Farah Abdulsalam, MD

Your Hospital Medicine Physician

Most medical patients admitted to the hospital will be cared for by a hospital medicine physician, also known as an HBS (hospital-based specialist) or hospitalist.

The role of the hospital medicine physician is similar to that of your primary care physician who cares for you at the clinic. Both lead and coordinate your care team, the difference being the setting now is the hospital rather than the clinic. Your hospital medicine physician is trained to oversee all aspects of your hospital care, including admission, diagnosis, referrals to other specialties, and treatment, until you are discharged and return to seeing your primary care physician.

Admission to the Hospital

A hospitalization can be a challenging time for you and your family. It is often unexpected, due to a serious health problem, and can come with uncertainty about the diagnosis and what the future will hold. Our goals during this time are: to address your medical needs by providing excellent care; to keep you informed and updated about your health and engage you in decisions made about your care; and to do our best to keep you comfortable.

There are a few ways patients are admitted to the hospital:

• A visit to the clinic to see your primary care provider or specialist and they refer you to the hospital.
• An Emergency Room (ER) visit.
• A preplanned surgery or procedure.
• Transfer from another hospital.

While you are in the ER, you may be evaluated and monitored by a hospital medicine physician. The hospital doctors typically do a physical examination, ask you questions, review your electronic medical record, and may consult with your other doctors and run further tests. Once an initial assessment is done, he or she will decide if your medical needs:

• Require admission to the hospital.
• Allow for safe discharge from the hospital. 

We may also decide you need further assessment in the Clinical Decision Area (CDA). The CDA is an observation unit where you will receive care and monitoring for up to 24 hours. From there you will be either discharged or admitted to the hospital. An electronic notification about your change in health will go to your primary care physician when you are seen in the ER or hospitalized.

Based on your response to treatment and on any other health needs you have, we will decide on next steps. If you need hospital care, you will be admitted, depending on your level of care, to one of the following areas: 

• Medical-surgical floor. This is the most common area where a hospitalist cares for patients admitted to the hospital. We often call it the “med/surg” unit. 
• Cardiac telemetry monitoring unit. This unit is for patients with a recent heart event or active heart problem. Special machines will monitor your heart.
• Intensive care unit (ICU). Patients in this area are in critical condition and require higher levels of care and monitoring. This may include care by an intensivist (an ICU physician especially trained in critical care), more nursing care, intravenous drip lines, more complicated monitoring equipment, and possibly some type of life support, like a ventilator. 
• Some hospitals have additional specialty units geared towards caring for specific patient populations. Examples of these are step down units (a step between ICU and telemetry), stroke units, dialysis units, and hematology/oncology units.

During the hospital admitting process the hospital doctor will discuss goals of care with you and your loved ones. This discussion will serve to document your thoughts about different life support and resuscitation measures you would desire if a more serious situation were to unexpectedly arise during your hospital stay. The admitting doctor may also refer to your Advance Directive for Healthcare (if this is available in the medical record). This form is a legal document that states who you wish to designate to make medical decisions for you if you are unable to do so. It may also document your wishes for life support or resuscitation. A POLST form is another document that serves to clarify your wishes with regard to goals of care. If you have not completed these forms prior to coming to the hospital, we may ask you to do so.

Your Care Team

Your hospital medicine physician will supervise medical decisions and coordinate your medical care from the time you are admitted to discharge. During your stay, you may be cared for by more than one hospital physician, depending on the length and days of your stay. We work a week at a time (7 day shifts). Rest assured that we make every effort to have clear and coordinated hand offs and communication about your care between physicians.

