Swedish Medical Center

Hospitalist Service

Per Danielsson, MD
Medical Director, Adult Hospitalist Team

Purpose: To provide an opportunity to work as an integral member of an experienced and proficient hospitalist team.

Description: Available to senior level Internal Medicine residents (R2 and R3 years), this one month long elective rotation is offered to one resident per month. Residents will join the Swedish Adult Hospitalist Team (AHT), directed by Dr. Per Danielsson. The Swedish Adult Hospitalist Team has 19 physicians, three to four of whom are working during the day at the First Hill campus where this rotation is located. There are also 2 dedicated nocturnists at First Hill, but this elective rotation does not involve any overnight call for residents.

As a member of the team, it is expected that residents will admit patients to the ICU and medicine wards, and manage their care during the hospitalization until discharge. Efforts will be made to select the patients who offer the greatest learning opportunity. Residents will be expected to build and care for a limited panel of inpatients (six to eight) as determined by patient complexity and resident ability and interest. Residents are expected to start at 7 a.m. when the physicians meet in their team room to get sign out from the nocturnist. As integral members of a hospitalist team, residents will be expected to dictate both admission notes and discharge summaries, following a prescribed format that is specific to the hospitalist team.

Residents will work approximately 45-50 hours per week, with evenings and weekends off. Residents will sign out their patients at night to the covering nocturnist, and are not expected to provide care to their patients at night. Similarly, on weekends, residents will sign out their patients to the attendings on the Swedish Adult Hospitalist Team. Throughout this rotation, the residents will be supported and supervised by Swedish AHT physicians, and all admissions will need to be reviewed by a Swedish AHT attending shortly after admission.

Learning Objectives: The rotation offers exposure to all the activities of a busy hospitalist service caring for inpatients at a large urban tertiary care hospital. Emphasis will be placed on creating a valuable learning experience rather than meeting the service needs of the medical group. Issues encountered will include appropriate utilization of resources, triaging efficiently and effectively, end of life care, relationships with subspecialty consultants, and coordination of care with outpatient physicians as well as allied health professionals (PT, OT, Nutrition, Social Services, Discharge Planner etc). There will also be opportunities to participate in some of the ongoing quality improvement projects that Swedish AHT physicians are working on, and if there is interest, to explore some of the economic challenges and opportunities that are presented to hospitalist teams today. The resident will discuss cases in more detail with the supervising attendings as 2 or more physicians from the team frequently meet for lunch in their team room. We hope this venue will give the residents a unique opportunity to discuss with practicing hospitalists not only medical aspects of a case, but also practice-specific issues for hospitalists. In addition, updates from the medical literature on 8-10 topics will be reviewed each month with the resident on the team.