Hospitalists at Harborview care for patients on both teaching and non-teaching medicine services. The hospitalists play a central role in all medicine admissions, the majority of whom come via the Emergency Department. We triage all medicine admissions and transfers and are responsible for directing them to the appropriate service and care setting.
We also provide perioperative medical care and medicine consultation for our surgical and other non-medicine colleagues. Harborview is the Level I Trauma referral center for the Pacific Northwest region of the United States (5-state WWAMI region) with specialization in trauma care, vascular surgery, neuroscience, and orthopedic care. Our role in the care of the medically complex surgical patients has grown with the implementation of an inpatient service in collaboration with Neurosurgery to care for medically complex and frail patients admitted with traumatic brain and spine injuries.
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Hospital Medicine Service | Medicine Ward Service | Medicine Consult Service | Medicine Operative Consult Service | Medicine Triage Service | Neurosurgical Medicine Service | Nocturnal Medicine Service
The Hospital Medicine Service (HMS) is our primary general medicine hospitalist-run service. Depending on time of year and hospital census, we staff with either two or three attendings. Hospitalists on HMS care for nearly 50% of all medicine patients who are admitted to Harborview. We provide 24-hour attending-level coverage for our patients through the assistance of our nocturnists. Residents (internal medicine and family medicine) and medical students (Sub I’s) frequently rotate on this service allowing learners to gain experience as an independent hospitalist and providing faculty an opportunity for teaching and mentorship. The service has a team-based social worker, discharge coordination RN, and pharmacist who work with our faculty in the care of our patients.
There are five medicine ward teams at Harborview: Medicine A through E. The Medicine E team is staffed exclusively by Hospital Medicine faculty, and our hospitalist faculty also attend on the other teams throughout the year. The ward services are traditional resident teaching services run by a senior resident, two interns, and medical students.
The Medicine Consult Service (MCS) provides traditional medicine consults to non-medicine services throughout Harborview.
A single attending on service provides daytime staffing seven days per week. Consults at Harborview most commonly come from our large inpatient psychiatry services and extensive surgical services (orthopedic, vascular, otolaryngology, etc.) who consult us for medically complex surgical patients typically admitted after non-elective surgery related to trauma. Learners (medical students, medicine, and subspecialty residents) are often part of this team.
The Medicine Operative Consult Clinic (MOCC) provides comprehensive perioperative medicine consultations to medically complex patients undergoing planned surgery at Harborview. In addition to a reputation for excellent trauma care, Harborview also serves as a UW center for excellence in elective and planned surgery, such as neurosurgery and orthopedic and vascular surgery. Our service provides pre-operative outpatient medicine consultations and continuing post-operative inpatient consultations, with the goal of providing continuity of care throughout the entire perioperative period. We see patients on referral from our surgical, anesthesia, and medical colleagues from across the UW system. On a typical day on the service, providers spend a half-day in clinic performing pre-operative evaluations and the other half-day seeing post-operative patients in the hospital. There are residents (medicine and non-medicine) and fellows (i.e., geriatric) who participate in the clinic and on the inpatient service, which provides a variety of teaching opportunities. The service is staffed on a weekday basis, with weekend coverage of post-operative patients provided by the Medicine Consult Service and Triage Medicine Service.
All patients admitted to the inpatient medicine services flow through the medicine triage attending. The majority (85%) of our inpatient admissions at Harborview come via the Emergency Department (ED). The triage attending plays an important role in maintaining good ED flow and assuring a safe transition from ED to inpatient care. The triage doctor is also responsible for facilitating admissions from our primary care clinics and transfers out of the ICU. Since Harborview is a referral center, the triage doctor assists in coordinating the transfer of patients from outside hospitals who require a higher level of care.
The Neurosurgical-Medicine Service (NMS) was developed in response to the aging US population resulting in an increase in elderly, medically complex patients being admitted with traumatic injuries. We work closely with our neurosurgical and neurocritical care colleagues to identify and care for medically complex patient who have sustained a traumatic brain and/or spinal cord injuries. Once accepted, these patients are cared for principally by the medicine hospitalist, with Neurosurgery serving as a consultant service. Similar to our other primary hospitalist services, we have a team-based social worker, discharge- planning RN, and pharmacist that work with us to provide multidisciplinary care.
We rely on a dedicated nocturnist service to provide critical continuity for all of our services overnight. Many interesting patients are admitted in the evening at Harborview, the vast majority presenting with new problems to the Emergency Department. The nocturnist service is also a teaching service. Learners work with our night attendings on new admissions and any cross-cover issues that arise. Middle-of-the-night chalk talks are common.