Home From The Editor Taking a new critical look

Taking a new critical look

August 2008

Published in the August 08 issue of Today’s Hospitalist

WHEN IT COMES TO the quality improvement movement, rapid response teams are often viewed as the gold standard of how to improve care and save lives. So why do many of the hospitalists interviewed in this month’s cover story talk about problems they have with implementing the concept?

It’s not that hospitalists think that rapid response teams don’t work, or that they shouldn’t play an important role on these teams. The problem is that some physicians feel like they’re being taken advantage of and they’re questioning what their role should be.

Turf issues are rampant in medicine, particularly in the inpatient setting, but I get the sense that hospitalists’ concerns with rapid response teams are more complex than arguing over who should care for which patients. Put simply, hospitalists are beginning to take a harder look at some of the conventional wisdom surrounding inpatient medicine.

In a similar vein, our coverage of surgical comanagement asks a simple question: Do all surgical patients “particularly a healthy 70-year-old undergoing an elective knee replacement “really need to be comanaged? It’s a good question, considering that the evidence behind the benefits of comanagement (just like the evidence behind rapid response teams) is mixed.

Like rapid response teams, belief in the value of comanagement arrangements has quickly become dogma in many U.S. hospitals. It’s not insignificant that both services are helping drive the growth of hospital medicine.

But while hospitalists as a group have always been eager to pitch in whenever they can improve care, it’s a good thing that the specialty is taking a step back and scrutinizing some of these services. That kind of critical thinking will help not only hospitalists, but their patients.

edoyleEdward Doyle
Editor and Publisher