Tuesday, June 14, 2005

Mandatory Hospitalist Programs in the ICU

Retired Doc's Thoughts posted on what to a hospitalist would be considered rather provocative. He relates that a friend of his from Florida reported that at his hospital, a policy was instituted that prevents anyone from caring for intensive care unit (ICU) patients unless they are "hospitalists". Such doctors are apparently internists, not critical care certified or specially trained and are largely hospitalists by self-description only. Pulmonary-critical care physicians are exempt.

As I commented at his site, this kind of policy is rather rare. The hospitalists' own Society of Hospital Medicine (SHM) has generally come out against such a policy. Legislation forbidding the mandatory use of hospitalists by hospitals and health plans is rare (Texas being one exception) because it is seldom necessary. Efforts to introduce mandatory hospitalists are usually not successful because of the ire of physicians and the efforts of some patient advocacy groups.

That said, the Leapfrog initiative is a voluntary set of hospital guidelines which does have a provision that ICU's should be staffed by critical care certified physicians. This is generally referrred to as a "closed" ICU. Hospitals in the future may very well seek to be Leapfrog compliant since reimbursement by some insurers may be contingent on such a designation.

The hospital mentioned in Retired Doc's Thoughts would apparently not be Leapfrog compliant. My initial thought is that either the details of the story are not complete or that the hospital's internal medicine staff fell asleep at the wheel!


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