The term “hospitalist” has become more common in recent years. But what are hospitalists, and why are they vital to emergency department and hospitalized patients?
As the name suggests, hospitalists are hospital-based physicians who provide immediate care to patients in the emergency department and continuing care to hospitalized patients. Most hospitalists have completed residencies and are board-certified in specialized areas such as internal medicine, neurology, obstetrics and gynecology, oncology and pediatrics. Many are also board-certified in hospital medicine.
Hospitalists provide highly specialized, immediate care to patients who face life-threatening situations. They also provide coverage for local office-based physicians who can’t always be at a patient’s bedside. Hospitals and private-practice physicians realize the countless benefits of using hospitalists for them and their patients, such as:
- Having immediate access to specialists, which can improve patient outcomes
- Real-time triage and hospital-based specialty coverage to ensure consistent, timely patient care
- Collaborative support for local physicians
- Evidence-based care that improves patient outcomes, reduces variability in care and drives operational and financial efficiencies
- Reduces emergency department call requirements for community physicians
- Improves work-life balance for local health care providers
Pediatrix® Medical Group partners with hospitals nationwide, offering high-caliber hospitalist programs in obstetrics-gynecology (OBGYN) and pediatrics.
Pediatrix OB Hospitalists
Pediatrix has more than 225 board-certified OB hospitalists serving 40 locations in 12 states. Their roles are multifaceted, from managing OB emergencies and emergency deliveries to providing urgent gynecologic care, addressing the medical needs of hospitalized patients and collaborating with numerous specialists to help ensure the best outcomes for all patients.
“We are the ‘first responders’ to handle some of the most critical issues when time is not on the patient’s side,” said Brian Gilpin, M.D., OB hospitalist and OBGYN specialty medical officer for Pediatrix. “When a patient hemorrhages, there’s no time to wait for a specialist to arrive at the hospital. Every second counts, and we are right there 24/7/365 to treat patients who are in crisis.”
Emergencies represent only one aspect of the OB hospitalist role.
OBGYNs have spent years seeing patients during the day for routine prenatal and gynecologic care. When a patient went into labor and was ready to deliver, her OBGYN would drop everything, travel to the hospital, deliver the baby and return to the office to continue seeing patients.
After a long day at the office, OBGYNs would travel back to the hospital and check on all their patients before finally going home at some point in the evening. Then, if a patient happened to go into labor in the evening, middle of the night or on weekends or holidays, they would go back to the hospital. It became a vicious cycle that left little time for a personal life.
OB hospitalists have solved this problem for office-based OBGYNs. They provide around-the-clock hospital coverage. They also care for unassigned patients who don’t have a primary OBGYN or are traveling and don’t have access to their primary care team.
“Regardless of the circumstances, we are there to provide immediate care to patients who come to the hospital with obstetric or gynecologic emergencies, and we also care for those who are hospitalized,” explained Dr. Gilpin. “The purpose of our program is to be there at the moment patients need highly specialized OBGYN care and continue with them throughout their hospital stay.”
While the first OB hospitalist program was established in 1989 at Alta Bates Medical Center in Berkeley, California, it took years for other hospitals to follow suit. In 2009, only 61 known OB hospitalist programs were in the United States. By 2016, that number had grown to more than 245 and continues growing exponentially as hospitals and private-practice OBGYNs realize the countless benefits for them and their patients.
Saving lives is the overriding priority for OB hospitalists, and communication and collaboration across various specialty areas are essential. Dr. Gilpin recalls when a pregnant woman who was entirely against modern medicine came to the hospital when her membranes ruptured at just 35 weeks’ gestation. He recommended inducing labor because the risks of keeping the baby inside and getting an infection far outweighed the risks of delivering the baby prematurely.
“We gave the mom medicine to induce labor, and when she stood up to go to the bathroom, she gushed blood,” he said. “I ran to her room and the baby’s heart rate, which should be in the 140s, was in the 50s, indicating that something was terribly wrong. We needed to perform a C-section immediately.”
