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PubMed2005

Hospitalists: a chief nursing officer's perspective.

The hospitalist "specialty" is sweeping the inpatient setting with numbers of physicians choosing this specialty expected to exceed 20,000 by 2010. Yet, little is known about the involvement of nursing in the design, implementation, and evaluation of a hospitalist initiative. The author suggests the chief nursing officer's pivotal role in proactively encouraging the design and implementation of a hospitalist-nurse manager patient-centered care delivery model. The chief nursing officer can create an environment to foster research designed to identify outcomes from this partnership of hospitalist and clinical (nurse) manager.

Communication↗
PubMed2005

Determining the professional attributes of a hospitalist: experience in one Australian metropolitan hospital.

Data were prospectively recorded on 1294 consecutive patients admitted to a General Medical Unit at the Gold Coast Hospital to review the caseload and pre-requisite professional skills of a general physician working as a full-time hospitalist. Based on this review, the general physician hospitalist must possess expertise in the management of common medical conditions and comorbidities, uncommon medical conditions, elderly patients, the seriously ill, the terminally ill, psychiatric patients, surgical patients and patients with dermatologic, ophthalmic and gynaecological problems. The hospitalist must also be proficient in medical education and organization governance. The demonstration of such skills ensures the 'hospitalist' model is efficient and effective for hospital-based care.

Aged↗
PubMed2004

Hospitalists as teachers.

OBJECTIVE: To compare evaluations of teaching effectiveness among hospitalist, general medicine, and subspecialist attendings on general medicine wards. DESIGN: Cross-sectional. SETTING: A large, inner-city, public teaching hospital. PARTICIPANTS: A total of 423 medical students and house staff evaluating 63 attending physicians. MEASUREMENTS AND MAIN RESULTS: We measured teaching effectiveness with the McGill Clinical Tutor Evaluation (CTE), a validated 25-item survey, and reviewed additional written comments. The response rate was 81%. On a 150-point composite measure, hospitalists' mean score (134.5 [95% confidence interval (CI), 130.2 to 138.8]) exceeded that of subspecialists (126.3 [95% CI, 120.4 to 132.1]), P =.03. General medicine attendings (135.0 [95% CI, 131.2 to 138.8]) were also rated higher than subspecialists, P =.01. Physicians who graduated from medical school in the 1990s received higher scores (136.0 [95% CI, 133.0 to 139.1]) than did more distant graduates (129.1 [95% CI, 125.1 to 133.1]), P =.006. These trends persisted after adjusting for covariates, but only year of graduation remained statistically significant, P =.05. Qualitative analysis of written remarks revealed that trainees valued faculty who were enthusiastic teachers, practiced evidence-based medicine, were involved in patient care, and developed a good rapport with patients and other team members. These characteristics were most often noted for hospitalist and general medicine attendings. CONCLUSIONS: On general medicine wards, medical students and residents considered hospitalists and general medicine attendings to be more effective teachers than subspecialists. This effect may be related to the preferred faculty members exhibiting specific characteristics and behaviors highly valued by trainees, such as enthusiasm for teaching and use of evidence-based medicine.

Adult↗
PubMedDate not supplied

The hospitalist: the newest member of the care management team.

Implementing a hospitalist program can be an answer to improving quality while reducing the cost of inpatient care. This article provides information to guide the decision-making process needed to initiate a hospitalist program. Included is a definition of the hospitalist's role, indications of the improvement in the effectiveness and efficiency of hospital care that can be expected, guidelines for assessing readiness for implementation of a hospitalist program, the ingredients of a successful program, and evaluation of program goals.

Decision Making, Organizational↗
PubMed2000

Evaluation of a pediatric hospitalist service: impact on length of stay and hospital charges.

