Learn about hospitalists and how to work with them as a caregiver in our essential guide for better patient care.
Picture this: Your mother is in the hospital. People come in and out of her room, asking questions, checking monitors, and taking notes. They introduce themselves so quickly that you can’t keep track of their names or roles. No one seems to be in charge. Finally, someone with an air of authority comes in. “I’m Doctor Smith. I will be managing your mother’s care while she’s in the hospital.” From her bed, your mother speaks up, “Where is Doctor Jones? I want my regular doctor.”
Do you know how to respond? This guide is here to help you navigate such situations.
Hospital care has evolved significantly in the past 20 to 30 years. Patients are now admitted primarily for serious illnesses or injuries, with shorter stays, and many are discharged when their condition stabilizes, often with little notice. As a family caregiver, you may have experienced this firsthand.
Another significant change relates to the doctors involved. In many hospitals, specialized doctors called “hospitalists” now manage patient care during hospitalization. This responsibility was previously handled by community-based doctors. Today, doctors in the community may not even be aware that their patients are in the hospital.
It’s crucial for family caregivers to understand the role of hospitalists, the services they provide, and those they don’t. This guide offers insights into hospitalists and provides guidance on ensuring the best care for your family member, both in the hospital and after discharge. Keep in mind that while this guide offers general information, each hospital may have its unique approach to patient care.
Who Are Hospitalists and Why Are They in Charge?
According to the Society for Hospital Medicine, a hospitalist is “a physician who specializes in the practice of hospital medicine.” The term was first coined in 1996, when only a few hundred doctors practiced in this field. Today, “hospital medicine” is the fastest-growing medical specialty, with over 30,000 hospitalists practicing in U.S. hospitals. You are likely to encounter these specialists in your local hospital.
Here are some key facts about hospitalists:
- Most hospitalists are trained in internal medicine (internists), while others have training in family practice, pediatrics, or other specialties.
- Some hospitalists have advanced training in managing critical illnesses and are leaders in patient safety and high-quality care.
- In the Intensive Care Unit (ICU), an intensivist may take charge, although hospitalists may play a role.
- Surgeons typically oversee their patients’ surgical care in the hospital but may consult with a hospitalist for other aspects of care, such as chronic medical conditions.
- Hospitalists may collaborate with palliative care specialists for pain management or other symptoms.
- Hospitalists possess knowledge about the hospital’s procedures, staff, and how to quickly access test results, consult with other specialists, and coordinate care.
- Hospitalists are typically available 24/7, with doctors working in shifts. This means that during a one-week hospital stay, you may interact with multiple hospitalists managing your family member’s care.
Hospitalists often work within teams that may include physician assistants, nurse practitioners, floor nurses, social workers, physical and occupational therapists, chaplains, and technicians. In teaching hospitals or academic medical centers, the team may include house staff—doctors-in-training (residents and interns) supervised by experienced physicians. Managing your family member’s care with so many team members can be overwhelming, so don’t hesitate to ask about their roles and names.
While hospitalists excel in managing acute (serious) illnesses due to their constant presence in the hospital, their knowledge of community resources and post-hospital care may be limited. As a family caregiver, you can help ensure communication between the hospitalist, you, and your family member’s primary care doctor regarding illness, treatment, and follow-up care.
An important distinction between hospitalists and community doctors is that most hospitalists do not provide post-discharge care.
Why Do Hospitals Use Hospitalists?
The rapid growth of hospitalist care is influenced by changes in how healthcare is delivered in hospitals and the community. Hospitals face economic pressures to discharge patients earlier while maintaining safety and quality care. Hospital care operates at a fast pace, making it impractical for community-based doctors to visit the hospital for brief periods each day. As a result, many hospitals rely on hospitalists to efficiently manage patient care while ensuring safety.
While hospitalist care offers numerous benefits, there can sometimes be challenges coordinating post-discharge care with hospitalists and primary care doctors. Family caregivers can play a crucial role in addressing these challenges.
What You Can Do Before a Planned Hospitalization
During a routine office visit or before a planned hospital admission, inquire about whether your family member’s primary care doctor provides hospital care. The response may vary, but understanding their involvement is essential. If your family member’s primary care doctor does not make hospital calls anymore, find out how the hospitalist service at that hospital operates.
8 Ways to Work with Hospitalists
Collaborating with a new doctor in the hospital, especially during a medical crisis or after waiting for hours in the Emergency Room, can be challenging. Here are some strategies to help you feel more in control:
- Identify everyone providing care and entitled to your family member’s health information.
- Request to speak with the hospitalist if you arrive when they are unavailable.
- Ask the hospitalist about contact information and the best times to reach them.
- Clarify your role as a family caregiver and the person responsible for post-discharge care.
- Provide your contact information to all involved in your family member’s care.
- Inquire about the hospitalist’s shift schedule and who will be managing care during shift changes.
- Request the hospitalist to contact your family member’s primary care doctor and other specialists.
- Inform the primary care doctor about your family member’s hospitalization, providing contact details for the hospitalist in charge.
Review your family member’s medications with the hospitalist, including over-the-counter medications, herbal preparations, and supplements. Mention any allergic reactions to medications. Ensure an updated medication list is available.
Getting Ready for Discharge
Although the hospitalist’s care ends upon your family member’s discharge, they should assist with the transition. Your input is invaluable during this critical phase. When preparing for discharge, ensure that the plan for returning home or entering a nursing home for short-term rehabilitation is well-structured and includes all necessary services and equipment. Here’s how you can help:
- Learn when your family member might be discharged and discuss options for post-discharge care.
- Work with a social worker or case manager to choose the appropriate post-discharge setting (home with or without home care services, short-term nursing home rehabilitation, or long-term nursing home placement).
- Engage in discussions about discharge dates and care needs early in the admission to allow ample time for exploration and understanding of the options.
- If home care services are needed, ensure you have agency information and contact details before the first nurse visit.
- Confirm that essential documents are signed, including those required for Medicare approval.
- If home care services are involved, inform the home care agency about the person responsible for post-discharge medical care.
- Notify the primary care doctor about your family member’s upcoming discharge, ensuring communication with the hospitalist and timely
Source: research and personal experience.
We hope this information is helpful to you in the important work you do as a family caregiver.
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