The Hospitalists’ Potential

By Chris Nussbaum, M.D., for HealthLeaders News , August 29, 2006
In 1846, expectant mothers in Vienna were in crisis. Many of them risked giving birth in the streets rather than face the horrors of the hospital. Ignaz Semmelweiss, an up-and-coming young general physician, had recently become the head of Vienna’s First Obstetric Clinic, a training hospital where puerperal fever was claiming the lives of mothers at a rate of nearly 14 percent.

The Second Obstetric Clinic, meanwhile, had a substantially lower death rate--only 2 percent--and was therefore much more difficult to get into. What was causing this drastic difference between two hospitals that were otherwise run in exactly the same manner?

When one of Semmelweiss’ colleagues cut himself on a scalpel during an autopsy and also died of the same fever claiming the lives of women in the First Obstetric Clinic, Semmelweiss had an astounding revelation: The medical students training on corpses were also delivering babies. They were spreading the disease from cadavers to mothers as they examined patients in the obstetric clinic.

After making the medical students wash their hands in a solution of chlorinated lime, Semmelweiss’ First Clinic began to match the Second Clinic’s death rate. Despite being dismissed out-of-hand by his superiors, Semmelweiss’ stunning insight later helped in the discovery of germ theory, and serves as one of the first examples of the hospitalist at work.

Growing numbers, growing potential

Semmelweiss’ unique position gave him the necessary top-down perspective to spot a trend that even the most skilled surgeon would have overlooked. He was trained, like modern hospitalists, to see the angles that others miss. But what role do hospitalists play in today’s changing world of modern medicine?

A February 2005 report by the Washington, D.C.-based Center for Studying Health System Change found that the number of hospitalists nationally increased from just several hundred in the mid 1990s to more than 8,000 in 2003. The ranks are swelling as the need continues to grow.

In numerous studies, hospitalists have proven to be a key factor in improving quality measures, and they often become team players for the hospitals in which they work. This environment has fostered an explosive growth of the subspecialty. Leading and coordinating the care of multidisciplinary patients, the hospitalist is in a position to reduce costs, shorten length of stay, enhance throughput and bring substantial savings.

When a patient is battling a serious condition, hospitals can be a confusing place. With changing clinician shifts come different faces, a multitude of tests, new medications and unfamiliar paperwork. Drawn in large part from the ranks of internal medicine, hospitalists are consistently available to patients while they are admitted to the hospital and are familiar with the specialists, nurses and managers who provide specific treatment. This inside position can equip them to help eliminate communication errors and bureaucratic mistakes. To make the most of their unique perspective, hospitalists should aim to become the quarterbacks of a patient’s treatment program, able to see the whole field, spot both beneficial and negative patterns in care, and adjust daily hospital management as necessary for optimum recovery.

Making connections

The role of the hospitalist is to navigate the treatment process to keep patients, families and primary care doctors informed throughout the hospital stay. As a constant presence in the hospital focused exclusively on the care of inpatients, hospitalists can free primary care physicians to spend more time in their office practices. They often cover emergency room call as well, which can relieve some of the pressure of scheduling physician coverage. Additionally, surgical and non-surgical specialists alike can benefit from readily available medicine consultation and day-to-day inpatient coverage.

The nature of the job means hospitalists are able to embed themselves in the culture of the facilities in which they work while they navigate the complex hospital care environment. Successful hospitalists bring excellent communication skills and clinical expertise to the halls and bedsides of the hospital, driving improved patient outcomes and enhancing bottom lines.

In the coming era of pay for performance, as well as in the competitive overall healthcare arena, hospitalists may be in a position to make the difference in achieving better patient care. When done right, a hospitalist arrangement allows a hospital and its physicians to focus on what they do best, while the hospitalists, like Semmelweiss, can pinpoint the best solutions for the many problems a large organization faces in providing quality healthcare efficiently, effectively and humanely.



Chris M. Nussbaum, M.D., is CEO and founder of Synergy Medical Group, PA, the first independent private practice hospitalist group in Florida’s Tampa Bay area. He can be reached at nussworld@verizon.net.

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