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Survey of Neurohospitalists: Subspecialty Definition and Practice Characteristics
David Likosky,Scott Shulman,Lucas Restrepo,William D. Freeman
Frontiers in Neurology , 2010, DOI: 10.3389/fneur.2010.00009
Abstract: Neurohospitalists represent an emerging neurological subspecialty focusing on inpatient neurological disease. Little data exists regarding neurohospitalist practice information and clinical activity. A survey among neurohospitalists was performed to help define the subspecialty, yield demographic information, practice characteristics, and understand clinical and non-clinical activities. During the formation the Neurohospitalist Section of the American Academy of Neurology September 2008, an online survey (29 questions mixed categorical, numerical, and free text) of 93 neurohospitalists was performed. The survey closed on October 13, 2008. The survey achieved a 54% response rate. Eighty-two percent of respondents were male, mean age 42 (range, 34–68), median practice duration 6 years, with broad distribution of practices across the US. Seventy-five percent of respondents reported having general neurology residency plus additional fellowship training (54% vascular neurology fellowship, 13% neurocritical care, and 33% other no response). Fifty-one percent of neurohospitalists were hired by non-academic (private) institutions, whereas academic institutions hired 49%. There was a wide array of responses for call frequency, duration, number of practice partners, and annual income. A uniform definition of the neurohospitalist subspecialty emerged as one who cares for inpatients, focusing primarily on in-hospital responsibilities. Neurohospitalists defined themselves as inpatient neurological subspecialists. Neurohospitalists have a broad US geographic distribution (and possibly international), in both academic and private practice (or hybrid) forms, and typically provide inpatient and Emergency Department (ED) call coverage for hospitals or outpatient neurologic practices. Most neurohospitalists were involved in administrative aspects of stroke or inpatient quality initiatives.
The impact of a hospitalist on role boundaries in an orthopedic environment
Webster F, Bremner S, Jackson M, Bansal V, Sale J
Journal of Multidisciplinary Healthcare , 2012, DOI: http://dx.doi.org/10.2147/JMDH.S36316
Abstract: ct of a hospitalist on role boundaries in an orthopedic environment Original Research (847) Total Article Views Authors: Webster F, Bremner S, Jackson M, Bansal V, Sale J Published Date October 2012 Volume 2012:5 Pages 249 - 256 DOI: http://dx.doi.org/10.2147/JMDH.S36316 Received: 24 July 2012 Accepted: 08 August 2012 Published: 05 October 2012 Fiona Webster,1 Samantha Bremner,2 Megan Jackson,3 Vikas Bansal,2 Joanna Sale4 1Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; 2Holland Orthopedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 3Faculty of Social Science, University of Western Ontario, London, ON, Canada; 4Mobility Program Clinical Research Unit, St Michael's Hospital, Toronto, ON, Canada Purpose: Hospitalists specialize in the management of hospitalized patients. They work with several health care professionals to provide patient care. There has been little research examining the perceived impact of the hospitalist's role on staff working in an orthopedic environment. This study examined the experiences of staff across several professional backgrounds in working with a hospitalist in an orthopedic environment. Participants and methods: A qualitative descriptive approach was taken to investigate the experience of staff working with a hospitalist at a specialized orthopedic hospital. Purposive sampling was used to recruit interview participants including nurses, internists, pharmacists, physiotherapists, anesthetists, senior administration, and orthopedic surgeons to the point of theoretical saturation, which occurred after 12 interviews. Interviews were coded, and these codes were combined into categories and predominant themes were identified. Findings: Overall, staff believed that the hospitalist role was a positive addition to the facility. The role benefitted patients and supported the clinical well-being and education of staff. Many staff felt the hospitalist had no impact on their workload, but others reported that their work had decreased or increased. Several described the potential for role overlap between the hospitalist and other physicians. Conclusion: The importance of interprofessional collaboration in the implementation of the hospitalist role was a recurring theme in our analysis. This study demonstrates the importance of educating staff about the hospitalist role boundaries prior to implementing hospitalist care.
Capacity Limitations of Medical Services Provided by Pediatricians in Japan  [PDF]
Jun Kohyama
Open Journal of Pediatrics (OJPed) , 2014, DOI: 10.4236/ojped.2014.41014
Abstract:

The shortage of pediatricians has been identified as one of the largest social problems in Japan. This study aimed to compare the assumed ideal nighttime working conditions of pediatric hospitalists in Japan with the actual current situation. By using available data on the age-related numbers of pediatricians in Japan, we described the ideal working conditions for pediatric hospitalists in Japan. The ideal situation was then compared with the existing actual working conditions. Compared with the assumed ideal condition, current pediatric hospitalists are working in many hospitals with a few colleagues. To solve the current supply-demand mismatch on medical care for children during night, an involvement of non-pediatric physicians in the medical care of children during the night is indispensable. Also, parents in Japan need to know the limitations relating to the available capacity of pediatricians, and accept that their children can be cared for adequately by non-pediatric physicians, who have been trained to provide primary medical care to children.

