As hospitalist groups evolve, they seek ways to make the best use of support staff to improve patient care and efficiency.
A look at hospitalist groups around the country shows there is no one perfect formula for putting together the best support staff. Rather, the choices groups make are tailored to their specific needs and their relationship with their hospitals.
Support staff members can include secretaries, clerical workers, case managers, social workers, administrators and administrative assistants, office managers, nurses, nurse practitioners, and physician’s assistants.
One trend is the use of registered nurses in hybrid nursing/administrative roles that require medical knowledge and hospital savvy.
Brian Bossard, MD, created a nurse coordinator role in 2003 to provide support to the 18 hospitalists he directs at Inpatient Physician Associates, a group that provides care to patients at BryanLGH Medical Center in Lincoln, Neb.
The group’s three nurse coordinators serve as liaisons with patients and their families and with the hospital’s nursing staff and ancillary staff. The nurse coordinators expedite discharge management by initiating discharge orders, justifying medications, and fielding any questions or issues that need to be discussed with doctors. They keep track of the group’s 18 hospitalists and determine who is available to take on new admissions. It’s an often-complex process of knowing who’s where on rounds and whether they’re busy with difficult cases.
Before the nurse coordinator roles were established, physicians were in charge of figuring out who would take the next patient. “That physician would take all the information, but that may not be the physician available to take care of the patient,” says Dr. Bossard. “That physician would have to call another physician and give the same information—which occupied our doctors’ time. The nurse coordinators are really a time-saving feature.”
At the hospital medicine program at Temple University School of Medicine in Philadelphia, six clinical care coordinators, all trained RNs, play a similar role for the program’s 23 hospitalists.
William Ford, MD, medical director for Cogent Healthcare directing the program at Temple University, credits the clinical care coordinators, who help maintain communication with patients’ primary care physician during and after discharge, for cutting the hospital’s 30-day and 72-hour readmission rate in half within a year’s time. He says coordinators have played a significant role in boosting the group’s overall efficiency. “Our doctors can see three to five more patients a day because of the time the clinical care coordinators save them,” he says.
Some companies providing hospitalist services have relied mainly on office manager-type staff members to take care of clerical tasks and ensure the flow of information between hospitalists and primary care physicians. “Practice coordinators” play this role at the seven hospitalist groups run by The Schumacher Group’s Hospital Medicine Division of Lafayette, La.
David Grace, MD, area medical officer for Schumacher’s hospital medicine division, says practice coordinators are also in charge of collecting data on patients’ length of stay and level of satisfaction and ensuring accuracy in coding and documentation of diagnoses.
Practice coordinators are not required to have nursing degrees, as the job doesn’t include direct patient care. But he looks for applicants with a background in healthcare and an understanding of medical terminology. “Although practice coordinators don’t provide clinical care, the position improves the care delivered by the hospitalists,” he says.