Cedars-Sinai Medical Center - Hospital innovators 2007

Location: Los Angeles, CA Website: www.cedars-sinai.edu What they’re doing: Cedars-Sinai, an 800-bed tertiary hospital and Level I trauma center, was already a leader in medical education, training up and coming physicians in 50 specialties. Over the past decade, however, it went from teaching the status quo to taking a lead role in the development of a new physician practice model. Following the trail blazed by hospitalists—and more recently, surgicalists—Cedars-Sinai has carved out a role for the hospital-based proceduralist, an internal medicine doctor trained in procedural techniques. The idea is that the proceduralists will take over high-volume routine procedures, while specialists like interventional radiologists and vascular surgeons focus on more-complex cases. It also may result in higher pay for these internists, obviously a major plus. Starting about 10 years ago, Cedars-Sinai developed a Procedure Center, served by four internists trained to handle a high volume of hospital-based ambulatory procedures. In 2005, the Cedars-Sinai proceduralists performed more than 2,000 procedures, including fluoroscopy, conscious sedation, upper airway endoscopy and percutaneous tracheostomy. And using proceduralists has been very successful for the hospital. During that year, the Cedars-Sinai proceduralists had a complication rate less than one percent, a big improvement on complication rates for many categories. Of late, Cedars-Sinai has begun training interns in specialty as well, using nonhuman tissue models to develop their skills. In championing this model, Cedars-Sinai has created a new way to keep internists interested and engaged, while freeing up specialists for unique tasks. Expect to see this approach become more popular in the near future.