• Growing field of hospital medicine provides quality, safety at Lahey

    Hospital medicine has been available at Lahey Clinic in Burlington since 1999. But today hospital medicine is an official clinical department. Led by Chi-Cheng Huang, MD, the department has a dedicated, collaborative team of 17 physicians who are available to care for inpatients at Lahey Clinic Medical Center in Burlington and Lahey Clinic Medical Center, North Shore (Peabody, Mass.).

    When a patient is admitted to Lahey, a hospitalist is assigned to that patient through the Emergency Department or through the clinic itself, and oversees care from admission and often discharge. Unlike a primary care physician (PCP), who may visit inpatients before or after clinic hours, the hospitalist is on site all the time and readily available to expedite treatment, improve communication between providers and family members, and take immediate action when test results are abnormal.

    The hospitalist does not replace the PCP, said Huang. In fact, the hospitalist communicates regularly with the patient's PCP, either by e-mail or phone to alert him or her to changes in the patient's condition or treatment. Comprehensive reports, including initial evaluations and discharge summaries, are also sent to the PCP in a timely fashion. On discharge, patient instructions are given and medications are reviewed by hospitalists. The patient then returns to the care of the PCP.

    "Physicians who see inpatients everyday," said Huang, "have a distinct combination of knowledge, skills and relationships. They know how to gain access for certain services in the hospital for patients very quickly because they know the hospital system well and know what additional services or consultations are clinically indicated."

    Clinical studies have consistently shown that hospitalists improve inpatient quality of care, reduce unnecessary days spent in the hospital, and decrease overall costs of hospitalization.

    Quality committees, in particular, at many hospitals like Lahey, can benefit from these specialists serving on their panels. Hospitalists are well positioned to examine wider processes throughout their hospital system, based on their frequent exposure to care delivery, and may recommend changes when needed to improve systems. Hospitalists also provide the continuity of care from floor to floor, or service to service, thereby reducing the number of handoffs from various specialties. They also play an active role in helping to educate Lahey's internal medicine residents and medical students.

    The average Lahey hospitalist sees 13 patients a day-usually multiple times a day, per patient, based on changing laboratory results or symptoms.

    At present, hospitalists are board-certified in internal medicine; there are however, fellowship programs in hospital medicine.

    The Society of Hospital Medicine, founded in 1998, estimates there are 28,000 hospitalists in the US. As baby boomers continue aging and as demand for inpatient hospitalization grows, so too will the number of physicians entering the field.