01. The Hospitalist

Definition

First defined in the 1990’s, the term “hospitalist” describes a physician who assumes the generalized care of a hospitalized patient and transfers care of the patient back to a primary care physician at discharge.

Context

Advantages to the hospitalist model of medicine include greater inpatient physician availability, increased emphasis on hospital-wide safety and quality improvement efforts, and potential increased participation in medical training and education. Studies have shown increasing differences between hospitalist and non-hospitalist-driven patient care outcomes, including length of stay, cost of hospitalization and performance with respect to certain quality of care measures.

Navigating the Hospitalist – Primary Care Physician Divide

  1. Patients may not understand the hospitalist model or who is responsible for their medical care. Explain to patients the hospitalist model of care, especially the role of the inpatient team, primary care provider (PCP) and specialists in decision-making.
  2. Inform the patient that their PCP will be contacted and updated with major decisions/results. There should be open communication between the PCP and the hospitalist and a consistent message should be provided to the patient.
  3. Collegiality is essential between the PCP and the hospitalist, even when disagreements arise. Hospitalists and PCPs face many of the same barriers to effective care coordination:
  • Insufficient time for tasks.
  • Difficulty reaching other clinicians.
  • Medication list discrepancies.
  • Lack of clarity regarding accountability for pending tests and home health.

 

Alpers A. Key legal principles for hospitalists. Am J Med 2001;111:5S-9S.

Jones CD, et. al. A Failure to Communicate: A Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations. J Gen Intern Med. 2015 Apr 1;30(4):417-24.

Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin EM, Auerbach AA. Outcomes of Care by Hospitalists, General Internists, and Family Physicians 2007; 357: 2589-2600.

Vasilevskis EE, Knebel RJ, Dudley RA, Wachter RM, Auerbach AD. Cross-sectional Analysis of Hospitalist Prevalence and Quality of Care in California 2010; 5: 200-207.

Wachter RM and Goldman L. The Emerging Role of “Hospitalists” in the American Health Care System. N Engl J Med 1996; 335: 514-517