Hospitalists

What is a hospitalist?

A hospitalist is defined as a physician “whose primary professional focus is the general medical care of hospitalized patients. Activities include patient care, teaching, research, and leadership related to hospital medicine.”¹ Hospitalists may be employed by medical institutions or a large group practice to provide inpatient services to children and/or adults. Hospitalists are most commonly trained as family physicians, pediatricians, or internal medicine physicians.

Family physicians possess the education and training necessary to be hospitalists and are eligible to sit for the Focused Practice in Hospital Medicine examination administered by the American Board of Family Medicine. Learn more in the Joint Statement from the Society of Hospital Medicine (SHM) and the American Academy of Family Physicians (AAFP) on Hospitalists Trained in Family Medicine.

Guidelines for Communicating With the Referring Primary Care Physician

Communication between the hospitalist and the primary care physician ensures optimal patient outcomes and reduces hospital readmissions. Timely communication supports successful transitions of care and care coordination of any necessary follow-up treatment.

Consultation with an intensivist, medical, or surgical subspecialist does not preclude the need for the continuing, comprehensive, and personal care provided by the hospitalist. An important attribute of the hospitalist is the ability to collaborate and communicate with other physicians in the inpatient setting as well as to ensure continuity between the inpatient and the outpatient setting.  

The following guidelines are intended to support quality, cost effective care to patients and their families, and to clarify expectations for communication between hospitalists and primary care physicians.

1. The overarching objective is optimal care for the patient.
2. When a patient presents to the emergency department (ED) and the ED physician determines an inpatient admission is necessary, the following should occur:  
   
   • Verification of the primary care physician name and address by the patient, family, or care giver. The information should be documented in the medical record to ensure a smooth care transition at the time of discharge.
     
   • The hospitalist should request from the primary care physician information on the pre-admission treatment and testing, co-morbidities, ongoing specialty consultations, family and social concerns, advance directives, etc., to assume management of the patient’s care. 
     
3. The hospitalist will assess the patient at admission and determine the best course of treatment and coordinate care during the hospitalization.
   
4. During the period of hospitalization, decisions regarding care, consultation, admission, transfer, and discharge should be the sole responsibility of the hospitalist in consultation with the patient and, as appropriate, family members and the patient's primary care physician.
   
5. The hospitalist should be readily available to discuss the patient's medical problems and hospital course with the family and should provide timely updates to the primary care physician designated by the patient. Timely and direct communication between the hospitalist and patient/caregivers concerning change in status, test results or new diagnosis, and any complications is extremely important.
6. The hospitalist should communicate the treatment plan and follow-up recommendations to the patient's primary care physician or the covering physician on the day of discharge.

Reference

1. “What is a Hospitalist?”  Society of Hospital Medicine. Accessed on March 26, 2018 at https://www.the-hospitalist.org/hospitalist/article/123072/what-hospitalist(www.the-hospitalist.org).