Dual Launch Benefits Both Hospitals
At the same time the Parkland Hospital Medicine Program was launched, the Southwestern University also started a hospitalist program at St. Paul University Hospital, Dallas. The Department of Medicine of the University of Texas Southwestern oversees both the programs. All hospitalists are hired by Southwestern University and are part of the Department of General Internal medicine.
The common leadership of both of these programs in the Department of Medicine led to the implementation of a variety of policies derived from the best practices of the two groups. The interaction between these programs has been fruitful. The exchange of physicians credentialed at both hospitals has also reduced the staffing problems that tend to occur due to vacations, holidays, and illness.
Working toward the Future
As we settle down, fully staffed with eight hospitalists, we have started participating in the hospital’s administration by joining various committees. Our hospitalists participate on the pathology clinical advisory committee, the antibiotic committee, the medical reconciliation committee, and the utilization review committee.
Every day brings new challenges and continuous hard work. To make a successful program, it is not only important to grow out of the teething problems, but also to provide exceptional care so that the idea of a hospitalist program is well thought of by the hospital administration. Two of our teething issues included:
- General acceptance of our hospitalists as attending physicians by nursing, support staff, and the other physicians—not as trainees interacting with residents for patient care; and
- Recognition of the distinction between residents who traditionally work under several restrictions as a part of their training as compared with hospitalists who have already undergone training in their field.
Naturally, the hospital wants improvements in both short-term and long-term quality of care. The advantages the hospitalists provide include rendering consistent quality of care, developing new clinical pathways to provide efficient care, and ensuring greater continuity of care.
Regarding specific expectations, for example, SHM advocates 10 to 12 patient encounters per day as adequate. And so we expect our hospitalists to see that number of patients. Other expectations we have:
- That our hospitalists be involved in research projects on patient safety and quality of care; and
- That our hospitalists be involved in developing clinical pathways.
The future of the hospitalist program at Parkland Hospital is bright. As part of the university’s teaching faculty, our hospitalists will be progressively more involved in resident and medical student teaching. As a result, as time goes on, the schedule will have to change in order to provide both continuity of patient care and continuity in the teaching service. While our schedule now works well, we expect to get involved in a resident teaching service to a greater extent, as well as medical consult service and perioperative consult and care. These additional responsibilities may change our schedule.
The hospitalists are actively involved in developing an inpatient curriculum for the residents, along with a new set of standard orders suited to hospitalist practice. Other areas the hospitalists will become more involved in include pre- and perioperative consultations and co-management of surgical and orthopedic patients. We are also working on special hospital projects, focusing on patient safety and hospital efficiency.
The hospitalists at the University of Texas Southwestern put in nothing less than their best efforts. After all, “High achievement always takes place in a framework of high expectation” (Jack Kinder, motivational author). TH
Dr. Mohan is the medical director of the hospital medicine program at Parkland Hospital, Dallas.