An introduction to the hospitalist model

Motivated by a search for improved quality and efficiency, increasing numbe rs of hospitals and physicians are moving from systems in which all primary care providers manage their own hospitalized patients or rotate this respo nsibility among themselves at infrequent intervals to voluntary or mandator y systems in which patients are "handed off" to the care of an inpatient ph ysician, the "hospitalist." All hospitalists manage medical patients in the hospital. Other potential roles for these physicians include triage in the emergency department, transfer of "out-of-network" patients, management of patients in the intensive care unit, preoperative and postoperative manage ment of surgical patients, and leadership in hospital quality improvement a nd regulatory work. Hospitalists may add value by being more available to i npatients, having more hospital experience and expertise, and having an inc reased commitment to hospital quality improvement compared with primary car e providers. Potential disadvantages of the hospitalist model include loss of information as a result of discontinuity of care, patient dissatisfactio n, loss of acute care skills by primary care physicians, and burnout among hospitalists. A variety of models of care are needed to meet the clinical, organizational, financial, and political demands of diverse health care sys tems. The favored model should be that which produces the best clinical out comes and the highest patient satisfaction at the lowest cost.