Current Neurology and Neuroscience Reports

, Volume 12, Issue 4, pp 481–488 | Cite as

Neurohospitalists: An Emerging Subspecialty

Critical Care (SA Mayer, Section Editor)

Abstract

Akin to the rapid growth in hospitalist medicine seen in the prior decade, there has been a recent explosion in the need for neurohospitalists. Factors driving this demand include nationally mandated quality and safety measures, the increasing complexity and age of the hospitalized patient, and diminished training in diagnosis and management of neurological illnesses for internal medicine residents. The role of the neurohospitalist is varied and may include not only providing neurological care to hospitalized patients but also serving as a leader in an institution’s push to meet quality and safety measures. Close collaboration with intensivists, vascular neurologists, and outpatient neurologists is both a challenge and essential for successful delivery of care both during hospitalization and after discharge. Future challenges facing neurohospitalists include defining its relationship to other fields, instituting a pathway for certification, and conducting research to guide the development of evidence-based practice and quality measures.

Keywords

Neurohospitalist Hospitalist neurology Inpatient neurology Acute neurology Acute neurological care Subspecialty hospitalist Neurocritical care Subspecialty neurology Stroke neurology Neurohospitalist fellowship Neurohospitalist medicine 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wachter RM. Reflections: the hospitalist movement a decade later. J Hosp Med. 2006;1(4):248–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Cors WK, Rohr R. The “ist” explosion: driving forces, current trends and future directions for hospitalists. Physician Exec. 2010;36(3):12–4.Google Scholar
  3. 3.
    Freeman WD, Josephson SA. The birth of neurohospitalists. The Neurohospitalist. 2011;1(1):5–7.CrossRefGoogle Scholar
  4. 4.
    • Josephson SA, Engstrom JW, Wachter RM. Neurohospitalists: an emerging model for inpatient neurological care. Ann Neurol. 2008;63(2):135–40. One of the original articles describing the forces leading to development of the neurohospitalist field, including the founding author of the hospitalist movement Dr. Wachter.PubMedCrossRefGoogle Scholar
  5. 5.
    Likosky DJ. Is it time for neurohospitalists? Neurology. 2009;72(9):859. author reply 859–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Avitzur O. Neurohospitalists: a new term for a new breed of neurologist. Neurol Today. 2005;5(10):44–5.CrossRefGoogle Scholar
  7. 7.
    •• Likosky DJ. If not neurohospitalists, who? If not now, when? The Neurohospitalist. 2011;1(2):64–6. Overviews the current state of the neurohospitalist field, with a very realistic discussion of updated issues, challenges, and recommendations for furthur establishing this field.CrossRefGoogle Scholar
  8. 8.
    • Likosky DJ, Shulman S, Restrepo L, Freeman WD. Survey of neurohospitalists: subspecialty definition and practice characteristics. Front Neurol. 2010;1(9):1–4. This is the only survey of neurohospitalists derived from the American Academy of Neurology Neurohospitalist Section; it consists of questions sent to 93 recipients regarding their neurohospitalist practice, with a 54 % response rate.Google Scholar
  9. 9.
    Freeman WD, Gronseth F, Eidelman BH. Invited article: is it time for neurohospitalists? Neurology. 2008;70(15):1282–8.PubMedCrossRefGoogle Scholar
  10. 10.
    •• Chang I. Structural Issues for Neurohospitalists. In: Josephson SA, Freeman WD, Likosky DJ, editors. Neurohospitalist medicine. Cambridge University Press: Cambridge; 2011. p. 213–23. This is a new authoritative textbook of neurologic disease states focused on inpatient management with a chapter devoted to structural and organizational issues of scheduling, financial compensation, and organizational considerations for neurohospitalists.CrossRefGoogle Scholar
  11. 11.
    • Douglas VC, Josephson SA. A proposed roadmap for inpatient neurology quality indicators. The Neurohospitalist. 2011;1(1):8–15. This article is a good start to developing quality goals for inpatient neurological diagnoses; it is based on review of all current evidence-based guidelines for the most commonly encountered inpatient neurological diagnoses at the authors’ institution.CrossRefGoogle Scholar
