Team Approach to Patient Care


Hospitalists find themselves working with nonphysician providers (NPP) more and more as institutions spread workloads and cut costs. The work arrangement can be panaceas when they work well, barely palatable when they don’t.

Several sessions at HM09 in Chicago explored the best practices of HM groups that use nurse practitioners (NPs) and physician assistants (PAs). A particularly popular session examined case studies that showed two main trends: NPP programs run into trouble when the people involved view their positions as competition; programs succeed when there is buy-in from all stakeholders.

“There are things DOs and MDs do better than NPs and PAs, and there are things NPs and PAs do better than DOs and MDs,” says Mitch Wilson, MD, FHM, corporate medical director for Eagle Hospital Physicians in Atlanta. "It’s all about understanding the cumulative skill set.”

Dr. Wilson and Tracy Cardin, ACNP, at the University of Chicago Medical Center, used care stories as teaching tools for hospitals looking to implement new programs. The first cautionary tale failed because an “old school” culture left a new NPP so isolated from physicians and nursing staff that she quit. Two other cases showed NPPs integrate more easily because of mutual respect, defined responsibilities, and an alignment of expectations between both hospitalists and NPPs.

Mac McCormick, MD, vice president of clinical services at Eagle Hospital Physicians in Atlanta, offers the following suggestions to best utilize NPPs:

Conduct an analysis of your practice environment, bylaws, staff experience, and pre-existing attitudes to identify potential barriers and optimal opportunities in hiring NPPs;

Avoid pigeonholing NPPs into such narrow roles as completing discharge summaries or collecting data. Tasks that tend not to utilize their skills set might lead to professional dissatisfaction and likely aren't the most cost-efficient use of resources; and

Approach things in a team model. Shared visits are one way to accomplish this. Keep communication lines open to make sure accurate and timely information is available to all.

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