What Emergency Doctors Say
Douglas Hill, DO, FACEP, emergency physician, North Suburban Medical Center, Thornton, Colo.
ACEP was founded in 1968, the first emergency medicine residency was begun in 1970, and emergency medicine became the 23rd recognized specialty in 1979, when the first certifying board exams were administered. The development of hospitalists has really mirrored the development of emergency physicians many years before. Now, as both specialties mature, collaboration between the hospital-based physicians is becoming more important.
Benjamin Honigman, MD, professor of surgery, head of the Division of Emergency Medicine at the University of Colorado School of Medicine, Denver: One example of how our collaboration has worked is with low-risk chest pain patients. Prior to our having hospitalists, there was a significant delay in getting stress testing done for patients after they’d been ruled out for acute coronary syndrome. By getting together with the hospitalists and creating a mechanism for how these patients would be taken care of and a time frame for how long these patients could be stressed, as well as the kinds of patients who would be admitted to that type of service, we were able to create that efficiency.
The model of hospitalists is the model that we developed years ago as emergency physicians. They do shifts, they come in for a certain period of time, they take care of patients in an episodic way, and most of them don’t have continuity after the patients are discharged; that’s a model that emergency physicians are used to. Some of them work 24/7, which is a model that is the foundation of our specialty. Not that we love to work nights and holidays and weekends, but we are one of the few specialties that do. The hospitalists have taken on that mantle. We are kind of kindred spirits, if you will, and it has made it easier to work on various problems.
I value the hospitalists. … I consider them trusted colleagues. And the issue comes down to one of trust. If we have a patient whom we’ve seen for a particular complaint, and that patient evolves differently, then the hospitalist has to trust that our initial evaluation and assessment is in fact accurate and valid. … Whether it’s an asthmatic patient or a patient with pneumonia or low-risk chest pain, it just seems that having the consistency of the [hospitalist] group really makes a difference in improving patient care.
James W. Hoekstra, MD, professor and chairman, Department of Emergency Medicine, Wake Forest University Health Sciences Center, Winston-Salem, N.C.: Both emergency medicine and hospitalists deal with patients in the same type of system: They are specialties that are centered on a time course in the patient’s acute illness. We grew out of clinical need, and they are growing out of clinical need. Ours is a generalist type of specialty, and so is theirs. ER [physicians] and hospitalists are synergistic. They’re very similar, very complementary. And most ER groups are extremely supportive of having hospitalists and being able to admit to hospitalists. We need more of them. Everybody’s looking for them. Everybody wants more.
Bruce Evans, MD, medical director of emergency services and assistant professor of surgery, University of Colorado Health Sciences Center, Denver: One of the real benefits of the hospitalist system is that we are familiar with the team of admitting physicians, which allows for a lot of collegiality and standardization. We can get someone admitted for a pulmonary embolism, for example, and start the workup in the ED because we know what our admitting colleagues need in order to provide the best standard of care.
One of the challenges of the system has been implementing it in a teaching institution where we continue to support the mission of the resident-based service. This sometimes results in extra phone calls when we’re trying to arrange disposition to the most appropriate service for the patient. A lot of these problems have been minimized as we have designated certain classes of patients, such as observation, as patients come in to go to an admitting team comprised of the hospitalists. —AS