The positive impact of initiation of hospitalist clinician educators

Abstract

OBJECTIVE:Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a midsized community teaching hospital 1 year after implementation. DESIGN:Two hospitalist clinician educators ( HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents ( N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service. RESULTS:Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged. A driving force behind the expansion of the hospitalist movement is the potential to deliver high-quality medical care while decreasing inpatient costs and improving efficiency. Several institutions have demonstrated that both length of stay (LOS) and cost per case (C/C) have been reduced through the use of hospitalists. CONCLUSION:1-6 On average, hospitalists have been reported to reduce LOS by 16.6% and C/C by 13.4%. 1 Such decreases have been shown in both academic 2,3 and community-based institutions. [4][5][6] Though economic forces ultimately drive the utilization of hospitalists, other outcomes, such as the benefit of hospitalists on the medical education of internal medicine residents and medical students, have been explored to a limited extent. 7 In one large university medical center, residents expressed satisfaction with the teaching provided by hospitalists and reported that it was equivalent and often superior to that of traditional ward attendings. 2 In fact, these residents requested that hospitalists be a part of all of their future inpatient ward rotations. Another university medical center found that the presence of hospitalists improved the quality of attending rounds, increased the emphasis on resident education during inpatient rotations, and enhanced residents' overall learning experience. 8Despite the fact that hospitalists often serve in dual roles as clinicians and educators, there are few data on their ability to effectively manage these roles simultaneously. For academic community-based teaching hospital...

Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes

“…3 Over the past ten years, an increasing number of studies have investigated the impact of hospitalists on outcomes, noting effects primarily in resource utilization and cost reduction, and less so in quality outcomes, patient satisfaction, and provider satisfaction. [14][15][16][17][18] Prior attempts to demonstrate an impact of overnight attending-level physicians on patient outcomes have been limited to the ICU, and revealed minimal impact. 19,20 To the best of our knowledge, our results are the first to describe patient-level outcomes following implementation of an OAH program for general medicine units.…”

Medicina hospitalaria a 15 años de su implementación: ¿Cuáles son los potenciales beneficios en nuestro medio?

“…En la medida que los hospitalistas reemplazan a sub-especialistas en el manejo de pacientes hospitalizados, se refuerza el concepto de manejo clínico general integral. Varios son los estudios que demuestran la preferencia de residentes por los hospitalistas en cuanto a satisfacción, calidad de las visitas, experiencia educativa, conocimientos del manejo intrahospitalario, discusiones de fisiopatología, énfasis en costo efectividad y feed-back (p < 0,05) [35][36][37] . Los estudiantes de medicina consideran que los hospitalistas proveen de una mejor experiencia educativa, de visitas más docentes y entusiastas, usan más la evidencia, modelan mejor los buenos modales, y tienen mayor presencia y compromiso con los pacientes (p ≤ 0,03) 38,39 .…”

Hospitalists in teaching hospitals: Opportunities but not without danger

“…The authors found that hiring two hospitalist educators at their community-based teaching hospital led to decreased resource utilization and improved resident education when compared to having private physicians manage hospitalized patients. 7 Enhanced efficiency due to hospitalists has been demonstrated in several previous studies, in both community and academic settings. 8 The finding of an educational benefit for hospitalists in a community teaching hospital, however, is relatively new.…”