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Practice Management Session

From: The Hospitalist, May 2010

IN THEORY, unit-based de-ployment of hospitalists is a perfect answer to the struggles of navigating, say, a 16-patient census that includes seven units on four floors. But in the real world, it’s not.

“Just placing hospitalists on a unit and giving them patients isn’t the answer,” said Russell L. Holman, MD, SFHM, chief operating officer for Cogent Healthcare in Brentwood, Tenn., and past president of SHM. “Structure has to support a deliberate strategy. Think of what your strategic goals are. … Don’t just implement a new structure and let that be the end.”

Mateen Dawood, MD, applauds an HM10 speaker.

Dr. Holman led a panel, “The Case for Unit-Based Hospitalists: Benefits and Challenges,” in which HM experts agreed that tracking the efficacy of the setup is key to success.

Although the benefits are usually clear—less time spent traveling from floor to floor and more direct communication between physicians and nonphysician providers (NPPs)—the challenges can be numerous, including:

• Fairness. The first complaint of most HM groups switching to a unit-based approach is that it unfairly distributes patient loads, leading to daytime shifts for which one physician starts with a patient census of eight, while a colleague starts with 15.
• Interunit transfers. By creating defined geographic areas, a patient’s movement from one unit to another becomes another transition of care and brings with it those issues.
• Buy-in from other stakeholders. Physician assistants (PA), nursing staff, and others are affected by geographic alignment. Make sure to pitch quantifiable goals—increased productivity, increased touch time with patients, reduced staff turnover—when instituting the new approach.

Kevin O’Leary, MD, MS, associate chief of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, urges physicians to be practical, and not to expect the unit-based approach to be a panacea. “This is really the first step,” he said. HM10