When hospitalists stepped into Parkland Hospital (Dallas) a few months ago, they knew they were taking up a new challenge. Initially, they were known as the doctors without a team in a place where everyone was used to seeing no fewer than six to eight physicians rounding in a group.
Soon our hospitalists realized that a lot of teaching and awareness was needed among the nursing and support staff of the hospital to get them ready for this new breed of physicians.
A Case of Nerves
After four years of administrative planning and developing, the hospitalist program finally started in July 2006. Parkland started a hospitalist program due to the new restrictions on resident work hours and the number of patients a resident can admit. There used to be a considerable delay in the admission process causing patients to wait in our emergency department (ED) for hours until an admitting team could see them. This led to higher patient load in the ED. This load not only affected our patient care adversely, but it also caused considerable financial loss to the hospital because we couldn’t bill for admission until the patients were assigned a bed.
Our hospitalists help ease this overcrowding because they don’t work under these restrictions and can increase the ED throughput of the patients. Parkland also instituted a hospital medicine program to decrease length of stay.
Initially there was a lot of excitement, nervousness, and anxiety about the program. When I say nervousness and anxiety, it was primarily related to the nursing and administrative staff’s skepticism about how they would deal with full-time attending physicians. They wondered whether hospitalists would be easily approachable or not. How would they compare with medical residents?
Fortunately, during the next few months, this anxiety gave way to a new trust between the nurses and the hospitalists as the nurses realized that their concerns were answered promptly. Nursing staff also enjoyed a new benefit: the ability to communicate directly with the attending physicians and, in the process, the potential to play a greater role in the medical management of their patients.
Initially we hired eight hospitalists (actually we started with two because the others were in the process of getting credentialed). We handled the workload in the beginning by limiting the number of admissions each day for each hospitalist until everyone was on board. One hospitalist was already a Parkland doc; the rest were hired from outside.
Like many new hospital medicine programs, Parkland’s hospitalists were venturing into a place where the nursing staff’s involvement in patient care was different from that of their private counterparts.
Background: Parkland Hospital is the main teaching site for the University of Texas Southwestern Medical School and Residency Training Program. The residents and medical students are involved to a great extent in patient care. They assume most patient care responsibilities, including placing PPDs (tuberculosis skin tests), caring for wounds, taking arterial blood gases (ABGs), and removing peripherally inserted central catheter (PICC) lines—to name just a few.
As a result of the residents’ involvement, our nursing staff took a back seat in these aspects of care. But once our hospitalists entered the picture they didn’t have the support of medical students or residents. Therefore, to increase the hospitalists’ efficiency in seeing more patients, the onus of doing those procedures fell on the shoulders of the nursing and paramedic staff. Educating the nursing and paramedical staff to help them regain autonomy and play a great role in patient care was a new challenge for the hospitalists.