There are many other specially trained clinicians that may be involved in your medical care:

• Specialty physicians. For patients who require care beyond the expertise of a hospitalist, specialists will provide coordinated care. These may be cardiologists, surgeons, intensivists, endocrinologists, infectious disease specialists, nephrologists, or psychiatrists.
• Resident physicians. These are physicians who have completed 4 years of medical school and are in training for their selected specialties. Some of our larger hospitals train residents and they will be part of your care team.
• Nurses. A bedside nurse is assigned to you for every shift (a shift is typically 8 to 12 hours). Nurses are responsible for your day to day care, such as giving you your medications at the correct times, bathing you, providing meals, getting tests done, taking your vital signs throughout the day, and making sure you are up and moving around as much as possible. If you need to speak with your doctor or another care team member, your nurse can contact them for you.
• Patient care coordinator. A key part of the care team is the Registered Nurse who oversees the continuum of care from your admission to your transition from the hospital at the time of discharge. They will help with arranging transportation to your home and with needed medical equipment for your use at home, as well as setting up appointments for referral care or rehabilitation, and following up for referrals and testing after your stay.
• Rapid response team. If your health deteriorates, a team of health care providers will come to your bedside immediately to respond to an emergency.

There are many more people who will be involved in your care, such as other clinicians and care staff. These include physical therapists, occupational therapists, respiratory therapists, speech therapists, nursing managers, social workers, nutritionists, patient care assistants, and unit clerks. To learn more about them and other support services, read about additional staff and rehabilitation services in “Additional References” below.

Your Hospital Stay

During your hospital stay, we will provide you with the best available medical care while keeping you comfortable and informed about your overall care plan as well as your daily care. We will work to make sure you and your loved ones are actively involved in decisions about your care and treatment. Your needs and care will be unique to your current health condition and treatment plan, but a typical day may include the following:

Your room

Depending on your care and treatment needs and bed availability, you will be placed in a single or shared hospital room. In your room, you will have a white board that will be updated daily with your care plan and the names of your nurse and hospital medicine doctor. The room will also have an adjustable bed, with a remote control button to call for additional assistance by a nurse. There will also be a telephone and a television with remote control. Many hospital televisions have a special channel with information about hospital services.

Your blood pressure, pulse, temperature, and other vital signs will be checked at regular intervals throughout your hospital stay in order to detect changes in your clinical status. You may also have some monitoring equipment. The two main types of monitoring equipment are a heart monitor (telemetry) and pulse oximetry to measure your oxygen and oxygenation levels. The information from the heart monitor and pulse oximetry device is sent to a monitor at your bedside and to a nearby central monitoring station. You may need other types of monitoring equipment, depending on the type of care you are receiving.

Rounding 

Every day you will see certain care providers regularly as they come to your room on their daily rounds. Rounds are a term we use to describe daily visits the physician or other care team member makes to monitor his or her patients.

Your hospital medicine physician typically rounds once a day. During this time we review your condition, assess your progress, adjust your treatment as needed, and discuss your care plan for the day. We are available to answer any questions that you and your family may have, and you can contact us at any time throughout the day. During the nighttime there will be another hospital medicine physician in the hospital available to answer urgent questions and address your health needs.
 
If you are also under the care of a specialist, they will also come and visit you at some point during the day. The specialist will update your electronic medical record to keep your hospital medicine physician informed about your care, or call to discuss your care, if needed.

A bedside nurse will be assigned for your routine care, and will take your vital signs as needed throughout the day. This typically includes recording your body temperature, blood pressure, pulse rate, respiratory rate, and other things, depending on your condition. 

Your patient care coordinator will also check with you daily and update your care plan. They also perform the role of case managers and oversee the coordination and implementation of all aspects of your care. This includes making arrangements for transfer to a skilled-nursing facility, arranging delivery of medical equipment to your home (such as home oxygen), and arranging for visits by the home health nurse.

Hospital nursing managers also visit patients to see if your stay is running smoothly and if there are any issues that need to be addressed. If you are having any problems during your hospitalization, you would first contact the hospital nursing manager for your unit to discuss how to resolve the issue.

A hospital pharmacist may also visit you to review your medical records if you are taking certain medications.

Environmental services will stop by daily to clean your room. They are also available as needed for additional cleaning.

