The hospitalist field turns 15: New opportunities and challenges

Wachter, Robert M.

doi:10.1002/jhm.913

Cited by 23 publications

(26 citation statements)

References 9 publications

(6 reference statements)

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“…20,21 The workload of the on-call medical registrar is also viewed by more junior trainees as particularly arduous, with 80% reporting this to be 'unmanageable' or 'very unmanageable' (Dillon A et al personal communication). 22 Consultant GIM duties have been reported to be unpopular because of increasing service requirements, particularly out of hours. Additional reasons are likely to include the workload volume and its unselected nature, lack of specialist prestige, and the extent of medical knowledge and diagnostic skills required to practice GIM to a high standard.…”

Section: Evolving Requirements For Inpatient Carementioning

confidence: 99%

“…Hospitalists have formed the fastest-growing specialty in US history, expanding from a few hundred to 30,000 in just 15 years, with hospitalists now present in approximately 70% of US hospitals. 22 In the UK, over a similar timeframe, acute medicine has emerged to become the fastest-growing specialty in the NHS. 23 Hospitalists in the USA and acute physicians in the UK have many duties and patterns of working in common.…”

Section: Reinvigorating Gimmentioning

confidence: 99%

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Inpatient care: should the general physician now take charge?

2012

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Section: Evolving Requirements For Inpatient Carementioning

confidence: 99%

Section: Reinvigorating Gimmentioning

confidence: 99%

Inpatient care: should the general physician now take charge?

2012

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“…1 In this changing clinical landscape, the daily routines of inpatient teams must be fine-tuned to optimize efficiency, reliability, and safety.…”

mentioning

confidence: 99%

Capsule Commentary on Leykum et al., the Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients’ Outcomes

Stearns

2015

J GEN INTERN MED

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T oday's inpatient providers are caring for ever-sicker patients during shorter hospitalizations, with reduced resident duty hours, while leading the charge for quality improvement and value-based care. 1 In this changing clinical landscape, the daily routines of inpatient teams must be fine-tuned to optimize efficiency, reliability, and safety.Clinical reasoning is often used as the framework for discussions of how providers conceptualize and treat individual patients, but it can oversimplify or neglect the reality of the many competing tasks carried out by providers on busy services. 2 This study by Leykum et al. 3 introduces the concept of Bsensemaking^as a tool for inpatient teams to use in organizing and carrying out their daily tasks. The authors used measures of sensemaking to assess how teams prioritized, processed, and cared for multiple sick patients simultaneously, and found that higher markers of sensemaking were associated with improved patient outcomes, including fewer complications and shorter lengths of stay.In many ways, the most surprising finding of the study was just how infrequently the low bar for sensemaking was met. The majority of observed teams never conducted rounds Bpurposefully,^as defined by the authors, and most teams had low sensemaking scores when rated on discussions of complex patients. It is not hard to imagine the many possible differences between teams with high and low sensemaking scores; teams that are explicit, flexible, and purposeful in daily work might also communicate more effectively both with other providers and with their patients, be more responsive to feedback, and be open to outside ideas. The question that remains is whether interventions to encourage sensemaking would make a difference in patient outcomes for teams that did not naturally function this way.There is a growing body of literature on how rounding structure can affect resident education in the new duty-hours climate. 4,5 As we consider how this core of our daily work affects trainees and patients alike, sensemaking may be a foundation around which we can evaluate and refine our practice. The authors can now investigate whether teams with low sensemaking scores are able to improve patient outcomes by improving these measures of sensemaking.

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“…1 The field has been shaped by societal, financial, and clinical factors within American health care, several of which also exist elsewhere in the world. 2,3 Outside the US, analogs of hospital medicine have evolved; in the United Kingdom (UK), where the term and concept of a hospitalist is widely unknown, the specialty of acute medicine has evolved to meet the complex needs of the acutely unwell medical patient in the modern health care environment. The similarities are notable, as are the differences.…”

mentioning

confidence: 99%