Riverside Healthcare puts the health and wellness information you need well within reach.

Helen Dandurand (Host): Welcome back to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Helen Dandurand. And joining me today is Ellen Bollino, Riverside's Chief Nursing Officer, who's here to talk a little bit about hospitalists. Welcome, Ellen.

Ellen Bollino: Thank you, Helen. I'm so glad to be here today.

Host: We're going to switch names by the end of this, I think. Can you start by telling us a little bit about yourself?

Ellen Bollino: Sure. So, I started my nursing career here at Riverside in 2001 at the bedside on a telemetry floor, in several nursing roles at Riverside, emergency department, manager of the emergency department. I left the organization for about eight years, and then recently came back in 2024 as the Director of Nursing, and I've been in my role as the CNO for about a year and a half now.

Host: That is awesome. You've got a lot of experience here, and that'll help with our topic today. So, we're going to talk a little bit about hospitalists. So, can you tell us, just to start off, what is a hospitalist, if anyone doesn't know? And why have hospitalists become such a common part of hospital care today?

Ellen Bollino: Sure. So back in 2001 when I first became a nurse at the bedside, hospitalist wasn't really a norm in the industry. So essentially, what would happen would be primary care physicians, they would come in the hospital in the morning, they would see any of their patients that might be admitted. They would leave, they would go to the clinic. As test results or patient's condition changed, either for the better or the worse, we would contact them at their office. And then, if needed, they would come back to the hospital at the end of the day to address any outlying issues or any new patients. And so, it was quite a commitment and a lifestyle.

And as a society, as we began to be more thoughtful about work-life balance and how that impacts, we started to look at that model as maybe not what was best for the physician or really even the patient. And so, Riverside implemented our first hospitalist program. It was I believe only about 20% to 25% of the patients. And so, a hospitalist is a physician that is only taking care of patients while they're in the acute care in the hospital. And so, they're called a hospitalist because they really just specialize in hospitalized patients. And so, a hospitalist would get a patient and take care of them from the emergency department all the way throughout their continuum of care until they were discharged, and then they hand off that care back to the primary care physician.

So, back when that model first came on the horizon, there was quite a mix. We still had a lot of family physicians and primary care physicians that were choosing to still see their own patients in the hospital. But over the years, that has trended to where it's very uncommon these days for a primary care attending physician to see their own patients in the hospital. We're probably about 90% of our patients now are being managed by our hospitalist group, which is the AIM Hospitalist Group.

Host: Wow. So, a lot of people have a primary care provider still, obviously—hopefully, they do—that they trust and they know. How do the hospitalists maybe work alongside the patient's primary care provider while they're in the hospital? Like, is there communication there, that kind of thing?

Ellen Bollino: Sure. So when a patient comes into the hospital, they're admitted to the hospital, Epic notifies that physician if it's logged into our medical record, and we really do have amazing technology in our medical record. Our hospitalist is able to see any notes from any clinic visit. They're able to see historical labs or diagnostic results. They are able to contact that primary care attending physician via phone if there is something that's not clear in the medical record.

And then ultimately, when the patient is discharged, all of the records of the patient's hospitalization are visible to their primary care, or specialty physicians within the medical group or even outside of the medical group if those providers have access to Epic. And so, the technology that we have in our medical record really does help us facilitate that bidirectional communication.

Host: That's great to know that people can feel comfortable, and still that their primary care provider that they know and trust is still a part of their care, knows what's going on, is up to date. So, you did mention that we have the AIM hospitalists here at Riverside. Could you tell us a little bit maybe more about them and our partnership?

Ellen Bollino: So, our AIM hospitalist group is staffed with 11 core physicians. So, it's always the same 11 physicians that are seeing the patients. It allows the nursing staff to really get to know kind of who they are and what their preferences are, and to help anticipate those to help support those physicians.

They work a week on and a week off. And so, they'll have seven days in a row where they're managing the same patient group, which really allows for coordination of care and strong communication between the provider and the patient. They rotate through a night shift. There's always physically at least one hospitalist here in the hospital, and then the physicians stagger throughout the day to be able to cover the admissions coming in through the emergency department.

There's always at least one physically in the hospital. But during the daytime hours, there's probably four of them here. And if they round on their patients, they are able to receive diagnostic tests, lab results, imaging results as they come in. They're able to interact with and speak with any specialty consult physicians, whether that's cardiology or infectious disease. And so, they're physically present here in the hospital, able to respond to the unit, if the nurse has a need, the patient has a need, or if they need to speak to someone else on the care coordination team.

Host: Great. I feel like that's also really kind of comforting to know that it's like this core group, it's not just, "Oh, a random provider." Like they're here, they know what's going on here. There's this coordination. So, I feel like that's a really good thing for patients to have someone who is here and present and ready. So, we also have a partnership with some pediatric hospitalists. Could you tell us about how having the pediatric specialists caring for children here benefit our younger patients and families?

Ellen Bollino: Sure. We have a partnership with the University of Chicago, where we have two pediatric physicians who are here. They're hospitalists. So, similar to the inpatient hospitalists, there's always physically at least one here, and similar also to the inpatient hospitalists, it's a core group of physicians. And so, we get to know them on pretty much a first-name basis. And so, they are here on site when we have babies that are born in the family birthing center. To be able to manage and oversee care of those babies, as well as identify if anybody needs more tertiary care, we have that partnership with University of Chicago where we send those babies right up to University of Chicago.

They also manage the care of any pediatric patients that we might have admitted to the inpatient, as well as respond to the emergency department for consults if the emergency department physicians need to see a pediatrician to see any of those ED patients. And so, another example of a hospitalist that physically is here in the hospital and is able to respond to the needs of our patients and our physicians.

