A hospitalist system in Korea began in August 2016. Patient safety issues, resident law, and reduction of resident numbers in Korea are leading to an increase in the demand for hospitalist in Korea. The roles and responsibilities of GI hospitalists have not been established. Therefore, cooperation among the Korean society of gastroenterology, each hospital, and government is necessary. In particular, it is important to prepare an education program for gastroenterology hospitalists.
Education ; Gastroenterology ; Hospitalists ; Humans ; Inpatients ; Jurisprudence ; Korea ; Patient Safety

BACKGROUND: The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS: A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS: HG LOS (median, interquartile range [IQR], 8 [5–12] days) was lower than NHG LOS (median [IQR], 10 [7–15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5–12] vs. 10 [7–16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION: Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.
Comorbidity ; Emergency Service, Hospital ; Employment ; Hospital Mortality ; Hospitalists ; Humans ; Korea ; Length of Stay ; Patients' Rooms ; Pneumonia ; Retrospective Studies ; Urinary Tract Infections

No abstract available.
Hospitalists ; Humans ; Korea

Resident law was enacted to improve the training environment and working conditions. However, the law caused confusion in the field and resulted in a medical vacuum in inpatient care. It also resulted in a lack of training time. A hospitalist system was introduced to improve the quality of patient care and to cover the shortage of residents. This study aimed to outline a development strategy for hospitalists participation in resident education in Korea. The result of pilot study of the hospitalists in Korea showed that patients, nurses, and residents were satisfied with hospitalists. Eighty-five percent of surgical residents were helped in postoperative patient care and 70.7% of residents were willing to work with a hospitalist. The competency of surgical hospitalists includes understanding surgery and the appropriate management of postoperative complications. In order to shift the paradigm of resident education, the Korean government must pay the expenses for resident training. Through hospitalists' participation in the resident training, it may be possible to provide residents with more comprehensive and continuous education for inpatient care.
Education ; Hospital Medicine ; Hospitalists ; Humans ; Inpatients ; Internship and Residency ; Jurisprudence ; Korea ; Patient Care ; Pilot Projects ; Postoperative Complications ; Vacuum

As the need for medical services increases, interest in the quality improvement of healthcare and patient safety is also increasing. This study aimed to propose a surgical hospitalist or surgicalist system in Korea. Specifically, it has been suggested that the essential capacities of the surgicalist, including their understanding of surgery, wound management, emergency management, surgical nutrition, and education, may be useful in improving the quality of healthcare and patient safety. The key characteristic of the surgicalist system is that surgeons are “readily available” in the hospital ward to provide primary care for hospitalized patients. Surgicalists provide both perioperative and advanced primary care. As the population ages, the number of high-risk patients who are undergoing major operations increases. The surgicalist system, which is responsible for the perioperative management and advanced primary care of inpatients, is expected to expand rapidly. The shift from the vertical surgeon-resident-centered system to the horizontal surgeon-surgicalist-centered system can help provide high-quality care for patients, and a systematic training system for residents. In addition, it is necessary to define the essential capacities of the surgicalist, and to determine the research and education that can promote them.
Delivery of Health Care ; Education ; Emergencies ; Hospitalists ; Humans ; Inpatients ; Korea ; Patient Safety ; Primary Health Care ; Quality Improvement ; Quality of Health Care ; Surgeons ; Wounds and Injuries

