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PubMed2000

Establishing a pediatric hospitalist program at an Academic Medical Center.

Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Children's Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees.

Academic Medical Centers↗
PubMed1999

An employer's perspective on hospitalists as a source of improved health care value.

The probable perspective of large employers toward the phenomenon of hospitalists can be derived by examining the four essential elements of health care value to employers. Current hospital care in the United States is thought to offer substantial opportunities for improvement, and the impact of hospitalist programs on an employer's sense of health care value is predicted to be favorable. This prediction, however, should be validated through outcomes research before it is widely propagated. If innovations as promising as hospitalist programs are to occur in ambulatory care, employers and other health care purchasers must be proactive in identifying and rewarding them.

Cost-Benefit Analysis↗
PubMed1999

The hospitalist: a new medical specialty?

Economic forces have stimulated a growing role for physician "hospitalists" in caring for patients hospitalized by other physicians, and the question of whether hospital care constitutes a new medical specialty has been raised. Three recently recognized specialties--emergency medicine, family practice, and critical care--originated from trends in medical practice. All three fulfill the major criteria for a medical specialty: scientific legitimacy, the development of new training pathways, and the existence of academic departments. The hospitalist movement is currently underdeveloped in each of these areas. By training, most hospitalists are internists who are well prepared to care for inpatients. Internal medicine must determine how this new movement fits into the traditional framework of general internal medicine and medical subspecialties. Until it does, the future of inpatient medicine as a recognized specialty will remain uncertain.

Forecasting↗
PubMed1999

Capitation or no capitation, hospitalist programs can pay off for hospitals.

A well run hospitalist program with sophisticated information and operational systems can reduce average length of stay by as much as 30% to 50% while actually improving care, according to. Michael Brouthers of Cogent Healthcare Inc., formerly Hospitalists, Inc. In an interview with Health Care Strategic Management, Brouthers discusses how a hospitalist program can benefit hospitals.

Capitation Fee↗
PubMed2000

The cost and quality of hospitalists.

The Hospitalist concept is becoming the standard of practice as managed care penetration grows. It is increasingly difficult to do a good job in the outpatient arena and this makes the old "double threat" model in which the physician speeds through inpatient rounds in the morning before clinic, during lunch, and again at night after his office closes, obsolete. There is simply too much at stake in the inpatient arena to have large periods of time in which physician coverage is minimal. Controversy exists as to whether or not the services should be "outsourced" to a Hospitalist management company or developed internally, using physicians who historically have had a significant presence in the hospital. If the services are outsourced, then it is essential that they be built around a strong local physician leader who remains active in patient care. The French author, Anais Nin wrote: "There are very few human beings who receive the truth, complete and staggering, by instant illumination. Most of them acquire it fragment by fragment, on a small scale, by successive developments, cellularly, like a laborious mosaic." Inpatient care in the United States is adequately described as a laborious mosaic in which providers of many different services surround patients with many different problems. Hospitalist programs can help to bring order to the mosaic by consistently combining the correct physician talent with the system's sickest and most expensive patients in order to achieve the best possible outcomes.

Aged↗
PubMed2000

Program description: a hospitalist-run, medical short-stay unit in a teaching hospital.

A hospitalist-run medical short-stay unit (MSSU) was created at a university-affiliated teaching hospital in Montreal in 1989. Its primary aim was to provide efficient and high-quality care to patients requiring a brief stay in hospital for short-lived medical conditions. After evaluation in the emergency department (ED), patients judged to have acute conditions requiring a short hospital stay are admitted directly to the MSSU. Conversely, patients with more complex conditions requiring a longer stay in hospital are admitted to a clinical teaching unit (CTU). Care in the MSSU is provided by a rotating group of hospitalists. Ensuring the admission of appropriate patients during non-daytime hours was the main difficulty identified. Preliminary evaluation of the MSSU suggested that ED consultants were effective at selecting suitable patients for admission to the MSSU, because only 1 in 5 patients later required transfer to other hospital wards. The 5 most common MSSU discharge diagnoses were asthma and chronic obstructive lung disease, pneumonia, congestive heart failure, urinary tract infection and cellulitis. MSSU patients had a shorter length of stay, lower rates of in-hospital complications and lower rates of readmission within 30 days of discharge compared with CTU patients. Our hospitalist-run MSSU appears to offer a workable system of health care delivery for patients with acute, self-limited illness requiring a brief stay in hospital. The MSSU appeared to promote the efficient use of hospital beds without compromising patient outcomes, however, further research is required to compare the efficiency and outcomes of care directly with that provided by the traditional CTU system.

