Hospitalists have continued a growing and vital role in care delivery at Duke Health that includes a partnership with advanced practice provider (APP) teams and an emerging emphasis on academic research to improve outcomes.
The hospital medicine program is deeply integrated into clinical operations with more than 200 individuals employed within DUHS Hospital Medicine as physicians and APPs, says David M. Gallagher, MD, Chief of the Duke University Hospital MedicineProgram.
“We provide admissions, discharges, rounding, and sometimes procedures, usually excluding surgery, for a significant percentage of patients at all three Duke hospital sites,” Gallagher says.
The hospital medicine program typically grows at about 8% annually, although COVID-19 slowed pace during 2020. Hospitalist physicians are board-certified in internal medicine and pass a separate exam with a hospital medicine focus.
“As patient volume increases, we are able to help backfill all general medicine inpatient operations, particularly with the addition of the medical pavilion and the new tower at Duke University Hospital,” Gallagher adds.
During the COVID-19 case spikes in 2020 and 2021, hospitalists played key roles at all three Duke affiliated hospitals by staffing COVID-specific teams supporting COVID clinical isolation units. “For a year, the biggest challenge we faced was COVID-19,” Gallagher says. “Our teams were deeply involved.”
Key research and education initiatives include:
Diversity, equity, and inclusion
For more than a year, a DEI committee has been working to help to record key metrics associated with hospital medicine and identify opportunities for improvement. Sonya Vipul Patel-Nguyen, MD, a medical instructor in internal medicine/pediatrics, and Talia Bernal, MD, a medical instructor, are helping establish goals.
Length of stay
Partnering with GE CareHub and nursing leadership, the hospital medicine team is studying length-of-stay trends, which revealed opportunities during 2021. When patients remain in the hospital longer, fewer beds open for new patients. A collaboration involving physicians, nurses, and APPS is analyzing the factors that cause longer hospital stays.
Hospital readmissions
Adding a case manager or social worker as well as a pharmacist can reduce readmissions, hospitalist research has demonstrated. By helping the patient and family plan more effectively for the post-hospital recovery, readmissions are reduced.
Geographic care units
Hospitalists have taken a key role in the development of geographic care units within the hospitals. By assigning teams to work consistently in a specific unit within the hospital, patient care is coordinated more efficiently.
Mortality rates
By engaging in a goals-of-care discussion with patients who are very ill, care teams and family members initiate end-of-life planning that may improve patient comfort and allow care to be delivered at non-hospital locations in line with patient wishes.
Resident training
Hospitalists are involved in training learners of all levels in their inpatient rotations. A new educational initiative last year involved hospitalists at Duke Regional partnering with Department of Family Medicine and Community Health to return the family medicine inpatient rotation to the Duke Health system. Previously, family medicine residents trained at hospitals outside the system.
Academic studies and clinical education
The Duke hospital team has produced a steady volume of scholarly studies, Gallagher says, with focus in COVID research, clinical education, quality, and safety. Recent educational accomplishments include the success of Saumil Chudgar, MD, MS, assistant dean for clinical education, and Poonam Sharma, MD, director of undergraduate medical education for DOM. Suchita Sha Stata, MD, a hospitalist, received the 2021 excellence in education award.
Story originally published in the Duke Department of Medicine's newsletter, This Week in Medicine
Written by Tim Pittman