Dr. Gilpin believed it was the baby’s blood and not the mother’s, so he called the neonatal intensive care unit (NICU) team and let them know blood was needed right away. He also urged the NICU team to get to the operating room and prepare for a blood transfusion as soon as the baby was born. Additionally, he asked the anesthesiologist to forego the epidural (spinal block) generally used for C-sections and to put the mom to sleep using general anesthesia as quickly as possible.
“We got that baby out in 5 minutes,” said Dr. Gilpin. “The baby came out white because she had lost at least half her blood caused by a ruptured vessel in the placenta. Because the necessary medical professionals were right there in the operating room and ready to start the transfusion, we were able to get her on cooling to counteract the shock of losing so much blood and safely transport her to the children’s hospital.”
That’s one of thousands of success stories that would have likely had a different outcome without the immediate presence of an OB hospitalist.
Pediatrix Pediatric Hospitalists
Similarly, pediatric hospitalists care for babies, children and teens with various illnesses and medical needs. They care for children hospitalized on the regular pediatric floor and can also care for children in the emergency department and newborn nursery, as well as the NICU and pediatric intensive care unit (PICU) under the supervision of intensive care doctors. Common conditions they treat include:
- Chronic illnesses (asthma, diabetes, hypoglycemia)
- Infections of the blood, kidneys, lungs and skin
- Newborn medical concerns
- Recovery from surgeries and injuries
- Respiratory illnesses (RSV, croup, pneumonia)
- Viruses (influenza, COVID-19)
Like OB hospitalists, pediatric hospitalists have been around for a few decades. In 2016, the American Board of Medical Specialties approved pediatric hospital medicine as an American Board of Pediatrics subspecialty.
Pediatrix has nearly 200 pediatric hospitalists and advanced practitioners caring for emergency department and hospitalized children in more than 55 hospitals in 17 states. They collaborate with various pediatric specialists, family practitioners, pediatric surgeons and other physicians to address the unique medical needs of every child entrusted to their care.
Pediatric hospitalists support local pediatricians and hospitals by providing around-the-clock care to hospitalized children and those who arrive in the emergency department.
“We provide care to patients in the hospital during all hours,” said Michelle Pastorello, M.D., pediatric hospitalist and pediatric hospital medicine specialty medical officer for Pediatrix. “If a child is recovering from surgery, we are the eyes and ears for the pediatric surgeon during the child’s hospital stay. When pediatricians in any pediatric unit are not available for any number of reasons, we’re there to cover for them.
Hospitals need physicians who specialize in inpatient care because this type of care is vastly different from outpatient medicine. It’s also vital that children are treated by experienced pediatricians who understand the intricacies of young bodies.
“We as pediatricians have had extensive training in caring for children and their health needs,” said Dr. Pastorello. “Children are not little adults. Their pathophysiology and the illnesses that affect them are different than adults, so their care needs to be managed differently and appropriately for their size, age and various other considerations.”
In addition to patients, hospitals and local physicians, parents also benefit from pediatric hospitalists. They have peace of mind knowing that highly specialized pediatricians are at their child’s bedside whenever needed.
“For parents, we are able to be there on a much more extended basis than an outpatient doctor,” Dr. Pastorello explained. “We can come to the bedside, check on their child regularly and communicate with them. In addition, we have the capability to call in other specialists or transfer patients to a higher level of care if their clinical condition dictates.”
As with OB hospitalists, pediatric hospitalists are available to hospitals and their patients at all hours. Their availability and specialized inpatient training help save lives when time is of the essence.
They regularly recognize when kids are deteriorating clinically, whether a child is septic, their vital signs are declining or they have other issues that need immediate medical intervention. Pediatric hospitalists can manage their care in any pediatric unit and get them to an intensive care unit when warranted. Dr. Pastorello describes a time when a patient may not have survived if a trained pediatrician hadn’t been readily available.
“A two-year-old came in to be monitored because he had a fainting spell,” she explained. “In the course of his hospitalization, he collapsed, had no pulse and wasn’t breathing. My team of pediatric hospitalists and hospital nurses provided him with advanced life support until we could get him to the PICU. Our presence in the pediatric unit that day made a difference in his ability to survive the event. That’s something we do on a regular basis.”