7AM-7PM Hospitalist Shift

I am an IM hospitalist. I will briefly tell how a typical hospitalist day goes.

It may slightly be different for different hospitalists and different in different hospitals. But I will describe how it’s like in a typical community hospital.

5:30-6:00am: Wake up.

7:00am. Reach the hospital. Team leader or nocturnists distribute the patients equally among all the rounding day time hospitalists. You will carry your own patients from yesterday but may get some more new ones who got admitted over the previous day by admitting shift hospitalists and by nocturnists. You may have anywhere between 10 to 20 patients each day depending on your hospital. Most hospitals do geographic rounds [Floor wise] and some may not do.

8:00am. You may start rounding anytime after 7am. You may take one hour to read about all your patients and also you may have breakfast and talk to your colleagues until 8am. This is very variable.

To begin with, print your complete patient list for the day. Check all the lab results from AM labs for all your patients and from the previous day. Read H&P for your new patients and formulate a plan for the day and write on your patient list. Correct electrolyte disturbances if any. Correcting the electrolyte disturbances reduces number of pages you get during the rest of the day saving you a lot of time. Scribble all this info on your patient list that you printed for the day.

Make sure important prior to admission [Home] medications like seizure meds, levothyroxine, Symbicort/Advair, psych meds etc, were ordered by admitters and make sure required consults were placed.

Review nursing notes and nocturnist notes if any on your patients from overnight to look for any events that happened at night.

Realize that nothing you do or say in front of others is Off-The-Record. Be very professional in dealing with anybody in the work place.

Always PRIORITIZE. First, see sick patients if any. You can know your sick patients by getting sign out from the nocturnists and also by looking at AM lab results and RN may page you first thing in the morning if your patient is sick.

After that, see patients who can be discharged today and then the rest is easy. Every day focus on discharging as many patients as possible.

9 am. Interdisciplinary team rounds/multidisciplinary rounds or huddle. The time and style of these rounds varies per institution.  You discuss about each patient with support staff including RN, charge nurse, Social worker, case manager, PT, OT etc. You tell them the treatment and discharge plan for each patient. Tell what kind of follow up appts need to be made prior to discharge if you have dedicated schedulers.

Some hospitals have MD-RN dyad system to round. You both round together and see patients. This helps you to get minute details about the patient from the nurse and also it reduces the number of pages to you from the nurse later.

Try to sit down when you are seeing a patient at bedside.

If you come across an upset patient, keep yourself calm when they are talking. Try to find out the reason why they are upset and what you can do about it. Sometimes, risk management may need to be involved.

12:00pm. Lunch time and probably grand rounds once a week or may be lunch time meeting in your office with your medical director (once in a while).

1:00pm. You can start rounding again.

Come back to your office whenever you are done. During the course of the day, depending on where you work, you may get one or two admissions if the admitting shift hospitalist is overwhelmed with admissions from ER.

Talk to the consultants whenever you need to, especially if your patient is sick. Ask for their cell phone numbers when you meet them in person. These cell numbers are of tremendous help later, you will realize why. Your life will get lot better if you have cell numbers of almost every specialist. If you are new, ask experienced hospitalists for these cell numbers when you need to talk to a specialist. They usually have them.

Call family members of elderly and sick patients. This is very important for various purposes like reducing their anxiety, HCAHPS scores, minimize medico-legal issues and improving patient care by getting more information from the family.

You may have family meetings with families of sick patients who are not doing well a few times a week.

Some days you may be very busy and some other days it may go smoothly. Try to relax for a few minutes every couple of hours as the shifts are 12hrs long. Some hospitals allow you to leave home once you are done with your work and some do not.

Things to remember before leaving for the day: 

1. Did you do all the discharge summaries for the day? It takes more time to do later.

2. Did you order Coumadin on the patient you needed to? Did you order AM labs for the next day?

3. Is any patient so sick that you need to sign out to night team?

4. Did you bill for all your patients that you saw today?

5. Did you collect your cell phone and ID badge from your coat to take home? You will be surprised that you may forget those many times.

Do not be in a rush to go home as it increases anxiety and you may forget something that needs to be done on a patient. I like diluting my work by pacing well so that I am not too stressed.

Try to live in close proximity to the hospital so that over a period of years you save enormous amount of time.

Sleep at least 7-8 hrs a night during the week you are working. The better the sleep at night is, the easier the work would be the next day.

Do not feel shy to ask for help from other hospitalists. Even the most experienced hospitalists ask for other’s help regularly. No one judges you for asking for help.

Plan for the next day possible or actual discharges by finishing discharge medication reconciliation and discharge instructions if you have free time in the later part of the day.

Hospitalist work is a marathon, not a sprint. Enjoy it with a nice pace.

Always, learn the culture of the facility first when you start newly. Listen to those who have been working there for years.

Be humble and nice to nurses, PT, OT, RT, consultants and everybody you meet in the hospital. Do not focus on complaining but focus on finding solutions. Keep calm.

Good luck.