hospitalists increasing your census?

[imaRN08]

We have had hospitalists at our facility for almost a year now. Most of the staff is not impressed with them, nor are the doctors in the area. It seems like ever since they have come into our facility we have seen our daily census increase dramatically. It's good that we are generating business, but a great deal of these admits are not appropriate admissions! we get people who come in and are admitted for the most ridiculous things. Or, on my unit, we get people who initially come into the ER for one thing (like poss UTI and usually negative or slight that they could be dc with an ATB), and before you know it, they will change the dx to CP and admit them for 24 OBS, never do enzymes, ekg, cardio consult or anything and the pt has never had anysort of CP. Our typical census on my unit averaged about 10 a day last time this year, and since they have come in, our daily census is 20-25 now; with large majority of pts being hospitalist pts. is this happening where you work?

[Cassaundra]

Our facility has a hospitalist, but he only works on the weekends. He stays on premise from Friday evening to Monday morning. I can't say he has increased admits. He's usually pretty conservative about that. The rest of the time we have our regular MDs. There is an MD in the ER at all times in addition to the others. The Docs love it because they can get their golf and family time in on the weekends with little to no disturbance.

[cardiacmadeline, RN]

We have hospitalists 24/7 at our facility. They don't admit people for silly reasons. Once in a while, we will get an admission that makes you wonder why they were admitted, but for the most part I feel patients are admitted for valid reasons. So no, our census has not increased since the hospitalists.

[Virgo_RN, BSN, RN]

We have about 8 hospitalist "teams", and usually they don't admit for silly reasons. If someone is admitted for CP r/o MI, they get on the cardiologist service and appropriate diagnostics are ordered. What I do see a lot of is delayed discharge because no SNF in the area will take the patient, or because while the pt. has been stabilized and does not need hospital care any longer, the risk that they will rapidly decompensate once left to their own devices and be readmitted within 24 hours is significant. But, these are not new things, and neither are hospitalists for our facility. In fact, I rather like hospitalists because I find them more accessible and responsive than regular docs with hospital privileges. I just wish our hospitalists were unit based so we'd have a doc on the unit at all times instead of hospital based so that you don't have to page them for things as silly as Mylanta.

[86toronado, BSN, RN]

In fact, I rather like hospitalists because I find them more accessible and responsive than regular docs with hospital privileges. I just wish our hospitalists were unit based so we'd have a doc on the unit at all times instead of hospital based so that you don't have to page them for things as silly as Mylanta.

I don't mind our hospitalists, except that they seem to come and go more frequently than the other docs, so you can't really seem to get to know them. The having one for each floor is a good idea in general, except that they'd have to be on call 24/7. But I know what you mean about having to page for Mylanta, or because they forgot to check a box on the admission paperwork, so pharmacy won't send the pt's meds...

[Virgo_RN, BSN, RN]

Some of the hospitalists where I work are in favor of having unit based hospitalists. Our hospital is huge, and they get tired of covering the entire hospital to round on their 20-30pts every day.