What is a Hospitalist?
Did you know there are physicians trained in the area of hospital care? They are called hospitalists and Pullman Regional Hospital is working toward providing a 24x7 hospitalist service specifically for inpatients, working closely with primary care physicians and hospital staff. Hear how this service contributes to the high level of quality care at Pullman Regional Hospital.
Featuring:
Learn more about Karen Geheb, MD
Karen Geheb, MD
Karen Geheb, MD is the Director of Hospitalist Service at Pullman Regional Hospital.Learn more about Karen Geheb, MD
Transcription:
Bill Klaproth (Host): Do you know what a hospitalist is and what that person does? Here to talk about hospitalist care is Dr. Karen Geheb, Director of Hospitalist Services at Pullman Regional Hospital. Dr. Geheb, thank you for your time. So let’s start right here, what is a hospitalist?
Dr. Karen Geheb (Guest): Well thanks Bill. Thanks for having me on. A hospitalist is a physician usually trained in either family practice or internal medicine who is uniquely qualified to take care of the acutely ill patient in a hospital. They do such services as covering patients that are in an intensive care unit when they’re really, really sick and they monitor and take care of patients who may not be quite so sick, and then they help to coordinate the discharge of that patient back to their regular provider or even to help transition them to another care facility such as a long term care, or be involved in the transfer of a patient to another facility like a different hospital.
Bill: So this is like a family physician, but staffed at the hospital only?
Dr. Geheb: Well you can think of it as a family physician, but it’s not always a family practice doctor, it could be an internal medicine doctor, but they are staffed by the hospital to practice at the hospital and it’s very rare that those particular providers see patients in an outside clinic.
Bill: Gotcha, so does the hospitalist take the place of your primary care physician while you’re in the hospital. Does your primary care physician still visit you or does the hospitalist take that person’s place?
Dr. Geheb: In most hospitals the hospitalist does take the place of your primary care provider but in our hospital, it’s always welcomed for the primary care provider to come in and do what we call a social consult or a social round. That helps the patient and the family feel still connected to their primary care provider and it gives them additional insight into the patient’s well-being by the – for the hospitalist in terms of their care. One of the reasons that we utilize a hospitalist at our hospital is because we think that when patients are in the hospital and then they transition back to home there is quite a bit of work that needs to be done for that patient and that family that might be new in terms of their general healthcare and medications they need to take or taking care of their wounds after a surgery, and so we focus a lot on care coordination, and we’ve got some new processes in place at the hospital and new staff – or some additional staff that will help us to coordinate that care of the patient. A lot of times when the patient comes into the hospital and is very sick, you know their family is very concerned and the patient of course does not even – doesn’t even really have a clue as to what’s happening to them while they’re in the hospital and so the family is very much involved in the patient care. Well it can be extremely overwhelming to patients and their families if now when they get out of the hospital, they’re not 100% back to normal. They’re still suffering the effects of being sick. So they may not be thinking through their new medications or the processes that they need to do or the regimen that they need to follow in terms of caring for themselves, and so while the hospitalist cares for them in the hospital and works with this team of nurses and physical therapists and other types of care providers while they’re in the hospital, going home can be difficult, and so we have a new focus on care coordination and we actually have a transitional care nurse and a team that will call and follow up with that patient after they’re discharged to make sure that all questions they might have can be answered to clarify any complicated instructions and just to make sure they’ve got follow up appointments.
Bill: That is wonderful that coordination of care. So does the hospitalist work with the primary care physician on the treatment plan? Do they work together?
Dr. Geheb: So a lot of times, when the patient first comes into the hospital, if it’s a patient that I have never seen before for instance, I may not know very much about that patient, and while I have to work really hard to establish a rapport with that patient very quickly because I only have a little while, maybe three days in the hospital to get to know that patient, their primary care provider has a much better picture of that patient and their health, so often times we will discuss that patient’s care when they first come into the hospital, and every time I put a note into the chart for that patient, that note goes to the primary care provider, and then when the patient is discharged from the home, especially if it’s a complex patient who has multiple medical problems, might be on a bunch of new medications or have some additional follow up that needs to happen, we will have a conversation with the primary care provider to make sure that the information that happens here in the hospital and the new plan gets correctly transmitted and correctly assumed by the primary care once the patient goes home.
Bill: So do all hospitals have hospitalists on staff? It seems rather unique that Pullman Regional Hospital, a small critical access hospital, has this service.
