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Hospitalists helping reduce patients’ lengths of stay, hospital costs

Hospital medicine is growing rapidly in the United States. According to the Society for Hospital Medicine, there were 15,000 hospitalists practicing in 2005 and that number is projected to reach 30,000 in 2010. That’s fast growth for a specialty that’s been around only 10 years.

Mississippi hospitals are part of this expanding healthcare trend with at least 11 hospitals having hospitalist programs, according to the Mississippi Hospital Association. The first one in the state was begun in 1997 at North Mississippi Medical Center in Tupelo. It started with one physician, Dr. Renee Wilson, who was affiliated with a local internal medicine group, and has grown to six full-time hospitalists who cover the hospital weekdays and evenings.

Wilson believes the trend is growing for multiple reasons.

“Initially, hospital systems were looking to reduce costs by providing more efficient and timely care of hospitalized patients this way,” she said. “We started our program so that our clinic doctors would be present in the clinic five days a week, without interruptions throughout the day and the need to run back and forth to the hospital.

“By covering the hospital, our clinic doctors are able to provide more preventative office-based care, and our hospitalized patients receive care from physicians dedicated to remaining in the hospital.”

She says this program allows hospitals to provide better urgent care and better ability to manage a hospitalization outcome by physicians being onsite and practicing critical thinking skills daily.

“Lifestyle choices for physicians have also driven this movement as physicians are trying to streamline their practices and devote time to their marriages and family,” she added.

Wilson says she prefers hospital medicine and that her training was predominantly inpatient.

“I love that I have more control over the care of the patient’s outcome than if he/she was outpatient, and I am encouraged when there are positive outcomes that I can see on a day-to-day basis,” she said. “It is an honor to bond with patients and families during the sickest days of their lives. The relationships are very rewarding for the most part.”

Family reasons led Dr. Teri Oakes Dyess into hospital medicine at Baptist Health Systems in Jackson. She’s completing her fourth year in the program that began seven years ago and now has four full-time and one part-time hospitalist on staff.

“I chose to make this transition because I am a single mother with children,” she said. “I had a traditional office practice for 13 years with patients scheduled every 15 minutes. As a hospitalist, I have more flexibility if something comes up with a child.”

Dyess also likes the intensity of hospital medicine and thinks it would be difficult to keep up with the fast-changing world of medicine if she were not in the hospital. “Many doctors don’t want to keep up with it, and we have good working relationships with the doctors outside the hospital,” she said.

She says hospitalists are a valuable asset to the healthcare system because they stay in the hospital where they are available to review test results and have more time to speak with patients and families. These in-house physicians are also available any time to discharge patients, thus reducing patient costs.

“Patients do not have to wait for their doctor to come to discharge them,” Dyess said. “Patients may think they’ve paid for the day and it doesn’t matter what time they check out, but it’s no longer like a hotel room. A patient’s length of stay is budgeted down to the hour. It’s not a per diem charge.”

In a 2005 study conducted by Mt. Sinai Hospital in New York, patients seen by hospitalists had a 16% reduced length of stay and reduced costs of over $700 per case. The study cited fewer unnecessary tests as part of the savings.

David Barber, administrator of North Mississippi Medical Clinics, concurs. “From an administrative standpoint, we have been very pleased with the growth and development of our hospitalist program,” he said. “We have seen better quality outcomes, increased patient satisfaction and decreased costs. From the earliest days with Dr. Wilson to our current number of six, we have been fortunate to have quality physicians who truly enjoy taking care of patients in the inpatient settings.”

The hospitalist program began at Singing River Hospital in Pascagoula in 1999 and has recently expanded to the system’s other hospital, Ocean Springs Hospital. Dr. Randy Roth, director of inpatient physician services, says the hospitalists provide medical and consulting services to hospitalized patients on a 24/7 basis.

The program expedites the admittance and discharge of patients. “Both processes take place with an abundant amount of information and discussion between the primary care physicians and the hospitalists,” he said. “We currently have four physicians working during the days and one covering the nights. By being available and seeing numerous cases of the same illnesses, hospitalists have somewhat become specialists in the hospitalized patient.”

Roth believes as the field has grown, much like the emergency medicine movement, residency programs are starting to form around the nation.

“When the hospitalist program first started, patients missed their primary care physicians,” he said. “Then as people meet our doctors and realize the care they are receiving, it is not infrequent at all for patients to ask, ‘Do you have an office outside of the hospital?’ Based on that, I think the program has been very well received.”

Wilson feels the hospitalists provide more timely care with better outcomes. “We are dedicated to the inpatient setting and remain available for urgent situations,” she said. “We alter these outcomes better. We are more expert as we focus our practice solely on the needs of hospitalized patients.”

At North Mississippi Medical Center, the hospitalists accept patients for admission from the emergency room, surrounding emergency rooms and clinics throughout North Mississippi. They also support the hospital staff with internal medicine consulting, make patient rounds daily and provide continuity to patient care.

“We respond to Code Blue situations and provide critical care for out of hospital staff when necessary,” Wilson said. “Weekend care of hospitalized patients is also shared by our clinic doctors as the volume of patients to care for is significant. The program works very well and we use many protocols to be sure all of our patients receive optimal, consistent hospital care.”

Dyess says patients at Baptist Health Systems are getting used to having hospitalists care for them and like it. Local physicians like it, too. “We help the ones who don’t want to come to the hospital. They can spend more time in the office,” she said, “and we send their patients back to them. We’re not taking their patients away from them.”

Contact MBJ contributing Lynn Lofton at llofton656@aol.com.

About Lynn Lofton

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