A year has passed since some hospitals ran pilot programs of the hospitalist system but many are still experiencing difficulties unable to find workforce.
Will the limited number of hospitalists be able to handle all the work related to caring inpatients? After lots of such thoughts, one hospital introduced a new professional field – the Department of Hospital Medicine.
Since last month, Inha University Hospital인하대병원 has been operating the new department by comprising hospitalists from internal medicine and surgical department, to accomplish its pronounced mission of “innovating inpatient care.”
The department, the first of such kind in Korea, is the treatment part composed of medical professionals armed with expert knowledge in inpatient caring and has established a new integrated treatment system.
Its core staffs include internist Lee Jung-hwan이정환, surgeons Park Jung-mi박정미, and Jang Yong-sun장용선, all of whom are hospitalists the hospital ushered in for its pilot project. Joining them were the two existing specialists dealing with critical patients -- Kim Jung-soo김정수 and Lee Man-jong이만종. Cho Jae-hwa조재화, chief of the Integrated Intensive Care Center, heads the new department.
The Ministry of Health and Welfare (MOHW)보건복지부 designated 36 hospitals to conduct the pilot programs of the hospitalist system, but 21 of them have yet to take the first step after failing to secure workforce exclusively responsible for it. The number of hospitalists at the other 15 institutions stood at only 52.
They have to perform various jobs, which, in addition to the primary treatment of inpatients, include educating and consulting patients, patients’ safety management, infection control, maintaining healthcare quality and conducting research and development activities.
Inha University Hospital has broken away from the previous inpatient care service separately run between internal medicine and surgery department and shifted to a system that allows for interdisciplinary treatments in which the Department of Hospital Medicine plays a central role.
“Patients can move from general wards to intensive care units and vice versa. We need to share patients information organically to improve treatments and quality of care, which is why the hospital had come to devise the integrated treatment system,” Cho said.
“We hired hospitalists in surgery division last year and those in internal medicine in March, but were concerned whether we could be of any help for patients with just the couple of hospitalists,” he said. “There are no cases to match the hospitalist system with the intensive care unit even in the United States that has long implemented the hospitalist system. However, we will provide emergency treatment to inpatients, including surgical patients, by linking them to rapid response team.”
Above all, the creation of the department can play the role of protector, helping to guarantee the status of hospitalists and present professional independence.
The hospital expects such attempt will provide a patient-friendly treatment and improve patients’ safety.
However, the hospital is not without problems it has to surmount to turn its efforts into fruitful accomplishment.
Most of all, because medical costs for the hospitalists are fixed by the number of medical residents and patients belonging to the pilot wards, hospitals that provide additional multidisciplinary treatment have to shoulder considerable financial burdens.
The medical costs of the hospitalists are 30,490 won ($27) when one hospitalist takes care of five patients or more a day and 24,390 won when they care for four patients, lower than the wages paid to other specialists.
“The hospital management can’t help but worry about costs,” Cho said. “Inha University Hospital, however, will be able to push ahead with the process because the decision was made by none other than the hospital head, who have grave concerns about patients’ safety and broad interests in the hospitalist system.”
The hospital has activated a task force and is discussing how to establish best a system that can operate the new department in ways that fit the original intention. It also plans to recruit two more hospitalists in internal medicine and one hospitalist in surgery division around October.
“It is difficult for specialists to care for inpatients exclusively. Without full support from the hospital, it would be further difficult,” Cho said. “We want to share the results with other hospitals in seminars or symposiums, and hope the government will pay more attention and provide support for this part.”
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