Hospital News Saint Francis
Kaiser
Patricia Galamba, MD
Robert Mithun, MD
When the term “hospitalist” was first coined in 1996, fewer than 1,000 internists limited their practice solely to the hospital. That soon changed. Between 2002 and 2007, the field grew from approximately 10,000 to 20,000 practicing hospitalists, and the number is now currently estimated to be nearing 30,000 in the United States. When Kaiser Permanente San Francisco hired its first hospitalists in 1997, they originally worked within the Department of Medicine. Soon after, the Department of Hospital Medicine (HM) became the first free-standing department of its kind within the Kaiser Permanente NCAL Region. Today, the Hospital Medicine Department has grown to include 21 providers and two full-time “nocturnists,” whose practice is based solely on overnight care. Moving forward with expanding the specialty, there will be more direct integration of providers into the Emergency Department and potentially a greater sharing of responsibility for general surgery patients with complex medical issues. Similarly, agreements with the Ob/Gyn Department are also expected in the coming year. Currently, in addition to staffing the traditional resident-teaching services, the Hospital Medicine Department has specific service agreements with many of the surgical departments. These include Head and Neck Surgery, Orthopedics, Urology, and Cardiovascular Surgery, as well as medical subspecialties such as oncology and cardiology. Encouraging hospitalists to assume various leadership roles within the administrative structure of the medical center has evolved naturally. Several physicians currently hold medical director positions and are leading quality-improvement projects and patientsafety initiatives. So, while hospital medicine is not the newest of specialties in the field, it is one that is adapting and expanding its scope in order to provide excellent patientcentered care.
Who says you can’t teach an old dog new tricks? In anticipation of the coming of age of electronic medical record (EMR) technology, here at Saint Francis we’re working with our practitioners to keep everyone in the loop. I don’t think the role of the Medical Informaticist has become a subspecialty yet, but the need for electronic competency is more pressing than ever. To that end, SFMH is hosting an information technology fair for the medical staff in October. We will have the opportunity to meet different EMR vendors and view the latest tech gadgets for physicians. Clearly we are all headed in the direction of EMRs, and the future will require that we get on board in order meet federal payer expectations. Members of the Medical Society are welcome to stop by on October 7 between 8:00 a.m. and 2:00 p.m. (second floor, Doctors’ Dining Room). Enjoying ourselves further still as we bravely move forward into the EMR era, Saint Francis Memorial Hospital will host a fun social event—the annual Saint Francis Day on Wednesday, October 6. This is a longstanding tradition of more than fifty years. It’s an afternoon of camaraderie including golf, bicycling, running, and walking, followed by en evening of fine food, dancing, and awards at the Olympic Club. I’ll report next time about all the goings-on. On November 1, Saint Francis becomes a fully nonsmoking campus. No one will be allowed to smoke inside any hospital buildings or any of its contiguous sidewalks. As an institution dedicated to improving the health of our patients and community, we must “walk the walk” and show our commitment and leadership in tangible ways. All CHW hospitals will be smoke free by January 1, 2011.
32 San Francisco Medicine October 2010 33 San Francisco Medicine October
UCSF
David Eisele, MD
For more than 100 years, UCSF Medical Center has fostered clinical innovations that have brought about dramatic advances in patient care. One such contribution is the hospitalist field, a specialty pioneered here nearly fifteen years ago. Hospitalists—a term coined in 1996 by Dr. Robert Wachter, chief of the Division of Hospital Medicine at UCSF, and Dr. Lee Goldman—are physicians who help comanage internal medicine patients, overseeing emergencies, anticipating and preventing problems, and providing early response treatment when necessary. Hospitalists play a critical role in reducing lengths of stay and rates of readmission and costs, while greatly improving patient safety and quality of care. In 2006, we looked at other patient populations who would benefit from the enhanced quality and safety of care that these physicians provide, and that led us to become one of the first medical centers to implement a “neurohospitalist” service. UCSF’s neurohospitalist program, the only one of its kind in the Bay Area, treats common neurological problems that require urgent treatment, rare or complex disorders that are difficult to diagnose, and neurological conditions that arise from other inpatient conditions such as delirium or confusion. Neurological disorders are diverse, complex, and common, affecting nearly 50 million Americans and costing more than $600 billion each year. Neurology patients in particular tend to have higher rates of complications, and as our population ages, more and more of us will find ourselves in the emergency room in a neurological crisis. The need for more specialized testing, diagnosis, and treatment is imperative. The success of neurohospitalist services such as ours has spawned a national movement to develop similar programs across the country and has played a key role in not only providing superior care to individual patients but also in helping hospital systems run more efficiently. www.sfms.org