A nutritionist or dietary aid will come to your room with a hospital menu, if you are eating solid foods. Typically you can choose what you’d like to eat for breakfast, lunch, and dinner.

Testing

There are many types of tests that can be done when you are in the hospital. Your hospital medicine physician typically will order tests to help with diagnosis of your medical condition or to monitor your health status. Many tests can be done from your hospital room and are scheduled so you will be informed and prepared ahead of time. Some examples of possible tests:

• Blood test. Typically, a lab technician comes to your room and draws your blood. Many patients need daily blood tests, which are done throughout the day.
• Imaging. There are many possibilities for imaging tests: CT scans, X-rays, MRIs, ultrasounds, to name a few. These images help us to identify problems, and check your progress.
• Cardiac testing. An echocardiogram is a kind of ultrasound of your heart to evaluate how well it is functioning. We can perform this test at your bedside. We also may do a stress test to evaluate you for any signs of blockage. This type of test can be pharmacological (we give you medication) or we may put you on a treadmill to stress your heart and then measure your blood pressure and heart rate.

There are many other types of tests to evaluate and monitor your health, such as sputum (spit) and urine samples, or biopsies. Be sure to ask us any questions you might have about what we are doing and the reason for any test.

Your nurse will be responsible for overseeing when you take your medications. Your nurse can also answer any questions you may have about your medications, and make sure you understand how to continue to take your medications once you return home.

Discharge Procedures

Your hospital medicine doctor in conjunction with other members of the care team will discuss your medical care and treatment daily. We will decide when you are medically stable and ready to be discharged from the hospital. Working with you, your family, and the care team, we will develop a post-discharge care plan for you to follow at home or in a rehabilitation facility. At discharge we may also consult with your primary care physician. Your patient care coordinator and/or social worker will assist with your transition to the next phase of care.

Going home or to another facility

Although medically ready to leave the hospital, some patients require additional care in another facility. Care may occur in any of the following locations after a hospitalization:

• Home. You may be able to care for yourself, or you might require home health care, additional hired help, continuing care assistance, and/or special equipment.
• Chronic conditions management. We may refer you to one of our outpatient care programs, such as diabetes or heart health programs.
• Palliative care. Some hospitals have an outpatient palliative care program that can begin or continue palliative care post-discharge.
• Skilled-nursing facility. You may need to stay in a skilled-nursing facility in order to continue active treatment or rehabilitation in order to get well enough to return home.
• Assisted living. Also known as board and care, an assisted living facility may have different levels of care, such as independent living, more assistance, or even medical care.
• Custodial nursing care. Ongoing nursing care is provided, for an undefined timeframe, if appropriate.
• Hospice. Goes to wherever you live, in any care environment. Hospice care will help keep you comfortable and manage pain medication, assisting with ongoing care and treatment.

Facilities vary a great deal as to what they offer, so we will work with you to find the facility that meets your needs.

The discharge process

We will begin planning your discharge the day before you leave the hospital. Discharges can occur at any time throughout the day, but usually in the morning. Your care team will work with you to make sure everything is in place before you leave. We will:

• Revisit why you were in the hospital, and review your and your family’s understanding of your hospitalization. 
• Explore next steps for your care and the resources required.
• Review your medications. A nurse will provide you a written copy and make sure you and your family members understand what you are taking, if any medications have changed, what you may need to continue taking, or what you should stop taking once you have completed your current prescription.
• Provide you with a packet of information on how to continue to care for yourself after you are discharged.
• Send a summary of your discharge plan to your primary care provider and any specialists that need to know about your hospitalization and any needed follow-up testing and medical care.
• Schedule appointments for any follow-up tests, medications, referrals, and follow-up appointments as needed.
• Talk with you and your family about your ongoing needs.

Once you leave the hospital, your medical care will be managed by your primary care doctor and specialist, as appropriate. You may also receive a phone call from a hospital staff member to follow up on any questions you may have after your discharge. We recommend that you discuss your hospitalization with all of your health care providers after discharge from the hospital.