  12. 12.
    McGinn T, Centor R. Where should hospitalist programs be housed? J Gen Intern Med. 2008;23(8):1288–9.PubMedCrossRefGoogle Scholar
  13. 13.
    McMahon Jr LF. The hospitalist movement—time to move on. N Engl J Med. 2007;357(25):2627–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Threlkeld RC. Opportunities and challenges in physician employment at a hospital or its affiliates. J Med Assoc Ga. 2008;97(3):33–4.PubMedGoogle Scholar
  15. 15.
    Archambault D. Despite advantages, perks fewer physicians work as employees. Mich Med. 2004;103(4):9–11.PubMedGoogle Scholar
  16. 16.
    Foa R. Reflections on the end of a practice: lessons learned. Neurol Today. 2010;10(16):4.CrossRefGoogle Scholar
  17. 17.
    Barrett KM, Biller J, Czartoski T, et al. Neurohospitalist section strategic plan. Proceedings from the American Academy of Neurology; Neurohospitalist Section. Toronto, Canada; April 2010.Google Scholar
  18. 18.
    • Freeman WD. Neurohospitalists reduce length of stay for patients with ischemic stroke. The Neurohospitalist. 2011;1(2):67–70. This is a study of 533 patients that demonstrate improved adherence to quality metrics in stroke and reduced LOS with a neurohospitalist program.CrossRefGoogle Scholar
  19. 19.
    Amin A, Likosky DK. The role of hospitalists in the acute care of stroke patients. Curr Treat Options Cardiovasc Med. 2010;12(3):240–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Manno EM. Neurohospitalists: challenges for the integration of a new field: a neurointensivist’s perspective. Front Neurol. 2010;1:154.PubMedGoogle Scholar
  21. 21.
    Zakaria A, Provenicio JJ, Lopez GA. Emerging subspecialties in neurology: neurocritical care. Neurology. 2008;70(15):1282–8.CrossRefGoogle Scholar
  22. 22.
    Rogove H. The intensivist and the hospitalist: defining responsibility. Hospitalist. 1999;3(4):10.Google Scholar
  23. 23.
    Murin S. Hospitalists in the intensive care unit: an intensivist perspective. Hospitalist. 1999;3(4):5.PubMedGoogle Scholar
  24. 24.
    Chang CW, Torbey MT, Diringer MN, et al. Neurointensivists: part of the problem or part of the solution? Crit Care Med. 2008;36(4):1350–3.CrossRefGoogle Scholar
  25. 25.
    Schwamm LH, Audebert HJ, Amarenco P, et al. Recommendations for the implementation of telemedicine within stroke systems of care. Stroke. 2009;40(7):2635–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Douglas VC. A message from the editor in chief. The Neurohospitalist. 2011;1(1):4.CrossRefGoogle Scholar
  27. 27.
    American Heart Association: Get With the Guidelines. Available at http://www.americanheart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelinesHFStroke/GetWithTheGuidelinesStrokeHomePage. Accessed Sept 2011.
  28. 28.
    •• Meschia JF. Grand challenge: the emerging field of neurohospitalist medicine. Front Neurol. 2010;1:8. This is an opinion article that introduces Frontiers in Hospitalist Neurology, a new peer-reviewed journal, and discusses current and future directions for the neurohospitalist field.PubMedGoogle Scholar
  29. 29.
    Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423–33.PubMedGoogle Scholar
  30. 30.
    Roter DL. Physician/patient communication: transmission of information and patient effects. Md State Med J. 1983;32(4):260–5.PubMedGoogle Scholar
  31. 31.
    Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143(2):121–8.PubMedGoogle Scholar
  32. 32.
    Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.PubMedCrossRefGoogle Scholar
  34. 34.
    Coleman E, Williams M. Executing high-quality care transitions: a call to do it right. Editorial. J Hosp Med. 2007;2(5):287–90.PubMedCrossRefGoogle Scholar
  35. 35.
    Snow V, Beck D. Transitions of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine. J Hosp Med. 2009;4(6):364–70.PubMedCrossRefGoogle Scholar
  36. 36.
    • Barrett KM, Fowler MV. Is fellowship training necessary for neurohospitalists? The Neurohospitalist. 2011;1(3):125–7. This is an interesting article that highlights opposing viewpoints regarding the need for developing dedicated fellowships in neurohospitalist medicine.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Blue Sky Neurosciences, PLLCEnglewoodUSA

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