Effective management of hospitalized patients--established role of hospitalists in the USA.

OBJECTIVES

Summarize and present benefits of effective management of inpatients in US hospitals by hospitalists and discuss the possible implications for healthcare system in Slovakia.

BACKGROUND

Inpatient or hospital-based internal medicine started to separate from traditional office-based medicine about a decade ago. Today, hospitalist programs are an integral part of most progressive hospitals in the US and the value of such programs is well documented.

METHODS

Literature review and analysis of Mercy Medical Center-North Iowa hospitalist program.

RESULTS

Hospitalists improve the quality of care for hospitalized patients, use fewer resources and decrease the length of stay. In 1998 there were 2,000 hospitalists and in 2005 there were more than 15,000 hospitalists in more than 1,800 programs throughout the US. It is projected that by the end of the decade there will be more than 30,000 hospitalists in the US. Mercy Hospital started its hospitalist program in 1999 with one hospitalist and by July 2006 the program will expand to six physicians. The average daily census for a hospitalist is 20 patients and the average length of stay is 3 days. In 2003, with 874 median new admits and consults per year per hospitalist, one hospitalist was able to save approximately dollars 400,000/year compared to the traditional internal medicine model.

CONCLUSION

Hospitalists are the fastest growing specialty in the US. In addition to the care of medical illnesses including subspecialty and surgical consults, hospitalists also serve as stewards of hospital systems. They improve quality, patient safety, efficient use of resources and reduce variation in diagnostic and therapeutic approaches (Tab. 2, Fig. 3, Ref. 10).