Collaborative Comanagement Between Neurohospitalists and Internal Medicine Hospitalists Decreases Provider Costs and Enhances Satisfaction With Neurology Care at an Academic Medical Center
James G. Greene
- , 2018, DOI: 10.1177/1941874417735173
Abstract: The majority of academic medical centers are moving to a neurohospitalist model of care for hospital neurology coverage. Potential benefits over a more traditional academic model of patient care include greater expertise in acute neurologic disease, increased efficiency, and improved availability to patients, providers, and learners. Despite these perceived advantages, switching to a neurohospitalist model can come at substantial financial cost, so finding ways to maximize the positive impact of a limited number of neurohospitalists is very important to the future health of academic neurology departments. Over the past 7 years, we have implemented a model for inpatient neurological care based on an intimate collaborative relationship between the neurology and hospital medicine services at our main academic hospital. Our goal was to optimize the value of care by decreasing cost while improving quality
Handoff Tool Enabling Standardized Transitions Between the Emergency Department and the Hospitalist Inpatient Service at a Major Cancer Center
Carmelita P. Escalante,Carmen E. Gonzalez,David Rubio,Diane C. Bodurka,Karen Chen,Mohamed Ait Aiss,Norman Brito-Dellan,Srinivas R. Banala,Terry W. Rice
- , 2018, DOI: 10.1177/1062860618776096
Abstract: Communication failures during patient handoff can lead to serious errors. A quality improvement team created a standardized handoff tool/process (DE-PASS: Decisive problem requiring admission, Evaluation time, Patient summary, Acute issues/action list, Situation unfinished/awareness, Signed out to) for admitting patients from the emergency department (ED) to the hospitalist inpatient service of a tertiary cancer center. DE-PASS mirrors the institution’s ED workflow, stratifies patients as stable/urgent/emergent, and establishes requirements for verbal and email communications between providers. Comparison of preintervention and postintervention results from the 1-month pilot revealed that within a 24-hour period, DE-PASS reduced the number of intensive care unit transfers by 58% (P = .393), the number of rapid-response team calls by 39% (P = .637), and time to inpatient order by 31% (P = .004). ED physicians’ and hospitalists’ satisfaction with DE-PASS increased. Reduction in intensive care unit transfers was sustained after the pilot (P = .029). DE-PASS feasibility was evidenced by 100% uptake. By stratifying patients by risk level, DE-PASS reduced admission-to-evaluation times for unstable patients, potentially improving patient safety
Neumonía en el anciano mayor de 80 a？os con ingreso hospitalario
Zubillaga Garmendia,G.; Sánchez Haya,E.; Benavente Claveras,J.; Ceciaga Elexpuru,E.; Zamarre？o Gómez,I.; Zubillaga Azpíroz,E.; Sarasqueta Eizaguirre,C.;
Anales de Medicina Interna , 2008, DOI: 10.4321/S0212-71992008000300004
Abstract: objetive: to analize and compare differences in patients older than 80 years with community acquired pneumonia admitted in internal medicine or pneumology of a general hospital from the emergency room. material and methods: retrospective study of all the 277 patients above 80 years admitted into the hospital in 2005 with the main diagnosis of pneumonia. results: 84% community-acquired, 16% from institutions. mean age: 85.8 y (48% men, 52% women). 19% fine-3, 49% fine-4, 32% fine-5. known etiology: 25% (pneumococcal 19%, h. influenzae and other gram (-) 6%. 75% treated by internists, 22% treated by pneumologists. standard guidelines followed up by 30,5% a variant 60% (equal by internists or pneumologists). time door-1st antibiotic dose 6.6 hours. global mortality 16.7%. women died at 87.4 y, men at 84.5 y (p = 0.035). mortality fine 3-4-5: 4.5, 12.4, 30% respectively. mortality treated before 4 hours: 34.6%, after 4 hours: 11.5% (p = 0.01). many more fine 5 cases in int. medicine than pneumology. mortality by internists 22%. mortality by pneumologists 3% (p = 0.001). mortality similar following strict guidelines or variant. conclusions: a) internist receive patients sicker than pneumologists; b) important mortality in these very old patients of 16.7%, and progressive according the fine severiy index, in spite of correct therapy; c) rapid initiation of antibiotics did not decreased mortality; d) mortality did not change following strict or variant guidelines; and e) there are areas of quality improvement in our hospitals.
