Concept of Hospitalist: Hospitalist
(practitioner of hospital medicine) ensures delivery of comprehensive medical
care to hospitalized patient. Apart from performing the above mentioned core
expertise, hospitalists work in coordination, communication and collaboration
with all those who are part of care taking team of hospitalized patient.
Hospitalist also ensures quality practice and effective use of hospital
resources. Thus hospitalists can enhance the performance of hospital and
healthcare setting.
Problem Statement: Do
we have proper infrastructure and environment in hospitals and healthcare
setting to deploy hospitalist? No, but we do need them in near future to
provide quality of care with human touch apart from the sophisticated technological
means of quality. Hospitalist can play huge role in improving the utilization
of healthcare facility as compared to by other means, especially in the era of
increasing literacy rate. More educated patient means higher needs of
knowledgeable and qualified personnel to take care and answer the in-depth
queries of patients. Basic concept of hospitalist was to have full time
presence of physicians inside the healthcare setting to take care of patients
round the clock. Consultants affiliated with hospital will need time to reach
to hospital to tackle the case without hospitalist. But with the presence of
qualified hospitalist, case management becomes more efficient and effective.
Indian Scenario: Even
though NABH accredited District Hospital, Gandhinagar has latest and improved
conditions, still educated population of well-doing capital of Gujarat, prefer
tertiary care teaching hospital (Civil Hospital, Ahmedabad) which has one of
the finest medical college in India (B.J.Medical College) affiliated with it.
Round the clock availability of qualified PG residents along with frequent
rounds of consultants (APs, HOUs and HODs) puts Civil Hospital, Ahmedabad in
top position as preferred choice by educated people of the capital city and
state. Patient outcome and patient satisfaction heavily depends on the presence
of qualified person within the healthcare facility. Though government is
putting stress on improving infrastructure of the district hospitals (DHs)
across the nation, healthcare personnel management becomes equally decisive
with regard to its utilization. The same scenario is there in private setup,
where patient chooses the hospital based upon presence of qualified person to
answer them immediately. With increasing trend of literacy rate, concept of hospitalist
will become essential in Indian hospital and healthcare setting. Currently
tertiary care teaching hospital is the only facility that has inbuilt advantage
of post graduate residents, whose work is more or less similar to that of the
hospitalist’s work.
Relevance
of Hospitalist: Hospitalist work is not
limited to family medicine or internal medicine, but any department with large
OPDs and small indoor admissions are suitable for hospitalist. Hospitalists are
hired by hospitals and they usually do not have office-based practice.
Hospitalist concept was criticized heavily by experts in late 1990s. But now as
the concept of hospitalist has already proved its worth in western world during
past one and half decades, it is now growing and expanding its span from
non-specialist hospitalist to specialty based hospitalists. Hospitalist program
covers emergency department, orthopedic, pediatrics, neurology and many more
specialties today in USA. For instance, there are nearly 35,000 hospitalists
are working in USA in 2012. The growth of hospitalist is incredible. By seeing
and sensing the need and usefulness of the hospitalist, currently fellowship
programs are being offered in hospital medicine, pediatric hospitalist,
Obstetrics and Gynecology hospitalist and so on. This suggests the importance
of hospitalist in healthcare setting to improve quality and add value to the
service delivery.
In
context to India, educated patients of urban and rural India seek for quality
healthcare and hurdles like distance and cost have lesser effect on choice
being made by them. Thus it is high time to implement new brigade of
hospitalists in hospital and healthcare setting to improve quality of
healthcare.
Challenges
and Scope for India: Hospitalist can play pivotal role in functioning of both
public and private setup. The current challenge would be to have effective
policy for the same. Not targeted, but integrated and broad approach is needed
to make it happen at each level of healthcare service delivery setup. As MCI
gave green signal for MD in Family Medicine, Medical education and MCI along
with ministry of health and family welfare should pursue preliminary research
for the possible scope of implementation of hospitalists (MD in Hospital
Medicine) in phased manner with enough regulations to ensure quality of care
being offered. Initially MCI and medical education division needs to carry out
evidence based planning for the same. In early transition phase, 3rd & 4th
year residents of tertiary care hospitals could be deployed for about 3 months
to various District Hospitals and CHCs of the vicinity as a specialist
hospitalist. In parallel to this, intern doctor could be posted in DHs (just
like current rural SC/PHC/CHC postings), where they could work as
non-specialist hospitalists. Just like MD in Family Medicine as post-graduate
branch, MCI could offer degree and diploma course like MD in Hospital Medicine
(hospitalist).
This
will definitely help to build the cadre of hospitalist for nation in a phased
manner. Also there should be enough provisions to be made for them to become
specialist hospitalist as super-specialist branch to pursue. Major proportion
of super-specialty branches offered should be for pediatrics, geriatrics,
psychiatry and emergency hospitalist to address the future burden of these
types of illness and diseases.
This
kind of strategic increase in numbers of healthcare personnel could ensure
better patient management in healthcare setting. Great challenges lie in terms
of economic and political commitment. But evidence based research could assure
favorable cost-benefit ratio for building healthy nation with quality of care
at each level of health service delivery system.
In
PHCs and CHCs, Medical Officer and AYUSH practitioner along with qualified
physician (MD in Family Medicine) would be best approach to cater the needs of
community. At district and tertiary care hospital level, along with
consultants, posts like hospitalist (MD in Hospital Medicine) is much needed to
address the patient needs and narrow down the gap in health personnel in
healthcare settings. This in-house approach of hospitalists can also work
effectively in private setup and can offer quality of care. Thus within the
scope of public and private setup, hospitalists can be the center point to
exercise patient centered care approach. They can form effective teams for
patient care and can provide leadership skills. They can ensure best use of hospital
resources and can perform vital role in real time monitoring the functions of
hospital. Finally hospitalists can offer comprehensive and complete healthcare
to the hospitalized. Hospitalists can be seen as transforming hands of Indian
healthcare system if deployed with great commitment across the nation.
Dr.
Biren Chauhan
MHA-Hospital
Administration
2012-2014
Batch
TISS,
Mumbai
