SMH hospitalist program aims at inpatient care
Implemented in 2012, program making strides
MANISTIQUE – A hospitalist program meant to improve patient care continues to be fine-tuned by the staff of Schoolcraft Memorial Hospital. The program, implemented more than a year ago, concentrates on adequately serving the inpatient population.
According to SMH CEO George Montgomery, the program is designed around the notion that inpatients need more attentive care and better-managed plans for treatment and eventual discharge. Under one program model, SMH hired two mid-level providers, a nurse practitioner and physician’s assistant, in Jan. 2012.
In a tradition health care model, family practitioners would care for patients admitted to the hospital. However, especially in rural hospitals like SMH, Montgomery said this model had become unrealistic, as the demands on family practitioners increase. Essentially, inpatients were not getting the attention they needed as the family doctors struggled to strike a balance between daily appointments and inpatient care.
“It’s (hospitalist programs) pretty much a standard in the industry now, if you look around our region even,” he said. “Family doctors no longer follow their inpatients.
When I looked into the model in critical access hospital, smaller ones like us … the model was to use a combination of the ER doctor and the mid-levels,” he continued. “That’s why we first hired the mid-level providers and followed that with an agreement with our ER doctors and our family doctors to act as a hospitalist supervising the mid-levels.”
Currently, the hospitalist program rotates three ER doctors with the most of the SMH Rural Health Clinic Staff. ER doctors rotate to see inpatients for five weeks, and in the sixth week, a clinic doctor takes over; then the rotation begins again. During the time a physician is on rotation for inpatients, they are considered hospitalists, and concentrate on those inpatients.
“Overall, it’s been successful in that it’s working well for us, and we’re seeing patients cared for here in Manistique who might have otherwise been transferred,” he said.
Some misunderstandings about the program have come to light since the program was implemented, explained Montgomery, including the belief that inpatients are no longer being followed by doctors – only mid-level providers.
“Physicians see patients every day in the hospital,” he said.
David Schoenow, M.D., who rotates as hospitalist, explained the mid-levels, members of the nursing staff and the rotating physician meet on a daily basis to discuss each individual chart and case and how the care plan will proceed for that day and in the immediate future, including discharge.
“We can get things done more quickly, more efficiently, particularly with their discharge planning so they’re not lingering on for a day or two to try to get those things arranged,” Schoenow said. “As far as being in the hospital, the patient does have the added benefit of having that mid-level provider be available to them much more frequently than the physician would potentially be.”
Because of this, the inpatient census has risen over the past year, he explained and more patients are able to receive the care they need at SMH, rather than being transferred. Currently, the SMH inpatient census ranges from five to 12 patients, whereas the census prior to the implementation of the hospitalist program hovered at 2-3 patients.
“The patient has much more provider contact time now than ever before,” he said. “The vast majority of patients really seem to appreciate that.”
Mid-level providers are especially beneficial in the area of data entry, Schoenow explained, as doctors have become increasingly constrained by the implementation of Electronic Medical Records.
“The introduction of the government required Electronic Medical Records has really slowed a physician’s ability to take care of patients,” he said. “They can take care of probably 20 to 30 percent fewer patients than they used to … that’s just not here, that’s everywhere.”
Because of this, the hospitalist program has blossomed, added Schoenow, since clinic doctors are able to maintain focus on their patient base. While large hospitals hire a full-time doctor to cover inpatient care, smaller hospitals like SMH have found doctors who have the ability to “wear a couple of different hats” – in their case, ER doctors, he added
“They do most of the acute care, obviously, in the emergency department, and so to follow that through into their (the patient’s) stay in the hospital seems very logical,” he said.
The hospital makes the current situation work, having only three ER doctors, by having physicians work extra days and using “contract doctors” for many of the weekends. These doctors are essentially leased to the hospital for days at a time using a certain company, Schoenow said.
“It’s very, very difficult to recruit physicians to come to the Upper Peninsula, and so we’ve been working short,” he said. “We do see some disruption in our continuity.”
Once another doctor is hired, and the hospital begins using the new facility on U.S. 2, Schoenow explained the patient experience will only get better. The new hospital will have 12 private rooms, with more privacy, less noise, better air circulation and climate control he added.