Bed Occupancy↗
PubMed2002

Thriving and surviving in a new medical career: the case of hospitalist physicians.

Managed care is cultivating a variety of new work careers within the medical profession, and it is worth asking whether they will function as long- or shorter-term career options for the individuals who participate in them. This paper uses the specific case of hospitalist physicians to explore how the surrounding social and economic work contexts contribute to two individual-level outcomes that inform the issue of career longevity: the concepts of burnout and intent to stay in the career. The findings of a national survey of hospitalists reveal that job burnout and intent to remain in the career are more meaningfully associated with favorable social relations involving colleagues, co-workers, and patients than with negative experiences related to the economically induced pressures of the job, such as reduced autonomy and the use of financial incentives. In addition, career longevity is enhanced by the extent to which individual physicians pursue intrinsic and extrinsic rewards through their choices to become hospitalists. These findings demonstrate that sociologists should pay greater attention to the career trajectories of contemporary doctors in order to understand larger scale professional stratification within medicine. They also offer empirical support for redirecting our focus towards the relational dynamics that shape these trajectories.

Burnout, Professional↗
PubMed1997

Inpatient specialists help cut costs, reduce LOS. Hospitalists partner with case managers.

Inpatient specialists, or hospitalists, represent a valuable resource in helping case managers reduce costs and lower lengths of stay. At Mercy Hospital in Springfield, MA, and Park Nicollet in Minneapolis, hospitalists have largely been responsible for a 20% reduction in costs across the board for hospital stays. Because they work full time in the hospital, these physicians tend to develop stronger professional relationships with case managers than other physicians do. They're also generally more open to quality improvement efforts, experts say. Due to their greater familiarity with "hospital illnesses," hospitalists have established a strong track record for cost-efficiency in treating patients in the acute care setting.

Case Management↗
PubMed2006

Developing a gastroenterology hospitalist service.

The concept of a gastroenterologist functioning primarily as a hospitalist is a new development in the way that gastrointestinal (GI) care is provided. The main advantages are rapid availability of endoscopic and consultative services, a close working relationship with other hospital-based providers, and enhanced familiarity with complex acute care and GI treatment algorithms. The GI hospitalist concept offers significant advantages for the outpatient providers and their ambulatory endoscopy centers, even for smaller and mid-sized groups; however, it hinges on finding the right individual for the job. The buy-in of all group members before launching the concept is crucial and a better quality of life for each team member can be the result.

Communication↗
PubMed2001

Rapport and the hospitalist.

One key issue in the hospitalist movement is the need for hospitalists to establish rapport and maintain relationships with their patients. Rapport is critical in obtaining a thorough history, and then effectively negotiating the diagnosis and treatment plan with patient and family. This article summarizes both the challenges to establishing rapport and the opportunities unique to hospital-based practice. It presents a basic framework for communication skills using the mnemonic PEARLS (partnership, empathy, apology, respect, legitimation, self-efficacy), and a detailed discussion of techniques for use in difficult relationships. The importance of the physical setting and of nonverbal skills cannot be underestimated. Rapport-building techniques can be learned but require practice.

Attitude of Health Personnel↗
PubMed2001

Passing the clinical baton: 6 principles to guide the hospitalist.

