Our hospitalists have a variety of roles on the inpatient medical wards including teaching on resident services, attending on non-resident services, and providing medical consultation and surgical co-management.
Resident Services | Non-Resident Services | Medical Consultation, Preoperative Services, Surgical Co-Management | Medical Hematology PA Service
The University of Michigan’s Department of Medicine has 6 inpatient general medicine ward teams. Four of the teams are traditional general medicine ward teams and each include an attending, resident, two interns, and students. Two additional teams, the Medicine Newburgh service, each include an attending and two residents. Hospitalists now staff all Newburgh services throughout the year in addition to 80% of the traditional ward teams. The remaining attending months are staffed by some our best subspecialists and non-hospitalist general medicine faculty. The Department of Medicine maintains separate resident based inpatient Cardiology, Hematology, and GI services that are not staffed by hospitalists.
In response to residency work hours requirements, coupled with increased inpatient volume, faculty members were hired to staff a non-resident inpatient service (the Medicine Faculty Hospitalist (MFH) service). The MFH service regularly admits up to 19 to 27 patients a day and has a daily census of 80-110 patients with a goal of managing approximately 10,000 admissions per year, over half the total admission to the entire department of Internal Medicine. The service is complemented by five dedicated discharge planners, five social workers and three clinical assistants. While a non-resident service, MFH does provide a critical teaching role for our medical students. Both sub-interns and fourth year students wanting an inpatient medicine elective regularly rotate onto the MFH service. We anticipate over 25 students rotating over the first four months of this coming academic year. Many of the physicians who regularly attend on this service are actively involved in quality improvement projects benefitting patients throughout the institution including the LEAN discharge project on the 5B hospital unit.
Medical Consultation, Preoperative Services, Surgical Co-management
The University of Michigan Hospitalist Program provides inpatient General Medicine consultative services, outpatient preoperative consultative services, and inpatient hospitalist-surgical co-management (to selected surgical services). The hospitalists provide inpatient General Medical consultation when requested by non-Medicine services. Also, the hospitalists staff a Medicine Pre-op Clinic in which they evaluate preoperative surgical patients comprehensively, optimize medical therapy, and offer recommendations for the perioperative management of existing or anticipated medical problems. The surgical co-management program allows selected subspecialty surgical patients to be co-managed by both a surgery attending and a hospitalist attending, in a coordinated manner. For these patients, a hospitalist takes an active role in managing any pre-existing medical problems, as well as any acute medical problems or complications that arise perioperatively. There are several ongoing QI projects related to improving perioperative care.
Medicine Hematology PA Service
The Medicine Hematology PA service (MHP) is a partnership between the Department of Hematology/Oncology and the Hospitalist Program. MHP provides sub-specialty care to inpatients with malignant hematologic diagnoses. We currently have four daytime hospitalist faculty attending year-round on this non-resident service, complemented by four full-time physician assistants. Patients with acute and chronic leukemias, Hodgkin's and non-Hodgkin's lymphomas, and plasma cell dyscrasias are admitted to the service to receive chemotherapy and/or for management of disease complications (neutropenic fever, infections, pain/nausea control, blood product transfusions, relapsed disease, end-of-life care). University of Michigan Hematologists work closely with our hospitalist faculty and provide consultation as needed for these complex patients. Added in July 2010, the MHP service is an important expansion for the University of Michigan Hospitalist Program (and for hospitalist medicine in general), serving as a model for delivery of inpatient specialty care in the future.
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