Harborview Service Descriptions
Hospital Medicine Service
The physicians who are part of the Hospital Medicine Program (HMP) are deeply dedicated to the broader mission of Harborview Medical Center to care for the community’s most vulnerable population which includes those with mental illness, substance abuse, indigent without insurance, persons incarcerated in the King County Jail, non-English speaking poor and victims of domestic and sexual assault. Harborview Medical Center also serves as a Level I Trauma referral center for the Pacific Northwest region of the United States. The HMP has special arrangements with our surgical colleagues to care for medically complex patients who are admitted for primarily surgical issues, typically related to trauma.
Med H: Medicine Hospitalist
Medicine Hospitalist or Med H has come to represent the primary inpatient medicine service of the Hospital Medicine Program. It is through the services of Med H that the hospitalists provide traditional medicine care to the patients of Harborview. Med H consists of three services: Hospital Medicine Service, Medicine Consult Service and Nocturnal Medicine.
Hospital Medicine Service (HMS)
The Hospital Medicine Service (HMS) is a traditional hospital medicine service in which an attending physician provides all aspects of direct patient care. There are currently three attendings on three HMS teams which are staffed seven days per week. We care for close to 50% of all medicine patients who are admitted to Harborview and have an independent admitting cycle that is separate from the resident run ward service. We provide 24-hour attending level coverage for our patients through the assistance of our nocturnists. The vast majority of our patients on HMS are socially underserviced. Physicians who staff HMS must be dedicated to the broader mission of Harborview to care for the community’s most vulnerable populations. Although HMS is primarily a clinical service, there are occasionally residents who rotate on this service providing opportunities for teaching.
Medicine Consult Service (MCS)
The Medicine Consult Service (MCS) provides traditional medicine consults to non-medicine services throughout Harborview. A single attending on service provides daytime staffing seven days per week. Consults at Harborview most commonly come from our large inpatient psychiatry services and extensive surgical services (orthopedic, neurosurgical, vascular, otolaryngology, etc.) who consult us for medically complex surgical patients typically admitted after non-elective surgery related to trauma. There are often learners (medical students, medicine and subspecialty residents) who are part of this team.
Nocturnal Medicine (NocMed)
The Nocturnal Medicine (NocMed) service plays a critical role within the Med H services structure. A single attending physician provides critical cross-cover for the Hospital Medicine Service (HMS) which allows us to maintain 24-hour attending level care. The nocturnists also admit patients during the night that are then signed over to the attendings on the HMS the following morning. The most interesting medical patients at Harborview are admitted in the evening, the vast majority of them are new problems admitted through the Emergency Department. As the sole attending-level medicine physician in the hospital overnight, the nocturnists are a key reference for medicine residents admitting on the ward services. The nocturnists participate in dedicated teaching sessions for residents during the evening hours.
Medicine Operative Consult Clinic
The Medicine Operative Consult Clinic (MOCC) provides comprehensive perioperative medicine consultations to patients undergoing elective surgery at Harborview. In addition to a reputation for excellent trauma care, Harborview also serves as a center for excellence in elective subspecialty surgery, such as neurosurgery, orthopedic and vascular surgery. Medically complex surgical patients are referred to the MOCC for perioperative evaluation and management. Attending who staff the MOCC will evaluate patient for half a day in a clinic setting and spend the other half-day in the inpatient setting performing post-op evaluations. The service is staffed five days per week. In the clinic, physicians perform perioperative evaluation and develop management plans. We work closely with our surgical colleagues to provide seamless comprehensive perioperative care for our mutual patients. Patient seen in our clinic are followed closely from our initial evaluation through the post-op period. Communication with the patient’s primary care and specialty providers is maintained through the perioperative period. All patients seen in MOCC are evaluated and monitored post-operatively while in the hospital, with the attending providing consultative support for any medical issues that may arise. There are residents who participate in the clinic and post-op inpatient setting allowing for teaching opportunities.
The After Care Clinic (ACC) at Harborview provides transitional care for patients recently discharged from the inpatient services or the Emergency Department who require urgent follow-up, but lack a primary care provider. Physicians in the Hospital Medicine Program have the opportunity to participate in this vital clinic if there is an interest in transitions of care.