretest probability influences the decision to order preoperative tests, and identifies appropriate indications for laboratory, radiologic, and other forms of preoperative test screening. The selection of appropriate screening tools to identify patients at high risk for specific perioperative complications and the use of post-test probability to select and interpret preoperative diagnostic testing is also examined.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Patients with cirrhosis who undergo surgery are at increased risk for complications. Perioperative morbidity and mortality vary depending on the severity of cirrhosis, type of surgery, and whether it is elective or emergent. Identification of cirrhosis and accurate assessment of severity can be challenging but is necessary for case selection, informed consent, and anticipation of potential complications. Inaccurate risk assessment can sometimes lead to inappropriate exclusion of patients with cirrhosis from receiving useful surgery, as well. For instance, reliance on the Child-Pugh score alone likely significantly over-estimates perioperative mortality in patients with cirrhosis undergoing most procedures. This activity identifies updated tools for perioperative risk prediction, outlines the most important elements of preoperative evaluation and optimization, and assists in formulation of pre- and postoperative care plans for patients with cirrhosis. Though our main focus is on cirrhosis, we will also touch on some important topics related to other acute and chronic liver disease.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Surgical site infections (SSIs) are a major cause of postoperative illness, longer hospitalization, and increased healthcare costs, making the prevention and treatment of SSIs an important aspect of patient care for hospitalists. The following activity outlines patient and procedural factors that increase the risk of SSIs, examines the basic principles of antimicrobial prophylaxis for SSI, reviews nonantibiotic interventions to lessen the risk of SSI, and outlines evaluation for and treatment of an SSI. In addition, a discussion of the controversy surrounding preoperative decolonization of Staphylococcus aureus is provided.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Prophylaxis for deep vein thrombosis (DVT) and pulmonary embolism (PE), together referred to as venous thromboembolism (VTE), must be addressed for every patient going to the operating room. Multiple guidelines are available to assist choosing the correct prophylactic agent for each patient and type of surgery. The American College of Physicians (ACCP) guidelines have been one of the standards for hospitalist for decades but was last updated in 20121 and recommendations and suggestions are based on the type of surgery. The American Society of Hematology (ASH), which put forth their first guideline in this field in 20192, took a broader and slightly more universal approach to prevention strategies. The authors of this activity bring forth a blended approach of these two guidelines with an emphasis on the newer guideline.
On-Demand
 2 CME available  2 ABIM-MOC available  2 Participation available
Acute kidney injury (AKI) is an important complication following cardiac and noncardiac surgery. Up to 18% of hospitalized patients develop AKI, and those who are critically ill have an even higher risk. Comparatively, the incidence of AKI in the perioperative period is 18-47%<sup>1</sup>. Patients with even modest increases in their serum creatinine have increases in their mortality, morbidity, length of stay, and hospital costs. Perioperative AKI is associated with an increased risk of sepsis, anemia, coagulopathy, and mechanical ventilation. Notably, mortality is higher in patients with perioperative AKI even after complete renal recovery<sup>1</sup>. Perioperative AKI correlates with type of surgical procedure, patient characteristics, volume status, hemodynamics, and exposure to nephrotoxins. Presurgical risk stratification and early risk mitigation is extremely important to avoid injury and need for renal replacement therapy (RRT). The following module defines perioperative AKI, identifies specific risk factors and tools for risk stratification, provides an overview of the workup of perioperative AKI, and evaluates various renal protective strategies that can be implemented during this high-risk period.
On-Demand
 No Credit
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