Health Take-Away: Hospitalists bring unique skill, attention to patient care

It was barely 20 years ago that a new specialty emerged in medicine, a unique class of specially-trained physicians, called hospitalists, who were wholly dedicated to in-hospital care. Today, hospitalists represent the fastest growing specialty in modern healthcare, essentially replacing the old model of hospital healthcare in which primary care doctors, in a constant tug-of-war with time, made whirlwind rounds of the hospitals each morning before returning to the office for their regular patient visits.

For patients admitted, the rise of hospitalists ensures a depth and level of care that's highly attentive to their individual needs. For primary care doctors, it means being able to devote their full time to excellent outpatient care.


Hospitalists are specifically schooled in treating the sickest patients in the population. The people they see 24 hours a day are often older, weaker and dealing with acute medical issues and a complex list of chronic medical conditions. Hospitalists are experts in managing multiple medical issues simultaneously, ensuring that patients receive the timely, continuous care they need to recover, return home in better health and avoid readmission.


Hospitalists are on-site around the clock, treating and consulting with patients and their families at bedside, answering questions, prescribing necessary treatments and medications, and working with the entire care team on all aspects of patient care. In addition to the daytime rounds by hospitalists, certain hospitalists called nocturnists are on-site overnight, ready to immediately manage patient issues that arise. Hospitalists also stand ready 24/7 to confer with hospital emergency departments regarding incoming admissions. As a result, newly admitted patients are seen in real-time, rather than the older model in which they were often seen the following morning.


One of greatest advantages of having hospitalists on staff is the level and depth of coordination between the lead inpatient caregiver (the hospitalist) and the primary nurses and care managers. The use of interdisciplinary teams at the bedside is increasingly recognized as being critical to patient safety. Also, they coordinate with a wide range of other specialists - surgeons, cardiologists, kidney doctors and others - who also are treating the patient. The hospitalist serves as the center-point and personal advocate of each patient, ensuring careful attention to detail and personalized, compassionate care.


As important, that collaboration extends to the patient's primary care doctor. While hospitalist may have direct access to the electronic medical records (EMR) of every patient, that's no replacement for the first-hand knowledge of the primary care doctor; they know more about their patients than anyone else, having treated them for years and knowing the nuances of their unique medical histories. Primary care doctors receive a complete summary of the hospital stay, usually within hours of discharge, and often delivered directly into their outpatient EMR.


Hospitalists also can eliminate the frustrating delays that, in years past, left patients nervously wondering and waiting in their beds. Hospitalists are able to see patients more frequently than a visiting primary care doctor could on morning rounds. If a patient is admitted at 4 or 5 in the afternoon, a hospitalist can immediately initiate evaluation and treatment rather than have the patient wait until the next morning. That faster treatment means quicker recovery and shorter hospital stays.

By focusing their practice on a specific group of patients in the population, hospitalists can efficiently manage the care of very ill patients and are able to provide high-quality, family-centered care in hospital settings. Together with primary care doctors, their daily work saves and improves the lives of millions.

William DeMarco, DO, is chief of the Division of Hospital Medicine at Berkshire Medical Center.


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