Teaching Service
The teaching service at Denver Health consists of six teams; each team is composed of an attending, one intern, one senior resident, one sub-intern and one third year medical student. Patients on these services have a broad spectrum of diagnoses. Individual team’s census averages 12 patients with a maximum of 14. While on teaching rounds, we have the privilege to round with a pharmacist as well as a Spanish interpreter if needed. Multidisciplinary teams are a key foundation for our patients’ care. They include but are not limited to the patient’s physicians, students, pharmacists, a social worker, case manager, nursing plus any ancillary services that are needed. While on the teaching service, our attendings are encouraged to attend noon conference with their teams as well as invited to participate all year round. Opportunities throughout the year are also available for our faculty to provide didactic teaching or run noon conference.
Non-Teaching Service
We currently have three acute medicine services that are comprised of one physician and either a nurse practioner or physician assistant. Patients on these services have a broad range of diagnoses. In the next year, we anticipate expansion of these services to include at least one additional team. Multidisciplinary teams are a key foundation for our patients’ care. They include but are not limited to the patient’s physician, nurse practioner or physician assistant, a social worker, case manager, nursing plus any ancillary services that are needed.
A small group of Hospitalists at Denver Health manage the ACUTE Center for Eating Disorders at Denver Health Medical Center. ACUTE is a nationally unique medical stabilization center serving the country's most medically compromised patients with anorexia nervosa. Dr. Philip S. Mehler, Denver Health's Chief Medical Officer and the world’s expert in the internal medicine of eating disorders, serves as the Medical Director. Patients ages 17 and up are referred from around the country by eating disorder programs, individual clinicians, and other hospitals who lack expertise in this field. With a mean admission BMI of 12.6 kg/m2, average age of 26 years old and often severe multi-organ failure, these patients receive the best of evidence based treatment, provided by a truly multi-disciplinary team. This team includes Hospitalists, registered dieticians, physical therapists, nurses and psychotherapists both from within ACUTE and from an outstanding local eating disorder program, the Eating Recovery Center (ERC). Patients are treated and supported through early re-feeding and then transfer directly to eating disorder programs around the country. ACUTE is a 5 bed unit on one of the hospital's medical floors with an average length of stay is 16 days. ACUTE has proven very academically productive, with multiple peer-reviewed publications, posters, and presentations at national meetings.
The Procedure service was developed in May of 2009 to provide high quality of care in patients requiring bedside procedures. This service was initially intended to assist hospitalist in non-teaching teams but quickly expanded to the Internal Medicine house-staff teams and surgical services on the floor. This team currently performs central venous catheter insertions, thoracentesis, paracentesis and lumbar puncture seven days a week.
The Procedure team has achieved zero central line associated blood stream infection rate in the first two years of service as well as a low rate of mechanical complication and 99% success rate of procedures.
Hospitalist physicians attending on the Procedure team also work with midlevel providers in the Oasis team. The Oasis service is involved in care of patients with complex disposition and those awaiting placement in a long term care facility.
The Admitting and Patient Flow Service was created in 2009 to address Emergency Department (ED) over-crowding, diversion and care of boarded ED patients. The main two functions of Telluride service are (1) to provide ongoing care for medicine patients boarded in the ED awaiting inpatient beds and (2) to work with the nursing supervisor at our institution to improve patient flow by adding physician clinical expertise to bed management. The Admitting/Patient flow service has reduced the proportion of total hours on divert due to medicine bed capacity from 4.5% to 3.3%. This 1.2% decrease in ED diversion extrapolates to approximately 100 hours less of ED diversion yearly. This service also reduced the percentage of patients transferred to a medicine floor and discharged within eight hours from 1.5% to 0.5% and increased the number of discharges from the ED of admitted medicine patients from 4.9% to 7.9% all of which aids in hospital flow. The physicians who serve on the Admitting/Patient Flow service are academically active and have presented their data at national meetings.
The Chest Pain Observation Unit (CPOU) is a consult service provided by the Hospitalists to aid the Emergency Room physicians in the evaluation of patients presenting with chest pain. This service is provided 24 hours a day and 7 days a week. The main objective of the consult is to determine whether patients meet criteria for exercise treadmill testing. Such tests are available 7 days a week and are completed within 24 hours of the initial consult.
The Clinical Transition Unit is a 5 bed, 24 hour observation unit located adjacent to the emergency department. This unit is managed by hospitalist physicians and midlevel providers with a dedicated nursing staff. There are strict inclusion and exclusion criteria guiding admission into this unit. In addition, order sets to simplify the admission process are in development. This unit cares for 80 to 120 patients per month and has decreased the total number of observation hours in the hospital for patients admitted to medicine under observation status.
The medicine consult program was the first service provided by our division and continues to be an integral part of hospital medicine at Denver Health. The medical consult team works closely with our colleagues in psychiatry, neurology, physical medicine and rehabilitation, anesthesia, the emergency department, the pre-operative clinic, general surgery and the surgical subspecialties. Internal medicine consults address both acute medical questions as well as peri-operative management of medical co-morbidities on total joint replacement, gastric bypass and oral maxillary-facial surgical patients during their time in the hospital. A small group of hospitalists round daily on medicine consult patients during the day but urgent medical consultation is provided by our group 24 hours a day.