Original Research

Impact of Hospitalist Programs on Perceived Care Quality, Interprofessional Collaboration, and Communication: Lessons from Implementation of 3 Hospital Medicine Programs in Canada

Journal of Clinical Outcomes Management. 2021 May;28(3):122-133 | 10.12788/jcom.0047

References

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Over the past 2 decades, the hospitalist model has become prevalent in Canada and internationally.¹ Hospitalist care has been associated with improvements in efficiency and quality of care.^2-6 However, less is known about its impact on the quality of interprofessional communication, teamwork, and staff satisfaction. In a 2012 study of a specialized orthopedic facility in the Greater Toronto Area (GTA), Ontario, Webster et al found a pervasive perception among interviewees that the addition of a hospitalist resulted in improved patient safety, expedited transfers, enhanced communication with Primary Care Providers (PCPs), and better continuity of care.⁷ They also identified enhanced collaboration among providers since the addition of the hospitalist to the care team. In another study of 5 community hospitals in the GTA, Conn et al⁸ found that staff on General Internal Medicine wards where hospitalists worked described superior interprofessional collaboration, deeper interpersonal relationships between physicians and other care team members, and a higher sense of “team-based care.”

Fraser Health Authority (FH) is an integrated regional health system with one of the largest regional Hospital Medicine (HM) networks in Canada.⁹ Over the past 2 decades, FH has implemented a number of HM services in its acute care facilities across a range of small and large community and academic hospitals. More recently, 3 hospitalist services were implemented over a 2-year period: new HM services in a tertiary referral center (Site A, July 2016) and a small community hospital (Site B, December 2016), and reintroduction of a hospitalist service in a medium-sized community hospital (Site C, January 2017). This provided a unique opportunity to assess the impact of the implementation of the hospitalist model across a range of facilities. The main objectives of this evaluation were to understand the level of physician, nursing, allied staff, and hospital administration satisfaction with the new hospitalist model, as well as the perceived impact of the service on efficiency and quality of care. As such, FH engaged an external consultant (EM) to conduct a comprehensive evaluation of the introduction of its latest HM services.

Methods

Setting

Hospital medicine services are currently available in 10 of 12 acute care facilities within the FH system. The 3 sites described in this evaluation constitute the most recent sites where a hospitalist service was implemented.

Site A is a 272-bed tertiary referral center situated in a rapidly growing community. At the time of our evaluation, 21 Full Time Equivalent (FTE) hospitalists cared for an average of 126 patients, which constituted the majority of adult medical patients. Each day, 8 individuals rounded on admitted patients (average individual census: 16) with another person providing in-house, evening, and overnight coverage. An additional flexible shift during the early afternoon helped with Emergency Department (ED) admissions.