In the Literature: Physician Reviews of HM-Relevant Research
Bottom line: Where feasible, reshuffling elective admissions to “smooth” demand across the week is associated with improved hospital flow.
Citation: Fieldston ES, Hall M, Shah SS, et al. Addressing inpatient crowding by smoothing occupancy at children’s hospitals. J Hosp Med. 2011;6:466-473.
Variability in Preferences, Experiences, and Expectations for Hospitalist Roles in Comanagement
Clinical question: Do provider expectations and experiences in comanagement differ from the traditional medical consultation model?
Background: Hospitalists participate in traditional medical consultation and, increasingly, a variety of comanagement with surgical and various medical specialists. It is uncertain what preferences and expectations on either side of the comanagement relationship might be. Learning more might lead to a better conceptual understanding and working definition of inpatient comanagement.
Study design: Baseline and follow-up surveys.
Setting: Large single-site academic medical center, hospitalist-hepatologist comanagement service.
Synopsis: All 41 respondents completed the baseline survey, with 32 respondents completing a total of 177 follow-up surveys. Respondents included hospitalists, hepatologists, nonphysician providers (NPPs), and GI fellows. Hospitalists were more likely than hepatologists to want to be informed about every patient care decision (83% versus 17%). The majority of respondents reported understanding their roles. At baseline, nearly all agreed that “comanagement tends to improve patient care.” However, at follow-up, fewer NPP and fewer GI fellows reported that patients on their service had received “better care than they would without comanagement.” At follow-up, fewer hospitalists than at baseline reported that there was one “physician leader to direct the overall management of the patient’s hospital course.”
Bottom line: Hospitalists were more likely than hepatologists, within a comanagement relationship, to want to be informed about every decision. Most expected—but fewer actually later reported—that the comanagement model improved patient care.
Citation: Hinami K, Whelan CT, Konetzka RT, and Meltzer DO. Provider expectations and experiences of comanagement. J Hosp Med. 2011;6:401-404.
