LVH-CC: The major driver of the hospitalist program at the Cedar Crest campus was assisting with the residency program. The existing faculty group staffed two of the five inpatient teaching services and was becoming increasingly busy as a result of new referrals. The hospitalist program helped decompress some of the volume from the existing faculty services by taking over one of the other inpatient teaching slots and establishing an overflow service. The program also seeks referrals from physicians outside the hospital’s traditional referral radius. The hospitalists have also worked with the medical and surgical subspecialists, developing standards for admission of subspecialty patients to the hospitalist service.
Teaching
LVH-CC: The LVH-CC hospitalists are intimately involved in the internal medicine residency program. They staff one of five inpatient teaching services during the morning. In the afternoon and overnight hours, the hospitalists cover their own service and the two pre-existing academic inpatient services. The hospitalists round either formally or informally with the residents of these three teams in the afternoon. They also review each new admission between noon and 8 a.m. to the three inpatient teams and provide bedside teaching on these patients.
A second daytime hospitalist also staff s an overflow service to ensure compliance with Residency Review Committee guidelines regarding service and admission caps. If the three teaching services hit their respective caps, any new patients are admitted by the hospitalists to this overflow service. In addition to rounding on the overflow patients, the second hospitalist staff s a consultative medicine service with a PGY-2 or PGY-3 resident.
The hospitalists participate in morning report and the resident lectures. The hospitalists are also involved in faculty development with the academic general internists as well as other residency initiatives.
LVH-M: Hospitalists at the LVH-M campus have no formal involvement in the teaching programs (osteopathic rotating internship and emergency medicine residency) at that campus. They are an available resource for housestaff, however, and have received many positive compliments from the housestaff for their assistance with difficult patients.
Schedule
LVH-M: The primary rounding hospitalist works Monday through Friday from 7 a.m. to 3 p.m. A second hospitalist works Monday through Friday from 10 a.m. to 7 p.m. and is available on Saturday if the census is high. This hospitalist also works the Sunday night shift beginning at 7 p.m. and ending 7 a.m. Monday. The overnight hospitalist works from 7 p.m. to 7 a.m. Monday through Saturday. There is always a back-up hospitalist available in case of emergency or significant influx of patients that overwhelms the system. The hospitalists work an average of 16 shifts per month.
LVH-CC: There are two hospitalists scheduled during the daytime hours. The hospitalist rounding with the resident team works 7 a.m. to 7 p.m. Monday through Sunday. The overflow/consult hospitalist works 8 a.m. to 8 p.m. Monday through Friday and 7 p.m. to 7 a.m. Saturday and Sunday. The overnight hospitalist works 7 p.m. to 7 a.m. Monday through Friday. The hospitalists work an average of 16 shifts per month.
Future Directions
LVH-M: As the campus continues to grow, the hospitalists aim to become more intricately involved in process improvement and quality-improvement measures. The program is exploring ways of becoming active in the teaching program, either with residents and medical students or with physician assistant students. Additionally, as the Network’s tele-intensivist initiative develops, the hospitalists are working closely with their critical care colleagues to provide top-quality ICU care for patients.
LVH-CC: The LVH-CC hospitalists are becoming increasingly involved in efforts to maximize institutional efficiency and throughput. This program is also seeking to establish itself as a premier research program, in both the educational and clinical realms.