Dan Hale, MD, FAAP, and Elisabeth Schainker, MD, FAAP, The Floating Hospital for Children at Tufts Medical Center, Boston
"Master the basics of a good hospitalist program and keep revisiting your core values, and you will continue to have a high-quality and sustainable program,” said Dr. Dan Hale at the PHM14 workshop “Building Blocks in the Evolution of a Successful Distributed Hospitalist Program.”
Dr. Elisabeth Schainker, chief of hospitalist medicine at The Floating Hospital for Children at Tufts Medical Center in Boston, and Dr. Hale, a hospitalist at The Floating Hospital and site director of the Lawrence General Hospital affiliated pediatric hospitalist program, allowed participants to share their experiences in program development.
This workshop reviewed the fundamentals that programs should review before starting and also periodically after established. Program changes should be made as needed. The workshop used an assessment tool to evaluate the basic elements of the participants’ programs. The February 2014 article “Key Principles and Characteristics of an Effective Hospital Medicine Group” in the Journal of Hospital Medicine were used as a starting point for program self-evaluation. These “building blocks” include:
• Establish the rationale for the program and include all stakeholders;
• Financial expectations; • Define scope of practice;
• Nursing and referral physician collaboration;
• Assess staffing and workload expectations;
• Referral base; and
• Basic code and emergency preparedness.
Ongoing program development elements of a program were discussed as well. These components help further integrate a hospitalist program with the hospital as a whole and help add value. These ongoing “building blocks” include:
• Communication and collaboration with other hospital departments (emergency, radiology, surgery, etc.);
• Newborn medicine care;
• Internal group clinical practice guidelines;
• Co-management of surgical or specialty patients;
• Transfers from other hospitals or continuing care from tertiary care centers;
• Pediatric code teams and rapid response teams;
• Advanced code and emergency preparedness and mock code training; and
• Nursing education.
These additive features may be different at each program. Not all of these components are applicable or needed at all hospitals. Thoughtful approaches and thorough planning can create synergy with other components of a program. The essentials of a successful distributed network of multiple hospitalist program site were also described. After assuring the fundamentals are present at each site, transparency and institutional alignment are imperative.
1. It is important to understand several fundamental elements of hospitalist programs and address goals before starting a program.
2. For existing programs, it is important to review the fundamentals periodically and provide program maintenance.
3. After a program is established and fundamentals are in place, other important advance practices can be added on. These include ongoing collaboration, advanced emergency planning, staff education, and clinical practice guidelines.
4. For a multiple site or distributed program, high level collaboration and transparency is essential.
Dr. Hale is a past member of Team Hospitalist and is a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.