Table 2 Elements and characteristics of ideal hospitalist programs as reported by interviewees (n = 27)
Program domain | Ideal characteristics | Illustrative quote |
|---|---|---|
Model design | Committed group of providers who are available 24/7 Rotating, unit-based models of care to improve efficiency Creation of teams of providers including a mix of hospitalists, specialists, nurse practitioners, nursing staff and allied health care Schedule designed to maximize continuity of care Flexibility and responsiveness to change | “Being on-site lends itself to better communication because they’re accessible. Hospitalists always answer the phone, but the GPs don’t always since they may be with other patients” “In a perfect world, they shouldn’t have to run around to all the departments. They should be unit-based, to improve efficiency. And they can rotate around so that nobody gets stuck with medical all the time; no body gets stuck with surgical all the time” “It should be team-based care, so teams of hospitalists, internists, NPs, nurses, and so on. Each can take patients depending on their complexity. Management would be needed to ensure the appropriateness of assignment” “Most are interested in the team and using each members’ strengths” “Less rotation between hospitalists so patients have a consistent doctor throughout their stay” “Changing doctors during the same admission for a patient. Continuity of care affected, more room for error” “We are so flexible. If we see something that’s not working, we change it as a group. We have a meeting every month to go over things and see what’s working, what’s not working, what the team wants” |
Clinical and non-clinical processes | Easy access to consultants, particularly when managing complex patients Tools and supports for rapid communication and consultation with community-based FPs Easy identification of patient assignment to individuals (i.e. which hospitalist is taking care of each patient and how to contact them) On call coverage for evenings and overnight, including admissions from the emergency department | “Easier access to consults with internal medicine, where you don't have to wait a week to get a consult and you can work together on patients” “I think there is potential pitfalls with the hospitalist system. If you are transferring a patient out you have to ensure your communication is impeccable with the family physicians. I think there is always room for improvement with that. When you're the family physician discharging your patient to your own practice and you're following them up, it's a lot easier to keep that continuity going” “It would be nice to know who to call for the admitted patients since right now it can be confusing to know which physician is responsible” “You would have a physician onsite for 24/7 and is very reliable, even on holidays and after hours” “…now having someone on 24/7, that hospitalist at night is actually awake and is usually down in the ER working with new patients. They’re awake and on the ball, which is always good. It wasn’t always like that” |
Hospitalist staffing and case load | Dynamic schedules where hospitalist staffing fluctuates in real-time with increases and decreases in patient volume Optimal individual hospitalist workload/ census (e.g. one hospitalist to ten patients) Adequate number of hospitalists per site to avoid burnout | “Increase the amount of hospitalists at the site to have hospitalists see the patients earlier in the day” “We are no longer putting out fires. Time was needed to iron out issues. Things are stable now” “The manpower for our program is finally stable. And everyone is very happy with the work environment” “As more and more GPs retire, the growth in the number of unattached patients increases, so you'll need to grow the numbers of hospitalists” |