A hospitalist system was introduced in Korea in September in 2016 to improve the quality of in-patient care and to cope with the shortage of medical residents. This study aimed to outline the current situation of internal medicine hospitalist and to suggest a development strategy. By May 2019, the number of hospitalists in Korea had increased to 124. Patient safety issues, resident law, and the shortage of medical residents has led to an increase in the demand for hospitalists in Korea. Internal medicine hospitalist care in Korea has been associated with patient satisfaction, length of stay, and waiting time in emergency departments. There are three different hospitalist ward models in the Korean health care system, and each hospital needs the model that fits its specific situation. In the general ward model, the role of the hospitalist is similar to that of the chief residents because the wards are categorized into nine subspecialty areas, such as internal medicine (including gastroenterology, pulmonology, and cardiology). In the short-term admission ward model, patients are usually turned around within 72 hours; therefore, the hospitalist is able to care for patients independently. After that, patients are discharged or admitted to a specialty ward. In integrated care model, patients from all specialty areas are admitted to the same ward; therefore, hospitalists care for patients independently. In this model, consultation with specialists is required. There were strengths and weaknesses in each model. Therefore, the models should be considered based on the hospital's function. This study found some problems in the present hospitalist system, including undefined roles and responsibilities, unclear future employment prospects, burnout due to patient' severity of illness, and inadequate payment systems for weekend and night work. To further develop the hospitalists system in Korea, the Korean government, the Korean associated of internal medicine, hospitals, and hospitalists must work together to solve the present problems.
Delivery of Health Care ; Emergency Service, Hospital ; Employment ; Gastroenterology ; Hospital Medicine ; Hospitalists ; Humans ; Internal Medicine ; Jurisprudence ; Korea ; Length of Stay ; Patient Safety ; Patient Satisfaction ; Patients' Rooms ; Pulmonary Medicine ; Specialization

The Korean hospitalist system was introduced in 2016. The new inpatient care system that provides direct care from a specialist required great efforts from various parties to implement successfully. This study outlines the implementation of the Korean hospitalist system and the development strategies based on pilot studies. The definition of the Korean hospitalist includes two elements which are 1) hospitalist is a physician who is in charge of a patient from admission to discharge and 2) hospitalist should stay in the hospitalist ward, where a hospitalist provides medical services to patients at their point of needs. The purpose of the Korean hospitalist system is to provide high-quality care and to ensure the safety of admitted patients. Due to a gap in the healthcare workforces in hospitals caused by changes in the residents' working hours and training period of the residents, the implementation of a new system was inevitable to provide care for patients. The result of private and public pilot studies indicated that hospitals, physicians, and patients are keen to have the hospitalist system in place. Also, those stakeholders agreed that reasonable and accurate fee-schedules for hospitalist services would enhance the service system. Within the current system, hospitals are reimbursed for providing the service, while patients pay out-of-pocket. Therefore, the service can only be applied to a patient who agrees to pay the additional fee for the service. As the Korean medical system is facing a paradigm shift, the Korean hospitalist system will play an essential role in the transition as moving forward to provide professional care for inpatients.
Delivery of Health Care ; Fees and Charges ; Hospitalists ; Humans ; Inpatients ; Patient Safety ; Pilot Projects ; Specialization

A resident is a preliminary specialist with a medical license. It is also the status of an employee at a training hospital who is trained by clinical faculty. This duality makes the role of a resident unique, because its interpretation differs dramatically depending on whether one focuses on a resident's status as a trainee or as an employee. Issues regarding patient safety have emerged as residents have come to emphasize their role as employees in discussions of how to balance their work duties with their learning responsibilities. The workload that was taken for granted is no longer considered natural. Two years have elapsed since the enactment of the resident law, which was passed to improve the training environment and working conditions of residents, and limits them to 80 hours of work per week. However, confusion persists in the field. In order to solve problems regarding resident education, new education program with hospitalists and the financial and administrative support from hospitals and the government are important.
Education ; Financing, Organized ; Hospital Medicine ; Hospitalists ; Humans ; Internship and Residency ; Jurisprudence ; Learning ; Licensure ; Patient Safety ; Specialization

A hospitalist system in Korea began in August 2016. Patient safety issues, resident law, and reduction of resident numbers in Korea are leading to an increase in the demand for hospitalist in Korea. The roles and responsibilities of GI hospitalists have not been established. Therefore, cooperation among the Korean society of gastroenterology, each hospital, and government is necessary. In particular, it is important to prepare an education program for gastroenterology hospitalists.
Education ; Gastroenterology ; Hospitalists ; Humans ; Inpatients ; Jurisprudence ; Korea ; Patient Safety

A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5–16.7) to 9.1 days (IQR, 5.1–15.0) (P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% (P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.
Emergencies* ; Emergency Service, Hospital* ; Hospital Medicine ; Hospitalists ; Humans ; Korea ; Length of Stay* ; Mortality ; Tertiary Healthcare*