Dr. Geheb: Well Bill it’s not that unusual for hospitalists – for hospitals to have hospitalists on staff. It is more unusual for a small critical access hospital like Pullman to have hospitalists on staff. We started our program back in 2007 and larger hospitals have been doing it since 1985 actually when that term was first coined by a physician at the University of California San Francisco. So now there’s, I don’t know, in the 20’s of thousands of doctors that act as hospitalists across the nation. Smaller hospitals though, there’s a few reasons why it’s harder to have hospitalists involved. The number of patients that are cared for in a critical access hospital is not nearly as many as the number of patients cared for at, for instance, Sacred Heart, on a daily basis, and so it’s difficult in terms of providing both the physician, the challenge of caring for patients that sometimes they want. We don’t have a large intensive care unit. We don’t have a lot of super sick patients all the time. Also, the variety of patients that come into the hospital might be challenging for hospitalists to work in a very big city, so our hospitalists need to be maybe like a jack of all trades. They need to really be able to take care of patients with cardiac problems or kidney problems or stomach problems where in a big hospital they might have a specialist actually caring for those patients and their acting as just the care coordinator of all the physicians caring for that patient, so it’s unique for a small hospital to have the hospitalist service. We are now trying to actually increase our service because we want the hospitalists to continue to provide care for patients in a 24/7 kind of service, so we’re moving forward with finding how to best provide someone in the hospital all the time. So in addition to have physicians care for the patients we’re also involving what we call an advanced practice provider. An advanced practice provider you might have come into contact with if you see your primary care provider, is a nurse practitioner or a physician assistant. In a hospital setting, these particular providers are again uniquely trained for caring for patients who are sick in a hospital and it’s a little different than caring for patients in a clinic. So they have to have expertise and they have to have training in very specific areas, and they don’t take the place of the physician but they help the physician extend their services so they are able to provide more hours and more days of service without becoming unsafe for the patient and so if you come to Pullman Regional Hospital, it’s possible that you will be taken care of by a physician, and you may be taken care of in addition by a physician assistant or nurse practitioner. The biggest reasons for us to move towards a 24/7 coverage to provide expanded coverage and improve our coordinated care is that we feel very strongly that we’re providing a product that brings a service to the patient and the family, and we’re providing a product that brings service to the nursing staff that is caring for the patient and we bring a product that provides service to other medical providers and the emergency department physicians so that they’re able to better do their job. You know that our surgeon service is here and the Palouse, they share 3 hospitals. They work at 3 different hospitals and it would be very difficult for them to be able to care for a patient in all 3 hospitals at the same time, and so having a hospitalist service here allows those patients to be cared for while the surgeon may not be immediately available, and so we provide a service to our other medical partners in that regard.
Bill: Well that’s great information Dr. Geheb. Thank you so much for your time today and talking to us about hospitalist care. For more information, visit pullmanregional.org, that’s pullmanregional.org. This is the Health Podcast from Pullman Regional. I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): Do you know what a hospitalist is and what that person does? Here to talk about hospitalist care is Dr. Karen Geheb, Director of Hospitalist Services at Pullman Regional Hospital. Dr. Geheb, thank you for your time. So let’s start right here, what is a hospitalist?
Dr. Karen Geheb (Guest): Well thanks Bill. Thanks for having me on. A hospitalist is a physician usually trained in either family practice or internal medicine who is uniquely qualified to take care of the acutely ill patient in a hospital. They do such services as covering patients that are in an intensive care unit when they’re really, really sick and they monitor and take care of patients who may not be quite so sick, and then they help to coordinate the discharge of that patient back to their regular provider or even to help transition them to another care facility such as a long term care, or be involved in the transfer of a patient to another facility like a different hospital.
Bill: So this is like a family physician, but staffed at the hospital only?
Dr. Geheb: Well you can think of it as a family physician, but it’s not always a family practice doctor, it could be an internal medicine doctor, but they are staffed by the hospital to practice at the hospital and it’s very rare that those particular providers see patients in an outside clinic.
Bill: Gotcha, so does the hospitalist take the place of your primary care physician while you’re in the hospital. Does your primary care physician still visit you or does the hospitalist take that person’s place?
Dr. Geheb: In most hospitals the hospitalist does take the place of your primary care provider but in our hospital, it’s always welcomed for the primary care provider to come in and do what we call a social consult or a social round. That helps the patient and the family feel still connected to their primary care provider and it gives them additional insight into the patient’s well-being by the – for the hospitalist in terms of their care. One of the reasons that we utilize a hospitalist at our hospital is because we think that when patients are in the hospital and then they transition back to home there is quite a bit of work that needs to be done for that patient and that family that might be new in terms of their general healthcare and medications they need to take or taking care of their wounds after a surgery, and so we focus a lot on care coordination, and we’ve got some new processes in place at the hospital and new staff – or some additional staff that will help us to coordinate that care of the patient. A lot of times when the patient comes into the hospital and is very sick, you know their family is very concerned and the patient of course does not even – doesn’t even really have a clue as to what’s happening to them while they’re in the hospital and so the family is very much involved in the patient care. Well it can be extremely overwhelming to patients and their families if now when they get out of the hospital, they’re not 100% back to normal. They’re still suffering the effects of being sick. So they may not be thinking through their new medications or the processes that they need to do or the regimen that they need to follow in terms of caring for themselves, and so while the hospitalist cares for them in the hospital and works with this team of nurses and physical therapists and other types of care providers while they’re in the hospital, going home can be difficult, and so we have a new focus on care coordination and we actually have a transitional care nurse and a team that will call and follow up with that patient after they’re discharged to make sure that all questions they might have can be answered to clarify any complicated instructions and just to make sure they’ve got follow up appointments.