OBJECTIVES: Inpatient medical services supervised by pediatric hospitalist physicians are a new development in academic medical centers in the United States. In a large pediatric teaching hospital, we compared length of stay, readmission rates, and hospital charges for children admitted to medical services with and without a hospitalist system of care. DESIGN: This retrospective observational study compared a baseline year of a traditional ward service (TS) with a subsequent year of a new hospitalist system of care called the Generalist Inpatient Service (GIS). Data were obtained from the hospital's clinical, demographic, and financial databases and from selected record review. All hospitalizations were at least 24 hours long and did not involve a stay in an intensive care unit. RESULTS: The average length of stay was longer for the 627 TS hospitalizations than for the 813 GIS hospitalizations (2.7 +/- 2.0 vs 2.4 +/- 1.7 days). Total hospital charges were significantly lower on the GIS ($3002 +/- $2160 vs $2720 +/- $1933) because of lower room and respiratory therapy charges. Three readmissions to the TS and 8 to the GIS occurred within 24 hours of hospital discharge and were, therefore, considered potentially preventable by a longer initial hospital stay. CONCLUSIONS: In a large pediatric teaching hospital, a system of inpatient care provided by hospitalists can reduce length of stay. This model has the potential to control hospital charges in a period of increasing health care costs.

Adolescent↗
PubMed2006

Imaging utilization in the era of the hospitalist.

OBJECTIVE: We sought to determine whether hospitalists specifically reduce inpatient radiologic testing and radiology costs, which to our knowledge has not previously been studied. We examined the number of radiologic studies ordered, total cost of radiology utilization, cost per patient, mean length of stay, and readmission rates for hospitalists and nonhospitalists across the top-10 discharge diagnosis related groups for hospitalists from October 2000 to September 2001. CONCLUSION: We found no decreases in the utilization of radiology resources by hospitalists. Given the increasing volume and importance of radiology in clinical decision making, there will be increased pressure to justify the costs of these studies. We believe that more data should be collected about the use of radiology resources.

Aged↗
PubMed2006

The expanding role of hospitalists in the United States.

Hospitalists are the most rapidly growing group of providers in the United States; in a few years, there will be more hospitalists than cardiologists in the U.S. While early growth in the field was driven by financial demands on hospitals, more recent incentives include a growing focus on improving the quality and safety of care. With current evidence suggesting both financial and educational benefits from the increased presence of hospitalists in both teaching and non-teaching settings, the environment is ripe for further expansion. Hospitalists are likely to embrace a number of additional clinical and non-clinical roles in the coming years. They will serve as change agents, hospital leaders and experts in both quality improvement activities and research initiatives around improving inpatient care delivery. As their skills sets and unique competencies become more clearly outlined, the next step will likely be the development of an independent specialty with its own board certification.

Burnout, Professional↗
PubMed1999

Implementation of a hospitalist system in a large health maintenance organization: the Kaiser Permanente experience.

This paper presents preliminary quality and utilization data from a hospitalist system that is being implemented at Kaiser Permanente, a large health maintenance organization with 16 hospitals in northern California. Hospitalist programs, which are staffed by clinicians highly skilled in caring for inpatients, are being launched with the aim of delivering high-quality, efficient medical care in an increasingly competitive health care delivery environment. This paper also describes, in some detail, the process of implementation at one hospital. Challenges to implementation included 1) overcoming the reluctance of clinic physicians to relinquish inpatient care responsibilities, 2) developing sustainable work schedules, 3) creating effective channels of communication between staff in inpatient and outpatient settings, and 4) designing appropriate compensation scales for hospitalists. Mean length of stay, patient-day rates, admission rates, consultation request rates, costs, and readmission rates were examined for patients discharged from adult medicine services at all 16 hospitals between 1 January 1994 and 30 June 1997. These preliminary resource utilization data seem promising, but further analysis is needed to assess how hospitalist programs may affect clinical quality of care, costs, and patient and provider satisfaction.

Adult↗
PubMed1999

The impact of hospitalists on medical education and the academic health system.

