Background: The hospitalist role is gaining increasing presence for inpatient care, with the opportunity to care for a variety of higher acuity patient across a breadth of specialties in the hospital setting. Further examination into the types and amount of MS-DRG categories seen by hospitalists and their ordering volumes can provide a better picture of the scope of practice and patient load for hospitalists.
Methods: Using the Vizient CDB/RM, encounters between July 1, 2015 and June 30, 2017 where the attesting physician specialty was hospitalist were analyzed. Physicians were included if they were the attending physician in 50 or more encounters per year during the two year cohort. Metrics examined were MS-DRG categories, average patients discharged per day, average number of orders per day, and average patients the hospitalist ordered resource for per day.
Results: Hospitalists discharged an average of 1.9 patients on days they were discharging attending physician. On an annual basis, hospitalists saw patients in an average of 99.4 distinct MS-DRG categories. The top five MS-DRG categories cared for by hospitalists were 871 (septicemia or severe sepsis w/o MV >96 hours with MCC), 392 (esophagitis, gastroenteritis & miscellaneous digestive disorders w/o MCC), 872 (septicemia or severe sepsis w/o MV >96 hours w/o MCC), 291 (heart failure & shock w MCC), and 603 (cellulitis without MCC), showing the breadth and severity of conditions managed by hospitalists. On the ordering side, the included hospitalists placed orders for an average of 8.6 patients, including a daily average of 31.5 pharmacy orders, 23.2 lab orders, 3.8 blood product orders, and 2.7 imaging orders. This volume of service ordering speaks to the acuity of patients managed by hospitalists.
Conclusions: Hospitalists serve an important role in the care of a breadth of patients in the inpatient setting, covering a large number of patients and spectrum of orders on a daily basis. The treatment of such a varied patient population can lead to complexities in delivery of care and knowledge needed to perform in a hospitalist role.