This piece, written by the physician who coined the term "hospitalist," provides an overview of the hospitalist model and reflects on key advantages of and challenges faced by the Comprehensive Care Physician Model.
Dr. Meltzer is the Fanny L. Pritzker Professor of Medicine, Chief of the Section of Hospital Medicine, and Director of the Center for Health and the Social Sciences at the University of Chicago. His research aims to improve the quality and lower the cost of hospital care. We spoke with him about the Comprehensive Care Physician Model, which he pioneered and was recently featured in an article in The New York Times Magazine.
Resler J, Hackworth J, Mayo E, et al. J Trauma Nurs. 2014;21:272-275; quiz 276-277.
Missed injuries and delayed diagnoses are a relatively common problem in trauma care. This study describes a 150% increase in the number of documented missed injuries that were caught following the introduction of acute care nurse practitioners on a pediatric trauma service. The authors attribute the uptick in identified missed injuries to better charting and follow-up examinations.
This article reports how hospitals are aiming to boost the safety of care delivered on nights and weekends by employing "nocturnists" (a hospitalist subspecialty)—physicians who work only the night shift.
An elderly patient seen in his primary care physician's office was stable but had a suspected heart failure exacerbation. The PCP chose to admit the patient directly to the hospital, to avoid a long emergency department stay. While in the admitting office awaiting an available bed, the patient deteriorated.
Barbara A. Blakeney, MS, RN, is President of the 150,000-member American Nurses Association (ANA). A nurse practitioner and expert in public health practice, policy, and primary care, Ms. Blakeney is on leave from the Boston Public Health Commission, where she has been director of health care services for the homeless. She is the recipient of numerous awards and has been named to Modern Healthcare Magazine's list of the 100 most influential people in health care for the past 3 years.
Roy CL, Poon EG, Karson AS, et al. Ann Intern Med. 2005;143:121-128.
This study followed more than 2600 discharged patients from two hospitalist services to capture the number and types of test results that required intervention. Investigators discovered that nearly 40% of patients enrolled had a pending lab or radiology test with 9% requiring action. Discussion also includes survey findings from inpatient providers, which demonstrated poor awareness of pending studies and general dissatisfaction with current systems to manage test follow-up. The authors conclude that future efforts to reduce these preventable errors in discharge follow-up require improved systems for retrieving tests after discharge and better communication between inpatient and outpatient providers.
Housestaff evaluate and admit a severely ill patient with lupus, suspect a viral syndrome, and do not initiate antibiotics. Despite discovery of the correct diagnosis in the morning by the attending, the patient dies.
A triage nurse instructed by a physician to immediately bring a febrile child, who was possibly dehydrated, to the treatment area is stopped by the charge nurse, citing overcrowding. The parents seek treatment elsewhere; upon arrival, the child is in full arrest.
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