Blog | Saturday, May 7, 2016

Extensivists, "big picture-ists," and more

At a Friday morning session, Jeffrey Greenwald, MD, offered a brief overview of evolving models for hospitalists in care transitions.

The extensivist. Extensivists see patients postdischarge, in skilled nursing facilities, and in preadmission clinics. "Finances of this have been shown to have a positive ROI," Dr. Greenwald said. "So I suspect we're going to be hearing more about this model in the coming years."

The "big picture-ist." This person manages care across the health care system, working with the ED to manage flow into the inpatient service and with outside clinicians to triage patients into the hospital or to other sites of care, Dr. Greenwald said.

The peer collaborator. This model wasn't designed for care transitions but has proven useful in that area, Dr. Greenwald said. Peer collaborators work with nonregionalized hospitalists by running cases, advising, assisting in answering questions, and promoting learning.

The psych comanager. Comanagement in hospital medicine is nothing new, Dr. Greenwald acknowledged, but "what's interesting about this model is they actually embedded the medical hospitalist in the psychiatric service." Through use of a transfer checklist and a verbal handoff, this model helped to reduce urgent needed transfers by 35% to 45%, Dr. Greenwald said.