Leon Reinstein, MD, was a hospitalist long before he even realized he was one. When he came to Sinai Hospital in Baltimore in 1985 to establish an inpatient rehabilitation unit, he became a staff physician. He enjoyed the opportunity to pay more attention to patient care and educational activities than to administration and business concerns, but he didn’t have a name for what he did. “I actually stumbled across the concept. I read an article about hospitalists,” he says. “And I realized that I was one.”
Following Dr. Reinstein through a day in his life as a hospitalist offers insight into what makes him so effective in his work and why—after 20 years—he continues to enjoy his role and to inspire other physicians to follow in his footsteps.
Round and Round
Dr. Reinstein, one of four hospitalists on the 46-bed unit, begins his day at 7:30 with rounds at the hospital. Unlike his colleagues in private practice, however, his hospital patients are just steps from his office. His rounds, involving mostly total joint replacement and fracture patients, take approximately 45 minutes, after which he returns to his office to write up notes. He also prepares for the daily 9:45 a.m. “morning report.” This meeting with Dr. Reinstein’s resident, Melita Moore, MD, along with representatives from nursing, social work, and physical therapy, is an opportunity to review any changes or developments from the previous evening.
One of the meeting’s goals is to prepare patients for discharge. With an average 10-day length of stay, the team has to address problems such as constipation or infections that could hinder patients’ progress and delay their release. Pain issues are also a common topic. Getting and keeping pain under control is a top priority for Dr. Reinstein and his team. When patients are comfortable, he notes, they are better able to participate in physical therapy and rehab, and they eat and sleep better.
Plugging into Patient Care
After the morning report, Dr. Reinstein gets on the computer to input some notes and check lab results. He can do this thanks to the hospital’s computerized physician order entry (CPOE) system. He loves having access to information “in a second at my fingertips.” For example, he looks up lab values for one patient and records them on a warfarin flow sheet. He then orders medication using a “quick orders” tab that gives him a choice of dosages. At the same time, he is able to view a chest X-ray for another patient.
“I’m not a computer geek, but I love this system. It’s very interactive and easy to use,” says Dr. Reinstein, adding, “It includes information on everything from allergies and patient alerts to diet, activities, and diagnostic tests.” He spends about 15%-20% of his day at the computer.
Afternoon: The Pace Picks up
After a quick lunch, during which he catches up with his fellow hospitalists and other colleagues, Dr. Reinstein begins his busy afternoon. On Wednesday, this starts with a 12:30 team conference. This is an important meeting in which all of the team members—social workers, physical therapists, occupational therapists, nurses, and Dr. Reinstein’s resident—meet to discuss every patient in detail and prepare each for discharge.
At the meeting, conversations focus on patient functioning, physical therapy progress, medical condition, and pain control. The group discusses arrangements for community support and/or family education needs for some patients and subacute care options for others. The team also addresses patient goals and how they can help meet these. For example, one patient has requested an assistive device. While the equipment is not considered medically necessary by the insurance company, the group discusses how to arrange this in order to satisfy the patient’s wishes.