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Pediatric Hospitalists in Community Hospitals

Pediatric Hospitalists in Community Hospitals. Who are we, where are we and what do we do ? Jacques C orriveau , MD Clota Snow, MD Pediatric Hospitalist M edicine 2017 Community Hospitalist M eeting Nashville, TN.

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Pediatric Hospitalists in Community Hospitals

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  1. Pediatric Hospitalists in Community Hospitals Who are we, where are we and what do we do? Jacques Corriveau, MD Clota Snow, MD Pediatric Hospitalist Medicine 2017 Community Hospitalist Meeting Nashville, TN

  2. If you’d like to use the content of these slides for any public purpose, please contact clota.snow@gmail.com prior to doing so.

  3. Background • Many hospitalists are working in a community setting • Number and scope of practice not previously quantified • Community hospitalists underrepresented in SOHM • Distribution of pediatric beds and availability of services outside of tertiary care center not well known

  4. Why this is important Community hospitalist can be a very different job than a hospitalist at a tertiary care center Better understanding of community hospitalists will help shape fellowship curriculum Likely more out there than we think Will demonstrate number of scope of community hospitalists to help advocate for community hospitalists in pediatric hospitalist medicine Many not connected with AAP/SOHM; opportunities for outreach

  5. Methods Concept/goals of census projects developed at PHM pre-conference in 2014 Developed survey questions with input from several leaders in community PHM Sent REDCap survey to listservs Recruited volunteers via listservs; recruited student/resident help Volunteers collected survey data in their area Hired paid research assistant to help finish the work with support of the AAP SOHM Initially focused only on community hospitalists only; project eventually expanded to include tertiary centers as well

  6. Survey Questions • Is the hospital considered a pediatric tertiary care referral center and/or a children’s hospital? • Distance (in miles) to nearest referral center • How many FTE Pediatric Hospitalist does your group have dedicated to covering the hospital? • Is this hospitalist group or hospital affiliated with a children’s hospital or university? • Which of the following duties do the pediatric hospitalists have: • Newborn Nursery, Delivery Attendance/Resuscitations, Inpatient Care, Level I/II/III NICU, PICU, Intermediate Level Care, Primary ED Coverage, ED consultations, Subspecialty/Surgical Co-management, Sedation Services, Transport, Other • What is the average daily census on the pediatric hospitalist service? • Do you have access to pediatric sub-specialists? • In-house or by phone • Do you have access to pediatric surgeons? • In-house or by phone • What do you consider are the primary issues facing pediatric community hospitalists?

  7. Collection Methods • Provided volunteers with list of hospitals (from the American Hospital Directory) • Personal contacts • Calling hospitals directly to determine if there are pediatric hospitalists • Charge nurse or secretary in ED, labor and delivery or pediatric floor • Contacting hospitalists via phone, email or fax • Entering survey data online

  8. Challenges • Defining a hospitalist • What to include in survey • What is important to know? • Comprehensive info vs survey length • Finding comprehensive list of hospitals • Technical issues • Lack of response (no returned calls/emails) • People unwilling to answer • Incomplete surveys • Time consuming

  9. Community PHM Data (so far) • Approx 7600 hospitals screened for PHM • 826 hospitals identified as having PHM services • 535 Hospitals with PHM responded to survey • 349 Community, 186 Tertiary/Children’s • 2737 FTEs (if stated): 1278 in community setting • Mean in community setting = 4

  10. Community PHM Data

  11. Community PHM Data

  12. CPHM: Affiliation +/- Residents ? 36.9% 14.7% 24.2% 24.2%

  13. CPHM: Average Daily Census (non-newborn)

  14. Newborn Nursery (72.8%) • Delivery attendance/resuscitations (44.1%) • Inpatient care (88.3%) • Level I NICU (14%) • Level II NICU (29.2%) • Level III NICU (3.7%) • PICU (6%) • Intermediate Level Care (17.5%) • Primary ED Coverage (14%) • ED Consultations (75.9%) • Subspecialty/Surgical Co-management (52.4%) • Sedation services (16.3%) • Transport (5.2%) • Other (8%)

  15. ***CPHM: “Other” Hospital Duties Some clinic (7) Long term inpatient care - subacute care (2) PA student supervision Outpatient infusions / chemo (3) Medical management of inpatient psych Adolescent Detox Unit Outpatient procedures (VCUG caths) Circumcisions

  16. CPHM: Subspecialists In house / On-call ? None Some / 1-3 Most / Full Complement Many / 3-6

  17. CPHM: Subspecialists Available By Phone? Some / 1-3 None Many / 3-6 Most / Full Complement

  18. CPHM: Pediatric Surgeons On-call? NO YES

  19. Tertiary/Children’s Data • 186 Hospitals • 54 did not have at least most subspecialists available on call • 25 had no residents • 24 did not have most subspecialists available by phone • 17 had no pedi surgeon • Could some tertiary centers still be considered community hospitals? • Better classification to use Quaternary vs. Tertiary?

  20. Community Non-full service Tertiary Full service Tertiary

  21. Neonatal Skills? • 192 / 535 hospitals = 36% all hospitals require skills for resuscitation and stabilization of newborns. (either level II/III NICU or delivery/resuscitation)

  22. What do you consider are the primary issues facing pediatric community hospitalists? 229 Comments 1. Lack of Subspecialty MDs/Services (77) 2. Justification/Finances (57) 3. PHM Physician Staffing (41) 4. Maintaining Skills, Knowledge (27) 5. Decreasing census/admissions (23) 6. Lack Pediatric training/staffing (ED, RN, etc) (21) 7. Lack of respect / being valued (18) 8. Burnout (11)

  23. What we’ve learned so far Many were surprised to find programs in their area they didn’t know existed Many community hospitals leave no trace of availability of PHM docs on their websites Some tertiary/children’s hospitals are more similar to community hospitals than other children’s hospitals (sub-specialist availability, residents etc.)

  24. Future directions • Publish results?? • Need to repeat in a few years? • New programs, current programs adjusting scope • Relatively easy to re-survey existing programs, but is there a more efficient way to identify new programs?

  25. Thanks! Our Volunteers: RishiMediratta, Greg Welsh, Kayce Morton, Cheryl Clarkin, Jim O’Callaghan, Debbie Marqulis, Steven Crouch, Salwa Kahn, Yeng Yang, Laura Hall, Laurie Carter, Ken Roberts, Allyson Boodram, Scott Stephens, Stephanie DeLeon, Megan Klenow, Kofi Asare-Bawuah, Michelle Hoffman, Petra Laeven-Sessions, Kamakshya Patra, Amanda Reynolds, Ira Wardono, Peter Rowinski, Christine Walravens, Beth Natt, Stephanie Kuhlmann, Jocelyne Tardos, Tony GiaQuinta, Tim Kilkenny, Alexandra Evindar, Amy Hepper, Lisa Capra, Amy Holst, Jack Percelay, Julie Sylvester, Diane Godorov, Julia Arana, Bryan Fine, Sofia Teferi, Adriane Garcia, Nancy Zhou, Micah Auerbach, Aziza Dawodu, Corinne Bernhard, Rishi Mediratta, Suzanne Mendez, Loan Nguyen, Rachel Marek Our Research Assistant: Margaret Lapsley

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