March/April 2008

Hospitalists Increase Quality of Care, Patient Satisfaction


As medical care continues to become more specialized, hospitalists have become the fastest-growing medical specialty in the U.S. These physicians, who currently number about 12,000 nationwide, spend most or all of their time caring for hospitalized patients, from admission to discharge. There are now about 250 hospitalists at work within Catholic Health Initiatives. “Hospitalists have an enormous impact on patient care within Catholic Health Initiatives,” said Cary Ward, MD, chief medical officer at Saint Elizabeth Health Systems, Lincoln, Neb. Ward also serves as an internal consultant for hospitalist programs throughout Catholic Health Initiatives. “Because they work in the hospital, hospitalists are readily available to respond to patient needs, talk with family members and consult with specialists, nurses and other caregivers,” said Ward. “They have a positive impact on quality of care and patient satisfaction. Primary care physicians and family practitioners report high satisfaction with hospitalists, too. The ability to temporarily turn over care of their hospitalized patients to hospitalists can relieve a lot of stress on their practices.” Survey Results According to a recent survey of hospitalist programs within Catholic Health Initiatives, 250 hospitalists work in 33 hospitals within the system. Hospitalists see approximately 1,500 patients each day within Catholic Health Initiatives; an individual hospitalist on duty sees an average of 15 to 18 patients per day. The survey also showed that most of Catholic Health Initiatives’ hospitalist programs see at least 25 patients per day. Eight are smaller programs that see less than 25 patients a day. In 15 of the programs, hospitalist coverage is available 24 hours a day. Some of the programs are run and staffed by outside firms. “Every hospitalist program is different and unique, because the needs of the community dictate the model used,” said Ward. “There are many different staffing models within Catholic Health Initiatives, and there are also wide variations in program efficiency. Attempting to standardize some elements of the hospitalist programs across Catholic Health Initiatives is a real challenge.” While some of Catholic Health Initiatives’ hospitalist programs are efficient, the unique nature of each program makes it difficult to determine exactly why. To discuss and capture best practices, program directors from throughout the system meet annually and stay in regular contact via phone and email. “There is some evidence that close relationships with outpatient home health services help hospitalists work more efficiently,” said Ward. “We’re also looking at developing standardized order sets and practice guidelines. As a system, we have a great opportunity to share information, knowledge and ideas about hospitalist programs.” Cost Savings, LOS Reductions The presence of hospitalists often makes a difference in a hospital’s quality measures and bottom line results. “Studies show that hospitalists practice inpatient medicine more efficiently than other physicians,” said Ward. “This may be because they can see patients more often and monitor them more closely. They also have an in-depth understanding of how their hospitals work. Studies show cost savings of up to $600 per patient and reductions in length of stay of up to one day for patients under the care of hospitalists.” However, the establishment of hospitalist programs can pose challenges for smaller hospitals. “A hospitalist program can be expensive, though most hospitals find that the quality-of-care benefits and cost savings outweigh the expense,” said Ward. “Still, the initial costs can make it difficult for a small hospital to get a program started.” Smaller hospitals within Catholic Health Initiatives that have hospitalist programs include St. Anthony Hospital, Pendleton, Ore.; Flaget Memorial Hospital, Bardstown, Ky.; and Mercy Regional Medical Center, Durango, Colo. Hospitalist Specialties Currently, most hospitalists are internal medicine specialists, with small percentages of family practice physicians and pulmonologists. However, there is a new trend toward specialized hospitalist programs: for example, a hospital might have specialized pediatric hospitalists on the pediatric unit, intensivists on the intensive care unit, laborists who work in the labor and delivery area, and nocturnists who work only on the night shift. “For all types of hospitalists, the demand definitely exceeds the supply,” said Ward. “Nationwide, there is about one hospitalist for every five openings. One other interesting thing about hospitalist programs is that it is very rare for them to fail. Difficulties usually arise only when a program is understaffed. Otherwise, hospitalist programs are highly successful.” For more information about the results of Catholic Health Initiatives’ recent survey of hospitalist programs, visit the Hospitalist Community on Inside CHI or contact Cary Ward at cward@stez.org.