Windy Lammers Stevenson, MD
Inpatient Pediatric Service
Doernbecher Children’s Hospital
Oregon Health & Science University
707 SW Gaines St. CDRCP
Portland, Oregon 97239
Phone: 503-494-6513 Fax: 503-494-4953
E-mail: [email protected]
Tracy Bumsted, MD, MPH
Carrie Phillipi, MD, PhD
Windy Lammers Stevenson, MD
Cynthia Ferrell, MD, MSEd
Arthur Jaff e, MD
C. Wayne Sells, MD, MPH
Scott Shipman, MD, MPH
Joseph Zenel, MD
The pediatric inpatient service at Doernbecher Children’s Hospital is a newly formed multidisciplinary team designed to creatively approach the continually evolving challenges of providing excellent inpatient care in the current financial environment.
Three pediatric hospitalists have joined forces with four general pediatricians and an adolescent specialist to assume care for all patients on the general pediatric inpatient service at this tertiary care academic medical center. A pediatric case manager and a nursing director complete our team. The eight board-certified physicians are members of the Division of General Pediatrics in the Department of Pediatrics at Oregon Health & Science University.
Our care model was introduced in a step-wise approach over 10 months beginning in the fall of 2003. Subspecialists who had been providing rotating coverage on the general pediatric service were replaced on the wards as each new hospitalist was hired. With staffing now complete, the subspecialists can focus on other clinical and research endeavors. Doernbecher’s open staff policy allows community physicians to admit and follow their own patients; however, most community providers choose to admit their patients to the hospitalist service.
The three hospitalists are scheduled in blocks of 3-7 days, each attending the equivalent of 13 weeks per year, weekends included. The general pediatricians provide coverage for the remaining weeks. Average daily census is 6-12, with a peak-season census of 10-16. The hospitalists are the primary attendings for the general pediatric patients and are available for consultation to any of 12 pediatric subspecialty and surgery services, as well as the emergency department. House staff presence allows for nighttime call from home. Additional off-service clinical responsibilities include supervision of resident clinic and attending in the newborn nursery.
Our hospitalists are committed to education. We are responsible for the inpatient education of third-year medical students as well as first- and third-year pediatric and family practice residents. We play key roles in clerkship direction. We welcome sub-interns from our own institution and from across the country. We have embarked on formal and informal education efforts for nurses, as well, and we are striving to provide all members of our team with quality feedback.
We are fortunate to have had the incredible support of an experienced case manager and talented nursing director in implementing change on the inpatient unit. Together we have decreased length of stay by 500 bed days in 11 months, redesigned morning flow on the wards, and tackled systems challenges. We are proud of our successes in solidifying a sense of identity on the unit, and improving morale for physicians, nurses, and ancillary staff. We are grateful for the continued support of our colleagues in the PICU, on our subspecialty and surgery teams, and on our Kaiser inpatient pediatric service.
Progress toward long-term fiscal independence is one of our biggest challenges. Hospitalists are salaried through hospital and school of medicine funds; like most academic programs with teaching missions, ours will need continued support.
Marketing efforts are underway to facilitate excellent communication with our referring physicians, improve access to care at our institution, and improve payer mix.
We are excited about the continued development of our young program. We are working on increasing collaboration with our subspecialty and surgical colleagues, as well as using evidence-based methods to implement additional best-practice guidelines. We are about to launch our new computer program for notes, billing, and data collection, with hopes of continuing to document decreases in length of stay and other financial benefits for the hospital. We are enthusiastic about implementing competency-based education and evaluation, and we look forward to interactions with others contributing to the pediatric hospitalist movement.