Bill: That is wonderful that coordination of care. So does the hospitalist work with the primary care physician on the treatment plan? Do they work together?
Dr. Geheb: So a lot of times, when the patient first comes into the hospital, if it’s a patient that I have never seen before for instance, I may not know very much about that patient, and while I have to work really hard to establish a rapport with that patient very quickly because I only have a little while, maybe three days in the hospital to get to know that patient, their primary care provider has a much better picture of that patient and their health, so often times we will discuss that patient’s care when they first come into the hospital, and every time I put a note into the chart for that patient, that note goes to the primary care provider, and then when the patient is discharged from the home, especially if it’s a complex patient who has multiple medical problems, might be on a bunch of new medications or have some additional follow up that needs to happen, we will have a conversation with the primary care provider to make sure that the information that happens here in the hospital and the new plan gets correctly transmitted and correctly assumed by the primary care once the patient goes home.
Bill: So do all hospitals have hospitalists on staff? It seems rather unique that Pullman Regional Hospital, a small critical access hospital, has this service.
Dr. Geheb: Well Bill it’s not that unusual for hospitalists – for hospitals to have hospitalists on staff. It is more unusual for a small critical access hospital like Pullman to have hospitalists on staff. We started our program back in 2007 and larger hospitals have been doing it since 1985 actually when that term was first coined by a physician at the University of California San Francisco. So now there’s, I don’t know, in the 20’s of thousands of doctors that act as hospitalists across the nation. Smaller hospitals though, there’s a few reasons why it’s harder to have hospitalists involved. The number of patients that are cared for in a critical access hospital is not nearly as many as the number of patients cared for at, for instance, Sacred Heart, on a daily basis, and so it’s difficult in terms of providing both the physician, the challenge of caring for patients that sometimes they want. We don’t have a large intensive care unit. We don’t have a lot of super sick patients all the time. Also, the variety of patients that come into the hospital might be challenging for hospitalists to work in a very big city, so our hospitalists need to be maybe like a jack of all trades. They need to really be able to take care of patients with cardiac problems or kidney problems or stomach problems where in a big hospital they might have a specialist actually caring for those patients and their acting as just the care coordinator of all the physicians caring for that patient, so it’s unique for a small hospital to have the hospitalist service. We are now trying to actually increase our service because we want the hospitalists to continue to provide care for patients in a 24/7 kind of service, so we’re moving forward with finding how to best provide someone in the hospital all the time. So in addition to have physicians care for the patients we’re also involving what we call an advanced practice provider. An advanced practice provider you might have come into contact with if you see your primary care provider, is a nurse practitioner or a physician assistant. In a hospital setting, these particular providers are again uniquely trained for caring for patients who are sick in a hospital and it’s a little different than caring for patients in a clinic. So they have to have expertise and they have to have training in very specific areas, and they don’t take the place of the physician but they help the physician extend their services so they are able to provide more hours and more days of service without becoming unsafe for the patient and so if you come to Pullman Regional Hospital, it’s possible that you will be taken care of by a physician, and you may be taken care of in addition by a physician assistant or nurse practitioner. The biggest reasons for us to move towards a 24/7 coverage to provide expanded coverage and improve our coordinated care is that we feel very strongly that we’re providing a product that brings a service to the patient and the family, and we’re providing a product that brings service to the nursing staff that is caring for the patient and we bring a product that provides service to other medical providers and the emergency department physicians so that they’re able to better do their job. You know that our surgeon service is here and the Palouse, they share 3 hospitals. They work at 3 different hospitals and it would be very difficult for them to be able to care for a patient in all 3 hospitals at the same time, and so having a hospitalist service here allows those patients to be cared for while the surgeon may not be immediately available, and so we provide a service to our other medical partners in that regard.
Bill: Well that’s great information Dr. Geheb. Thank you so much for your time today and talking to us about hospitalist care. For more information, visit pullmanregional.org, that’s pullmanregional.org. This is the Health Podcast from Pullman Regional. I’m Bill Klaproth, thanks for listening.