4 Strategies for Managing Hospitalists

Joe Cantlupe, for HealthLeaders Media , May 6, 2013

Success key No. 4: Team-based approach
Hospitalists are becoming pivotal players in carrying out team-based care. They are involved in admissions and discharges of patients, especially when patients don't have a primary care physician. In some cases, hospitals are characterizing hospitalists as "captains" of teams to coordinate care as they take leadership positions.

Having hospitalists in leadership roles helps to ensure proper coordination, as well as coordinating patient safety data and core measures, says Lux, the chief of hospital medicine at St. David's Round Rock Medical Center. At his facility, hospitalists have "a place at the table" in hospital governance, he says. Hospitalists are assigned roles on the medical executive committee, which represents all major departments in the hospital.

"We're having a permanent seat, and it's rotated after two years," Lux says of the medical executive committee. "We have become the universal admitters to hospitals, and we're admitting patients and assigning them to other specialists. It's important there is regular interface with other medical disciplines."

Hospitalists are on other major committees like quality and pharmaceutical. They are also on the hospital's cancer committee because of the increasing role that palliative care plays, he adds. "This is one area that can touch many patients," Lux says, noting that half of Americans die in hospitals. "That whole dynamic falls within the role of hospital medicine. It's a critical relationship and taking on more importance, especially as hospitals are becoming more concerned about readmissions for illnesses such as congestive heart failure," Lux notes.

Such collaboration is important because of hospitalists' workload, say officials at various hospitals. In an early 2013 Johns Hopkins University study, four in 10 hospitalists reported their workloads exceeded safe levels at least once a month. In a research letter published in JAMA Internal Medicine, Henry J. Hichtalik, MD, and Peter Pronovost, MD, and others said that 36% of 506 hospitalist respondents reported workload assignments exceeding safe levels at least once a week.

Nygaard at Lee Memorial Health System says workloads have been a consistent issue for hospitalists, but he and other organizations are working to resolve the problems through scheduling changes. "We're trying to have our hospitalists have 18 to 20 patients, but any more is a lot for an individual physician," he says. "We had one physician who had 30 to 40 patients, and that was too much. The acuity of these patients is high."

In Arizona, Banner Baywood Medical Center also is embracing the team-based model to improve coordination with hospitalists, but CMO Spratling says the process isn't easy.

"It was very hard for the older docs to get used to working as a member of a team of physicians. We determined that a team of unit-based physicians could improve not only patient flow but also patient and staff satisfaction, as well as physician efficiency. With all the patients in one location, travel and communication delays were removed. That was what we wanted."

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This article appears in the April 2013 issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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