Elizabeth Calkins is having a good morning: She has just gotten a doctor’s blessing that strawberry parfaits would be a healthful addition to her diet, and she’s being discharged from the hospital.
An oncology patient, Calkins has shed pounds and could use some extra calories. She hugs her doctor
Courtney O'Rourke, DO, a hospitalist at UC San Diego Health and a member of one of the fastest growing specialties in medicine.
O’Rourke is one of the nation’s estimated
44,000 practicing hospitalists, representing a new breed of primary care physician who spends his or her workdays taking care of hospitalized patients.
Besides their dedication to the particular intricacies of inpatient care, hospitalists are hybrid physician-administrators, taking lead roles in enhancing the performance of hospitals and health care systems in the electronic, post-Affordable Care Act era.
O'Rourke sits at a computer and begins preparing a discharge report for Calkins, summarizing the most salient aspects of the care she has received at Thornton Hospital and her condition. She will also prepare a “medication reconciliation” that translates Calkins’ medication regimen in the hospital into something doable and appropriate in an outpatient setting. These reports are included in the patient’s electronic medical record or faxed to a primary care physician.
“Communicating with doctors outside these walls is so important for establishing a continuum of care,” O’Rourke said. “It’s particularly important for individuals who may go back to a primary care physician with another health care system.”
A notice flashes on the computer screen: Calkins is flagged for being at high-risk for 30-day re-admission. The impossible-to-miss, brightly colored alert both explains and demonstrates the value of hospitalists to patient care.
In the 1990s, when there were fewer than 1,000 hospitalists in America, family doctors, internists and pediatricians bounced from clinic to hospital to see their patients. Today, more than 70 percent of U.S. hospitals have hospitalists on staff, according to a 2012 study published in the
Journal of the American Medical Association.
The advent of hospitalists corrects two weaknesses of the old model. One is that “there is a shortage of primary care physician's throughout the American health care system,” explained
Deepak Asudani, MD, a hospitalist at UC San Diego Health. “The other is that it is impossible for a doctor to be two places at once. Hospitalists address the urgency of inpatient care and coordinate in-patient care.”
“We are the quarterbacks for hospitalized patients from admission to discharge,” O’Rourke said.
Among the most compelling reasons for embracing and expanding the hospitalists' role are studies that at least partially attribute declines in length of hospital stays, reductions in complications and improved patient outcomes to the rising prevalence of hospitalists.
Many of the benefits of dedicated, in-patient primary care physicians are commonsensical and process-oriented and the result of a more coordinated, team-based approach to patient care. Case in point: the at-risk-for-readmission flag on Calkins’ medical record. It is a cue for hospitalists to take a second look at things that can be done to reduce the patient’s chances of needing an emergency readmission.
“In Elizabeth’s case, we need to ensure that she receives appropriate outpatient follow-up care and we should look at whether she has needs for home health care,” O’Rourke said.
At UC San Diego Health, many of its
42 hospitalists also take leadership roles on committees that relate to topics as diverse as ethics, patient flow, medical education and informatics.
“We are so involved in the day-to-day, minute-to-minute basics of hospital care that we see the deficiencies, inefficiencies and strengths and are able to help develop plans to fix, build on and improve quality-of-care,” O’Rourke said.
UC San Diego Health hospitalists are, for example, at the fore of developing strategies for reducing hospital infections with protocols as simple as mandatory hand-washing for health care professionals with every patient visit. “This is simple stuff, but it can make a huge difference in patient outcomes,” she said.
Speaking to the success of the hospitalist model, medical specialties such as obstetrics, cardiology, pulmonology and neurology are adopting hospitalist sub-specialties.
“Hospitalists are an important member of the care team and have become a vital part of the health care system,” O’Rourke said. “We expect their role to continue to grow.”