Conducting Care

Hospitalists coordinate complex inpatient care.

On a hospital staff, everyone matters. Medical technicians and anesthesiologists, custodial crew members and cardiothoracic surgeons—in the medical center, everyone has a vital role.

It can be a complex workplace. Patients are at the center of care, and providing the care each patient needs—from diagnostic tests to physical therapy—may involve multiple specialists and support staff, all working in concert.

Coordinating patient care requires up-to-the-minute information and an awareness of everything about the patient’s history, condition and treatment. That’s where hospitalists come in.

If the interaction between specialists, medical technicians and support staff is an orchestra, hospitalists are the conductors. Where primary care physicians track their patients’ health and care over years as outpatients, hospitalists coordinate and monitor care during the shorter (but more intense) periods of inpatient care.

“We effectively become patients’ primary care physicians while they are in the hospital,” explains Alexander Shen, MD.

“We’re the patients’ stewards through the hospitalization,” adds Torrance Memorial hospitalist Valente Ramos, MD. “We manage their medical care but also guide them through the hospitalization and answer any questions they might have. When I introduce myself, I tell patients to think of hospitalists as their surrogate primary care physicians—it’s the same kind of role. I explain to them, in layman’s terms, what’s going on with them. Being a hospitalist presents a unique challenge in trying to establish a rapport very quickly. Our group in particular is very good about trying to bridge that gap and make patients as comfortable as possible.”

As specialized physicians, hospitalists train in internal medicine. “Our training is very broad in scope and very specialized in inpatient care,” says Dr. Shen, who came to Torrance Memorial in 2009 as medical director of the center’s then-new hospitalist program. “We receive extensive inpatient training in essential subspecialties including cardiology, critical care, pulmonology, nephrology, infectious diseases and gastroenterology—just to name a few! This is essential because we work hand in hand with these subspecialties to gather all the recommendations. When a condition requires a specialist, we’re good at knowing who to call and when. We’re also advocates for patients and their families, so we translate medical terminology for them and develop the best care plan.”

Torrance Memorial’s hospitalist program has been so successful that the center recently launched a medical teaching hospital program for Cedars-Sinai internal medicine residents. The residents will work two-week rotations including hospitalist services, ambulatory primary care, and specialty and urgent care training.

“This program is a recognition of the high level of health care we provide in the community,” notes Heidi Assigal, Torrance Memorial senior vice president. “Ninety percent of medical care in the United States is provided by community centers like Torrance Memorial, and our center is a great location for residents entering medical practice to see how a top-ranked hospital operates.”

“Torrance Memorial is such an amazing, dynamic place,” agrees Dr. Shen. “There is so much expertise in so many fields and such a diverse patient population. It’s a great experience for any hospitalist who wants to see a high-functioning medical center.”

The hospitalist specialty developed during the 1990s as inpatient hospital care became increasingly too complex for primary care physicians to be able to track their patients’ progress throughout each day alongside running their outpatient practice.

“You really do need someone to coordinate the team providing care, especially urgent care—heart attacks, strokes and the like,” says Dr. Shen. “These are conditions that must be treated within an hour, if not minutes. As hospitalists, it’s our job to coordinate complex care in a very short amount of time.”

Hospitalists coordinate care for elective inpatient procedures as well. “Many patients undergoing elective procedures have other conditions such as diabetes,” Dr. Shen explains.

Unlike primary care physicians, hospitalists don’t get to follow their patients’ health over years, but the specialty provides the satisfaction of seeing patients—most of whom arrive at the hospital with an urgent medical condition—progress and leave in better health.

“We help patients through potentially some of the most difficult times in their lives, ” Dr. Shen says. “To see them walk out the door recovered is very gratifying. We spend quite a bit of time with our patients. We get to know them and really dive into their medical issues. We have discussions with them and their families to discuss their values and their goals for their medical care. We have the luxury of treating them in a very controlled environment, so we can see what’s working and what’s not working. After they leave, we check in on our patients and their primary care physicians too.”

The hospitalist specialty also emphasizes teamwork and systems thinking, Dr. Shen adds. “Teamwork is in the DNA of hospitalists. We’re really good at coordinating and operationalizing health care, making health care delivery more efficient and safer. Because we are everywhere as leaders in the hospital, we see how different systems are working, and we can develop improvements. A big part of our job as hospitalists is to lead our health system in improving the quality, safety and efficiency of patient care, so we find ourselves extending the reach of our leadership. We help develop better systems outside the four walls of the hospital, including care coordination at skilled nursing facilities and post-discharge outpatient clinics, and facilitating transfers of patients from outside facilities into the Torrance Memorial system.”

“The dedicated work of hospitalists is one of the keys to Torrance Memorial’s success in providing top-ranked inpatient care,” says Assigal. “We have close to 40 hospitalists on staff—hospitalists are on duty 24/7/365. That depth of coverage will be even more important when our expanded emergency department facilities come on line. When I speak with hospitalists, they tell me they’re busy—but also they love what they are doing.”

“I truly enjoy what I do” reflects Dr. Ramos. “I get a sense of satisfaction out of my job. To this day I enjoy what I do as much as I did when I finished my residency, if not more.”