Profiles in Clinical Excellence: UH Hospital Medicine

Hospitalists embracing positive change and new status at UH

By Charles LoPresti, MD, SFHM

Charles LoPresti, MD, SFHM

Hospitalists at University Hospitals have always provided excellent, round-the-clock care for the patients hospitalized at one of our medical centers. But over the past two and a half years, our team has undergone a significant and welcome change that may be unfamiliar to some.

Prior to 2022, we contracted with third-party companies to provide the majority of the hospital medicine coverage for our medical centers. But in July 2022, we started down a path of internalizing the various hospital medicine groups so that they were fully employed by UH as hospitalists. The process concluded just this past August.

The upshot of this change? Hospital Medicine at UH has now become a service line of 150 hospitalist providers, including a mix of physicians and advanced practice providers. We’re on-site at 11 medical centers, while providing some remote coverage to UH Conneaut and UH Geneva now as well (which you can read more about in this issue of UH Clinical Update). If you're a patient within any of the UH hospitals, you’re taken care of by one of our hospitalists.

Why the change? First and foremost, we believed we could provide better patient care if our hospitalists were fully employed by UH. We saw a golden opportunity to standardize both the care and the patient experience for each hospitalized patient interacting with a hospitalist. In short, we saw it as a quality improvement issue. The change also promised to bring improvements in workload and quality of life for our hard-working hospitalists themselves, which is no small thing.

So now we’re one UH team. Of course, that’s not to say that hospitalist care is in lockstep at each UH hospital. The nature of hospital medicine means that in some circumstances, the hospitalist manages the patient’s care, while in others, care may come from a combination of a hospitalist and other physicians. It’s a variety of different models, always guided by what’s best for the patient. In some cases, the hospitalist acts as a “quarterback” for the patient, managing consulting services with needed specialists. But in others, they may be the only provider to take care of that patient over the course of the hospitalization.

But whatever their specific role, we know our hospitalists are making a difference in UH hospitals on important metrics like length of stay and patient experience – one of many members of the multidisciplinary teams making these areas a high priority.  At UH Geauga, for example, Chief Medical Officer Marlea Miano, MD, highlights a daily interdisciplinary call where each attending physician runs through the patient list, detailing the plan for the day, the plan for the stay and any barriers that might exist. Also joining this pivotal call are transitional care coordinators, social work, palliative care, radiology, nurse managers and therapy. “I believe this call and the engagement from all teams has contributed our success in achieving our goal LOS and OE,” Dr. Miano says. We’re proud, too, to have hospitalists provide leadership for our hospitals, sitting on committees and advocating for patients to identify inefficiencies or patient safety concerns, as well as leading residency programs.

Now that the contractual and logistical infrastructure is in place, what gets me excited is thinking about how Hospital Medicine at UH innovates and grows. Now we can start to have some fun. For example, we recently launched a monthly Hospital Medicine Grand Rounds, and that’s just the beginning.

Bottom line: I couldn’t be more pleased with our team and what we can accomplish. By way of example, you can read about the stellar work of two of our talented colleagues in the articles in this issue of UH Clinical Update - see below. They represent UH Hospital Medicine well. As we go forward, I can’t wait to see what’s next from this team.