PEDIATRICS Vol. 103 No. 2 February 1999, pp. 473-477
SPECIAL ARTICLE:
The Hospitalist Movement and Its Implications for the Care of
Hospitalized Children
From the * Division of General and Community Pediatrics,
Children's Hospital Medical Center and the University of Cincinnati
College of Medicine, Cincinnati, Ohio; and the Department of
Medicine, University of California San Francisco, San Francisco,
California.
| The first 300 words of the full text of this article appear below. |
Over the past several years, the traditional American system of care for hospitalized adult patients has undergone a revolutionary change. The traditional system, in which primary care physicians (generally internists or family physicians) managed their own patients in the hospital, is being replaced in many areas of the country by a new system in which primary care physicians relinquish the care of hospitalized patients to a new group of inpatient specialists called hospitalists.1 The most important forces driving the hospitalist movement in adult medicine are the demand for higher quality hospital care and more economical use of resources. Although the use of specialists in inpatient medicine has existed in Europe and Canada for many years and also in some academic centers in this country, the widespread adoption of the hospitalist model in the United States has important implications for patients and physicians. This article explores the rationale for this change in the organization of inpatient care, the experience to date with hospitalists in the care of adult patients, and the potential implications of this change for the care of hospitalized children.
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THE HOSPITALIST MOVEMENT IN ADULT MEDICINE |
|---|
Wachter has defined hospitalists as physicians who spend at least
25% of their time serving as the physician of record for hospitalized
patients who have been referred by primary care physicians and who are
referred back to their primary care physician at the time of
discharge.2 The rationale for hospitalists is a natural
extension of the burgeoning literature that supports the idea that
"practice makes perfect" in the care of patients with illnesses
such as acute myocardial infarction, stroke, and AIDS.3-5
This minimum time commitment for hospitalists (here defined as 25%,
although most community hospitalists serve in this role for 100% of
their time) permits the development of expertise related to clinical
content and efficiency and also ensures a
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