Background: Hospital medicine continues to expand and hospitalist practitioners are now rising to challenges of other venues looking to capture the value hospitalists bring. One area with a paucity of such skill but a rising need is the realm of eating disorder medicine.
Purpose: To showcase hospital medicine in a niche role, specifically eating disorder care.
Description: Medical complications of eating disorders have been well documented as has the fact eating disorders have the highest mortality of all mental illness. When patients are seeking care, they are at high risk for a myriad of complications related to the nutritional restoration process, separate from the damage from malnutrition. Because these acutely ill patients require frequent monitoring, they are best served under close medical care. These patients may not meed criteria for traditional acute hospitalization, but require prolonged monitoring for treatment to recovery. Veritas Collaborative is a national healthcare system for the treatment of eating disorders across multiple levels of care, including inpatient medical stabilization. In 2018, Veritas added hospitalists to elevate care in their eating disorder hospitals. Currently, 77 beds at 2 sites are under direct care of 1 IM trained and 1 pediatric trained hospitalist. The decision to add hospitalists to provide expert care has had large impacts on many levels.Hospitalists have overall increased revenue as a consultative service on psychiatric patients. Revenue has increased directly and indirectly. Hospitalist documentation has allowed Veritas to capture complex patients on presentation. Inpatient level of care increased from 10% of patients prior to hospitalist care to 30% of admitted patients with appropriate documentation. In addition to more patients maximizing bed acuity, daily documentation has increased RVUs generated as well. Hospitalists have also impacted cost of care delivery by decreasing utilization of EKG overread services, redirecting use of ancillary staff, and by developing a cost effective formulary.Hospitalists have also been called on to implement best practice guidelines. A strong knowledge of organizational medicine allowed the hospitalists to improve delivery of evidence based medicine at inpatient and outpatient sites. Specifically for diabetic care in eating disorders, vitamin supplementation, fluid/electrolyte management, and functional motility disorders, hospitalists have helped to develop best practices for patients. These standards help the patients remain in therapeutic treatment rather than the prior practice of medical management at another facility.Throughput has been addressed, specifically as it relates to flow of the admission process. Hospitalists are keenly aware of creating stakeholder work groups to move to organizational standards. In voluntary treatment with average length of stay 60 days, first impressions are critical to ensure patients feel the environment can meet their recovery needs. Additionally, hospitalists at Veritas advocate for patients that meet criteria for traditional inpatient admission, when it may not seem clear to acute hospital providers. Using eating disorder guidelines as well as speaking hospitalist “language” helps patients and providers navigate admission when acute care is needed.
Conclusions: Hospitalists are in high demand both in and out of acute care. Skills sets developed in traditional acute care medicine have value beyond traditional hospital settings, including eating disorder medicine.