As editor of this supplement to The Hospitalist, I would like to introduce these eight papers prepared by the SHM Benchmarks Committee by identifying the unifying themes and consistent messages.
In all of the papers, the value provided by hospitalists comes across loud and clear. The authors not only cite statistics and published research studies, they provide examples and quotes from acknowledged hospitalist experts and leaders. However, perhaps more importantly, the papers convey a strong rationale as to WHY hospitalist programs provide value. Figure 1 attempts to describe this rationale. It depicts three elements:
- The characteristics of hospitalists: These are immutable attributes that uniquely define this new physician specialty.
- The expertise of hospitalists: As they practice hospital medicine, hospitalists have developed a unique combination of knowledge, skills, and relationships
- The value added by hospitalists: Hospitalists impact a wide range of issues that address the patient care, financial, and strategic goals of the hospital.
The Characteristics of Hospitalists
What attributes differentiate hospitalists from other medical specialties?
The first attribute describes what hospitalists do: they practice hospital medicine; for the most part, hospitalists have an inpatient practice. Their day consists of admitting, rounding, managing, discharging, and consulting for hospitalized patients.
The second attribute describes where hospitalists practice; they have a consistent presence in the hospital. As a consequence, hospitalists do similar things and relate to the same people in the same place on a daily basis.
The third attribute describes how hospitalists are organized. A hospitalist program is a cohesive physician group, and like any other medical group, the members develop a common organizational identity, a consistent practice philosophy, and a balance of individual and communal goals.
The Expertise of Hospitalists
What skills, knowledge, and relationships are unique to the specialty of hospital medicine?
As inpatient generalists, hospitalists continually treat the most common reasons for admission, thus acquiring exceptional clinical knowledge of these conditions and issues involved in managing patients with multiple co-morbidities. In addition, hospitalists are familiar with the clinical tools supporting the patient care process.
In addition to clinical knowledge, hospitalists have impatient clinical skills, including diagnosis, physical examination, discharge planning, medical chart recording, family meeting coordination and oversight, and the performance of technical procedures.
Through their constant presence in the hospital, hospitalists develop exceptional organizational knowledge and relationships. They are quite familiar with the flow of patients through their hospital, including hospital processes, procedures, rules, regulations, and information systems. They understand "how to get things done" in their facility and often have good relationships with other healthcare professionals and hospital departments.
Hospitalists often are the most knowledgeable inpatient clinicians with regard to a wide range of healthcare industry issues. These include comprehension of the payer/insurance rules, state and Federal regulations, public health initiatives, recently enacted or pending healthcare legislation, and financial issues facing their hospital.
The Value Added by Hospitalists
How do hospitalists add value to the major stakeholders in the healthcare industry: hospitals, physicians, and health plans?
Each of the eight papers describes a different dimension of the benefits provided by hospital medicine programs.
First, hospitalists provide an effective solution to hospital that are having a difficult time organizing their medical staff to provide on-call coverage for unassigned patient care, both in the ED and subsequent to admission.
A second issue of concern for hospitals relates to the fact that many physicians are no longer able or willing to serve on hospital committees or play a medical staff leadership role. Hospitalists have emerged as strong candidates to play this role in their hospitals.
Third, hospitalists provide value by helping to improve physician practices, including primary care physicians, surgeons, emergency physicians and specialists.
Today, most hospitals use traditional physician on-call systems to provide overnight coverage. A fourth value added by hospitalists relates to the extraordinary coverage (24/7) provided by many hospital medicine programs.
The dominant challenge facing American hospitals relates to financial pressures. Published research studies have consistently documented that hospital medicine programs generate resource utilization savings.
Improved throughput management is a sixth value added by hospitalists. Many hospitals are operating at or close to capacity, creating a crisis of bed availability. Hospitalists are uniquely qualified to address these patient flow issues.
A seventh dimension of the value provided by hospitalists relates to the formal and informal education they provide. In a formal capacity, hospitalists are teachers of clinical and non-clinical inpatient skills to medical students, residents, and fellows. In an informal role, hospitalists impart knowledge to other physicians, healthcare professionals, patients, families, and hospital administrators.
Hospitalists make major contributions to the healthcare quality and patient safety, the eighth aspect of value added by this new specialty. Hospitalists can reduce medical errors, improve the process of care, and achieve better patient outcomes.
Hospital medicine has developed as a specialty with unique characteristics and expertise. Hospilalists have specialized skills, knowledge, and relationships that contribute value to hospitals, physicians, patients, and health plans. These benefits include and go significantly beyond the delivery of quality patient care to hospital inpatients. The hospital medicine specialty continues to grow at a significant rate because of the broad-based positive impact made by hospitalists.
Joseph A. Miller, Editor
Mr. Miller can be contacted at firstname.lastname@example.org