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New hospitalist program aids patient care

By Emily Ford
eford@salisburypost.com
SALISBURY — Rowan Regional Medical Center has changed the way patients are admitted to the hospital and cared for during their stay.
Twelve physicians called hospitalists now admit about 80 percent of the patients to Rowan Regional and coordinate care while they are hospitalized.
The change comes as the hospital prepares for health-care reform and looks for ways to increase efficiency. Studies show using hospitalists can lower the cost and length of hospital stays by 10 percent to 20 percent.
During its public debut Tuesday, the program received an endorsement from longtime Salisbury physician Joel Goodwin, now retired.
“I applaud the hospital for this,” Goodwin said. “Great job.”
Dr. Doug Shellhorn, hospitalist medical director and a physician with Rowan Diagnostic Clinic, discussed the program at the Salisbury Rotary Club, where hospital President Dari Caldwell is a member and organized the presentation.
NovantHealth, which owns the hospital, contracted with Shellhorn and Rowan Diagnostic about 18 months ago to provide hospitalist services.
Using hospitalists prevents physicians from leaving their clinic to treat patients in the hospital.
“It is stressful to need to be in two, three, four places at the same time,” Goodwin said.
To coordinate each patient’s care, hospitalists communicate with primary care physicians and doctors who specialize in areas like cardiology and pulmonology.
“The hospitalist acts as the quarterback,” Shellhorn said.
Some patients have been confused about why their physician can no longer admit them, Shellhorn said. As people become more familiar with the program, they will become more comfortable, he said.
Dr. Albert Aymer, president of Hood Theological Seminary, said he’s concerned that many of Rowan Regional’s hospitalists are right out of residency.
“I would rather have my primary care looking after me,” Aymer said.
Shellhorn said he understands the concern and has instituted a mentoring program for the hospitalists who are new doctors.
“We have to groom them and let them grow,” he said.
Regardless of their speciality, doctors can’t learn everything in medical school, Shellhorn said. Cultivating relationships with other physicians is crucial to a doctor’s development, he said.
Hospitalists communicate with other doctors to better understand issues involved in a patient’s care, he said. Once a patient is discharged, Shellhorn said, he often calls the primary care physician as a follow-up.
Hospitalists can shorten a patient’s stay, he said. Long hospital stays can lead to infections, blood clots and loss of muscle tone.
“The longer we keep people in the hospital, the more bad things happen to them,” Shellhorn said.
Doctors often make multiple decisions throughout the day for each hospitalized patient. Having hospitalists on-site at all hours can move patients more quickly to discharge while cutting readmission rates, Shellhorn said.
In 2012, Medicare will begin penalizing hospitals for readmission rates above 10 percent to 12 percent. Readmission is defined as re-hospitalization within 30 days.
Rowan Diagnostics ran a similar program from 1996 to 2006, when the clinic’s physicians admitted unassigned patients. The clinic eventually pulled out, Shellhorn said, but approached Novant in 2009 about offering the hospitalist program.
Hospitalists have gone from admitting 40 patients a day in 2009 to as many as 120 patients a day now, he said.
Rowan Diagnostic has two six-member teams of hospitalists that switch every Wednesday. They work 12-hour shifts during their appointed week.
Five physicians at the clinic serve as dual hospitalists, treating patients in both the hospital and clinic. They are Shellhorn, Christopher Agner, Frederick Goss, Sean Malone and Brent Seifert, according to the clinic’s website.
Rowan Diagnostic also has four mid-level providers — physician assistants and nurse practitioners who work in support of the primary and dual hospitalists.
Rowan Regional has the only private hospitalist program in the Novant system. At other facilities, hospitalists are employed by Novant.
“This is a very unique system,” Shellhorn said. “It shows Novant is willing to do things differently.”
About 90 percent of hospitals nationwide now use hospitalists, Shellhorn said.
Contact reporter Emily Ford at 704-797-4264.

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