// PERSPECTIVES
“It is important for the GIH to remember that the goal is always to keep patients with chronic diseases out of the hospital and to work closely with their outpatient gastroenterologist to implement preventative strategies.” a GIH to be tolerant of the emotional waves associated with the role. The hospital environment generates an incredible spirit of teamwork and comradery which is often appreciated by those who enjoy multidisciplinary engagement. Finally, a GIH position caters well to those whose image of work-life balance is to leave their clinical responsibilities within the walls of the hospital.
“GI HOSPITALIST HANGOUT”— CREATING A VIRTUAL NETWORK Since becoming a GIH, I have been fortunate to meet a few other physicians in this role and to help others start their careers. I had long been searching for the right opportunity to introduce everyone and this new era of video conferencing lent itself well for the occasion. In January 2021, I hosted the first ever “GI Hospitalist Hangout” which virtually connected twelve GIHs from across the country. When the meeting began, we were all amazed to see so many faces on the screen, especially since many of us had perceived ourselves to be a rare breed of gastroenterologist. The enthusiasm was palpable, and we were all excited to have finally found like-minded individuals who shared a similar passion for inpatient GI care. We reflected upon our common experiences as GIHs and share a few of our insights below: 1. Sometimes the simplest GI problems (e.g., hemorrhoids, chronic anemia), the ones deemed acceptable for outpatient follow-up in lieu of inpatient evaluation, can contribute to frequent readmissions. For certain patients, such as those with
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chronic illnesses or complex medical issues, GI issues are best managed proactively. 2. Delays in care have profound effects on hospital operations and throughput. A GIH understands the value in timely endoscopic evaluation and care. In the recent pandemic with hospitals operating in states of overflow, delays in discharge have profound impacts on resources. For the GIH, this means helping to ensure timely endoscopic procedures, such as percutaneous gastrostomy tube placement for patients with SARSCoV-2. 3. Some patients with chronic GI conditions may see the GIH more regularly than their outpatient gastroenterologist. There is the potential for paradoxical continuity of care on the inpatient side. It is important for the GIH to remember that the goal is always to keep patients with chronic diseases out of the hospital and to work closely with their outpatient gastroenterologist to implement preventative strategies.
model for inpatient GI care as it has for general medicine. So far studies have shown that the GIH model increases inpatient and outpatient endoscopic procedural volume, reduces unnecessary costs, shortens time-to-endoscopy, and decreases complications.1-6 Following our initial “GI Hospitalist Hangout,” the idea for a Society of GI Hospitalists came to life. Alongside my fellow GIHs we vowed to raise awareness of the GIH model, to demonstrate its value through research and to provide support for anyone considering a career as a GIH. By sharing our insights and experiences, we hope to inspire the next generation of GIHs.
REFERENCES 4. Schoeppner HL, Miller SL. Developing a gastroenterology hospitalist service. Gastrointest Endosc Clin N Am 2006;16:743-50. 5. Overholt BF, Wagonfeld JB, Miller SL, Oblinger M. Revenue enhancement for the practice and the endoscopic ambulatory surgery center. Gastrointest Endosc Clin N Am 2002;12:385-93. 6. Shung D, Hung H, Laine L, Hughes M. Adopting a GI Hospitalist Model: A New Method for Increasing Procedural Volume. Session: Oral Paper Presentations - General Endoscopy presented at the American College of Gastroenterology Annual Scientific Meeting 2020. 7. Hughes M, Sun E, Enslin S, Kaul V. The Role of the Gastroenterology Hospitalist in Modern Practice. Gastroenterology & Hepatology 2020;16. 8. Latorre M, Meneses M, Arbuah N, Adenikinju A, Wasterlain A, Swensen S. Multidisciplinary Quality Improvement Initiative to Reduce Bowel Complications in Post-Operative Orthopedic Patients. Am J Gastroenterol. 2019;114:S73-S74. 9. Levine I, Hong S, Bhakta D, McNeill MB, Gross S, Latorre M. Predictors of Hospital Readmission Among Patients With Obscure Gastrointestinal Bleeding Following Inpatient Capsule Endoscopy. Am J Gastroenterol. 2019;114:S665. 10. Tran J, Kimmel J, Betesh A, et al. Effect of a Team-Based Approach to Improve Enteral Access Decision-Making. Am J Gastroenterol. 2018;113:S607. 11. Mahadev S. LB, Ramirez I., Garcia-Carrasquillo R.J., Freedberg, D.E. . Transition to a GI Hospitalist System
A MODEL FOR INPATIENT GI CARE Since receiving that first email there has been a growing demand for GIHs and it is likely that will become the preferred
is Associated with Expedited Upper Endoscopy. Gastroenterology. 2016;150[4]:S639-40.
“As a GIH, it helps to be adaptable to the unpredictability of the day and to be capable of executing quick judgement with a calm temperament when life-threatening situations arise.” Melissa Latorre, MD, MS Director, Inpatient GI Services at Tisch Hospital & Kimmel Pavilion; Director, Enteral Access Team, NYU Langone Health; Assistant Professor of Medicine, NYU School of Medicine