Hospitalists

October 24, 2013 | Healthcare Risk, Quality, & Safety Guidance

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Recognizing the reasons behind the growth of hospitalist programs can help risk managers understand the potential benefits and downsides of hospitalist programs, enabling organizations to identify and focus on issues that require risk management attention. The growth of hospitalist programs can be traced to several developments, including limitations on hours of resident physicians-in-training, reimbursement pressures on hospitals, high patient volumes in office-based physician practices such that physicians are time-pressured to make hospital rounds on their patients, younger physicians’ interest in seeking work-life balance and their greater comfort level with changing hospital technology, use of electronic health records (EHRs), and cost-cutting decision making (Gross).

Hospitalist programs, whether staffed with physicians employed by hospitals or made available through contractual relationships, have the potential to provide numerous benefits to hospitals, the medical staff, and patients. Hospitals are able to exert greater control over the quality of care provided at the facility, particularly when hospitalist physicians are involved in developing and managing aspects of hospital operations, because they are better situated to recognize inefficiencies in long-standing processes and to be motivated to improve them. Hospitalist programs also promote consistent use of clinical protocols and best practices and provide a patient safety mechanism to ensure that physicians with demonstrated skills are available around the clock to respond to significant changes in a patient’s condition. Hospitalist physicians also serve as effective liaisons with the medical staff at large in a way that may not be possible for administrative staff. As hospitals strive to align physicians with their strategic goals, hospitalists are taking greater leadership roles; some have become chief executive officers and chief medical officers at hospitals (Caffarini).

But as hospitalists continue to fill more roles within the hospital and as higher demands are placed on them, the risk of patient harm and litigation may also increase, observes an executive and patient safety officer at the Doctor’s Company, a physician professional liability insurer (Gallegos). Several medical negligence cases involving hospitalists are discussed in Hospitalists in the Courts.

While it is reasonable to speculate that the hospitalist model should reduce the overall legal risks for hospitals, certain practices and behaviors of hospitalists may raise the risk of potential liability for hospitalists and hospitals. For a discussion on how a court analyzed whether a hospital could be held vicariously liable for the...

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