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Tool: Sample surgical hospitalist clinical responsibilities

Hospitalist Leadership Connection, September 21, 2009

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The clinical duties of a surgical hospitalist, or “surgicalist,” vary from one setting to the next. The duties are typically listed in employment contracts and maintained in the practice policy and procedure manual, which the hospital updates periodically. Successful surgical hospitalist programs involve a high level of cooperation, trust, and mutual respect. Careful selection of the physicians, nurse practitioners, physician assistants, and administrative support staff requires people who function well as team players.

A sample job description is listed below:

• The surgical hospitalist will arrive promptly at 06:30 hours. The previous surgeon on call will provide a report.
• If emergency duties preclude the outgoing general surgeon from attending 0603 report, it will be the outgoing surgeon’s responsibility to arrange with the incoming surgeon the means and timing of the report. The report must, in all cases, be given to the incoming surgeon.
• The outgoing surgeon will be responsible for assisting with any early morning operations that occur at the time of or shortly after the report. The incoming surgeon will also be responsible for ensuring that appropriate coverage of these early morning operations occurs.
• The surgical hospitalist will make rounds on all consult patients, postoperative patients, and other patients admitted to the surgical hospitalist service.
• The general surgeon will respond to the emergency department (ED) or to an inpatient consult within 30 minutes unless prevented by other priorities, such as an ongoing surgery or management of an unstable patient. If unable to respond immediately, he or she will evaluate the patient at the first opportunity.
• The surgical hospitalist will evaluate all consults and ensure their disposition is appropriate by either admitting the patient for operation, admitting the patient for medical treatment or observation, arranging for discharge from the ED and follow-up, or deferring the patient to a more appropriate physician service for care. Appropriate communication will be made with physicians who will assume primary or consultant care.
• The general surgeon will communicate personally with all referring and consulting physicians after completion of the patient evaluation.
• After all procedures, admissions, discharges, ICU evaluations, and daily notes are completed on patients that are not within the global period, the physician will complete the billing/coding sheet for each patient. Coding should be completed within 48 hours of service or sooner.
• The on-call surgeon will respond to all patient calls, such as those that come via an answering service (e.g., calls from recently discharged patients who have concerns such as pain or fever).
• The on-duty surgeon will see post-discharge patients in the outpatient clinic.
• Other duties will be assigned to the surgical hospitalist as appropriate to ensure fulfillment of the program goals.

The above excerpt is adapted from The Surgical Hospitalist Program Management Guide: Tools and Strategies for Executives and Physicians by John Nelson, MD, FACP, FHM, John Maa, MD, FACS, foreword by Robert M. Wachter, MD, published by HCPro, Inc., in Marblehead, MA.

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