All groups, regardless of size, should ensure that the hospitalist who picks up patients from a colleague who has rotated off the day before writes an order in the chart indicating “change attending to Dr. Jones,” or clearly communicates who the new hospitalist is by some other means, such as an electronic medical record or a phone call from a clerk. It isn’t enough that patients are assigned to a particular team—say, the “white team” or the “green team”—for their entire stay. Nurses and other staff need to know which hospitalist is covering that team each day.
One test of how well your system is working is to assess how the nurse answers when a patient or family asks, “Which doctor will be in to see me today?” It isn’t good enough for the nurse to just say, “The green-team doctor will see you, but I don’t know who that is today.” The nurse needs to be able to provide the name of the doctor who will be in. If nurses at your hospital regularly page the wrong hospitalist, or must call around just to figure out who the attending hospitalist is for a particular patient, then you have an opportunity to improve how you communicate this information to the nurse and others.
Even if you have a system in which it is clear to everyone which hospitalist has taken over for one who has rotated off-service, you need to ensure that nurses can easily determine the attending hospitalist for patients admitted the night before. Night-shift staff not knowing which doctor will take over in the morning is an all-too-common problem, and it results in too many staffers not knowing who is caring for the patient from the time the night doctor goes off (e.g., 7 a.m.) until the rounder taking over gets to that patient on rounds. Having evening/night admitters assign attending, or rounder, hospitalists at the time of each admission is a great solution, and I’ll provide ideas about how to do this in next month’s column.
I worry about patient satisfaction if the evening/night admitter can’t tell the patient the name of the hospitalist who will take over in the morning. How can the patient feel that they’re getting personalized care when they’re told, “I don’t know which of my partners will take over your care tomorrow. They all get together and divide up the patients each morning and will assign a doctor to you then”? It’s different if the admitter tells the patient, “I’m on call for our group tonight, but will be home sleeping tomorrow and my colleague, Dr. Clapton, will take over your care in the morning.” I usually go on to say with a wink that the patient is getting an upgrade, because Dr. Clapton is so much smarter and better-looking than me. I’ll understand if the embellishment doesn’t feel right for you, but I think there is value in the admitter, or a hospitalist rotating off-service, taking a minute to say something nice about the hospitalist who will take over next.
Next month, I will continue to explore issues that are particularly problematic for larger groups. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He also is part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. This column represents his views and is not intended to reflect an official position of SHM.