Hospitalists may also become more involved in providing continuity to the delivery of healthcare services. Consider the opportunities that exist to involve hospitalists in improving preoperative and postoperative patient care. For example, hospitalists could play a role in the management of patients who require perioperative beta-blockers to decrease cardiac events in major non-cardiac surgery. Hospitalists may also continue to diversify their clinical roles by coordinating care in ICUs where intensivists are unavailable or by caring for patients in post-acute settings (4,5).
With the ability to manage varying aspects of a patient’s care, hospitalists can help resolve the disconnect that exists as a patient moves across the continuum of care. A patient may enter the system through the ICU, followed by a transfer to a Medicine Unit, and then be discharged to his primary care physician or a nursing home. The reality of ineffective communication and incomplete hand-offs may result in poor information exchange that impacts the care of the patient. By involving a hospitalist in this process, the coordination of patient care becomes seamless and the chance for medical error decreases.
In order to expand the current hospitalist model to the clinically diverse and dynamic model of the future, all stakeholders, from management to physicians, must take proactive steps. Part of this process will involve the development of an economic model that accounts for the value that hospitalist programs bring. The more quantifiable these programs become, the easier it will be to prove their value and implement them in capital-strapped facilities. Another part of moving the hospitalist model to the future centers on relationship management. A lack of understanding of the benefits that hospitalists provide and the roles that they assume in hospitals prevents collaboration with other specialties. Lines of communication must be opened and issues of distrust resolved to facilitate the relationship between hospitalists, the medical staff, and management. Finally we must educate the community about the benefits of hospitalists in the delivery of patient care. The success of hospitalist programs is just as dependent on the development of an external support network as it is on the existence of a strong internal infrastructure.
Without a doubt, hospitalists add value to our nation’s hospitals. An exciting debate is emerging about how hospitalists will continue to change the model of healthcare as we know it, and what implications this will have for our hospitals and health systems.
References
- Wachter RM Goldman L. The emerging role of ”hospitalists” in the American healthcare system. N Engl J Med. 1996;335:514-7.
- 2003 American Hospital Association (AHA) Annual Survey (preliminary results)
- Olsen K, Wachter R. The word on medical mistakes. Healthleaders News. Aug 20, 2004.
- Pham HH, Devers K, Kuo S, Berenson R. Health care market trends and the evolution of hospitalist use and roles. J Gen Intern Med. 2005;20:101-7.
- Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287:487-94.