Hospital Medicine Program (HMP), Code Blue And Expectations.

This blog is a continuation of hospitalist issues which I wrote here and emerging expectations from a Hospital Medicine Program (HMP). As I have mentioned earlier, we are in the process of making a transition from a traditional call-from-home service to a 24/7 in-house hospitalist service. At this moment in time around the nation 39% of HMPs have adopted a 24/7 model, which is growing every year. There are several factors which play a part in this transition and this brings certain expectations.

• 24/7 model presents a real time admitting service. Meaning in a conventional hospitalist group, a patient admitted with pneumonia at 7 pm by a hospitalist, may not be seen by a physician until 7 AM. 24/7 model assures that patient is seen within a specific time. This not only helps with the ER patient flow but also shortens the length of stay along with assistance in pre-operative clearance and decreased crowding of observation patients. Not to mention improved patient satisfaction.

• Staffing: You need to have adequate number of physicians to cover a 24 hour rotation. Considering our program is relatively new, we need to make sure that we have enough referral source to support all physicians.

• With 24/7 service, it is natural that hospitalist should be able to provide Code Blue coverage. This is easier said than done, but very much doable. This would require a) Change in hospital privileges for some physicians b) ReTraining courses to brush up their skills c) preceptors for the initial 5-10 procedure d) Back up assistance preferably from ER if needed e) All hospitalists should have FCCS (Fundamental Critical Care Support)  certification. f) All physicians involved need to make a firm commitment to be part of the process. It is imperative to have clear guidelines for implementation, as at the end of the day safety of the patients comes first than changing paper protocols.

• 24/7 model is expensive and difficult to adopt by private groups. Historically nocturnists are expensive and less desirable by private groups as they generate comparatively less revenues.

• It is imperative to have a reliable staff and an ability to retain physicians. For instance, if a physician decides to leave the group, it can destabilize the whole shift model. On the other hand there needs to be a process where a back up system is in place either by locums or an incentive plan within the group if such a situation arises.

• The program needs to be marketed to the rest of the physician staff where private physicians should be comfortable admitting patients to the hospitalist group at night if they wish to and these patients can be signed off to them in the morning. This would benefit all the parties involved; the patient, the HMP and the private physician.  

Well these are some of the issues involved; I would keep you apprised as things develop.

About the picture: The angel represents hope and Prometheus, the Gold Statue at Rockefeller Plaza.