Hospitalists: How I make it work

January 19, 2007

For this doctor, letting the inpatient staff assume care for his patients hasn't been easy. But now he's glad about it.

After providing hospital care for more than 20 years, I turned over my hospitalized patients to the inpatient team because I was ill. When I felt better and was ready to resume hospital care, my call group had already decided to give up the hospital. There was also pressure from our medical group to use the inpatient team. It was a difficult situation for me-something I still feel a bit guilty about. I don't like the idea of transferring my longtime patients to physicians whom they don't know. My patients aren't too happy about it, either. But there are advantages.

The biggest plus: patients with severe illnesses have physicians available to them 24 hours a day and, fortunately, our inpatient service provides good care. Also, my schedule is a bit less chaotic now that I don't have to respond to emergency admissions at any time of the day or night.

So I've adjusted. The changes I've made that make the hospitalist system work for me and for my patients might work for you, too. Here's my seven-step approach:

Having learned the hard way, I now tell all of my patients that my colleagues on the inpatient team will be responsible for their care in the hospital. I explain that the team members are capable and current on hospital care, that they have all of my records available to them, and that they communicate regularly with me. I assure patients that I'll be involved in any major decisions that occur while they're in the hospital and that I'll reassume their care after discharge. They don't like it, but if they're informed of the system ahead of time, they're more accepting of it.

2 I have a relationship with the hospitalists. Our first inpatient physicians were people I knew well, who were recruited to establish the inpatient service. I did fine with them. Still, I confess I wasn't overly welcoming when the new hospitalists starting showing up. I didn't know them, and they didn't know me. They were ordering tests and treating my patients in a manner different from mine.

But I noticed that most of the care they were providing was good, and I saw that some of the problems were due to their misunderstanding of the wider system, and of what is and isn't done in the outpatient setting. Specifically, they didn't understand what I like to do with my patients.

So I've made it a point to meet the hospitalists, discuss cases with them, and let them know my preferences. I try to call at least once during each patient's admission to see what's going on and to let the inpatient team know I'm still interested.

Recently I've taken this a step further. As director of CME at our hospital, I've initiated a series of evening meetings for inpatient and outpatient physicians to get together, have dinner, and dis-cuss interesting cases-focusing in particular on the continuum of care provided in the hospital and outpatient settings.

3 I write better notes. My records, which are created in an EHR, are available to the hospitalist team. Because the completeness and accuracy of those records will affect the care my patients receive, I'm making a special effort to improve my notes.

I especially want to make certain that medications, allergies, code status, and overall treatment plans are clearly articulated and are up to date. Already, several hospitalists have told me that they like admitting my patients because the notes are so clear and help them as they formulate their care plan.