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Yale Hospital Medicine: A Beautiful Partnership

June 22, 2022
by Julie Parry

Hospital medicine or designated internal medicine-trained physicians who focus on the care of patients admitted to the hospital, launched at Yale New Haven Hospital (YNHH) in 1995.

Care for medical inpatients at YNHH by practitioners of hospital medicine includes caregivers from Yale School of Medicine (YSM) and Northeast Medical Group (NEMG). The collaboration between the teams has been extremely successful to date on multiple, shared inpatient medical services. This YSM-NEMG partnership has now reached a new height, as marked by the launch of a new educational and care initiative: the Hospital Medicine Firm at the York Street campus of YNHH.

The director of the Department of Internal Medicine’s and Section of General Internal Medicine’s Program in Hospital Medicine, Chris Sankey, MD, FACP, SFHM, is excited about the project. “When I recruit for faculty to join us, I say that this is as exciting a time as ever to be involved in hospital medicine here at Yale. We are going live with a new clinical rotation in our internal medicine program, one specific to hospital medicine, which hasn’t existed before,” explained Sankey, associate professor of medicine (general medicine).

The new firm is the combination of a clinical rotation, an educational curriculum, and the formalized presence of hospitalists on a specific teaching team, said Sankey. The hospital medicine rotation will teach trainees specific skills related to hospital medicine in an individually curated experience. “Across all three training programs, our graduates are choosing hospital medicine jobs at a rate that is two to three times higher even the most popular fellowship,” he said.

Sankey will co-manage the firm with NEMG’s Anisha Advani, MD, associate director, YNHH Hospitalist Service; and assistant clinical professor (YSM), which will be physically located on East Pavilion 5 at YNHH’s York Street Campus.

“It has been a great partnership and collaboration between our group and the Program in Hospital Medicine. We bring different perspectives about figuring out what trainees need and then the practical applications of that. Chris has been wonderful about the needs assessment and pushing to understand at a global level, what trainees think education in hospital medicine should look like, and then we try to balance that with what we think they need. And then from the hospitalist attending side, it’s so important to be able to bring the faculty who have expertise in doing this day in and day out, of caring for larger numbers of patients and sharing that skill set with PGY-3s as they start to think about a career beyond training,” said Advani.

YNHH is a 1,541-bed tertiary medical center, with two campuses in New Haven. The daily census for the hospitalist service has grown by nearly 100 additional patients on average over the past three years. Their responsibilities span throughout the hospital, caring for patients on the medicine floors, the Step-Down Unit, Hip Fracture/Spine Co-management, Geriatric/Psychiatry Co-management, Medicine Consults at YSC, In-patient procedure service, and Point-of-Care Ultrasound (POCUS). They also run and staff the Rapid Response Team (RRT) and cover the medicine patients boarding in the emergency rooms at both campuses.

During the height of the COVID-19 pandemic, the two groups partnered across Yale New Haven Health and YSM leadership to alter hospital processes, physically relocate entire units, and help determine the best way to care for patients. This teamwork led to Healthgrades naming YNHH has one of the leading hospitals in early COVID care.

William Cushing, PA-C, MHA, SFHM, executive director of the Hospitalist Service at YNHH, recalled the evolution of the partnership. “The Department of Medicine underwent an evolution over the past 20 years. Historically many patients were covered by their primary care doctors when admitted to the hospital. That model transitioned through the 2000s, into a new paradigm where the attending physician is now a hospitalist or faculty on the residency teams,” explained Cushing.

He commends hospital and School of Medicine leadership, such as Internal Medicine Chief Gary V. Désir, MD, Paul B. Beeson Professor of Medicine, vice provost for faculty development and diversity, and chair of internal medicine, YSM; and Keith Churchwell, MD, president of YNHH, and others for their shared vision. “When you're admitted to an internal medicine service," said Cushing, "it doesn’t matter whether you're on one of the many firms we have in medicine or the hospitalist team, you can expect the same signature of care. Recently we have heard a consistent vision from Chris O'Connor and Dean Brown. This vision has been reinforced by Keith and Alan Friedman from the hospital, along with Gary, Patrick [O’Connor], Vinny [Quagliarello], and Lynn [Tanoue] from the university side. That shared message has really started to coalesce within the department.”

Cushing cites the COVID-19 pandemic as an extreme example, but other challenges like solving staff constraints and increased patient volume have further united these groups.

“Now we try to solve any problems that are in the Department of Medicine together, which has created a culture of collaboration that seeks to improve the experience of patients and providers. We're looking to accomplish our goals as a department and there is unified commitment to continuing this strategy into the future,” he said.

Sankey is enthusiastic about the future of hospital medicine at Yale. “Another exciting potential future endeavor for the Program in Hospital Medicine would be creating, implementing, and then running a fellowship program in hospital medicine. I'm excited to think about and actualize it in the coming years,” commented Sankey.

“We are at an exciting time indeed for hospital medicine at Yale,” said Patrick G. O’Connor, MD, MPH, Dan Adams and Amanda Adams Professor and chief of Yale General Internal Medicine. “The collaborations across the medical center led by Chris, Anisha, Will, and many others as exemplified by the system-wide response to COVID-19, the new Hospital Medicine firm, and research efforts in the Program in Hospital Medicine led by Sarwat Chaudhry, [MD, associate professor of medicine (general medicine)], clearly demonstrate Yale’s unique strengths to lead in hospital medicine nationally. The rapid evolution of the YNHH Care Signature program led by Deborah Rhodes, MD, professor of medicine and vice president of Care Signature, YNHH, will surely provide many more opportunities to strengthen hospital medicine at Yale even further.”

Sankey took charge of the Program in Hospital Medicine in September 2020, and led it through its recent rebranding and programmatic growth. The program has four core faculty, in addition to Sankey: Chaudhry; Angela Kang-Giaimo, MD, MPH, instructor (general medicine); Sharon Ostfeld-Johns, MD, assistant professor of clinical pediatrics (hospital medicine); and Thilan Wijesekera, MD, MHS, assistant professor of medicine (general medicine).

For NEMG, hospital medicine leadership includes Thomas Donohue, MD, vice president, medicine; Cushing; Physician Directors Lirim Ameti, MD, and Jensa Morris, MD; Associate Directors Advani; Adam Ackerman, MD; Leah Burke, MD; Rupert Dogbey, MD; and Skerdi Fotjadhi, MD; and APP Managers Stacy Adil, PA-C and Heather Carney, PA-C.

Submitted by Julie Parry on June 22, 2022