1. Wilson, Eleanor RN, MSN, MHA

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The hospitalist movement, whereby dedicated inpatient physician groups manage hospitalized patients, is sweeping the nation. The complexity of today's acute care patients is greater than ever. Primary care physicians who've traditionally cared for patients in the hospital may see three or four cases per year of a specific complex diagnosis, while a hospitalist may care for five times that number.


Under the stringent managed care reimbursement system, it's no longer feasible for primary care physicians to take several hours per day from a busy office practice to travel to and from hospitals and make rounds for a few hospitalized patients.

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Hospitalists manage high-volume medical diagnoses such as congestive heart failure, chronic obstructive pulmonary disease, gastrointestinal bleeds, and chest pain. A hospitalist performs the initial patient assessment on admission, develops a care plan, reports findings to the primary care physician, and consults with specialists and subspecialists. The hospitalist also works collaboratively with case managers and social workers to establish a discharge plan. Because hospitalists have an on-site hospital presence, they easily expedite care. More frequent evaluations can be performed, response to laboratory and radiology studies is faster, and care becomes more standardized. These advantages are especially important because of public reporting and standard protocols initiated by the Centers for Medicare & Medicaid Services.


Hospitalists also help to develop and implement evidence-based protocols. Given the importance of technology, hospitalists' efforts in developing and implementing computerized physician order entry systems are invaluable.


As more and more hospitals use the dedicated inpatient physician model, the outcomes speak for themselves-decreased length of stay and decreased cost per case with no increased morbidity or mortality.1 Patient satisfaction remains stable or improves, and hospitals can more easily recruit primary care physicians.2 Unnecessary testing also diminishes, and fewer consults are needed.


Adopting a hospitalist model may significantly impact nurses. The long and valued relationship between nurses and primary care physicians may diminish as these physicians leave the inpatient setting. Patients entering the hospital under the care of an unfamiliar physician may turn to nurses to assist them in communication with a new physician. Nurses can also bridge the gap in "hand-offs" from acute care to primary care.


As more and more evidence-based protocols are developed, nurses will be crucial to implementing these protocols. Nurses working with hospitalists may have an opportunity to influence end-of-life decisions, thus conserving precious hospital resources and providing appropriate end-of-life care to dying patients. The use of hospitalists will provide more efficient and more standard care to acute care patients, resulting in a collaborative working relationship with nurses and a safer environment for acutely ill patients.




1. Wachter RM, Katz P, Showstack J, Bindman AB, Goldman L. Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education. JAMA. 1998;279(19):1560-1565. [Context Link]


2. Hospitalist Programs, Clinical Initiative Center. The Advisory Board. 1999;40-41. [Context Link]