Host: Well, that's great. It sounds like we've got people covered from birth all the way through their life journey with the different types of hospitalists, and we will get into another kind after we take a quick break to talk about primary care at Riverside.

At Riverside, our primary care providers are right here in your community, offering personalized care for you and your family, close to home and connected to the specialists and services that you may need. Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up, because remarkable care should never be out of reach. Remarkable care, right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

All right, and we are back. I mentioned we have another group of hospitalists here at Riverside that we're going to talk about, and that is our OB hospitalists, which is a newer partnership that we have. Could you tell us a little bit about what that is and how they work alongside our women's health providers here?

Ellen Bollino: We have the OB Hospitalist Group, OBHG, that we entered into a partnership of February of this year. This model is a little bit different than the inpatient or the pediatrician model. It is a model where our Riverside Medical Group providers, they come in and deliver babies when they're on call. When they're not on call, our OB Hospitalist Group is going to cover call.

So previous to the hospital group coming to Riverside, we would have our Riverside Medical Group OB physicians covering clinic, as well as covering patients who are coming in to be evaluated for potentially being in labor in addition to, of course, delivering those babies when they are in labor.

And so, when we talked a little bit about work-life balance, that's a pretty challenging lifestyle for an OB physician, especially since we've seen increase in our babies that we're delivering here at Riverside over the last year. And so, the OB hospitalist group is covering, in current state, 20 days per month in the OB, and our medical group is covering the other 10 or 11 days. And so, they're working 24-hour shifts. And while they're here, they're evaluating any patients who come in who may need to determine if they're in labor, who might be having concerns over their pregnancy, as well as delivering babies. They do the full complement of services, so C-sections, et cetera.

And, of course, our medical group physicians also still want to deliver babies, and so they're still covering that 10 to 11 days a month of call. And so, it's not 100% hospitalist coverage. However, when it is our medical group physicians on call now, they're also going to be here on site 24 hours a day and no longer have those clinic hours.

And so, while they're technically not hospitals, we are going to follow the model of having a physician here 24 hours a day, seven days a week, 365 days a year to be able to support those moms and those babies and the staff members. So, it's a pretty exciting partnership for us. It's kind of a hybrid model.

The initial feedback that we're getting from all of the nursing staff and the patients and their family members has been overwhelmingly positive. And so, it's been a really great start to the partnership.

Host: That's good. I feel like that's really comforting to know that someone's here all the time. They don't need to drive here. They don't need to leave a clinic or XYZ. just really comforting to have that person here always specializing in that to take care of our patients.

So, one thing that people often worry about is communication. How do hospitalists make sure that patients and their families and specialists and primary care providers are all on the same page throughout the process?



Ellen Bollino: Well, I will still say that is and still remains a challenge. I think the benefit of the hospitalist model is that they're 100% focused on the patients that are in the hospital. And so, their outside distractions of maybe clinic and other things around, scheduling outpatients, that's removed from their caseload. And so, they're able to fully focus on the patients that are in the hospital.

Also, because it's 100% of what they do, they know generally what is the turnaround time for a CAT scan. They know what orders to put in the computer for an inpatient versus an outpatient, et cetera. And so, they have that specialized knowledge of what it means to be an acute care patient in the hospital, and stay abreast of the patient's condition in a way that they can help support those specialty physicians who might not physically be in the hospital 24 hours a day like they are.

They are here and can come by even if they round on a patient, say, in the morning, and a family member comes in the afternoon and they request to speak to the hospitalist, my nurses can send out a message to them, and they can swing by and speak to a patient or their family member. Whereas when it was the previous model, right, and that physician had already gone back to clinic, the nurse was really the one left translating about what the physician said.

And so from a nursing perspective especially, we have a really strong partner in the hospitalist because they help us manage that communication, where historically, previous to the model, that really fell on the nurse, right? And so, while the nurse still takes a significant and probably primary role in managing that coordination of communication, the hospitalist is a strong second partner to that.

Host: Great. And so from your perspective, you kind of mentioned this a little bit in some of your other answers. But as CNO here, how have hospitalists helped to improve the patient experience and the quality of care at Riverside? You said that you started before they existed, so how have you seen that change?

Ellen Bollino: I think the support and knowledge that they give to our patients and families and nursing staff, it just is unable to be replicated by a physician that is split between a clinic practice and a hospital.

And so, I think that just that dedication of being here and specializing in patients that are acutely ill, they're really a partner to the clinical staff, the nursing staff, the respiratory therapists, the physical therapists, et cetera, that I think was absent in the previous model. And so, they're able to participate in every aspect of the patient's care when they're a hospital-based physician.

And so, I think that just speaks to a well-rounded care experience. We're able to consider all aspects. And so, I think the quality and safety our patients receive is enhanced by having a hospitalist model. And I think it also gives the nurses a lot more support and peace of mind. So, I'm excited that the model is expanding from the inpatient to the pediatrician to the OB, and I could foresee other specialists also moving in that direction as well. So, I'm excited what it means for inpatient healthcare.

Host: Yeah. That'll be exciting to see how that changes and evolves in the future. Well, that is all that we have for today. Thank you so much for being here, Ellen.

Ellen Bollino: Thanks for having me.

Host: Of course.

Ellen Bollino: And any topic, I think I love being a podcaster. I'm going to have to listen to myself back to see, but this was fun.

Host: Okay. Well, we'll sign you up. We'll get some more topics going. And thank you listeners for tuning into the Well Within Reach podcast. Be sure to like and subscribe to Well Within Reach on Apple, Spotify, or wherever you get your podcasts. And to learn more about services at Riverside Healthcare, go to riversidehealthcare.org.