Top PICS

The Hospitalist. 2006 January;2006(01):

January 1, 2006|The Hospitalist

Busy community physicians planted the seeds of Charlotte, N.C., Presbyterian Hospital’s hospitalist program in the late 1990s. The hospital, which anchors Novant Health’s presence in North Carolina’s Southern Piedmont region, is a 460-bed tertiary care hospital offering emergency, medical, surgical, and behavioral services.

Novant, the parent company, is a nonprofit healthcare system headquartered in Winston-Salem. Adjacent to Presbyterian Hospital and joined by skywalks is the Presbyterian Orthopedic Hospital. Two community hospitals, Presbyterian Hospital Matthews (10 miles south in suburban Charlotte) and Presbyterian Hospital Huntersville (16 miles north and close to an interstate) complete the Charlotte Presbyterian Hospital system.

By 1997 Charlotte’s population was growing so quickly its office-based physicians struggled to cover night calls or leave their office practices during the day to admit patients to the hospital. Presbyterian Hospital answered by forming an Inpatient Management Team (IMT) of five hospitalist internists to handle admissions for community internists from 5 p.m. to 7 a.m. Monday through Friday and on weekends.

Hospitalist Specialist—The PICS Neurology Team

In 2003 Presbyterian Hospital was struggling to better care for more than 700 patients flooding the emergency department with possible stroke symptoms. Although there was a core group of community neurologists committed to responding quickly to stroke symptoms, they couldn’t drop everything to see patients at the hospital.

“We felt we weren’t giving them much support. Our ED physicians were just overwhelmed,” says Dr. Wallenhaupt.

With two interventional neuroradiologists available, Presbyterian Hospital opted to expand the PICS team by hiring two (now three) neurologists. The hospital became a certified stroke center under the VHA Stroke Sense program (www.strokesense.org). It launched a major campaign, StrokeSense, alerting the public to stroke symptoms. Presbyterian Hospital (Main) of Charlotte, N.C., won VHA’s 2005 Best Practices in Clinical Quality Improvement to the PICS neurology team for its leadership in the Stroke Sense program and its cutting-edge treatment of stroke at that hospital. The team is also participating in a clinical trial of desmoteplase, a clot-busting protein discovered in bat saliva shown to be effective for up to nine hours after onset of symptoms.

“If this drug proves useful in extending the time when treatment is effective it will help us significantly restore blood flow after a potentially catastrophic event,” says Aris Chaconas, MD, a neurologist and PICS medical director of Presbyterian Hospital’s Stroke Center.—MP

While the internists delegated admissions to the IMT, they subsequently managed their own patients. Family practitioners, on the other hand, usually delegated the care of their inpatients to the IMT from admission to discharge. Steven Wallenhaupt, MD, and Presbyterian’s executive vice president of medical affairs says that the evening hours overwhelmed local physicians—particularly those who had moved to the Charlotte area for a decent lifestyle.

“It’s really not all about the money—either for the hospitalists or community doctors,” he explains. “It’s about wanting to have a good life and to practice good medicine.”

Mary Le-Bliss, MD, a Presbyterian Hospital clinical director, was one of the original IMT hospitalists. She explains what happened next, in 1999. “Three of the IMT physicians weren’t happy. They felt we were just running an admitting service,” she says. “They wanted something bigger—to manage patients throughout their stay—so they resigned.”

That was a wake-up call. While some community physicians still resisted turning over their patients completely to the hospitalists, a large majority decided to work with the hospitalists. The two groups of physicians (community-based and inpatient) found ways to coexist, hammering out a written agreement that community doctors sign to empower Presbyterian’s hospitalists to follow their hospitalized patients.

“It was nothing out of their pockets, they had an affiliation and the hospitalists got what they wanted,” notes Dr. Wallenhaupt.