What is a hospitalist — and why should you care?

BRAINERD, Minn. — Chances are if you have ever been checked into a hospital for medical care you’ve been treated by a hospitalist.

Most hospital patients know little, if anything, about one of the fastest-growing medical specialties since its creation more than two decades ago.

“I feel like multiple times, if not more throughout the day, I get the question ‘What exactly is that?’ and ‘Who are you?’” said Dr. Jeremiah Eisenschenk of Essentia Health-St. Joseph’s Medical Center in Brainerd, Minn.

Eisenschenk received additional training in hospital services. Hospital medicine is a specialty dedicated to the delivery of comprehensive medical care to hospitalized patients.

“It's typically a physician, though not always these days,” Eisenschenk said. “It can be a nurse practitioner or physician assistant. … Melissa and I happen to care for adults, though there are also pediatric hospitalists.”

Contributed / Andrea Baumann via Essentia Health

Dr. Melissa Simonson is the section chair of the hospitalist department at Essentia Health-St. Mary’s Medical Center in Duluth. The hospitalist model of patient care has existed for the past two decades in the Duluth area and a dozen years in the Brainerd lakes area.

“The scope of our practice is really broad so we do take care of adults that are hospitalized but for a lot of different reasons,” Simonson said. “And so people coming in with pneumonia or other infections all the way to strokes and heart attacks, we admit for and take care of patients.”

Hospitalists typically undergo residency training in general internal medicine, general pediatrics or family practice, according to the Society of Hospital Medicine, and a minority of hospitalists specialize in fields including neurology, obstetrics and gynecology, and oncology.

Kelly Humphrey / Brainerd Dispatch

“We're still a relatively new specialty,” Eisenschenk said. “We're essentially in most larger institutions, like the primary care physicians or providers in the hospital so for a lot of patients this is still a relatively new thing.”

Almost half a century ago, an emergency room visit would likely entail a nurse taking your vitals and then contacting your primary care doctor. Intensive care units used to be staffed by rotating physicians lent from other departments, many with no special training in critical care.

“Maybe they were used to having their primary care doctor see them while they were hospitalized. But that’s less common these days,” Eisenschenk said.

There were more than 50,000 hospitalists in 2016 working to improve inpatient care across the U.S., according to a University of California, San Francisco, retrospective on the specialty.

Contributed / Jeff Frey via Essentia Health

“The reason I chose hospitalist medicine is because I really liked the acute aspect of it. I like taking care of patients when really they need me the most, when they're at their most vulnerable,” Simonson said.

The term “hospitalist” is relatively new, having been coined by Dr. Robert Watcher at the University of California-San Francisco, and the need for these specialty practitioners emerged from the increasingly complex nature of hospital patient cases.

“I want to be there to help them get through that illness, help them get through their hospital stay and set them up for success when they leave the hospital … and hand them off to their primary care doctor who can help on their journey to wellness,” Simonson said.

Studies have even demonstrated how hospitalists help reduce the length of patient stays, according to the University of California-San Francisco.

“I like to tell patients I'm the quarterback of their team, so I'm the one that is coordinating their care with additional specialists, with their nurses and with them because they're the core member of that team,” Simonson said. “And so I'm there to help get their care moving in the right direction.”

There are 10 hospitalists at Essentia Health in Brainerd and 75 in the health care provider’s location in Duluth.

“If you're seen in an emergency room, which is the most common pathway to becoming hospitalized … if the emergency room physician feels ongoing care is needed … we are the default next step of meeting you … and developing a care plan until discharge,” Eisenschenk said.

Eisenschenk said Essentia Health hospitalists have cared for thousands of COVID-19 patients and believed hospitalists have been central in educating and transitioning patients to their primary care physicians and life after leaving the hospital.

“I think our role during the pandemic has really been front and center,” Eisenschenk said. “We still are the primary physicians and care providers for some of the sickest patients with COVID.”

Hospital medicine practitioners actively support the implementation of evidence-based guidelines and practices to facilitate optimal continuity of care and enhance the performance of hospitals and health care systems by:

• Managing day-to-day care and providing prompt and complete attention to all patient care needs including diagnosis, treatment and the performance of medical procedures (within their scope of practice).
• Employing quality and process improvement techniques and practices to make the hospital a safer place and improve patient outcomes.
• Facilitating collaboration, communication and coordination with all physicians, health care personnel and care team members caring for hospitalized patients.
• Supporting safe transitioning of patient care within the hospital, and from the hospital to the community, which may include oversight of care in post-acute care facilities.
• Practicing efficient and judicious use of hospital and health care resources.

Through these practices, hospitalists provide efficient care delivery and improve clinical outcomes, reducing mortality rates, enhancing care coordination, preventing hospital-acquired infections and facilitating comprehensive transitions of care.

Source: Society of Hospital Medicine