Inpatient care: should the general physician now take charge?

Kirthi, Varo; Temple, R. M.; Patterson, Linda

doi:10.7861/clinmedicine.12-4-316

Cited by 4 publications

(2 citation statements)

References 13 publications

(14 reference statements)

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“…Any future strategy to improve inpatient care should appraise the three models suggested by Kirthi et al,19 namely: extending geriatrician numbers and services, extending acute physicians' role and the development of US-style hospitalists, compared with improving the current situation as suggested by the authors' project. The limited resources of the NHS make significant expansion of the number of geriatricians or AMU physicians quite difficult.…”

Section: Resultsmentioning

confidence: 99%

Improving the quality of care for medical inpatients by placing a higher priority on ward rounds

et al. 2013

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-Models suggested for managing acute, non-elective, medical admissions include expanding geriatric services, extending the role of the acute physician and rejuvenating the role of the general physician. We investigated improving in patient care by changing consultants' work patterns and placing a higher priority on the ward rounds. A focus group and a questionnaire were used to study the impact on several ward round parameters. All respondents reported an overall satisfaction: 93% rated the quality of care as good or excellent, 75% reported increased safe patient discharges and 68% observed improved teamwork. Length of stay reduced to 4 days from 5.3 days without an increase in readmission. The main themes showed improved quality of care, better assured patients and relatives, and better consultant job satisfaction, but also showed reduced junior doctors' independent decision-making and a slight reduction in specialty-related activity. The study concluded that placing a higher priority on ward rounds by altering consultants' work patterns has a positive impact on inpatient care.

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Section: Resultsmentioning

confidence: 99%

Improving the quality of care for medical inpatients by placing a higher priority on ward rounds

et al. 2013

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“…The latter is the subject of Kirthi et al's article in the current issue of Clinical Medicine and it draws out a number of themes. 1 They highlight the important issue of ensuring optimum care for the acutely ill, frail and elderly patient (constituting the majority of emergency patients in UK hospitals) and emphasise the need for a cadre of trained and focused physicians to take a clear overview, provide leadership and carry responsibility for the inpatient care of this group. While they pose the question in the context of the frail, elderly patient with comorbidities, the question is similarly relevant to all emergency patients.…”

Section: Hospitalists -Too Much Baggage To Travel?mentioning

confidence: 99%

From the editor

Hodgson¹

2012

Clinical Medicine

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Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study

Vaughan

Bardsley

Bell

et al. 2021

Health Serv Deliv Res

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Background The increasing number of older, complex patients who require emergency admission to hospital has prompted calls for better models of medical generalist care, especially for smaller hospitals, whose size constrains resources and staffing. Objective To investigate the strengths and weaknesses of the current models of medical generalism used in smaller hospitals from patient, professional and service perspectives. Methods The design was a mixed-methods study. Phase 1 was a scoping and mapping exercise to create a typology of models of care, which was then explored further through 11 case studies. Phase 2 created a classification using the Hospital Episode Statistics of acute medical ‘generalist’ and ‘specialist’ work and described differences in workload and explored the links between case mix, typology and length of stay and between case mix and skill mix. Phase 3 analysed the relationships between models of care and patient-level costs. Phase 4 examined the strengths and weaknesses of the models of care through focus groups, a discrete choice experiment and an exploration of the impact of typology on other outcomes. Results In total, 50 models of care were explored through 48 interviews. A typology was constructed around generalist versus specialist patterns of consultant working. Twenty-five models were deployed by 48 hospitals, and no more than four hospitals used any one model of care. From the patient perspective, analysis of Hospital Episode Statistics data of 1.9 million care episodes found that the differences in case mix between hospitals were relatively small, with 65–70% of episodes accounted for by 20 case types. The skill mix of hospital staff varied widely; there were no relationships with case mix. Patients exhibited a preference for specialist care in the discrete choice experiment but indicated in focus groups that overall hospital quality was more important. From a service perspective, qualitative work found that models of care were contingent on complex constellations of factors, including staffing, the local hospital environment and policy imperatives. Neither the model of care nor the case mix accounted for variability in the length of stay (no associations were significant at p < 0.05). No significant differences were found in the costs of the models. Professionally, the preferences of doctors for specialist versus generalist work depended on their experiences of providing care and were associated with a healthy organisational culture and a co-operative approach to managing emergency work. Concepts of medical generalism were found to be complex and difficult to define, with theoretical models differing markedly from models in action. Limitations Smaller hospitals in multisite trusts were excluded, potentially leading to sample bias. The rapidly changing nature of the models limited the analysis of typology against outcomes. Conclusions The case mix of smaller hospitals was dominated by patients with presentations amenable to generalist approaches to care; however, there was no evidence to support any particular pattern of consultant working. Matching hospital staff to better meet local need and the creation of more collaborative working environments appear more likely to improve care in smaller hospitals than changing models. Future work The exploration of the relationships between workforce, measures of hospital culture, models of care, costs and outcomes in both smaller and larger hospitals is urgently required to underpin service reforms. Study registration This study is registered as Integrated Research Application System project ID 191393. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

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Inpatient care: should the general physician now take charge?

Abstract: -In an ageing population, patients are living longer with one or more chronic disease, and with acute illnesses increasingly extending outside the boundaries of a single medical specialty. Therefore, is it time for the general physician to take charge?

Cited by 4 publications

References 13 publications

Improving the quality of care for medical inpatients by placing a higher priority on ward rounds

Improving the quality of care for medical inpatients by placing a higher priority on ward rounds

From the editor

Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study

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