The collaboration between emergency medicine (EM) physicians and hospitalists is critical for ensuring seamless patient care within the healthcare continuum. However, this partnership is not without its challenges. One of the primary hurdles lies in the differing approaches and priorities of EM physicians and hospitalists, particularly in the realm of patient admissions. This article delves into the complexities of this relationship and explores potential solutions to enhance cooperation and improve patient outcomes.
Understanding the Challenges
The core challenge between EM physicians and hospitalists most often revolves around patient admissions. EM physicians are tasked with efficiently determining dispositions for patients to accommodate emergent cases, all while managing a consistently full waiting room. On the other hand, hospitalists focus on caring for patients who require admission, necessitating detailed information to initiate treatment promptly. These disparate responsibilities can lead to conflicts in priorities and approaches.
Moreover, competing physician performance metrics exacerbate these challenges. According to Emergency Physicians Monthly, EM physicians performance measurement include metrics like door-to-room time and rates of patients leaving without being seen. Hospitalists, on the other hand, are measured on indicators like length of stay and discharges before noon per Today’s Hospitalist. Both physician groups are often evaluated based on time to admission further compounding the issues as they each seek to optimize the process within their department–which frequently the other department’s performance.
Potential Solutions
To address these challenges, collaborative efforts between EM physicians and hospitalists are essential. Amanda Green, M.D., in her article Improving Communications Between ED and Hospitalist Physicians: Viewpoints from Both Perspectives, suggests four key questions that can guide this collaboration:
- Does the patient require admission?
- Is the patient medically stable for admission?
- Is the general ward the most appropriate setting for admission?
- Is the medicine service the suitable choice for the patient’s care?
Additionally, the decision of whether to order diagnostic tests in the emergency medicine department warrants consideration. While prioritizing diagnostic tests may expedite treatment initiation by hospitalists, it prolongs patients’ stay in the ED, presenting a dilemma for timely patient care.
In an article by Phyllis McGuire titled How Hospitalists Handle Admission Requests from the Emergency Department, various healthcare institutions have implemented different strategies to streamline the admissions process. For instance, the University of Virginia established an admissions and throughput coordinator responsible for managing all ED admission and transfer requests. Similarly, discussions at Hershey Medical Center have revolved around implementing sEmergency Medicine Physicians and Hospitalistspecific protocols for admissions to hospitalists versus specialists, along with guidelines for determining when ED observation is more appropriate. These institutional approaches, coupled with shared performance metrics, contribute to more efficient decision-making and better patient outcomes.
Conclusion
The partnership between emergency medicine (EM) physicians and hospitalists is essential for delivering high-quality patient care across the healthcare spectrum. However, challenges remain, particularly in reconciling differing approaches and priorities, especially in patient admissions. Implementing systemic process improvements, clearly defining protocols, adopting shared performance metrics, and enhancing direct communication can enhance decision-making efficiency and ultimately result in better patient outcomes.
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