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Characterizing Hospitalist Practice and Perceptions of Critical Care Delivery
Author(s) -
Sweigart Joseph R.,
Aymond David,
Burger Alfred,
Kelly Andy,
Marzano Nick,
McIlraith Thomas,
Morris Peter,
Williams Mark V.,
Siegal Eric M.
Publication year - 2018
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2886
Subject(s) - medicine , intensivist , staffing , hospital medicine , scope of practice , intensive care unit , family medicine , medline , preceptor , economic shortage , nursing , emergency medicine , health care , intensive care medicine , linguistics , philosophy , government (linguistics) , political science , law , economics , economic growth
BACKGROUND Intensivist shortages have led to increasing hospitalist involvement in critical care delivery. OBJECTIVE To characterize the practice of hospitalists practicing in the intensive care unit (ICU) setting. DESIGN Survey of hospital medicine physicians. SETTING This survey was conducted as a needs assessment for the ongoing efforts of the Critical Care Task Force of the Society of Hospital Medicine Education Committee. PARTICIPANTS Hospitalists in the United States. INTERVENTION An iteratively developed, 25‐item, web‐based survey. MEASUREMENTS Results were compiled from all respondents then analyzed in subgroups. Various items were examined for correlations. RESULTS A total of 425 hospitalists completed the survey. Three hundred and twenty‐five (77%) provided critical care services, and 280 (66%) served as primary physicians in the ICU. Hospitalists were significantly more likely to serve as primary physicians in rural ICUs (85% of rural respondents vs 62% of nonrural; P < .001 for association). Half of the rural hospitalists who were primary physicians for ICU patients felt obliged to practice beyond their scope, and 90% at least occasionally perceived that they had insufficient support from board‐certified intensivists. Among respondents serving as primary physicians for ICU patients, 67% reported at least moderate difficulty transferring patients to higher levels of ICU care. Difficulty transferring patients was the only item significantly correlated with the perception of being expected to practice beyond one's scope ( P < .05 for association). CONCLUSIONS Hospitalists frequently deliver critical care services without adequate training or support, most prevalently in rural hospitals. Without major changes in intensivist staffing or patient distribution, this is unlikely to change.