This letter is in response to the cover story, “Integrated ED-hospitalist services: coming to a hospital near you?” in the November 2014 issue. I was disappointed to see that all the proponents of such services had a vested interest in promoting them. They pointed to intangible quality and operational benefits of integration without offering any quantifiable improvements as evidence or, more importantly, of how integrated services specifically produced those improvements.
I have always found ED-hospitalist integration troubling. The natural tension between an ED physician, who tends to err on the side of admitting patients, and a hospitalist, who needs to justify the medical necessity of the admission and subsequent treatment, serves to ensure that patients are not needlessly admitted. In my opinion, the specter of questionable hospital admissions is raised when both lines are incentivized to achieve the same metrics in an integrated service environment.
Innovative Solutions Consulting LLC