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HRH to Start Hospitalist Program

August 13, 2010
By Amanda Breitbach Ragsdale, Miles City Star Holy Rosary Healthcare will fully implement a new hospitalist program beginning next week on Aug. 16. A hospitalist is a physician specializing exclusively in the care of hospitalized patients. The program will be a change from the current system at HRH, in which doctors working in the outpatient clinic have also served hospital patients. The change will primarily affect non-surgical adult patients in the hospital, who will no longer see their primary care physicians and will instead be served by the hospitalist, working in close cooperation with their doctor. Children and obstetrics patients will continue to see their primary care physicians. Patients with no primary care physician will also be seen by the hospitalist. While this may at first cause anxiety for some patients, according to Ron Webb, Holy Rosary’s chief executive officer, the hospital’s most important consideration is patient care. “We really do feel that we can elevate the level of care,” Webb said. “(Providers) are trying to be in two places at once,” said Janice Hirsch, manager of the medical/surgical unit at Holy Rosary. “And sometimes that can delay care when there are immediate concerns.” Tayeb Al-Hafez, MD, an internal medicine physician and hospitalist who is helping HRH start up the program, said a hospitalist program better serves hospitalized patients because care is immediately available at all times, improving the treatment and response to changing conditions. The hospitalist is in contact with the primary care physician at all times to manage each patient’s care correctly and responsibly, and this is the case both for local hospital patients and for patients from outlying areas like Broadus, Forsyth and Terry, he said. “A critical piece of this is the communication handoff, so that’s where a lot of our emphasis is being placed,” Webb noted. In addition, the hospitalist helps integrate different aspects of a patient’s care by working closely with ancillary services such as physical therapy, respiratory therapy and nutrition. “It’s more collaborative and integrative and really looks at the bigger picture,” said Al-Hafez. Another advantage of the program is for providers at HRH, who will no longer have to be on-call at the hospital or make rounds there. This will prevent stress and burnout and be a great recruitment tool, Webb said, adding, “They know they can have a life and spend time with their family.” Providers at Holy Rosary are excited about this change, he said, noting that in other facilities that have started hospitalist programs, the nursing staff especially appreciates the constant availability of a highly trained physician. The initial startup of the program is expensive, Webb said, because it includes the cost of hiring the specialized hospitalist staff. “It will cost more than what we gain from it (initially), but we feel it’s worth it for the quality of care. And over the long haul, I think the investment is good.” Costs are not passed along to hospital patients, he emphasized. In fact, treatment in a facility using a hospitalist program can actually be more cost effective for patients. Because hospitalized patients have access to immediate care at all times, hospital stays may be shorter, and patients can be moved to swing beds or beds in the extended care when their needs become less acute. This will also help Holy Rosary manage a 25-bed acute care limit required by their new status as a Critical Access Hospital. The integrated approach helps take patients from admittance to discharge safely and quickly, Al-Hafez noted, and the heightened level of care will keep local patients in the community, closer to their homes and families. Hirsch said ties to local hospital staff are also important to patients. “They haven’t always felt that in a bigger facility,” she said. “They would rather be here.” Two physicians, Al-Hafez and Derek Gilbert, MD, a family medicine physician, will work as full-time hospitalists at Holy Rosary, admitting and evaluating patients from 8 a.m. to 6 p.m. daily and available around the clock for urgent needs. The two doctors will work in an alternating schedule, switching every four to five days, and will be supported by two part-time physicians to complete the schedule. Al-Hafez is originally from Damascus, Syria and obtained his doctor of medicine degree from Tichreen University in 1991. He moved to the United States in 1992 and did his internship and residency at the Brody School of Medicine at East Carolina University in Greenville, N.C. He has worked as an internist and hospitalist in Alaska, Oregon, California, Idaho and Washington. Most recently, he was a hospitalist at Kittitas Valley Community Hospital in Ellensburg, Wash. Gilbert is currently practicing family medicine in Sheridan, Wyo. He has worked in the emergency room at HRH in the past and already has a good relationship with the staff, said Hirsch.