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Redefining the role of hospitalist

ST. LOUIS -- Dr. Philip Vaidyan used to spend a big chunk of his day, often an hour or more, in the halls and stairwells of SSM St. Mary's Health Center in Richmond Heights, Mo. The busy physician didn't see all this running around as a good use ...

ST. LOUIS -- Dr. Philip Vaidyan used to spend a big chunk of his day, often an hour or more, in the halls and stairwells of SSM St. Mary's Health Center in Richmond Heights, Mo. The busy physician didn't see all this running around as a good use of his time.

As a hospitalist -- a doctor who cares for patients while they are in the hospital -- Vaidyan typically sees patients on nearly every floor, in a variety of units, each with its own nursing staff. He found he was spending too much time moving among patients or answering pages from another area of the hospital.

"The struggle for hospitalists is (that) patients are scattered," Vaidyan said.

Then Vaidyan learned about a growing number of hospitals that were able to reduce these frustrations by assigning hospitalists to specific units of the hospital.

More time

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Most of these hospitals -- including St. Mary's -- say the move has nearly eliminated wasted travel time, giving physicians more time with patients, families and staff. The hospitals hope better access to physicians will lead to better communication, treatments will begin sooner, fewer complications will occur and patients will go home more quickly.

One example: With the same physicians covering the same patients with the same staff, it's easier for them to "round" together in the morning.

These bedside discussions about the patient's condition and treatment allow all members of the care team -- from the social worker to the nurse's aide to the physician -- to share observations and suggestions. Patients and families are brought in to share information and learn about follow-up care.

At St. Mary's, the hospital worked with IPC The Hospitalist Company Inc. to create a pilot dedicated 20-bed hospitalist unit. Five physicians and two nurse practitioners work in the unit.

Other patients are under the care of another contracted hospitalist company or of their primary care doctor.

Similar units are popping up at hospitals around the country. Though all are structured slightly differently, the goal is the same: improve patient care by giving physicians better proximity to their patients and staff.

"You're right there in the unit all the time," said Dr. Mark V. Sheffield, assistant physician-in-chief at Kaiser Permanente, which has introduced the concept in two of its hospitals in northern California. The units will celebrate their two-year anniversary this summer.

"Nobody would go back to the previous system," said Sheffield. "I think that's a pretty good sign that we're going in the right direction."

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Sheffield points out that back in the day when family physicians cared for most hospitalized patients, proximity wasn't as critical. Most only had a couple of patients in the hospital at a time.

Safer care

Dr. Amy Boutwell, a director at the Institute for Health Care Improvement, a nonprofit health care think tank in Cambridge, Mass., supports the transition to dedicated hospitalist units. A hospitalist by training, Boutwell sees the benefits of improved proximity to patients and thinks the change supports the institute's objectives for safer care.

Still, there have been some challenges.

For example, when patients come into the emergency room, they can't simply be sent to any room. Patients have to be spread evenly among units without compromising patient flow.

This problem and others caused Staten Island University Hospital in New York to dump the program after 1 ½ years.

The hospital often was too busy to give each unit a fair share of the workload, said Dr. Aaron Gottesman, director of hospitalist services at Staten Island.

When a bed opened it had to be filled immediately, even if that meant one hospitalist cared for many very sick patients while another treated less critically ill patients, Gottesman said.

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As part of the pilot at St. Mary's, the hospital is measuring how nearly every aspect of patient care functions in the new unit. Those results will help determine whether the unit is kept long term and implemented at other SSM-St. Louis hospitals.

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