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'A clinical instinct:' Hospitalists improve care for acutely ill inpatients

Winter 2013

By Mary Brolley

Maria-Claudia Campagna, M.D., 
and Josiah Halm, M.D.

In an institution as large as MD Anderson, providing seamless care for patients throughout their cancer journey is a constant challenge.

Those who go from outpatient to inpatient care — and back again — need an expert in both internal medicine and the ins-and-outs of the hospital environment.

Enter the hospitalist.

A specialty that’s exploded in popularity in the past three decades, hospital medicine recognizes that caring for acutely ill patients within the hospital setting requires physicians who are on site — embedded, in fact — in the hospital culture.

Hospitalists are expert in providing treatment in a multidisciplinary setting, consulting with specialists as needed and managing comorbidities and the complications of the disease process and of therapy.

They work cooperatively with the supervising oncologists and return the patient to their care when the acute issues are resolved.

Managed care spurs growth of specialty

A 1996 article in the New England Journal of Medicine predicted that hospitalists would be ever more in demand as a national shift to managed care forced improvements in efficiency in both inpatient and outpatient settings.

This has proven true at MD Anderson, as the number of hospitalists has doubled since the program’s launch in 2007. Then, Carmen Escalante, M.D., professor and chair of the Department of General Internal Medicine and colleagues began to recruit physicians dedicated to caring for cancer patients with medical problems requiring hospital treatment.

One of the first hired was Maria-Claudia Campagna, M.D., who’d had the perfect reparation for such a career. In 2001, while practicing outpatient medicine following her internal medicine training, the leadership of the county hospital district asked her to assist their sole oncologist.

She jumped at the chance.

“I took care of all the hospitalized cancer patients under the direction of Dr. Debra Prow, who happened to be MD Anderson-trained,” she says. “It was intense and rewarding — like a first-year fellowship in general oncology.”

Though all of MD Anderson’s hospitalists are generalists, able to handle problems of any oncology patient, some problems — high blood pressure, chemotherapy side effects or uncontrolled pain — occur frequently.

‘We know when something isn’t quite right’

Campagna is quick to give credit to the whole hospitalist team, which includes three advanced practice nurses and two pharmacists. “We know the system. With experience, we develop a sixth sense and pay attention to it. It’s often a clinical instinct — something isn’t quite right.”

To centralize their efforts, the team, led by Josiah Halm, M.D., section chief ad interim and associate professor in the Department of General Internal Medicine, was recently assigned a permanent home on the newly opened Floor 19 in Alkek Hospital.

The typical seven-day clinical rotation begins Monday and the hospitalists must quickly get to know every patient’s history, Campagna says.

“First, we get a briefing about complex patient interactions and the day’s discharges. Then, after doing ‘computer rounds’ — looking over each patient’s charts and records — we see the new admissions and those being discharged,” she says.

Hospitalists improve patient care and overall efficiency, says James Abbruzzese, M.D., chair of the Department of Gastrointestinal Medical Oncology. An early and enthusiastic supporter of the practice of hospital medicine, he and his colleagues often refer their acutely ill patients to the hospitalists.

‘Tremendous value’ for patients

“Our faculty has worked closely with the hospitalist service during the past five to six years,” Abbruzzese says. “This relationship not only provides excellent care for patients with GI cancers who require hospital admission, but working together has allowed our faculty to provide their expertise to more new patients coming to the GI Center.

“The arrangement offers tremendous value to our patients.”

A 2010 survey by the National Association of Inpatient Physicians found that more than 7,000 hospitalists practice nationwide. The overwhelming majority of hospitalists practice general internal medicine, though some work in specialized areas like pediatrics or oncology.

What kind of physician is drawn to this intense and demanding career?

“It requires a longer-term commitment to acquire the subset of skills we need, in addition to general aptitude and abilities,” Campagna says.

“And, of course, patients and their families are in crisis and need time and empathy. It’s very dynamic, and interpersonal skills are important. You learn a lot about life’s realities they don’t teach at medical school.”

And it doesn’t hurt to have energy to burn.

“We usually don’t take lunch,” she admits. “We start, and we’re done when we’re done.”

© 2015 The University of Texas MD Anderson Cancer Center