[Feature] Surgical hospitalists band together

Surgical hospitalists have formed an association. Their purpose is to share know-how with one another and play a role in helping the pilot project take root in medical fields and become institutionalized.

Currently, 15 surgical hospitalists are working at five hospitals – four each at Yonsei University Health System (YUHS), Samsung Medical Center and Inha University Hospital, two at Seoul National University Hospital, and one at National Medical Center. They got together to launch the “Surgical Hospitalists’ Research Society,” and held their inaugural meeting on March 31. Ten out of the 15 surgical hospitalists attended the meeting.

Professor Jung Eun-joo, who is working as a surgical hospitalist at Yonsei, will serve as the head of the group. Prof. Jung became the talk of the medical community when she opted to take the non-regular job of surgical hospitalist, leaving the stable position of an associate professor at the surgery department of a university hospital. YUHS has hired Jung and three other surgical hospitalists to operate its Nos. 145 and 146 wards as those exclusively for surgical hospitalists. Patients hospitalized at the wards of surgical hospitalists pay 3,000 won ($2.8) more than others in hospital bills.

In an interview with Korea Biomedical Review, Professor Jung emphasized the need for surgical hospitalists to treat patients after surgery more efficiently and help them recover quickly. Particularly, Jung said, she had come to form the research group to share with other surgical hospitalists her experiences of the past one year during which she strived to establish her ward’s position firmly by, for instance, coordinating the spheres of business.

Surgical Hospitalists Research Society holds its inaugural meeting on March 31.

Question: What are reasons for forming the Surgical Hospitalists’ Research Society?
Answer: There are fewer hospitals and doctors engaged in the pilot projects of running the hospitalist system for surgery department, compared with internal medicine department. YUHS, too, started the pilot project for surgical hospitalists in earnest in May last year. It also has undergone numerous trials and errors over the past year. Hospitals that started pilot projects later than us have asked about our operating system frequently. So we thought it would be good to share our know-how with others, and launched the research group.

Q: What are the projects on which you put the priority?
A: We will begin by grasping the current situation. Applying our hospital’s system to other hospitals is impossible. Different hospitals have different conditions with varying numbers of hospitalists and types of patients. We will understand how each hospital is being run and create Korea’s standardized system.
In the case of internal medicine hospitalists, we have several foreign models to benchmark. As far as surgical hospitalists are concerned, we have few examples to follow as even the U.S. is just at a beginning stage. We have to create our own from the start. We will grasp the situation at each hospital and find out ways for improving the system.

Q: Surgical hospitalists are lesser known than their counterparts in internal medicine. What are differences, if any?
A: The two are similar in part but dissimilar in many ways. They are identical in that both treat hospitalized patients. A significant difference between the two is surgical hospitalists treat patients who had the operation. To treat surgery patients, one needs to have a high level of understanding about the operation. She or he needs to understand sufficiently what happens within the operating room and what process a specific operation undergoes. As surgical specialists with a good understanding about such a process treat patients, there are gaps in the quality of treatment.

When there were no surgical specialists, medical residents were mainly responsible for treating inpatients. Since the implementation of the law for improving training environment for medical residents and advance their status, however, their training environment has changed. Also, patients have asked to be treated by specialists, well aware of the difference between specialists and residents. To meet the changing climate, surgical hospitalists have come to become necessary to treat in-patients at wards, naturally leading to the enhanced safety of patients and improved quality of treatments.

Q: What is the difference between wards with surgical hospitals and those without them?
A: Above all, patients can meet specialists more frequently. In the case of surgical hospitalist wards at YUHS, doctors are doing three or found rounds a day. They make morning rounds and visit patients briefly once more to explain decisions. After lunch, they make another round if there are newly hospitalized patients, and go to patients in between to meet patients who returned to the ward after an operation. Lastly, they make one more round before leaving the hospital for the day and deal with problems that may occur during the night. As specialists stationed at the ward, they can also run into patients frequently shuttling back and forth.

When doctors talk with patients and their guardians, they can also explain about long-term treatment in detail, deepening the latter’s trust in the hospital. As operation requires plunging a scalpel into patients’ body, we need to consider the possibilities of complications. Wards with surgical hospitalists have the advantage of diagnosing complications early.

Professor Jung Eun-joo, who is working as a surgical hospitalist at Yonsei University Health System, talks about why she launched the research association, in a recent interview with Korea Biomedical Review.

Q: How are medical workers and patients satisfied with wards having surgical hospitalists?

A: We surveyed nurses, and got 8.2 points out of 10 regarding the overall system of surgical hospitalists. Nurses gave unusually high points to smooth communication, sharing of treatment plans, and the speed of response. Formerly, they had several doctors for patients hospitalized at the ward. Now, however, nurses have only to report to one specialist at the ward.

Patients’ satisfaction is also high. For example, there was a patient who had been hospitalized in a ward with surgical hospitalists and left the hospital later. When he was re-hospitalized for a different disease, he was hospitalized at an ordinary ward (without surgical hospitalists). We received a complaint from the patient for not being treated by surgical hospitalists.

Q: What is the optimal number of patients per surgical hospitalist?

A: In the pilot-project stage, we think up to 25 patients are proper for a hospitalist to handle. YUHS is also trying to maintain that level. Currently, two YUHS wards (Nos. 145 and 146) are being run as those exclusively for surgical hospitalists, and we have recently hired one more specialist to increase the total from three to four. And we are planning to a system with the aim of increasing the number of patients from 50 to 69, too. Our specialists are working only during daytime.

Q: Don’t you have any difficulties determining work boundaries?

A: Surgical hospitalists at YUHS are responsible for overall treatment before and after operations, such as managing wounds and pain, diet and nutrition, treatments at wards, early diagnosis of complications and their treatments. When I began work as a surgical hospitalist, I felt confused because work boundaries were not clear. So we started by setting minimal work sphere and kept readjusting them while continuing to work by exchanging opinions between professors, residents and nurses. A year later, much of the ambiguity has disappeared. However, we are still in the process of rearrangement.

Q: There are not many doctors who apply in response to wanted ads. What are the reasons as you see it from the field?
A: First of all, they still do not know precisely what surgical hospitalists are doing. The sphere of business is not specific and their statuses are unstable as contract workers. It is difficult to set everything explicitly from the start, though. If the system takes its root, much of uncertainty will likely disappear. We will also be able to determine work boundaries more clearly. Notably, for the hospitalist system to get settled in the field, the government should provide systemic support, not leaving all to hospitals.

Different hospitals have different environments. YUHS had many medical workers who understood the need for this system. And there was a consensus that only when this system is established well, can the nation change its hospitals and its entire healthcare system. That made our discussions easier than elsewhere. There are many hospitals where the situation is different from ours, however. They tend to think the system is for filling up the workforce, which became short with the implementation of the new law on medical residents. That explains why we plan to discuss the roles of surgical hospitalists and share our views at this research society.

Q: What is your advice for surgical specialists interested in hospitalist system?

A: I, too, had fear when I took this path. However, I chose it thinking it would help our country’s healthcare sector. As I see it, becoming surgical hospitalists is like launching a startup business. There is nothing wrong with following the trodden path, but it is also good to take the road of a startup with challenging spirits.

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