Exploring the hospitalist movement in the USA
Published: 20 Apr 2016
Tehmeena Khan is a junior doctor training in Acute Internal Medicine for the NHS in London. She has recently travelled to Chicago where she spent five weeks learning about Hospitalist Medicine on a Winston Churchill Memorial Trust Fellowship.
Hospitalist Medicine is a relatively new speciality in the USA and provides general medical care for inpatients during the entirety of their hospital stay. In the UK, its counterpart, Acute Internal Medicine, also a relatively new speciality, provides acute general medical care for patients within a contained dedicated medical unit, for the first 48-72 hours of their care. After this time, patients are transferred to a specialty-based ward.
“Working as an Acute Internal Medicine Registrar in the UK, I am an advocate for generalist medical care for hospital inpatients. For this reason, I chose to explore the Hospitalist model of care in the USA, where generalised medical care is provided for the majority of hospital inpatients. I spent some time at Rush University Medical Centre in Chicago, Illinois, shadowing and observing the Hospitalist Medicine faculty. This gave me great insight into their work, the barriers and challenges they have faced, and the care they provide for their patients” –Tehmeena Khan
At a time when the UK has an ageing population, with people with chronic illnesses and multiple conditions living longer, many patients do not fit into the “one organ, one problem” category, thus the need to explore more holistic generalised models of care.
During her travels, Tehmeena observed the working practices of the Hospitalist Medicine faculty and she conducted interviews with faculty members regarding their day to day work, any barriers they face and what advice they would give to their counterparts in the UK. She also met with the founding members of the Hospitalist Medicine Department at Rush University Hospital and explored their drivers to change and the challenges they encountered. She conducted interviews with patients regarding their experiences with Hospitalist Medicine and how satisfied they were with their care. Tehmeena spent time interviewing many specialist doctors and primary care physicians regarding the impact of generalised medical care and Hospitalist Medicine on them and their working practices.
Tehmeena’s travels led her to conclude that while it is not feasible to adopt a Hospitalist Medicine model of care in the exact form she had witnessed in Chicago, there are several aspects of it that could be adapted for use in the UK. Her recommendations include improving medical peri-operative care delivery, ensuring the Acute Medicine faculty are encouraged to undertake and are supported in quality improvement initiatives, and capping patient numbers per team to ensure admitting teams are able to provide safer care for patients. Since her return to the UK, Tehmeena has spoken to the Advisory Board Company ahead of their latest publication for the International Clinical Operations Board, and she will also disseminate her recommendations to colleagues in Acute Medicine in the UK.
Read Tehmeena’s report here.
Notes to editors