Hospitalists provide crucial care for inpatients, but a few adjustments could make them more efficient and improve quality.
Robert Pearl, M.D., a clinical professor of plastic surgery at Stanford University School of Medicine and former CEO of the Permanente Medical Group, said in a contributed post for Forbes that the group took a number of steps to reduce hospital use and improve efficiency.
Several actions especially paid off, he said, including:
- Dividing hospitalists into two groups: "rounders," who focus on patient care and "admitters," who focus on where patients are treated. Making the admitters part of the emergency department can help ensure patients who would heal better at home or in a long-term care facility are sent to the right setting, Pearl said.
- Using a seven-day rotation. Pearl said that having "rounders" work a seven-day rotation can eliminate some handoffs that put patients at risk, and cut down on inefficient work days where new physicians are studying the cases they're taking over.
- Matching each hospitalist with a patient care coordinator. This may require a significant financial investment, especially in hospitals with large fee-for-service populations, Pearl said, but in hospitals using prepaid reimbursement models, the hospital use reductions will pay for these staffers.
"Today's hospitals are inefficiently organized and staffed, replete with the kind of inefficiencies no business would tolerate," Pearl said. "Simply, hospitalists can't be in two places at once—as a result, patient care is delayed and, of course, it's the patient who pays the price."
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Though the hospitalist model has led to improvements, like reduced utilization and costs, there are still challenges. Poor communication between hospitalists and primary care physicians can hinder care coordination and increase readmissions.
Physicians have pushed for a more collaborative process between hospital-based doctors and primary care providers. Allowing primary care providers to serve as the "quarterback" of patient care can improve quality and satisfaction.
A recent study also found that patients cared for by hospitalists in their first year of practice had higher mortality rates than those treated by more experienced physicians.