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Do hospitalists improve hospital care?

August 11, 2009 |  6:00 am

Hospitalists are part of a relatively new medical specialty focused on caring for patients while they are being treated in a hospital. Working with a patient’s regular internist, cardiologist or oncologist, these physicians make sure needed tests are given and treatment guidelines are followed. You can think of them as the inpatient equivalent of an emergency room doctor. An estimated 20,000 hospitalists now work in 29% of the nation’s hospitals, and those numbers are growing fast.

But do they improve patient care? That question has been difficult to answer.

Two hospitalists and their colleagues at institutions affiliated with Harvard Medical School offer new evidence today that the answer is yes. Writing in the Archives of Internal Medicine, they find hospitals that employ hospitalists provide better care to patients with acute myocardial infarction and pneumonia than hospitals that don’t.

The researchers looked at data from 3,619 general medical and surgical hospitals that are part of the Hospital Quality Alliance. Of those facilities, 40% have hospitalists, and were more likely to be private, nonprofit teaching centers in big cities with at least 200 beds and a intensive care unit.

The study found that 93% of hospitals with hospitalists provided high-quality care to patients with acute myocardial infarction, or heart attacks, compared with 86% of hospitals without the specialists. For pneumonia, the scores were 75% versus 71%. After adjusting for several factors, the researchers concluded that care was 21% better for heart attacks and 11% better for pneumonia when hospitalists were involved. There was no statistically significant difference in outcomes for patients with congestive heart failure, according to the study.

Do hospitalists really deserve the credit for boosting those scores? The data show a correlation between their use and the quality of patient care, but that’s not the same as cause and effect.  What’s more, the study shows that hospitals with higher ratios of registered nurses to patients “were consistently associated with better care.” Perhaps hospitals with more RNs were also more likely to employ hospitalists.

An editorial accompanying the study was also skeptical about its findings, calling them “not persuasive.” For instance, if hospitalists indeed made a difference in treatment of heart attacks, the researchers would need to explain how these doctors influenced the treatment prescribed by each patient’s cardiologist. Perhaps the hospitalists were able to make sure the cardiologists’ orders were carried out. If so, more research is needed to show that link.

-- Karen Kaplan

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Comments (2)

I enjoyed Karen Kaplan's intutitive thinking regarding the Hospitalists on whether they deserve all the credit. I feel they are most helpful to have arround for emergencies, and will often contribute assistance even when not assigned during high need and the attending hasn't responded. However, I donot see the need for as many of them which exhists in many hospitals today. Many time there can be miscommuication with "too many hands in the pot", and time is then wasted and confusion often may occur. I feel Nothing replaces good Nuring communication with the major attending physician or resident who is versed on what is actually going on with Her/His own patient. Perhaps a lessor amount of hospitalists and serving only for emergency sake. I welcome any comments, agreements or diagressments.

I, too, enjoyed K. Kaplan's article regarding hospitalists and less patients per nurse ratio. I completely agree that the less patients I have per night, the better quality care I am able to give my patients. I'm sure most RN's would agree, and don't need evidence backing that point up. Although I give good patient care to my patients, the nights I have a smaller assignment, I am able to spend more time with my patients, and give them the time and quality care they deserve. When I have a large assignment, I still provide good care, but I find myself running around, unable to give the patients the time they deserve just because I am trying to get all my tasks, charting, passing meds, procedures, etc. done. Oh well, I know all you nurses can relate to that, so I'll leave that point there.

My hospital is a small town community hospital that employs hospitalists only (I work in Progressive Care) in all our units. There are at least 2 sides to every issue, but I, as a RN, happen to like the continuity of only dealing with a set group of physicians. I learn their ways, typical tests they order, orders, etc, and it makes it much easier for me, as a relatively new nurse. These doctors specialize in inpatient hospital care, it is their only specialty, which makes most of them (most) great at what they do.

However, I have heard from patients more than once that they don't prefer the hospitalists. The hospitalists many times aren't as familiar with the patient, their history, etc as their primary physician would be. Although, since our hospital is in a small town, many of our patients are repeatedly admitted, so the hospitalists do learn, quite well, many of our patients.

I appreciate P. Ryndak Krys's thoughtful comments on the topic. I agree that nothing will ever replace good nursing communication-we are now and will always be the eyes and ears of the physician-hospitalist or attending. Since our facility only uses hospitalists, we don't have the problem with too many "hands in the pot". Most patients that come to our hospital know we only use hospitalists. I'd be curious to find out what the patients' primary care physicians had to say on the issue.

I wonder if the future trend will lead to hiring more hospitalists. I am happy to see this article, hopefully our philosophy of using hospitalists only is going to prove better patient outcomes. As the article states, and I agree, more research definately needs to be done on this topic-It will be one that I follow in the future!



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