A hospitalist without a hospital? It’s almost laughable. Almost no one questioned the idea that patients should travel to hospitals for care. However, shifts in utilization and patient preferences have prompted some healthcare leaders to rethink the concepts of “hospital” and “inpatient” care. And Vituity hospitalists are excited to be at the forefront of this paradigm shift.
“Today’s patients are looking for more convenience and access,” says Joshua Niebruegge, MD, Vice President of Hospital Medicine at Vituity. “They want healthcare to be as seamless as online shopping or banking. For hospitals, this means meeting patients when and where they need us. Which might mean taking the patient, the clinician, or both outside hospital walls.”
While hospitals (especially ICUs) have been dabbling with virtual care for years, the pandemic accelerated this trend. Regulatory reform has opened up new possibilities, as have cultural shifts. “We did a lot of virtual care out of necessity, and that softened up providers and patients who previously would have resisted this approach,” says Payton McGowen, MD, System Medical Director for Hospital Medicine at Hospital Sisters Health System (HSHS). “We definitely have more buy-in today for these innovative, patient-centric models.”
The Next Generation of Virtual Care Delivery
Hospitals will always exist to serve the sickest and most vulnerable patients. However, not all “inpatients” require face-to-face care on-site. Nor are there enough hospitalists to provide this level of service. Fortunately, innovative hospitalist programs like Vituity’s are bridging these gaps.
Remote monitoring: Due to the nationwide shortage of intensivists, ICUs adopted virtual care early. At HSHS, Vituity physicians have evolved a hub-and-spoke model in which an intensivist panel uses remote monitoring and telehealth to support critical patients at community and rural hospitals. This helps patients to avoid transfers and receive ICU care close to home.
Virtual rounding: During the coronavirus pandemic, many Vituity hospitalist practices extended virtual care to all inpatients through virtual rounding. Seeing patients via telehealth helped to preserve personal protective equipment and also allowed quarantined physicians to work from home. Going forward, such models could allow for more flexible staffing as well as scaling of hospitalist programs to community and critical accesss hospitals.
Hospital-at-home: Perhaps one of the most exciting models to gain traction is the hospital-at-home concept. “The pandemic got us thinking creatively,” says Gurvinder Kaur, MD, MHA, Chief Medical Officer at Adventist Health Central Valley Network in CA. “We were the first system in our region to create a virtual hospital, and it’s had excellent outcomes.”
Adventist’s 150-bed hospital-at-home program serves heart failure, COPD, and COVID-19 patients who require an inpatient (but not critical) level of care. “Most of them are elderly and prefer to be home,” Kaur says. Hospitalists round on patients via telehealth, while mobile nursing and ancillary teams provide in-home care, including infusions, X-rays, ultrasounds, and medications.
In addition to satisfying patients, Adventist’s program delivered strong outcomes. “One key benefit is the seamless transition from inpatient to outpatient care,” Kaur says. “Many patients pass the acute phase of their illness but still benefit from checking in with the team. That extra period of support and education improve their compliance tremendously.”
“When we focus on the patient, we create a positive reinforcement loop that’s a win for everyone—patients, providers, and hospitals.”
Payton McGowen, MD
Vituity Board Member & Medical Director
Benefits of Patient-Centered Care
Redesigning care delivery around patients may sound like a heavy lift. But in the long run, it makes life easier for all involved. “When we focus on the patient, we create a positive reinforcement loop that’s a win for everyone—patients, providers, and hospitals,” McGowen says.
Benefits of patient-centric care include:
Increased access to care. Virtual delivery models remove barriers to care—especially for patients who live far from hospitals or lack transportation. They’re also more palatable to patients who have concerns about delirium or hospital-acquired infections.
Improved patient satisfaction. Adventist Health patients give the virtual hospital rave reviews. “Because they were videoconferencing with their doctors, they got to see them without masks,” Kaur says. “They also loved having their families beside them anytime they wanted them.”
Job variety for clinicians. “Traditionally, hospitalists put on our tennis shoes and run from floor to floor,” Kaur says. “Having multiple delivery models allows us to sometimes sit down and work from a desk.” Kaur notes that this has been especially beneficial for hospitalist colleagues whose health makes prolonged walking difficult.
Burnout prevention. When patients have better experiences, so do providers. “Over time, this adds up to less burnout and turnover, which are serious challenges facing healthcare right now,” McGowen says.
Greater patient-provider connection. “Seeing patients and families in their homes has been an incredible satisfier for our physicians, and it also improves clinical care,” Kaur says. “We’re able to address social as well as medical challenges. It's a completely new way of doing hospital medicine.”
Encouraging Hospitalist Innovation
How can health systems partner with hospitalists to bring patient-centered care models to life? First and foremost, they must create cultures of caring. “Great cultures embrace both the human and the clinical aspects of medicine,” Niebruegge says. “Viewing patient care as a shared goal inspires us to work together and lift up our colleagues.”
Second, healthcare leaders need to engage hospitalists as partners in the change process. “Providers are our greatest innovation assets,” Niebruegge says. “This was on full display as we innovated our way through the worst pandemic in a century.”
Finally, providers should request a seat at the table. “Healthcare is going to continue to change. It has to,” Niebruegge says. “As frontline providers, who better to lead that transformation than us?”
Today’s Hospitalist webinar panelists consisted of:
- Pablo Echeverria, MD - Medical Director, Critical Care Medicine; Vituity
- Gurvinder Kaur, MD - Chief Medical Officer, Adventist Health; CVN
- Payton McGowen, MD - System Medical Director, Hospital Medicine; Vituity
- Joshua Niebruegge, MD – Vice President, Hospital, Critical Care and Post-Acute Care Medicine; Vituity