b'The post-acute care journey is now squarely withinThe integration of these two teams also remains the hospitalists purview. This includes identifyingessential for optimizing quality outcomes, including the appropriate next site of care for each patient andsepsis and antibiotic administration, as well as mortality proactively teaming up with other care providers. Thiswith early discussion of advanced directives.could include care coordination with external resources such as Skilled Nursing Facilities (SNFs), hospital atSecond, the post-COVID hospitalist is critical to home programs, primary care offices, or communicatingmanaging the continuum of inpatient care. From the with home health resources, family caregivers, or homemorning sign-in/out of the nocturnist (be they onsite or nursing aids to support adherence to care plans. virtual) for new admissions and change in status, to the morning multi-disciplinary rounding with all participants Reducing Cost in the transitions of care (nursing, case management, We can also evolve the cost side of the equation bySNF or swing bed, hospice, inpatient rehab, home renewing focus in several areas including the expandinghealth, etc.), assuring discharge orders by 11:00 am, physician-led teams, ensuring throughput optimization,the identification and prioritization of tomorrows and advancing telemedicine. discharges, afternoon barrier rounds to further identify root causes of discharge failures, to telemetry andstepdown assignments, hospitalists continue to re-Expanding Physician-Led TeamsSince the beginning of hospital medicine, advanceddefine inpatient process improvement.practice providers (APPs) have been critical to expandingphysician reach. With continued cost pressure, as well asIntegrating Telenocturnistspost-COVID physician demand, APPs remain a valuablePre-pandemic, telehospitalist programs were primarily part of the hospital medicine care teams.used to supplement nighttime and weekend coverage in facilities where the patient volume would not support With the inclusion of APPs both in clinical and non- on-site physician coverage expense. The goal then, as clinical roles, the care team can manage larger patientnow, is to help communities and rural hospitals ensure panels with more flexibility for changes in acuity24/7 coverage for its inpatient population while reducing and meeting discharge timelines. Challenges to APPburnout and overwork for the physicians providing the integration continue to surround local medical staffcare. cultures and facility by-law restrictions.During the COVID surges, hospitalists were frequentlyfaced with a patient census that would double or Ensuring Throughput OptimizationThere is no question that one of the driving pressuressometimes triple in a matter of a few days, or even of the past two decades in hospital medicine has beenovernight. Additionally, and especially prior to the imperative to manage throughput more efficiently.vaccination availability, many hospitalists found Hospitalists must continue this primary focus.themselves on the sideline with their own COVID infections and exposures. First, the skyrocketing of ED hold times seen during the pandemic brought a new requirement for the EM andPost-pandemic, the hospital medicine programs can HM teams to not only work more collaboratively, butleverage the telenocturnist role to handle these surges also be viewed as a single team. From the developmentin volume, not just for COVID, but for any significant and of admission protocols to the ED dedicated hospitalistunexpected change.and HM admitter shifts, as well as the regular cadenceof EM and HM leaders meeting to discuss bottlenecksAdopting Teleadmissionistsand process flow, all are tactics to facilitate keeping theSurges in volume revealed the need, at times, for a front door to the hospital open to capacity needs.dedicated teleadmissionista physician who can work across multiple facilities to smooth the admissions process. By reimagining the role, this can be available 24/7, yet only actually provided and paid for when necessary.Together, we healTogether, we heal 5Together, we heal SCP HEALTHIA NEW HOSPITAL MEDICINE EQUATION FOR A POST-COVID FUTURE'