Academic Hospitalists

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  • 1.  clinical coverage model on direct service teams

    Posted 09-21-2018 17:15
    Hi Colleagues - one of our new hospitalist services is in a geographically separate care tower that will not have housestaff involvement. As a result, we will be running direct care service teams, or non-house staff covered teams. They will need to function more like a community hospital non-teaching service. 
    My question is - "How do those of you running non-teaching services staff your day?"
    I know in many community hospitals, staffing is done with three shifts per day, each having some degree of overlap for handoffs.

    Many thanks for your input in advance.
    mark

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    Mark Eckman
    Director, Division of Gen Int. Med.
    UC Health
    Cincinnati OH
    (513) 558-7581
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  • 2.  RE: clinical coverage model on direct service teams

    Posted 09-22-2018 18:31

    Dr. Eckman

     

    I help lead a hospitalist group in Boston with about 95 clinical FTEs which started in 1998 at our academic medical center, Beth Israel Deaconess Medical Center. Today, we also care for hospitalized pts at 3 other BIDMC-owned community hospitals in suburban Boston. At any given time, our hospitalists care for roughly 400 hospitalized pts at these 4 hospitals. Similar to the situation you described, we care for pts in 2 buildings at BIDMC. In one building, we care for pts without any involvement of trainees (direct care service) while in the other building, we supervise residents and students in the care of these pts. I don't think there is any single best model for staffing hospitalist programs. Much of it depends on your hospital's specific needs. On our direct care service at BIDMC, we have daily rounders, am admitters, pm admitters and overnight drs. Hope this is helpful. Happy to speak w you offline if I can be of further assistance.

     

    Joe

     

    Joseph Ming Wah Li, MD SFHM FACP

    Assoc Professor of Medicine, Harvard Medical School

    Chief, Beth Israel Deaconess Hospital Medicine

    Boston / Milton / Needham / Plymouth

    330 Brookline Ave, Span 221 Boston, MA 02215

    617 754-4677 / F 617 632-0215

    JLi2@bidmc.harvard.edu  / www.bidmc.org/hospitalist

     

    image001.png@01D132AC.DB613680

     

     



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  • 3.  RE: clinical coverage model on direct service teams

    Posted 09-24-2018 09:19

    Dr. Eckman,

     

    At Montefiore we have a model that is similar to what you describe. At each of three hospitals we have a traditional teaching service, and a Direct-care service. (Sometimes we call this the hospitalist faculty service, but I discourage "non-teaching service").

     

    We schedule the hospitalists on the teaching service in 2-week or month-long blocks, to maximize the time a teaching team is together.

    The Direct-care service we schedule in a 7on-7off fashion, which has advantages and disadvantages.

     

    We have a relatively small number of faculty who do a lot of time on the teaching service (5-7 months) and also rotate on the direct-care service. And we have a larger number of faculty who primarily work on the direct-care service, and who rotate on the teaching service. Of course there is lots of detail hidden in there. Happy to have a conversation if that helps.

     

    I agree with Dr. Li: I don't think there is a "right" model. I think local needs and priorities drive the model at each institution...

     

    Best,

     

    Will

     

    William Southern, MD, MS, SFHM

    Chief, Division of Hospital Medicine

    Professor of Medicine

    Office 718-920-4746

    Fax 718-654-6908

    wsouther@montefiore.org

     

    Montefiore

    THE UNIVERSITY HOSPITAL FOR THE ALBERT EINSTEIN COLLEGE OF MEDICINE

    111 East 210th Street

    Bronx, New York 10467

     

     




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  • 4.  RE: clinical coverage model on direct service teams

    Posted 09-24-2018 11:00
    Our non-teaching service is not geographically isolated. Currently, we have one hospitalist per week assigned to the non-teaching service with a cap of 10 patients. That attending is on duty from 8am to 5pm; he/she hands off to the admitting-on-call attending at 5pm, who covers until 8pm. We have one nocturnist in house from 8pm to 8am who is responsible for covering the non-teaching patients, as well as supervising the house staff on night float and the PGY3 assigned to admissions in the ED.

    I understand from my section chief that there are current negotiations with administration to add mid-level providers (we currently use none on the general medicine service), but when and how has yet to be decided.

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    Randy Goldberg, MD MPH FACP
    Westchester Medical Center
    Valhalla, NY
    randy.goldberg@wmchealth.org
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  • 5.  RE: clinical coverage model on direct service teams

    Posted 09-26-2018 13:25
    ​Thanks folks. We were particularly interested in the issue of swing shifts. Dr. Goldberg mentioned that they have a 5PM-8PM swing shift. Is that typical in other institutions on non-house staff covered services?
    thanks
    mark

    ------------------------------
    Mark Eckman
    Director, Division of Gen Int. Med.
    UC Health
    Cincinnati OH
    (513) 558-7581
    ------------------------------

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  • 6.  RE: clinical coverage model on direct service teams

    Posted 09-27-2018 10:18
    That swing shift is actually sort of vestigial, going back to the days when we did not have nocturnists, and the attendings took overnight call by phone from home. As we expanded in-house coverage, we reached a point where we wanted to guarantee 24 hour attending supervision of house staff - that's where the swing shift came from. (The fact that 4pm-9pm is probably the busiest time for admissions also contributed to the decision.) The formation of the direct-care service came later - as I mentioned, we don't use a 12-hour model for our daytime hospitalists, and ACGME frowns mightily upon moving patients back and forth between teaching and direct care, so the swing shift attending has to be responsible for those patients.

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    Randy Goldberg, MD MPH FACP
    Westchester Medical Center
    Valhalla, NY
    randy.goldberg@wmchealth.org
    ------------------------------

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