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Defining and Protecting Scope of Practice Critical for Hospitalists


Scope creep can lead to suboptimal clinical outcomes if hospitalist practices fail to plan appropriately, Dr. Simone says. The plan must include “development of a staffing and schedule model to accommodate service expansion (when applicable), creation of policies and procedures addressing the new services, and hospitalist training (when appropriate) to ensure competently trained providers,” he adds.

Before any HM group agrees to comanagement, it should first understand the reasons for the request, Dr. Siegal says. According to a presentation he gave at HM07 on the topic, group leaders should:

  1. Determine if comanagement is a reasonable solution to the problem.
  2. Identify stakeholders and understand their goals, concerns, and expectations.
  3. Ask what might be jeopardized if hospitalists participate: Will it overload an already busy service, compromise care elsewhere, or set unrealistic service expectations?
  4. Set measurable outcomes to quantify the success (or failure) of the new arrangement.

It’s also important to define responsibilities, establish clear lines of communication, and determine how disagreements will be adjudicated. Establish your scope of practice and stick to it, Dr. Siegal says. A big red flag is when your group does things on nights, weekends, or holidays that it doesn’t do during the week.

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