AVAILABILITY

Hospitalists will accept RMG patients that are admitted through the emergency department, directly admitted from a physician’s office or transferred from another facility 24 hours a day, 7 days a week, 365 days a year during their coverage period. RMG will ensure that patients being transferred from another facility are medically stable for transfer. Should a physician escort be required, as determined by the medical director, one will be made available.

Hospitalist will ensure that mentoring responsibilities, (i.e., clinical residents, nurse practitioners, etc) do not delay the management and discharge of RMG patients.

RESPONSE TIME

Hospitalists shall return RMG radio pages or cell phone calls within 20 minutes. In the rare instance the hospitalist is unable to do so due to emergent patient care issues, the hospitalist will ask support staff to call back to inform RMG of the delay. RMG’s commitment is to engage the Hospitalist for less than two (2) minutes on such page requests.

PATIENT ROUNDS

All RMG inpatients shall be seen daily by 11:30 a.m. including weekends and national holidays so as to facilitate care and prevent delays in management and discharge.

Hospitalists shall evaluate and write management orders on all newly admitted RMG patients within 1-2 hours of admission. For established inpatients, Hospitalists will write orders on the chart by 9:30 a.m., each day.

If notified of a commercial patient in the emergency department that may need admission, the hospitalist is expected to perform his own evaluation of the patient prior to admission to determine if the patient truly needs to be admitted or if his care can be adequately serviced in another fashion, such as a skilled nursing facility. If the patient does need to be in a hospital, the hospitalist, if working in a non-contracted facility, will determine if the patient is medically stable for transfer to a contracted hospital. If so, the case manager will assist in arranging for that transfer to the other facility. Commercial patients that are not immediately stable for transfer to a contracted facility should be transferred as soon as they are considered medically stable.

PHONE ROUNDS

Hospitalists shall participate in telephonic physician rounds with RMG senior case manager/medical director on a daily basis, 7 days a week, at a pre-established time. Hospitalists should be prepared to discuss all patients in a detailed, yet succinct manner, with a disposition plan for each patient. Time estimate is 1-2 minutes per patient.

Hospitalist shall agree to a thorough and complete sign-out to covering physicians (weeknights, weekends, and national holidays) with specific instructions for treatment and management of all inpatients. Hospitalist must indicate to covering physician the requirements that would result in the discharge/repatriation of the patient in the absence of the Hospitalist so that no discharge delays are incurred.

CONSULTATION AND TESTING

Hospitalists will exercise their full ability as clinicians prior to requesting specialty consultations. When such consultations are requested, the Hospitalist will clearly indicate to the specialist which aspects of the particular patient’s care he would like assistance with.

Consultations will be requested from RMG contracted specialists whenever possible and only when the patient’s clinical needs are beyond the expertise or clinical capabilities of the hospitalist. It is the responsibility of the hospitalist to only use physician providers contracted to RMG, unless under emergency situations. Hospitalist shall request specialty services on RMG patients by directly contacting specialists (physician-to-physician) to request either the consultation itself, or approval from the specialist to discharge any patient under the care of the specialist. Relying only on written chart documentation to request consultations or specialist permission for discharge shall be avoided. Direct physician-to-physician communication is required.

Hospitalists will ensure that all tests and specialist consultations are ordered only when it is clear that the management plans are likely to change depending on the results of such services.

Hospitalists will interact directly with specialist consultants involved in a patient’s care on a daily basis and shall report the specialist management plans to RMG during phone rounds.

Hospitalists shall attend and coordinate care on ALL RMG inpatients. Although the actual treatment and management may be conducted by the attending specialist (e.g., surgical, OB, transplant), the Hospitalist will be needed to help with communication, coordination of care and discharge planning services.

Hospitalist shall assist RMG in meeting timeline goals for specialist consultations and test (lab/radiological) requests as follows: 1) Specialists shall provide consultations within 2-3 hours of the Hospitalist’s request. 2) Hospitalists shall order tests by 8:00 am or, preferably, the night before. Hospitalist shall make every effort to utilize specialist consultants who are responsive to the guidelines outlined above and accept the need to expedite care through patient repatriation and/or discharge.

For new admissions or transfers, Hospitalist shall not delay implementing the clinical management of the patient by repeating radiological and laboratory tests that have just been performed elsewhere and are deemed adequate to initiate care.

Should a patient be receiving care at a tertiary care facility, it is the responsibility of the Hospitalist, acting in conjunction with the specialists, to notify RMG immediately of a patient’s eligibility for repatriation at the point that services no longer require a tertiary care facility and can be provided by an RMG contracted community hospital and contracted physician. Hospitalist shall indicate to RMG what services are required upon repatriation. RMG will arrange for physician-to-physician transfer and shall warrant the competency of the accepting physician and the availability of services and resources requested by the Hospitalist.

DISCHARGE PLANNING

Hospitalist will notify the hospital case manager and/or medical director as soon as he is aware of any hospital admission during the day, or by 9 am if the admission occurred overnight.

Hospitalist shall cooperate with and utilize (as available) the services of the assigned RMG case manager to 1) coordinate the transmission of clinical information to RMG Medical Director or designee, 2) provide updates on the status of the clinical management of inpatients to facilitate and plan for their discharge needs and/or transfer requirements.

For all patients, Hospitalist will consider whether the patient may benefit from hospice or palliative care evaluation and inform RMG of any patient that may be hospice eligible. RMG will determine which contracted hospice or palliative care agency is appropriate for the patients’ specific needs. In such cases, RMG will inform the hospitalist of the agency name and the hospitalist will arrange an evaluation with the agency directly.

Hospitalist shall discuss with patient/family length of stay expectations at the time of admission. Hospitalist shall discuss discharge plans with family/patient at least two (2) days prior to day of discharge. For special discharge needs (home visits, tests, follow-up office visits, referrals, etc.), hospitalist shall notify RMG 72 hours prior to discharge to ensure that RMG can arrange such clinical services or resources needs in a timely fashion. Hospitalists are reminded that RMG offers a full range of post hospital services.

Hospitalists shall identify patients at high risk for readmission and notify RMG so that these patients can be included in RMG’s high risk patient program.

Hospitalist shall notify RMG telephonically and agree to commit to writing in the clinical chart any inpatient day(s) that is deemed “aberrant” as a result of Hospital related reasons that delay the management, discharge or care of the RMG inpatient. It is the responsibility of the hospitalist to ensure that these notes are faxed to RMG for the purposes of meeting RMG quality control requirements.

Hospitalist shall notify RMG immediately upon knowledge that RMG inpatient’s management and care will be delayed. This shall apply to inpatients and to patients requiring transfer into the Hospital, where needed services, (i.e., MRI, availability of consultants, operating suites etc) are not immediately available.

Immediately upon recognition of a likelihood of discharge to home, transfer to a SNF, or transfer to another facility, all services required for discharge shall be clearly communicated to the case manager before 2 PM and orders written before 3 PM to complete the discharge or transfer as planned.

(Not applicable to USC Hospital) Upon notification by the ER, Hospitalists shall attend to RMG patients in the ER and if clinically stable discharge patients to home or SNF if applicable. RMG is available 24 hours a day, 7 days a week, 365 days a year to provide assistance with discharge management, i.e., home resources, follow-up appointments, referrals.

Hospitalist must participate with Regal’s discharge dictation summary program by completing the Regal discharge summary form on the day of discharge in order to support a more efficient and effective transition of care process.

1. Education and/or Experience: