In his eight years with Brookwood Medical Center along with his work as chairman of Anesthesia Services of Birmingham PC, Matt Sherrer, MD, has seen the value of teamwork. Shared experiences over time build professional relationships and continuity, helping medical teams work together more seamlessly to enhance quality of care.
That’s one reason Sherrer has been encouraging the development of locally based collaborative groups in other specialties. The first such endeavor launched this month is Brookwood’s new hospitalist group.
“Hospitalists have made tremendous contributions to the quality of inpatient care,” Sherrer said. “What is changing in this new healthcare environment is how these positions are staffed. In many hospitals, national companies have won contracts to provide hospitalists. When that happens, those already working there either become employees of the national company or have to seek another position. We think a local solution is better than a transient solution for just about everyone. That’s why we decided to build our own group.
“Local hospitalists are likely to be here because they want to be here, not because they were transferred. If they want to be here, they are more likely to be thinking long term. That gives them the time to build professional relationships and learn the nuances of the local culture to enhance rapport with patients. This continuity also avoids the disruptions that come when new people have to learn a new environment.”
From the hospitalist’s point of view, there are also advantages in working for a local group. Stirling Shirah, MD, is chairman of the new hospitalist group at Brookwood Medical Center.
“Working with a local group is attractive to hospitalists who think of this area as home,” Shirah said. “We can do our jobs without the stress of wondering whether we might be transferred across the country on short notice, and what that would mean to a spouse’s job and our children’s school and friends. We can build a life and a career here.”
The Brookwood Medical Center hospitalist team begins with nine physicians who will be working throughout the hospital.
“We have 24-hour coverage, with two groups of four alternating in two-week daytime shifts, and a nocturnist on duty through the night,” Shirah said.
Sherrer said the group has been welcomed with a great deal of enthusiasm from other members of the Brookwood health care team.
“Our primary care physicians like knowing that even when they are taking care of other patients or have to be elsewhere, there’s always a doctor nearby, keeping close watch if their patient needs immediate attention,” Sherrer said. “The response from surgeons has also been positive. Having a hospitalist monitor the patient’s condition before and after procedures frees surgeons to focus on surgery. The hospitalist is checking blood sugar, blood pressure and other vital signs to make sure the patient is in the best possible condition going into surgery, and then follows the healing process afterward. That can mean better outcomes for patients—and a record of better reported outcomes, which reflects well on everyone.”
Another advantage of a locally based hospitalist group is local decision making, which facilitates fine tuning of working procedures to better meet the specific needs of the hospitals. One of the first goals Brookwood hospitalists are working toward is expediting the transition of new patients from the emergency room to their room in the hospital.
“We work very closely with emergency department physicians and staff to get patients who need to be admitted into their rooms faster. Then we make sure they are seen by a physician promptly,” Shirah said.
The sooner patients are evaluatedand the labs and consults they may need determined, the sooner a treatment plan can be developed to get them on the road to recovery. Moving patients to their rooms faster also frees up ER space. Hospitals avoid losing patients to diversion, ER waiting times are shorter, and incoming patients can be treated at the nearest hospital rather than having to go farther for care.
Sherrer is also looking into determining whether there is interest among emergency physicians and/or other intensivists in forming a locally based collaborative group similar to the new hospitalist group. This would allow a similar degree of local autonomy in issues related to their work.
As an example of how local decision making allows agility in implementing advances in treatment, Sherrer can point to his group’s multimodal anesthesia program.
“You can’t simply hammer patients with narcotics without creating problems like respiratory distress. A broader approach with smaller doses works better. That’s why our group has made multimodal anesthesia a priority. We combine multiple medications, procedures and treatments to not only deal with acute pain, but to also help patients feel better the next day, the next month and the next year,” Sherrer said. “We might combine analgesics and anti-inflammatories with regional blocks before surgery so patients are in better condition post op. Treating acute pain early and effectively with a multimodal approach is the first step in preventing chronic pain later.”