Home Forums Discussions General Discussion Hospitalists

I would be interested in what people think about hospitalists deciding whether your patient should be admitted. This has not been a huge problem, but several times I have tried to admit a patient, and they have tried to convince me why the patient should not be admitted. Some times they are right, and we make a plan as to how to follow the patient.

But, there are times where I tell a patient/parent I think their child needs to be admitted, the parents agree, and then the hospitalists refuse to admit the patient.

Has anyone else had any similar issues? Any ideas what to do?

If I get a denial from the hospitalist, I just send the patient to the same hospital's ER, after a brief call to the ER doc. Never fails.

I learned this technique as a medical resident at Duke, trying to get my "public" (i.e., poor) patients admitted from my resident's clinic to the hospital. They hate you, but a bird in the ER is worth 2 in the bush...

Do you mean the hospitalists hate you? I always found the following philosophy:

If you work for a hospital and get a salary, then every patient who comes in with a cold or conjunctivitis bothers you. However, if you get paid by the patient, every cold or conjunctivitis makes your day.

I was always taught that a patient fails outpatient therapy, they get admitted. Many times (most), it is obvious they will fail out patient therapy, so they get admitted.

They hate you because they have to work late. I think doctors don't think of patients as income, at least until they are responsible for the overhead.

We have this same issue. It bothers me a lot. Usually I can talk to the hospitalist ahead of time and smooth the path. I find this especially irritating because our hospitalist team started life as internists in the same community (and sometimes with the same group) as I still occupy. It's like I suddenly became stupid because they prefer inpatient medicine.

A variation on the theme is their demand that everyone I send over go through the ER, thus tacking on another few thousand dollars. Their response when I complain is that they have been forced to do this because other providers (sometimes midlevels at outlying clinics or neighborhood health facilities) were sending over totally inappropriate admissions.

Working in a small hospital I have no hospitalists to deal with, but I found this attitude permeates tertiary care hospitals. I have had to send people from my ER to their ER so the ER doctor can see them to finish and do admit for the hospitalist - this after I have done x-rays, lab, CT scan, stabilized and found issue such as acute appendicitis. This is one way medicine is not efficient. I even saw a pt. sent to a nursing home where they had a MRI done Wed - kept observation, sent to nursing home where the physician then transferred to a nursing home 30 miles away - repeated the same MRI and all same lab - kept 3 days and then sent back to nursing home.....does that sound reasonable?

Ours does the ER thing as well, but for a reason that is somewhat feasible. I guess they got burned a few times when the patient went directly to the floor and they weren't as advertised. But, they could at least see them themselves.

The not advertised was they were sicker than expected. You can send them directly from the office unless, of course, there are no beds.

I pretty much send all probable admissions through ER. Not the most cost effective way, but I think patients do get labs/radiology quicker. The case managers are better able to pre-certify admissions this way as they have more data.