UAB Synopsis, Vol. 27, No. 31, August 11, 2008
25-bed Unit Opens at UAB Highlands, Additional MDs Planned
The Hospitalist Service has played a significant role in the care of patients since its founding in 1998. Housed under Prime Care and academically integrated with the Division of General Internal Medicine, the Hospitalist Service has exclusive management of their inpatient care.
“The hospitalist model of care provides the opportunity to concentrate on inpatients by delivering effective, efficient care, reducing length of stay, and increasing patient satisfaction. In addition, without the time constraints of hospital rounds and calls, primary care physicians can focus on outpatients,” says Hospitalist Medical Director James D. Lyman, MD.
The service, which was initiated with two physicians, now has seven full-time physicians. “We have increased involvement from internal medicine physicians from the Division of General Internal Medicine who will begin rotating through our service,” he says. “We have a physician joining the service in December whose responsibilities include quality improvement initiatives — an area hospitalists are becoming more involved in throughout the country.”
Traditionally not a house staff service, the hospitalist group was identified as a solution for increased inpatient census and fixed resident manpower. The addition of UAB’s North Pavilion and expanded Emergency Department, as well as initiation of the resident 80-hour work week limit, are cited as forces behind the continued growth.
UAB Highlands
UAB Highlands recently opened a 25-bed hospitalist unit, which increases the hospitalist capacity to 30 to 35 inpatient beds for the future. The hospital retained its ability to overflow inpatients to existing units.
“We have modified the Hospitalist Service’s clinical coverage to incorporate a 24-hours-a-day, 7-days-a-week physician presence that is designated for the care of moderately acute patients from any of the Prime Care or General Internal Medicine services who would like to refer to a hospitalist,” Dr. Lyman says. One physician, a nurse practitioner, and a rotation of UAB fellows staff UAB Highlands’ Hospitalist Service.
“UAB Highlands serves as a relief valve when UAB Hospital reaches capacity,” Dr. Lyman says. “Inpatient growth at Highlands is generated from referrals from the UAB Prime Care physician network at The Kirklin Clinic® and the UAB Health Center satellite clinics.”
UAB Hospital and UAB Highlands administrators have developed an age-based admission protocol for patients entering UAB Hospital through the University Emergency Department (UED). “If a patient and his family agree, patients 75 years and older are transferred to UAB Highlands for inpatient care,” he says. “This protocol ties in with our goal of establishing a UAB Highlands acute care for elders [ACE] unit, which will be a joint venture with the Division of Gerontology, Geriatrics, and Palliative Care Medicine.
“A focus on older adults at Highlands, including the development of the ACE unit, with its special focus on an elder-friendly environment and system of care that helps to avoid geriatric syndrome complications, are aspects of care we believe will benefit the patients and their families,” he says.
The Hospitalist Service also has a clinical criteria protocol for hospitalist admissions from the UED that works to transfer inpatients to UAB Highlands regardless of their age.
Increasing Staff
Growth plans include developing a daily census of 20 to 30 patients to help support two hospitalists practicing at UAB Highlands during weekdays and increasing the UAB Hospital staff to eight full-time hospitalists.
“Throughout the nation we are starting to see hospitalists take on leadership roles in their organizations,” says Dr. Lyman, who points to his role as UAB Highlands physician-in-chief as an example. “Because the hospital is the only place they practice medicine, hospitalists are able to provide unique expertise as they become more involved in patient safety and quality initiatives. This kind of involvement, along with the additional services hospitalists provide, adds significant value to patient care.”