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A New Vision for Hospital Medicine

Amir Jaffer, MD, MBAHospitalists have long played an integral role in patient care and education at Rush. But with the January 2013 arrival of Amir Jaffer, MD, MBA, Rush established the Division of Hospital Medicine within the Department of Internal Medicine, articulating a defined vision for hospital medicine.

"We want to be considered the best academic hospital medicine division in Chicago and one of the best in the country," says Jaffer.

Hitting the Ground Running

In an effort to achieve that vision, the division has already greatly expanded the responsibilities of its hospitalists with focused initiatives in patient care, graduate medical education, patient safety, quality improvement and research.

In the past year, they have achieved the following:

Patient Care

  • Launched the attending directed service (ADS) on several units to improve the quality, safety and efficacy of patient care, and to ensure that an attending is consistently on-hand to coordinate care and answer questions. For the ADS, an attending physician from the division partners with an advanced practice provider to care for medicine inpatients.
  • Started care coordination rounds to ensure safe discharges. Attending hospitalists meet each morning with case managers and nurses to review patient care lists and identify potential impediments to discharge. The goal is to make discharges more efficient and safer.
  • Redefined the division's care coordination model to help identify patients at high risk for readmission, and launched a transitional care clinic to connect these patients with their primary care providers after discharge.
  • Established the 24/7 presence of hospitalists by having three nocturnists in-house nightly to cover the ADS and admissions for house staff, surgical services and hematology-oncology.

Education

  • Created a Section of Global Health, under the leadership of Stephanie Wang, MD, as well as a global health fellowship. Through the section, hospitalists and other health care providers travel to underprivileged countries to provide education and deliver care.
  • Aligned the division with the internal medicine training program around internal medicine's newly established safety pillars: handoffs and transitions of care, medication safety, infection control and value-based care.
  • Established monthly grand rounds, in partnership with John H. Stroger, Jr. Hospital of Cook County, and journal club, both for CME credit.
  • Began holding monthly faculty development sessions.

Research and Quality Improvement

  • Launched patient safety and quality improvement projects in several key areas, including identifying triggers for blood transfusions to reduce the number of transfusions, and identifying early recognition factors that would help to prevent sepsis. A third project is aimed at improving handoffs between day shift and night shift house staff.
  • Became site principal investigators for two trials funded by the National Institutes of Health. Jaffer is the site PI for a genetics-informatics trial of warfarin to prevent deep vein thrombosis; Jisu Kim, MD, is slated to become co-PI of an upcoming myocardial ischemia and transfusion trial.

Looking Toward the Future

"The trend — at Rush and nationally — is for today's hospitalists to be leaders not only in the delivery of care in the hospital, but in efforts to improve quality and patient safety," Jaffer says. "Quality and patient safety will continue to be priorities for the division moving forward. Given the rapid changes taking place in health care, we will also increasingly be looking for new and more efficient ways to deliver care while still maintaining the high level of quality for which Rush is known."


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