It’s 3 a.m. and a patient has come to the emergency room with chest pains. Dr. Jason Cadwallader is at the bedside in minutes.
Cadwallader spends 12-hour shifts at Johnson Memorial Hospital for a week. From 8 a.m. to 8 p.m., Cadwallader is the doctor who sees every patient who needs immediate care in the hospital. Some days, that can mean seeing up to 17 patients.
But with Cadwallader seeing those patients, doctors who see patients in their own office won’t need to be called into the hospital. That saves money and time, since those specialists are then free to see more patients for daytime appointments, handling issues such as adjusting medication or treating a consistent pain, before they require a hospital visit.
Cadwallader is a hospitalist, or a doctor who works strictly for the hospital. In the past year, Johnson Memorial Hospital created two full-time hospitalist positions who care for patients with any kind of medical need 24/7.
The position has become more common in hospitals across the state and nation. Franciscan St. Francis Health recently created an acute cardiology hospitalist program to help with the rising number of cardiology patients coming through the door. Community Hospital South also has hospitalists who provide patient care.
Hospitalists treat the most extreme cases on a day-to-day basis — from a heart attack to suturing a wound. The doctors studied internal medicine and have specific training to be ready for any case that comes through the door.
Before hospitalists, local physicians were called in to the hospital when immediate medical attention was needed. That required them to take time off from their practice to work overnight. Eventually, those same physicians urged the hospital to create the hospitalist program since the need for a doctor on-site was in such demand, Johnson Memorial Hospital director of business development Bill Oakes said.
On some shifts, as many as 20 patients would need to be seen by a doctor who rotated out of the hospital each day. Doctors would make their rounds at the hospital then go to their practice to see patients in their office. If that same doctor were called into the hospital for an emergency, their office schedule would become backed up, and the patient at the hospital had to wait for the doctor to arrive.
Doctors knew those cases could better be handled by a hospitalist, who could consistently be at the hospital for seven days straight. With hospitalists on site 24 hours a day, they can see a patient within minutes, and the other specialists can continue their office schedule without interruption.
By using a hospitalist program, patients can have a shorter stay at the hospital, said Dr. Randall Lee, vice president of clinical performance at Community Hospital South.
Community Hospital South put a hospitalist program in place in September 2011 in order to meet the demands of a growing number of patients with more complex issues, including diabetes, antibiotic resistance, newly discovered viruses and substance abuse, Lee said.
While most hospitals, including Community Hospital South and Johnson Memorial Hospital, now have a general hospitalist program in place, Franciscan St. Francis Health created a cardiology-specific hospitalist position.
Its cardiology department has five full-time doctors, but after-hours, a team of three cardiovascular hospitalists take over in order to provide constant care for patients overnight. Doctors Emmanuel Sarpong, Louis Landman and the recently added Jerome Cordova spearhead the cardiovascular hospitalist program, which is one of the first in the nation.
Six to 10 cardiovascular patients are admitted overnight, Franciscan St. Francis Health interventional cardiologist Dr. Saeed R. Shaikh said.
In addition to admitting patients through the emergency room, the cardiology-specific hospitalists manage patients already in the hospital, oversee patients transferred from other hospitals and work with patients in case any cardiovascular issues arise.
The faster a doctor can see the patient, the shorter their stay can be in the hospital, Shaikh said.
“In order to provide better care, the doctors need to be in the hospital,” Shaikh said.
That 24-hour care is the best way to treat patients’ needs in the hospital and for specialists to be able to be proactive to avoid a hospital visit for their patients in the future, Shaikh said.
“The cardiologists are more available to see patients during the day where they can more closely manage the patients’ disease process by adjusting medications and making recommendations to try and keep them out of the emergency room,” he said.
With patients taken care of throughout the night, the cardiologists can see more patients during the day, Shaikh said.
Allowing the cardiologists to have a more set schedule during the day solves an unmet need. Too many patients needed to see a doctor, but many doctors could not schedule a full day of appointments since they worked both day and night, Shaikh said.
The hospital also runs more efficiently since no one has to wait at least 30 minutes for a doctor to arrive. Instead, nurses can get the hospitalist who is in the building, ready to see patients. This gives patients immediate care, and the patient can leave the hospital sooner, Shaikh said.
What: A doctor who works specifically for a hospital. The doctor sees any new patient within minutes of walking through the door
Where: Johnson Memorial, Community Hospital South, Franciscan St. Francis Health-Indianapolis
When: Hospitalist programs have been created within the past three years in central Indiana.