Hospitalism as a career option is likely to reinforce the emphasis of traditional medical residency programs on inpatient care; may become an alternative area of emphasis in many subspecialty fellowship programs; and may even generate its own specific types of advanced training and certification. In the academic setting, subspecialists and their trainees are concerned that hospitalists may request fewer consultations, which could adversely affect subspecialists and the education of both fellows and residents. However, the focus and expertise of hospitalists is likely to improve inpatient education for students and residents and is appealing because it has the potential to improve the quality of inpatient care. Perhaps the major effect of the hospitalist movement on academic centers will be the creation of a cadre of physicians committed to critical pathways; clinical guidelines; quality assurance; risk management; clinical re-engineering; and the use of the inpatient service as a laboratory for developing, evaluating, and implementing initiatives to improve patient care. Although any fundamental change in the organization of clinical services brings with it the risk that essential components of the current system will be jeopardized, the hospitalist movement may have great benefits if it can develop safeguards to ensure seamless patient care and the appropriate use of subspecialty expertise.

Academic Medical Centers↗
PubMed2000

Beta-blocker use in patients with acute myocardial infarction treated by hospitalists.

It is well recognized that the administration of beta blockers to patients after myocardial infarction improves survival. This retrospective cohort and prospective study sought to define the usage of a large hospitalist group and enhance this usage by education and the utilization of a uniform discharge summary. All patients with a discharge diagnosis of acute myocardial infarction were included for analysis. The use of beta blockers by the hospitalist group was initially collected retrospectively and compared with two large cohorts. The data were presented to the hospitalist group. Prospective data collection then commenced. Retrospective analysis of the use of beta blockers showed a rate of 68% as compared with 21% and 34% in two large cohorts (P < .0001). After data were reviewed and conference occurred, prospective use of beta blockers increased to 90% (P < .0005). Patients with myocardial infarction were extremely likely to be treated with beta blockers by this hospitalist group. Review of previous usage and review of contraindications along with the use of a uniform discharge summary resulted in a significant increase in the use of these life-saving drugs.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Comparison of a family practice teaching service and a hospitalist model: costs, charges, length of stay, and mortality.

BACKGROUND AND OBJECTIVES: One third of our nation's health care costs are incurred in the hospital. This study compares the inpatient outcomes between a family practice teaching service (FPTS) and a hospitalist group in the same suburban community hospital. METHODS: All patients discharged by the hospitalist group or the FPTS between April 1998 and June 1999 were included for study if they had one of the 10 most frequent principal diagnoses on discharge. The outcomes compared between the groups were length of stay, mortality, total charges, laboratory charges, radiology charges, and direct costs. Student's t test, chi-square, and analysis of variance were used to compare the outcomes, after adjusting data for severity of illness. RESULTS: Mean severity of illness for the FPTS patients was 2.42 and for the hospitalist patients was 2.26, with higher scores indicating greater severity of illness. After adjusting for severity of illness, there were no differences between the two groups of physicians for total charges, laboratory charges, radiology charges, direct costs, length of stay, or mortality rates. CONCLUSIONS: This study failed to demonstrate a statistically significant difference in the use of hospital resources between a family practice residency teaching service and a hospitalist team. Given the outcomes measured in this community teaching hospital, the residency teaching service appears to be a financially competitive model for delivery of inpatient care.

Analysis of Variance↗
PubMed2003

Effect of hospitalist consultation on treatment of osteoporosis in hip fracture patients.

The objective of this study was to determine if hospitalist consultation during admission for hip fracture results in improved treatment for osteoporosis. This was a retrospective chart review, carried out in a university-based academic hospital. Administrative discharge data was used to identify patients discharged between 1 September 1999 and 1 September 2001, discharged with the diagnosis of hip fracture. Eighty-two patient charts were reviewed after exclusion for traumatic and pathologic fractures. Treatment for osteoporosis consisted of medications recommended by the National Osteoporosis Foundation (NOF), including calcium (+/-vitamin D), estrogen, raloxifene, calcitonin, alendronate and risedronate. Osteoporosis treatment improvement was defined as the addition of a medication for osteoporosis that strengthened treatment. Twenty-nine percent of patients in our study received treatment for osteoporosis at the time of discharge from the hospitalization for hip fracture. While 20% received calcium, only 7% received a bisphosphonate. Twelve percent received improvement in osteoporosis treatment from admission to discharge. Those that received hospitalist consultation did not have a significant improvement in osteoporosis treatment (P=0.314), but had significantly more co-morbid illnesses and were significantly older than those receiving no consultation (P<0.05). Identification of osteoporosis as a medical problem was significantly associated with osteoporosis treatment (P<0.05). Potential barriers to hospitalist consultation's effect on osteoporosis treatment included patient age and co-morbidities. Further research is needed to identify and overcome barriers to effective osteoporosis treatment in patients with fractures.

