The U of M Hospitalist Program has grown substantially over the past few years. What started as a small group of physicians dedicated to inpatient general medicine has grown to 60 faculty members whose clinical work, teaching, research, and administrative responsibilities all center on inpatient medicine.
Our hospitalists have a variety of roles on the inpatient medical wards including teaching on resident services, attending on non-resident services, and providing medical consultation and surgical co-management.
The University of Michigan’s Department of Medicine has 6 inpatient general medicine ward teams. Four of the teams are traditional general medicine ward teams and each include an attending, resident, two interns, and students. Two additional teams, the Medicine Newburgh service, each include an attending and two residents. Hospitalists now staff all Newburgh services throughout the year in addition to 80% of the traditional ward teams. The remaining attending months are staffed by some our best subspecialists and non-hospitalist general medicine faculty. The Department of Medicine maintains separate resident based inpatient Cardiology, Hematology, Pulmonary, and GI services that are not staffed by hospitalists.
In response to residency work hours requirements, coupled with increased inpatient volume, faculty members were hired to staff a non-resident inpatient service (the Medicine Faculty Hospitalist (MFH) service). The MFH service regularly admits up to 16 to 20 inpatients per day, and has a daily census of 60-65 patients with a goal of managing about 3600 to 4000 patients over the year. In addition to general medicine patients, the MFH service also admits selected patients from all the subspecialty services. The service is complimented by 8 physician assistants as well as three dedicated discharge coordinators and social workers. The MFH service, while a non-resident service, does provide a critical teaching role for our medical students. Both sub-interns and fourth year students wanting an inpatient medicine elective regularly rotate onto the MFH service. Many of the physicians who regularly attend on this service are actively involved in quality improvement projects benefitting patients throughout the institution including the LEAN discharge project on the 5B hospital unit.
Medical Consultation, Preoperative Services, Surgical Co-management:
The University of Michigan Hospitalist Program provides inpatient General Medicine consultative services, outpatient preoperative consultative services, and inpatient hospitalist-surgical co-management (to selected surgical services). The hospitalists provide inpatient General Medical consultation when requested by non-Medicine services. Also, the hospitalists staff a Medicine Pre-op Clinic in which they evaluate preoperative surgical patients comprehensively, optimize medical therapy, and offer recommendations for the perioperative management of existing or anticipated medical problems. The surgical co-management program allows selected subspecialty surgical patients to be co-managed by both a surgery attending and a hospitalist attending, in a coordinated manner. For these patients, a hospitalist takes an active role in managing any pre-existing medical problems, as well as any acute medical problems or complications that arise perioperatively. There are several ongoing QI projects related to improving perioperative care.
Medicine Hematology PA Service:
The Medicine Hematology PA service (MHP) is a partnership between the Department of Hematology/Oncology and the Hospitalist Program. MHP provides sub-specialty care to inpatients with malignant hematologic diagnoses. We currently have four daytime and three nighttime hospitalist faculty attending year-round on this non-resident service, complemented by four full-time physician assistants. Patients with acute and chronic leukemias, Hodgkin's and non-Hodgkin's lymphomas, and plasma cell dyscrasias are admitted to the service to receive chemotherapy and/or for management of disease complications (neutropenic fever, infections, pain/nausea control, blood product transfusions, relapsed disease, end-of-life care). Our nocturnists also provide cross-cover for the hospital's Bone Marrow Transplant service. University of Michigan Hematologists work closely with our hospitalist faculty and provide consultation as needed for these complex patients. Added in July 2010, the MHP service is an important expansion for the University of Michigan Hospitalist Program (and for hospitalist medicine in general), serving as a model for delivery of inpatient specialty care in the future.
The hospitalist faculty have been integrated into the fabric of the Department’s educational program. Several faculty members have administrative roles within the training programs; including associate internal medicine residency program director, and associate internal medicine–pediatrics residency program director. The hospitalist faculty work regularly to enhance the inpatient medicine curriculum, attend resident report, facilitate noon conferences and grand round presentations, and most recently, have developed a medical consultation curriculum.
All hospitalist faculty are actively involved in scholarly pursuits within the field of hospital medicine. Some current research projects include:
- VA-based patient safety enhancement program
- Multi-hospital patient safety consortium (HELPS Consortium)
- Device-related infections
- Nosocomial fever
- DVT prophylaxis in medical inpatients
- Guideline implementation: ETOH withdrawal, smoking cessation
- Perioperative beta-blockers, glucose control, DVT prophylaxis
- Mock-code educational program
- CPOE implementation / computer based sign-out and hand-offs
- Applying “Lean” business practices to inpatient processes
- Intensive Care Unit staffing
- Community-acquired and nosocomial pneumonia
- Pharmacist facilitated discharge
- Inpatient curriculum innovations
A full list of faculty research projects and relevant recent publications can be found under links to individual faculty.
The U of M Hospitalist Program Goals:
The University of Michigan Hospitalist Program is dedicated to maximizing the quality, safety, and efficiency of inpatient care; achieving excellence in inpatient education for our trainees; pursuing research and scholarly work that advance the field of hospital medicine and ultimately improve the care of hospitalized patients.
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