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Smilow’s New Hospitalist Program Benefitting Patients, Physicians

March 29, 2022

A new program designed to further enhance patient care at Smilow Cancer Hospital is already reaping benefits and leaving indelible impressions on the young physicians at its core. Smilow Cancer Hospital launched its first Hospitalist Program in July 2021 with five physicians—Erin Gombos, MD, Mathew Kottarathara, MD, Jensa Morris, MD, Nathaniel Parker, DO, Urs Weber, MD—and will expand to 10 later this year, including board-certified hematologists.

As the name implies, hospitalists are doctors dedicated to treating hospitalized patients. They are on staff around the clock to coordinate medical care among a team of physicians and specialists, analyze lab results, admit and discharge patients, and communicate with patients and family. “They really are experts at acute medicine and inpatient care,” said Kerin Adelson, MD, Chief Quality Officer and Deputy Chief Medical Officer at Smilow. “And our patients, so far, love it.”

“The oncologists provide the oncologic expertise of the disease process, cancer therapies, side effects, and complications of therapy,” Dr. Morris said. “And the hospitalists bring the management of general medical diseases and all the complications thereof.”

Dr. Parker said he likes that his new position allows him to focus on patients. “I have the opportunity to be a vital stakeholder in the overall continuum of patient care,” he said. “This is important to me because I feel patient care can be fragmented between the inpatient and ambulatory settings. I enjoy being a stakeholder who works towards eliminating that fragmentation.”

The hospitalist’s work, while rewarding, is not easy. They typically log 12-hour shifts, seven days a week, followed by seven days off. One works a 13-hour overnight shift. It can be a demanding position, but some, including Dr. Parker, don’t mind it. “I like the hustle and bustle. I enjoy the inpatient setting, the pace, and the breadth of content,” he said. “Also, I like the patient interactions and seeing results in real-time.”

Dr. Gombos said she’s already been inspired by her new position. “My patients are the best part of the job,” she said. “Everyone admitted to Smilow is on an incredible journey. By having the privilege to care for them, I have witnessed pure individuality, bravery, love, and loss. I believe everyone who works at Smilow appreciates this.”

The Smilow Hospitalist Program is already making a significant difference in reducing patient hospital stays. “The business plan was built on reducing patient stay by one quarter of a day,” Dr. Adelson said. “We actually reduced patient stay by 1.1 days, which is a huge number.

That’s four times what was expected.” That opens beds for other patients who need them. The key is a hospitalist’s ability to manage general medical diseases as well as navigate the hospital system and be available around the clock to admit and discharge patients.

“A hospital is probably the most complex system you could work in, in terms of figuring out where to get the resources and determining how to get things done,” Dr. Morris said. “Hospitalists manage the day-to-day care with prompt and complete attention to all patient needs, from the mundane to the complicated.”

Dr. Morris was one of the first hospitalists when Yale New Haven Hospital began its program 20 years ago and remains clinically active as a Smilow hospitalist. There are now more than 200 hospitalists in the Yale New Haven Health System, including those at Smilow.

“I think the Smilow Hospitalist Program is going to become so vital that we couldn’t do without it,” Dr. Adelson said. “The patients love having a doctor who spends time with them and is always accessible.”

With much of the hospitalists daily focus on collaborating and coordinating with all physicians, care team members, and patients and families, effective communication is essential to the position. “The staff hospitalist must possess excellent communication skills and exhibit these through communication with primary oncologists, hematologists, in-house consulting physicians, and colleagues,” Dr. Morris said.

Dr. Parker agrees good communications skills are important. “From in-person patient encounters to multidisciplinary rounds to phone calls/texts/emails between other specialists or attending physicians and beyond, it’s simply such an important part of being a hospitalist,” he said. “It’s truly a skill and something I’m always trying to improve.”

Dr. Gombos explained how effective communication is imperative when the care team often includes nurses, nurse practitioners, residents, interns, medical students, pharmacists, the consulting oncologist or hematologist, and the hospitalist.

“It can be confusing for patients when four or five providers walk into their room. Communicating upfront everyone’s name and role and providing a united plan for the day is extremely important,” she explained. “I often tell my patients that my role as a hospitalist is to coordinate their inpatient stay, while ensuring their outpatient providers are kept up to date so that there is a seamless transition when it is time for discharge.”

Dr. Adelson, a medical oncologist who specializes in breast cancer, said she’s constantly working to improve her communication skills, because the field of oncology— and the sensitive nature of some conversations she has— requires it. “The one thing that I’m still getting better at is communications, especially around end-of-life,” Dr. Adelson said. “It is really the hardest thing and the highest art of medicine that we still do. And it’s so important in terms of aligning care with patient values and making sure that there’s an environment where they can express their wishes.”

“These hospitalists are going to become experts at that form of communication because they’re doing it all day long every day, and they’re also seeing the impact. They really are experts in medicine and inpatient care.”

Submitted by Emily Montemerlo on March 30, 2022