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The Hospital Medicine Movement

The evolution, or more appropriately the revolution, of providing physician care to patients during their hospital stay is a remarkable and valuable example of how healthcare has adapted to meet the needs of the patient and those who care for those patients. Born of the quest for quality and efficiency, hospital medicine has proven its ability to transform satisfaction and performance in a large segment of hospital-based healthcare delivery system, while simultaneously relieving primary care physicians (PCPs) of the increasing burden of the inpatient portion of their practices. Hospital medicine directly impacts inpatient hospital processes to simultaneously improve the patient experience and utilization of hospital resources. In a time of significant advances in medicine, new technology, evidence and information, and a focus on quality and efficiency, it is interesting to see how something as simple as a basic reassignment of responsibilities can have a significant effect on patient care as well as overall hospital performance.

The hospital medicine movement continues to grow based largely on its ability to impact value-based purchasing from a cost, satisfaction, and quality perspective. As hospital medicine continues to become more available, new questions arise about the most effective options for implementation and management. It is opening up new challenges and opportunities for refining processes of inpatient care and uncovering new avenues for improving that care through better interdepartmental relationships.

As the specialty becomes more mainstream, hospital medicine is capturing the serious attention of practice management companies interested in diversifying into this area. This chapter explains the history and development of hospital medicine as well as the reasons, advantages, and challenges facing those who have an interest in providing this service. For emergency physicians interested in diversifying their practices, hospital medicine is among the best options available.

Hospital Medicine as a Specialty

As defined by the Society of Hospital Medicine (SHM), hospital medicine physicians or “hospitalists” are physicians whose primary professional focus is the general medical care of hospitalized patients. The role of the hospitalist is to coordinate care for the inpatient portion of the hospital stay often referred to as inpatient services. The specialty is broad in scope and can support multiple specialties, but the majority of hospitalists have trained in internal medicine or family practice. Hospital medicine fellowships are increasing in number each year, though hospitalist medicine is not yet recognized as a distinct subspecialty requiring additional training or certification. The hospitalist's role starts with the patient's evaluation after being informed by the emergency physician (PCP in the case of direct admissions) that admission is required. The hospitalist then works to provide the most appropriate treatment, monitors the patient's progress, provides daily care supervision, manages postdischarge planning and follow-up, and ultimately discharges the patient to the next level of care. In the best of practices, the hospitalist also keeps the PCP informed of the patient's care. The specialty has also ...

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