An Endocrine Specialty Hospitalist Program: Filling an Unmet Need

Presentation Number: SUN 278
Date of Presentation: April 2nd, 2017

Stephen Colgan Clement*1, Michelle Wilson Jeffery2, Shirley Kalwaney3, Nahrain H Alzubaidi4, Min Jin Detrick2 and Madeline Erario2
1test, Fall Church, VA, 2Inova Fairfax Hospital, Falls Church, VA, 3Inova Fairfax Hospital, 4Private Practice Endocrinologist, Fairfax, VA

Abstract

INOVA Fairfax hospital is a 894 bed multi-specialty community-based teaching hospital in northern Virginia. During the years 2000-2013, the number of endocrine practices that performed hospital visits diminished until there was not a single practice to perform hospital consultations. To fill this unmet need, the Department of Medicine obtained approval to recruit an adult endocrinologist (SCC) whose practice was restricted to providing inpatient consultations and follow up hospital care.

Methods: Two quality metrics were collected during the 2014-2016: readmission rate for diabetes and a physician satisfaction survey. The satisfaction survey was sent to all staff physicians who care for adult patients.

Results: Average monthly patient encounters (both new consults and follow up visits) grew significantly: 168, 182, 366 per month for the years 2014, 2015 and 2016, respectively (P < .0001 for trend). This growth allowed the Endocrine Specialty Practice program to hire an additional endocrinologist (MWJ), an internist ( SK, .2 Full time equivalent), a Physician’s Assistant (MJD), and a part time community endocrinologist (NHA). As the needs of the service grew, the role of the Endocrinologist-led team expanded to include perioperative diabetes management and comprehensive discharge planning for patients with diabetes. The spectrum of problems addressed were diabetes (77%), adrenal (4%), pituitary (6%), hyponatremia (4%), thyroid (6%) and other metabolic problems (3%). The subgroup of patients with a diagnosis of diabetes that were seen by the consult service had a reduced 30-day re-admission rate (9.46% vs. expected rate of 13.9%) during a 4 month observation period. The physician satisfaction survey: Eighty-one percent of respondents rated the endocrine consult service at the highest mark for answering the consult within 24 hours and 94% of respondents rated the service at the highest mark for adequately addressing their request. Free-text feedback was provided by 50% of the survey respondents. All the free-test comments were positive except for one physician who was not aware that an endocrine consult service was available.

We conclude that there is likely an unmet need for endocrinology consultative care in large community hospitals. This need can be adequately met by an endocrine hospitalist-led team.

 

Nothing to Disclose: SCC, MWJ, SK, NHA, MJD, ME