SAN DIEGO – Pediatric hospitalists are treating a greater proportion of acutely ill children than ever before, results from the largest and most up-to-date national survey suggests.
“What we’re seeing is that our colleagues in ambulatory medicine are treating a large swath of patients that used to spend 1, 2, 3, or even more days in the hospital,” Dr. Erin Stucky Fisher said in an interview at the annual meeting of the American Academy of Pediatrics. “Given that those patients are no longer being hospitalized, and given that our emergency room colleagues stabilize and discharge yet another group of ill patients, patients who are admitted require a higher level of acute care thinking. More often the skill sets required for hospital medicine will require clinicians to be able to care for patients that require multiple visits daily and acute care decision making 24/7.”
Dr. Erin Stucky Fisher
In an effort to describe current pediatric hospitalist work trends, Dr. Fisher and her associates sent a survey to 1,260 members of the AAP’s Section of Hospital Medicine during the winter of 2012-2013. A total of 542 completed the survey for a response rate of 43%, making it the largest cohort of pediatric hospitalists surveyed to date. Of these, 64% were female and 85% were white.
Slightly more than half of respondents (51%) reported working 6-7 or 8-14 consecutive days when on service, with 57% spending 40-60 hours of on-site time per service week, and 28% spending more than 60 hours. Fewer than half (43%) provide 24/7 in-house coverage, 34% take call from home, and 23% use a hybrid model for after-hours coverage.
Nearly all respondents (97%) cover general pediatric units, and 49% consult in emergency medicine departments. Other common areas of coverage include the observation unit (36%), well baby nursery (34%), intermediate care/step-down unit (27%), and the pediatric intensive care unit (9%).
More than two-third of respondents (43%) routinely comanage surgery patients, 23% provide consultation to surgery patients, and nearly one-third (29%) participate in rapid response teams. In addition, 21% provide a sedation service and 11% provide a diagnostic referral service. While only 6% currently provide patient emergency transport, this is of interest as a partnership opportunity with critical care colleagues.
The most common procedure performed by respondents are lumbar puncture (88%), followed by arterial puncture (29%), intubation of children without teeth (29%), venipuncture (28%), peripheral IV placement (26%), and bladder catheterization (20%).
Findings “not surprising but notable – as the field has evolved – are that there is increasing provision of critical care and emergency level services,” said Dr. Fisher, a pediatric hospitalist at Rady Children’s Hospital–San Diego and professor of clinical pediatrics at the University of California, San Diego. “This reflects both the need for these services and a fact reported in other studies on hospitalized patients over the years: In all hospital settings, patients that are admitted – particularly children – are sicker. Many leaders and clinicians in hospital settings state that hospitals are or soon will be in essence a high-end critical care ICU, a step-down ICU, and an emergency department. Nowadays there are fewer patients admitted who are what would be considered standard ward patients. For community sites that’s particularly telling, because hospitalists in those settings are having to care for many sicker patients because there aren’t [enough] critical care physicians available in those environments.”
The study’s lead author is Dr. Daniel A. Rauch, a pediatrician based in Elmhurst, N.Y. Dr. Fisher reported having no financial disclosures.
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