Hospitalist systems make it increasingly common for responsibility for a patient to be passed from one physician to another. During such transfers, patients' outcomes and satisfaction can benefit from better communication between hospitalists and the primary care physicians whose patients they care for. We propose 6 principles to guide such communication, to ensure that critical information about patients is not lost and to optimize the quality of care. We also discuss special considerations for patients discharged to a skilled nursing facility or to home with home care.

Attitude of Health Personnel↗
PubMed2001

On educating and being a physician in the hospitalist era.

Among its responsibilities, the hospitalist movement in internal medicine must fulfill the educational needs of medical students and residents. Rigorous studies can discern what special objectives, curriculum, and funding will be effective for hospitalists to meet these obligations.

Clinical Clerkship↗
PubMed2002

Rapport and the hospitalist.

One key issue in the hospitalist movement is the need for hospitalists to establish rapport and maintain relationships with their patients. Rapport is critical in obtaining a thorough history, and then effectively negotiating the diagnosis and treatment plan with patient and family. This article summarizes both the challenges to establishing rapport and the opportunities unique to hospital-based practice. It presents a basic framework for communication skills using the mnemonic PEARLS (partnership, empathy, apology, respect, legitimation, self-efficacy), and a detailed discussion of techniques for use in difficult relationships. The importance of the physical setting and of nonverbal skills cannot be underestimated. Rapport-building techniques can be learned but require practice.

Communication↗
PubMed2002

Passing the clinical baton: 6 principles to guide the hospitalist.

Hospitalist systems make it increasingly common for responsibility for a patient to be passed from one physician to another. During such transfers, patients' outcomes and satisfaction can benefit from better communication between hospitalists and the primary care physicians whose patients they care for. We propose 6 principles to guide such communication, to ensure that critical information about patients is not lost and to optimize the quality of care. We also discuss special considerations for patients discharged to a skilled nursing facility or to home with home care.

Communication↗
PubMed2002

On educating and being a physician in the hospitalist era.

Among its responsibilities, the hospitalist movement in internal medicine must fulfill the educational needs of medical students and residents. Rigorous studies can discern what special objectives, curriculum, and funding will be effective for hospitalists to meet these obligations.

Curriculum↗
PubMed2002

Teaching by hospitalist physicians: a practical approach.

This article discusses an approach to the teaching of residents and medical students by hospitalist physicians on a general pediatric unit. It focuses on three basic principles of teaching and describes how these can be operationalized in a practical way. If this approach is followed, hospitalist physicians can be more effective teachers.

Clinical Clerkship↗
PubMedDate not supplied

Productive interdisciplinary team relationships: the hospitalist and the case manager.

Since the introduction of the National Patient Safety Goals (Joint Commission International Center for Patient Safety, 2005) into the Joint Commission on Accreditation of Healthcare Organizations standards, there appears to be a positive movement toward improvement in patient care outcomes and safety. Case management has been an integral part of the care team, and has emphasized standards of performance in quality of care, collaboration and resource utilization since 1995. When Leapfrog defined hospitalist intensivists as one of the three requirements necessary to be a safe hospital, an opportunity was borne to create a professional partnership. With the patient and the safety as the central focus of care, case managers and hospitalists are beginning to exponentially change the face of healthcare. This article will demonstrate the value of this partnership.

Benchmarking↗
PubMed2003

The rotating hospitalist: a solution for an academic internal medicine practice.

BACKGROUND: Concerns have been raised about the role that hospitalists may have in changing the educational process for medical students and residents, especially with regard to the primary care specialties. METHODS: We implemented rotating hospital and office duties within our five-physician group. RESULTS: Resident and student satisfaction increased, and additional faculty members could be added without expanding office space. Financial benefits then also ensued. CONCLUSION: Rotating hospital with office duties among a small group of internists has resulted in most of the advantages with few of the drawbacks related to the hospitalist approach.

Academic Medical Centers↗