Medical Students’ Perspectives on Careers in Hospital Medicine: A National Study
Anne Catherine Miller Cramer,John D. Yoon,Kamel Ibrahim,Sandra A. Ham,Shalini T. Reddy,Yassen Alkaddoumi
- , 2017, DOI: 10.15694/mep.2017.000207
Abstract:
Changes in medicine: the decline of physician autonomy
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2011,
Abstract: No abstract available. Article truncated at 150 words. Thirty years ago when I left fellowship, there were predominantly two career paths, private practice or academics. I had chosen academics by virtue of doing a fellowship at a heavily research-based program, the National Institutes of Health (NIH). However, even at the NIH many of my colleagues eventually ended up in private practice, which was more lucrative and much more common than the academic practice I chose. Now a third path has become more common, practice as a hospital employee. I became a hospital employee over 30 years ago when I became a part-time, and later, full-time physician at a Department of Veterans Affairs (VA) medical center affiliated with a university. Apparently I was ahead of my time. In an article entitled “Majority of New Physician Jobs Feature Hospital Employment” 56% of physician search assignments by the national physician search firm Merritt Hawkins in 2011 were for hospitals (1). This …
A Daily Hospital Progress Note that Increases Physician Usability of the Electronic Health Record by Facilitating a Problem-Oriented Approach to the Patient and Reducing Physician Clerical Burden
Akram Al Makki,James M Sutton,Rabih Kalakeche,Steven R Ash
- , 2019, DOI: 10.7812/TPP/18-221
Abstract: We suggest changes in the electronic health record (EHR) in hospitalized patients to increase EHR usability by optimizing the physician’s ability to approach the patient in a problem-oriented fashion and by reducing physician data entry and chart navigation. The framework for these changes is a Physician’s Daily Hospital Progress Note organized into 3 sections: Subjective, Objective, and a combined Assessment and Plan section, subdivided by problem titles. The EHR would consolidate information for each problem by: 1) juxtaposing to each problem title relevant medications, key durable results, and limitations; 2) entering in the running lists under Assessment and Plan the most relevant information for that day, including abbreviated versions of relevant reports; and 3) generating a flow sheet in a problem’s progress note for any key results tracked daily. To reduce physician EHR navigation, the EHR would place in the Objective section abbreviated versions of notes of other physicians, nurses, and allied health professionals as well as recent orders. The physician would enter only the analysis and plan and new information not included in the EHR. The consolidation of information for each problem would facilitate physician communication at points of transition of care including generation of a problem-oriented discharge summary
Characterization, Categorization, and 5
Joyeeta G. Dastidar,Min Jiang
- , 2018, DOI: 10.1177/0825859718769095
Abstract: Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. We sought to characterize this group including mortality rates, with the goal of better understanding this population. Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital. Single large academic medical center. Adult inpatients on general medicine and medicine subspecialty services. The number of nonelective medicine hospitalizations, age, clinical conditions and comorbidities, calculation of an age-adjusted Charlson Comorbidity Index (CCI), outpatient and emergency department visits, length of stay, costs of hospitalization, and mortality over a 5-year period. Descriptive statistics were used to characterize variables of interest. We identified 153 patients with a total of 781 nonelective hospitalizations, totaling greater than 4000 hospital days and with charges of approximately US$9 million during the 6 months. Nearly all had insurance coverage and good outpatient follow-up (median of 7 appointments over the 6-month study period). Only 14% of those admissions qualified for observation status. Over 40% of patients had comorbid mental health disease or chronic narcotic dependence. Twenty-nine percent of patients died within 1 year; 50% were dead within 5 years. Age-adjusted CCI scores ranged annually from 3.00 to 3.58 among surviving patients versus 4.31 to 6.60 among deceased patients. These findings point to distinct groups of patients who are frequently hospitalized, and therefore would benefit from tailored management strategies: Those with progression of end-stage disease comprised one-third of the group and targeting that subset with palliative care referrals could help decrease readmission rates. Those with recurrent exacerbations of a chronic medical condition could be managed through telemanagement programs. Those with exacerbations of chronic pain could be addressed through collaboration with pain management specialists. Individualized care management plans may be useful for all, especially the latter two groups. Based on differences between survivors and deceased patients, an age-adjusted CCI score of 4 or 5 could be valuable sensitive or specific cutoffs, respectively, for predicting those who would benefit most from palliative care consultation regarding end-of-life goals and management
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