Hospitalists?

[YankeeHater]

I am hearing rumors about our facility starting a hospitalist program and I'm not sure what to think.. This is a small hospital where currently we have internists or family practice docs that take turns with call. Anyone have opinions, either positive or negative with this type of thing? Specifically with regard to night shift.. I can't imagine a doc sticking around all night..is that what it's like with a hospitalist or would we still just call them at home and wake them up like we do now?

Thanks!

[perfectbluebuildings, BSN, RN]

I love having hospitalists. They're experts in, at the risk of sounding redundant, hospital care, and the treatment of acute illnesses. They become even more expert and specialized the longer they work in your hospital, as to the patients and illnesses that are most common there.

In our hospital, there isn't always a physician from that service there all night. There is during busy times of the year.

[donsterRN, ASN, BSN]

Our facility employs them, too. They rotate shifts and are at the hospital (and awake!) during their assigned hours.

I love the hospitalists. They are always available, take call for most of the attendings, and are generally personable and approachable.

[Daliadreamer]

I love the hospitalists in my hospital too. Like the other poster said, they truly are experts in what they do. They are sometimes more efficient and better than the internists. You get familiar with them just like you do the other physicians, and because it's a group, all the hospitalists are familiar with the patient and work together.

[Sonjailana]

Our hospitalist group consists of PA's, NP's, and MD's. They do a lot of nighttime admissions for other services, and are almost always really easy to locate/call/get orders from. They also tend to know hospital policies and how to discharge/put orders in/etc really well.

[ChristineN, BSN, RN]

My facility has hospitalists. They are awake and in house 24/7 They are much more involved with the patient's than the outside attending's are. They round on pts, write orders, and are very intune to nursing concerns. The hospitalists are often the ones that are assisting in helping to get policies changed. Luv them!!

[Bumashes, MSN, APRN, NP]

We have hospitalists who cover about 60-70% of our pts. The doctors who used to make rounds everyday and take call at night utilize our internal physician services so they don't have to do that anymore. Some still do their own rounding and don't use the service but most do.

I love it. Especially love it for the night shifters b/c you're not waking up a doc at home, just calling him in his hospital office. And if you need them, they're able to come right to your floor. Great for quick interventions when your pts are headed south. The day shift hospitalists make rounds throughout the day, not usually coming back to the same floor unless needed. Then, they do all their paperwork (or whatever) and are physically accessible to us when we need them. On nights, the there is usually only one dr (160 bed facility) to cover the hospital, whereas there can be 2 or 3 during the day. The night dr doesn't make rounds like the day shifter drs do, but usually heads down to the ER or ICUs to either help transfer, admit, etc. I wish all of the drs in our area would utilize this service as I believe it has very good pt outcomes since the drs are easily available and accessible. And 95% of them are super nice and great to work with. The other 5% just aren't very social, not mean at all, just not social. And when pts come back, we try to assign the same drs to them for continuity of care. The drs who work around in the area that use this hospitalist service can easily access the goings on with their pts if they choose to. And we always give a courtesy notification to them when there pts are admitted so they can follow the progress if they choose to.

This service also allows the drs who work on the hospitalist team to actually have a life. When you have your own practice and make rounds all day every day just about, plus taking call at night and on weekends, well, it just doesn't lend itself to having much of a family life. Our drs come in and work their 12 hrs just like us and then get to go home and forget about it for a while. And on their days off, they actually get to be OFF. No call, no rounding, no weekend clinic, etc. Most of the ones I've spoken with about it consider it a very good way to gain a lot of acute and critical care experience for later use when they do open their own practices. Seems like a win-win to me.

[Up2nogood RN, RN]

I've worked in a smaller community hospital where they've had one hospitialist at night and there was usually enough to keep him/her busy with ED admits to the floor (they write orders), pts going south, nurses calls etc. Every once in awhile it would be slow enough and they'd take a nap but would always be available when we called.

Where I work now we have usually 4-7 on the floors at all times. They take turns taking admits and cover/follow the same pts. Great continuity for medical pts. Our surgeons also use the hospitalists for their pts who have other comorbidities that need closer monitoring ie diabetes, mild cardiac/respiratory issues. They also cover rapid responses and codes; a great asset to have in any hospital.

[shodobe]

One of the hospitals in the area uses hospitalists thru a private group. They are not looked to favorably by other specialists because they are looking out for the bottom line of the hospital, money! So they are like the gatekeepers of insurance companies and will keep the pursestrings very tight while treating. There were a few older GPs that were basically retired early because this was the only hospital they had practiced in for many, many years. They really never saw this coming and some of them could have practiced for a few more years, instead they were sent out to pasture way too early and all the great expereince was lost. So, good for those who have good experiences with hospitalist but I am glad they stay across town.

[grannyrn65]

shodobe said:

One of the hospitals in the area uses hospitalists thru a private group. They are not looked to favorably by other specialists because they are looking out for the bottom line of the hospital, money! So they are like the gatekeepers of insurance companies and will keep the pursestrings very tight while treating. There were a few older GPs that were basically retired early because this was the only hospital they had practiced in for many, many years. They really never saw this coming and some of them could have practiced for a few more years, instead they were sent out to pasture way too early and all the great expereince was lost. So, good for those who have good experiences with hospitalist but I am glad they stay across town.

