September 19, 2008

I WOULD like the opportunity to correct a number of inaccuracies in your article of Friday, September 12 when some anonymous GPs voiced their concerns about BHB's Hospitalist Programme. We were disappointed that the Mid-Ocean News used such a small part of the statement that was sent by BHB explaining why House Officers are now reporting to Hospitalists. Unfortunately this has led to a number of inaccuracies to which we need to respond so that the community is factually informed.

The Hospitalist Programme gives patients in KEMH the option of being cared for by a Board Certified Internist, called a Hospitalist, who has specialised in hospital patient care.

Privileges for our GPs remain unchanged. GPs can still elect to care for their patients and even if they do, if their patients become critical, our Hospitalists will respond until the GP arrives on-site. Unfortunately the quote from our letter to GPs has been taken out of context. Patients in emergency situations are responded to by our Hospitalists, but we will not take the patient from the GP. Our statement that the patient will not be "automatically transferred to a Hospitalist" in an emergency, simply means that the patient is not permanently transferred to the Hospitalist Programme. We were reassuring GPs who elect to care for their patients that they will remain the responsible physician for a patient, even if a Hospitalist needs to provide an interim response to an emergency. This means when a GP arrives onsite there is no process to transfer the patient back to the GP – he or she can immediately take over.

With regards to House Officers, it should be noted that they are not fully qualified specialists and need greater supervision than GPs are always able to give. This is an issue vital to the quality and safety of patient care in the hospital. House Officers have not completed their specialist physician training, although they are capable of caring for patients as long as adequate oversight is in place. They were originally employed by KEMH to help GPs care for patients in the hospital. However, it was impossible for our House Officers to be supervised adequately by over 45 primary and specialty physicians who could not always be on-site to review their actions.

To ensure the care delivered in the hospital meets high quality and safety standards at all times, we assigned our House Officers to the four Hospitalists at KEMH. Hospitalists are fully trained in House Officers' specific specialty and can provide appropriate oversight. Admissions should never be delayed because of the Programme. GPs can ask a Hospitalist to admit their patient and then have them transferred back to their care, so there should never be a delay unless a GP wishes to admit a patient himself or herself, in which case BHB respects the GPs decision and the patient will wait until his or her GP arrives. However, the practice of having House Officers admit while speaking to a GP by phone is an example of the kinds of practice that occurred only because GPs had no other option before. House Officers are not fully qualified and require on-site guidance if they are assessing a patient and ordering tests. We are sorry if a patient has not had that experience and we would ask the person anonymously quoted in your article to contact us directly so it can be properly investigated.

It should also be noted that GPs can check their patients are being seen daily if they are under the Hospitalist Programme by checking their patients' records. This is a completely transparent process to both patients and their GPs.

Our Hospitalist Programme has only been fully functioning for about a month and already we have noticed increased efficiency and communication between team members and we expect patient, family and staff satisfaction will continue to climb as the program matures. The Board closely monitors satisfaction and other quality indicators and will be looking for evidence in both these areas in the coming months that the Hospitalist Programme is delivering improved care. Certainly our nursing staff has already voiced greater satisfaction with the new system, and the hospital support areas are certainly seeing more activity that indicates more proactive care.

While the Mid-Ocean News article focused on the fact that our Hospitalists charge a fee, it is important to note that this is to reimburse the cost of hiring our Hospitalists. BHB has invested in hiring Board Certified Internists as we believe this is an important investment in quality care for the patient. It is supported by our accreditors, Accreditation Canada, and as part of our ongoing accreditation we expect unscheduled visit by surveyors. We will not know ahead of time when they are coming, so we are aware that at all times our standards of quality and patient safety must be met.

We do welcome hearing back from the community, physicians and patients regarding our Hospitalist Programme. A number of complimentary letters have already been received, but we welcome all feedback. Our goal is to improve and become a hospital our community is proud of. This will take investment, time and it will take some changes. It also needs our community to talk to us about what they see and experience, where we are getting better and where we can still improve. This journey of improvement is why we invested in a Hospitalist Programme. We recognise it is a change and we will continue to monitor closely patient and physician satisfaction, as well as quality and safety clinical indicators to ensure it is achieving its goals of improving the quality and safety of patient care in our hospital.

HERMAN TUCKER

Chairman, BHB