Aged↗
PubMed2005

The laryngology hospitalist.

The traditional pattern of medical practice is a combination of outpatient and inpatient care. There has been a recent trend for many specialties to separate this care, concentrating on only one of these spheres. A clinician caring only for inpatients is a Hospitalist. The care pattern for airway and swallowing disease adopted at the University of Maryland Hospital is in the form of the laryngology hospitalist. This new surgical specialty is a hybrid of an airway surgery subspecialist and a pure hospitalist. It offers an array of advantages to patients and colleague clinicians. One advantage is that of ubiquitous availability, which offers obvious safety benefits to patients with airway patency problems. Other advantages include the potential for consistent in-depth collaboration with other clinicians such as emergency room physicians, intensivists, neurologists/neurosurgeons, pulmonologists, gastroenterologists, speech and language pathologists, and radiologists. Financial benefits to the clinician include a more favorable ratio of operative disease versus total patient contacts. Benefits to third-party payers include the more efficient and timely delivery of care in the context of an inpatient stay.

Cooperative Behavior↗
PubMed2001

The "continuity visit" and the hospitalist model of care.

Previous analyses have focused on the importance of hospitalist-primary care physician communication to mitigate the harms of discontinuity when hospitalists care for inpatients. We believe that both patients and physicians may benefit if primary physicians visit patients (or at least speak directly to them) during hospitalizations when a hospitalist is the physician-of-record. We propose calling such encounters the "continuity visit" to emphasize that the visit is not purely "social." Moreover, we encourage research on the value of continuity visits and recommend compensation if research establishes that these visits improve the efficiency and quality of inpatient care or patient satisfaction and comfort.

Communication↗
PubMed2001

The importance of postdischarge telephone follow-up for hospitalists: a view from the trenches.

Hospitalist practice highlights the need for effective communication between doctors that share the care of a patient, and between doctors and patients. Telephone contact with patients after hospital discharge can enhance adherence, inform the hospitalist about the results of treatment or of adverse outcomes, and allow the hospitalist to receive feedback from the patient and family.

Aftercare↗
PubMed2002

The "continuity visit" and the hospitalist model of care.

Previous analyses have focused on the importance of hospitalist-primary care physician communication to mitigate the harms of discontinuity when hospitalists care for inpatients. We believe that both patients and physicians may benefit if primary physicians visit patients (or at least speak directly to them) during hospitalizations when a hospitalist is the physician-of-record. We propose calling such encounters the "continuity visit" to emphasize that the visit is not purely "social." Moreover, we encourage research on the value of continuity visits and recommend compensation if research establishes that these visits improve the efficiency and quality of inpatient care or patient satisfaction and comfort.

Continuity of Patient Care↗
PubMed2002

The importance of postdischarge telephone follow-up for hospitalists: a view from the trenches.

Hospitalist practice highlights the need for effective communication between doctors that share the care of a patient, and between doctors and patients. Telephone contact with patients after hospital discharge can enhance adherence, inform the hospitalist about the results of treatment or of adverse outcomes, and allow the hospitalist to receive feedback from the patient and family.

Hospitalists↗
PubMedDate not supplied

Hospitalists and case managers: the perfect partnership.

Part of every hospital case manager's strategic advocacy is the promotion of a consistent partnership with the patient's primary clinical player. The presence of hospitalists, a new and growing specialty, offers the case manager an opportunity to advance that partnership. Instead of having to wait for a doctor whose practice is outside the hospital to review a test result or order a procedure, hospitalists can do the same thing faster--leading to greater efficiency, better care, and shorter stays for patients. Unlike private attendings who visit their hospitalized patients once a day for a few minutes, hospitalists spend all their time at the hospital. It's a perfect arrangement for a dynamic point-of-care partnership.

Case Management↗