Last Christmas I was admitted and my entire stay was managed by a hospitalist. In general, I have no complaints about his care. And it made it simpler for the nurses to contact him when I need medication or my condition worsen. My Primary Care is a member of a seven physician, two NP's practice. Previously, who ever took call came into the ER to admit me and write orders. My stay was covered by who ever had call that week. I also had no complaints about them.

I did have a complaint about was their billing practice. I am covered by PPO Medicare. Humana does not cover a hospitalist or so I was informed when I first contacted them. Then they said they would cover at out of network rates, which left me holding the bag for a hugh hunk of change. I finally got them to agree to pay in network rates after telling them I had no choice in the matter, the hospitalist was covering the practice. The hospitalist billed me for what was left but I only paid him the percentage I would have had to under Medicare. He is still after me for the rest. Hope he gets it.

I am not looking forward to this Christmas. I was admitted because of an asthma attack. I went to my daughter's that morning and she has cats, triggering my attack. I had been in a disagreement with Humana because they will not authorize my singulair, which stops my attack in it's tracks. She still has the cats. Humana still will not authorize the singulair and I am looking forward to spending Christmas afternoon in the ER. If admitted, I'll be under the care of another hospitalist.

I had all ways worked in teaching hospitals with residents. Down here, outside the major teaching centers, there are no house staff. I view them as being a means to an end. Providing in house care at the expense of the patient's pocketbook. I am assuming they don't fee split because it would violate regulations. I do wonder how they bill Medicaid?

[RNperdiem, RN]

Before I worked in a teaching hospitals with residents, I used to have to deal with answering services and calling doctors at their offices/homes with patient needs.

My current hospital is a large teaching hospital, and we reserve a resident who acts as a hospitalist to handle the patient needs in our 16 bed ICU.

Generally they are on the unit and they stay busy from morning rounds with the surgical team, line changes, line placements, being called to changes in a patient status etc. I rarely need to page anyone, I simply find the "bed commander" and tell them what is going on.

When another unit in my hospital got a NP and MD hospitalist team, they loved the change.

[HollyHobby]

I work at in an ICU (nights) in a small hospital. We started using hospitalists several months ago, and it's been overwhelmingly positive.

Our hospitalists are very approachable; they are never grumpy when you call them at all hours or when you have to call them repeatedly. They've all been trained to put their orders directly into the computer system, so this saves a lot of time. When the patient arrives in the ICU, all I have to do is give the hospitalist a call and he comes right over to see the patient.

Our hospitalists are all new doctors, so their practice is current. (No order for pureed bacon down the NG- honest to god, I used to work with a doctor who routinely ordered that.) They aren't burnt out yet, so they're pretty enthused about what they're doing. If my patient is going south, I can simply call and say, "I want you to come and look at this guy. I think he's fixing to die" (actual quote from me) and he will be there within a minute.

Since they haven't been steeped in the nurses-are-worthless-scum school of medicine, hospitalists will listen to what the nurse has to say. If I know that my patient needs such-and-such, I don't have lick to the doctor's shoes to get it. He will actually listen, and if I'm right, he'll give me what I need. (And if I'm wrong, he'll be polite and explain his reasoning: he won't scream and throw things.)

The only downside to hospitalists (aside from any billing/financial issues; I can't comment on that) is that they are new docs. They tend to be overcautious in some situations, which can make a heck of a lot more work for the nurse. An example of this is a certain doc we have who feels compelled to order a full lab workup every two hours on every DKA patient. And I must call him with all of those labs, and he never changes a thing based on those labs. I could have told him exactly what those labs would be, just through my experience and watching the clinical course, but by god we have to draw a whole panel and ruminate about it and do nothing new. This doc is insecure.

By then end of one night, with a DKA patient (who was very sick but in no way at death's door) I had called this doctor at least 15 times (per his orders). He'd called ME at least 20 times. Finally, I told him I was just sick of talking to him, and I didn't want to hear from him again as long as I lived. I assured him I was joking, and I said it in a joking manner, but in a way I meant it. I kind of just wanted to shake him. :redbeathe

I do think the patient benefits greatly. Usually, the attending doctor is infuriated when you call him at night for admission orders. If he's not enraged, he's too sleepy to give you anything to work with: "just monitor him and I'll be there sometime before noon". Hospitalists won't do that to the patient (or you). They don't care if it's 2am; the treatment starts right now.

Overall, I'm very pleased with our hospitalist service. I used to work in a big teaching hospital where we had residents available at night, but that was not as good. The residents were too exhausted to even stand up most of the time, much less think. And they had just about NO experience. They were the first person you would call, but usually you'd have to go up the chain of command to correct inappropriate/dangerous orders.

With a resident, when you have to go over his head to correct his dangerous/inappropriate orders, he naturally hates you. (I had one resident order massive fluid boluses on an end-stage renal patient and I could not talk him into a more appropriate course of action. I had to call the renal doc- who was horrified by what the resident had ordered- to get the orders changed, and that resident hated me forever.) I've seen our hospitalists being a bit excessive, but never dangerous or inappropriate.