Helpful tips for someone transitioning from Out patient primary care to Hospital Medicine to work as a Hospitalist

The best way to transition to inpatient care from outpatient care is to shadow an experienced hospitalist for a few days to learn the work flow.

There are only 30-35 conditions that patients get admitted with repeatedly. Become thorough with those conditions and your work will become very easy. Ask colleagues to help in the beginning.

Pick up day shift first if you are new to hospital medicine as there will be other hospitalists to help if you need help which you will need for sure. Do not feel shy to ask for help. We learn fast and correctly from colleagues than anywhere else.

Use the admission “order sets” made for some important diagnoses like CHF, TIA/CVA, COPD, sepsis to meet “Core Measures” requirement.

ER physicians are in a hurry to move the patients out of ER. It is understandable. Do not take their diagnosis as final. Many times, patient could have a totally different diagnosis. Just do your own assessment and come up with right diagnosis.

Save all the cell phone numbers of all the consultants as sometimes they are very helpful to communicate for quick patient care.

First thing in the morning, correct electrolyte abnormalities, then see sick patients, then see discharges.

Round with nurse preferably so that you can help patient better. It is the safest thing to do.

Always, start the day on time. If you delay in the morning, the whole day could be delayed causing stress.

Try to finish discharge summaries on the same day.

Always order PRN medications while admitting the patient to reduce pages or texting from nurses later. PRN situations include nausea,insomnia, fever, pain, BP over 160, shortness of breath, constipation, anxiety, agitation, headache, etc.

Always give benefit of doubt to nurses when they say the patient is not doing well. Just go and see the patient ASAP.

Avoid friction with your colleagues, nurses, specialists and for that matter with everyone. You never know who you will need help in future.

Most common diagnoses you see as a hospitalist are: Dizziness, Syncope, TIA, CVA, Epistaxis, Cellulitis, Pneumonia, Viral upper respiratory infections like Influenza, RSV, Rhinovirus, Human Metapneumovirus infection, etc which cause COPD exacerbation, Asthma and CHF exacerbation, Osteomyelitis of toes in diabetics, Ortho consults for joint surgeries for preop clearance, UTI, Urinary retention, Diverticulitis, Pneumonia, Rectal bleeding, Sepsis from different kind of infections, Bowel obstructions [with surgeons], Hepatic encephalopathy, Cirrhosis with ascites, Pleural effusions, Respiratory failure, DVT, PE, Meningitis, Intracranial bleeds, DKA, AKI, CKD, Hypertensive urgency, Hypotension, Code Blue, Hypo and Hyperglycemia, Electrolyte disturbances, Hospice as inpatient if terminal, AFib with RVR, Bradycardia, Diarrhea, C Diff infection, Gastroparesis, Drug seekers, Dementia with behavioral disturbances requiring medications and sitter at bedside, encephalopathy, chest pain, Sickle cell crisis, Patients on vent with PEG, ESRD on HD. etc. I am sure there are a few more. This site covers most of them.

If you have any questions about managing any of the above cases especially initially, do not hesitate to discuss with an other hospitalist until you get a grip over them. Even after that, if in doubt, discuss with someone either hospitalist or a consultant.

Always, talk to the family members about sick patients and explain what you think and what you are doing. If patient is in critical condition, clearly explain that.

Drink enough water in the morning before starting rounds as you may forget later if you are busy.

Sleep well every night so that day time work will be easy.