Hospitalists will accept RMG patients that are admitted through the emergency
department, directly admitted from a physician’s office or transferred from
another facility 24 hours a day, 7 days a week, 365 days a year during their
coverage period. RMG will ensure that patients being transferred from another
facility are medically stable for transfer. Should a physician escort be
required, as determined by the medical director, one will be made available.
Hospitalist will ensure that mentoring responsibilities, (i.e., clinical
residents, nurse practitioners, etc) do not delay the management and discharge
of RMG patients.
Hospitalists shall return RMG radio pages or cell phone calls within 20
minutes. In the rare instance the hospitalist is unable to do so due to
emergent patient care issues, the hospitalist will ask support staff to call
back to inform RMG of the delay. RMG’s commitment is to engage the Hospitalist
for less than two (2) minutes on such page requests.
All RMG inpatients shall be seen daily by 11:30 a.m. including weekends and
national holidays so as to facilitate care and prevent delays in management
Hospitalists shall evaluate and write management orders on all newly admitted
RMG patients within 1-2 hours of admission. For established inpatients,
Hospitalists will write orders on the chart by 9:30 a.m., each day.
If notified of a commercial patient in the emergency department that may need
admission, the hospitalist is expected to perform his own evaluation of the
patient prior to admission to determine if the patient truly needs to be
admitted or if his care can be adequately serviced in another fashion, such as
a skilled nursing facility. If the patient does need to be in a hospital, the
hospitalist, if working in a non-contracted facility, will determine if the
patient is medically stable for transfer to a contracted hospital. If so, the
case manager will assist in arranging for that transfer to the other facility.
Commercial patients that are not immediately stable for transfer to a
contracted facility should be transferred as soon as they are considered
Hospitalists shall participate in telephonic physician rounds with RMG senior
case manager/medical director on a daily basis, 7 days a week, at a pre-
established time. Hospitalists should be prepared to discuss all patients in a
detailed, yet succinct manner, with a disposition plan for each patient. Time
estimate is 1-2 minutes per patient.
Hospitalist shall agree to a thorough and complete sign-out to covering
physicians (weeknights, weekends, and national holidays) with specific
instructions for treatment and management of all inpatients. Hospitalist must
indicate to covering physician the requirements that would result in the
discharge/repatriation of the patient in the absence of the Hospitalist so
that no discharge delays are incurred.
CONSULTATION AND TESTING
Hospitalists will exercise their full ability as clinicians prior to
requesting specialty consultations. When such consultations are requested, the
Hospitalist will clearly indicate to the specialist which aspects of the
particular patient’s care he would like assistance with.
Consultations will be requested from RMG contracted specialists whenever
possible and only when the patient’s clinical needs are beyond the expertise
or clinical capabilities of the hospitalist. It is the responsibility of the
hospitalist to only use physician providers contracted to RMG, unless under
emergency situations. Hospitalist shall request specialty services on RMG
patients by directly contacting specialists (physician-to-physician) to
request either the consultation itself, or approval from the specialist to
discharge any patient under the care of the specialist. Relying only on
written chart documentation to request consultations or specialist permission
for discharge shall be avoided. Direct physician-to-physician communication is
Hospitalists will ensure that all tests and specialist consultations are
ordered only when it is clear that the management plans are likely to change
depending on the results of such services.
Hospitalists will interact directly with specialist consultants involved in a
patient’s care on a daily basis and shall report the specialist management
plans to RMG during phone rounds.
Hospitalists shall attend and coordinate care on ALL RMG inpatients. Although
the actual treatment and management may be conducted by the attending
specialist (e.g., surgical, OB, transplant), the Hospitalist will be needed to
help with communication, coordination of care and discharge planning services.
Hospitalist shall assist RMG in meeting timeline goals for specialist
consultations and test (lab/radiological) requests as follows: 1) Specialists
shall provide consultations within 2-3 hours of the Hospitalist’s request. 2)
Hospitalists shall order tests by 8:00 am or, preferably, the night before.
Hospitalist shall make every effort to utilize specialist consultants who are
responsive to the guidelines outlined above and accept the need to expedite
care through patient repatriation and/or discharge.
For new admissions or transfers, Hospitalist shall not delay implementing the
clinical management of the patient by repeating radiological and laboratory
tests that have just been performed elsewhere and are deemed adequate to
Should a patient be receiving care at a tertiary care facility, it is the
responsibility of the Hospitalist, acting in conjunction with the specialists,
to notify RMG immediately of a patient’s eligibility for repatriation at the
point that services no longer require a tertiary care facility and can be
provided by an RMG contracted community hospital and contracted physician.
Hospitalist shall indicate to RMG what services are required upon
repatriation. RMG will arrange for physician-to-physician transfer and shall
warrant the competency of the accepting physician and the availability of
services and resources requested by the Hospitalist.
Hospitalist will notify the hospital case manager and/or medical director as
soon as he is aware of any hospital admission during the day, or by 9 am if
the admission occurred overnight.
Hospitalist shall cooperate with and utilize (as available) the services of
the assigned RMG case manager to 1) coordinate the transmission of clinical
information to RMG Medical Director or designee, 2) provide updates on the
status of the clinical management of inpatients to facilitate and plan for
their discharge needs and/or transfer requirements.
For all patients, Hospitalist will consider whether the patient may benefit
from hospice or palliative care evaluation and inform RMG of any patient that
may be hospice eligible. RMG will determine which contracted hospice or
palliative care agency is appropriate for the patients’ specific needs. In
such cases, RMG will inform the hospitalist of the agency name and the
hospitalist will arrange an evaluation with the agency directly.
Hospitalist shall discuss with patient/family length of stay expectations at
the time of admission. Hospitalist shall discuss discharge plans with
family/patient at least two (2) days prior to day of discharge. For special
discharge needs (home visits, tests, follow-up office visits, referrals,
etc.), hospitalist shall notify RMG 72 hours prior to discharge to ensure that
RMG can arrange such clinical services or resources needs in a timely fashion.
Hospitalists are reminded that RMG offers a full range of post hospital
Hospitalists shall identify patients at high risk for readmission and notify
RMG so that these patients can be included in RMG’s high risk patient program.
Hospitalist shall notify RMG telephonically and agree to commit to writing in
the clinical chart any inpatient day(s) that is deemed “aberrant” as a result
of Hospital related reasons that delay the management, discharge or care of
the RMG inpatient. It is the responsibility of the hospitalist to ensure that
these notes are faxed to RMG for the purposes of meeting RMG quality control
Hospitalist shall notify RMG immediately upon knowledge that RMG inpatient’s
management and care will be delayed. This shall apply to inpatients and to
patients requiring transfer into the Hospital, where needed services, (i.e.,
MRI, availability of consultants, operating suites etc) are not immediately
Immediately upon recognition of a likelihood of discharge to home, transfer to
a SNF, or transfer to another facility, all services required for discharge
shall be clearly communicated to the case manager before 2 PM and orders
written before 3 PM to complete the discharge or transfer as planned.
(Not applicable to USC Hospital) Upon notification by the ER, Hospitalists
shall attend to RMG patients in the ER and if clinically stable discharge
patients to home or SNF if applicable. RMG is available 24 hours a day, 7 days
a week, 365 days a year to provide assistance with discharge management, i.e.,
home resources, follow-up appointments, referrals.
Hospitalist must participate with Regal’s discharge dictation summary program
by completing the Regal discharge summary form on the day of discharge in
order to support a more efficient and effective transition of care process.
* Education and/or Experience:
* Graduate from accredited medical school
* Board certified (current)/eligible in own specialty
* Active California medical license
* Current Federal DEA
* Additional credentials as required by virtue of specialty