Yale Hospital Medicine, a great partnership

Hospital medicine or designated internal medicine trained physicians who focus on the care of patients admitted to hospital, started at Yale New Haven Hospital (YNHH) in 1995.

Inpatient care provided at YNHH by hospital medicine practitioners includes caregivers from the Yale School of Medicine (YSM) and the Northeast Medical Group (NEMG). The collaboration between the teams has been extremely fruitful to date on multiple shared medical services in hospitalization. This YSM-NEMG partnership has now reached a new height, marked by the launch of a new education and care initiative: the Hospital Medicine Firm on the York Street campus of YNHH.

Director of the Department of Internal Medicine and the Section of General Internal Medicine Hospital Medicine Program Chris Sankey, MD, FACP, SFHM, is enthusiastic about the project. “When I recruit faculty to join us, I say it’s as exciting a time as ever to be involved in hospital medicine here at Yale. We will be implementing a new clinical rotation in our internal medicine program, a rotation specific to hospital medicine, which did not exist before,” explained Sankey, Associate Professor of Medicine (General Medicine).

The new venture is the combination of a clinical rotation, an educational program and the formalized presence of hospitalists in a specific educational team, Sankey said. The hospital medicine rotation will teach trainees specific skills related to hospital medicine through a personalized experience. “Across all three training programs, our graduates choose hospital medicine jobs at a rate two to three times higher, even the most popular scholarship,” he said.

Sankey will co-lead the company with Anisha Advani, MD of NEMG, associate director, YNHH Hospitalist Service; and Assistant Clinical Professor (YSM), who will be physically located at East Pavilion 5 of YNHH’s York Street campus.

“It was a great partnership and collaboration between our group and the hospital medicine program. We bring different perspectives to determine what trainees need and then the practical applications of that. Chris was great at assessing needs and pushing to understand globally what trainees think hospital medicine education should look like and then we try to balance that with what we think they have need. And then from the hospitalist side there, it’s so important to be able to bring in the faculty that has the expertise to do that day in and day out, to care for more patients and to share that skill set with the PGYs -3 as they start thinking about a career beyond training,” Advani said.

YNHH is a 1,541-bed, tertiary medical center with two campuses in New Haven. The daily census of the hospital service has been enriched by almost 100 additional patients on average over the last three years. Their responsibilities span the entire hospital, caring for patients on the medical floors, reduction unit, co-management of hip/spinal fractures, co-management of geriatrics/ psychiatry, medical consultations at the YSC, the intervention service in hospitalization and Point-of-care ultrasound (POCUS). They also lead and staff the Rapid Response Team (RRT) and cover medical patients boarding emergency rooms on both campuses.

At the height of the COVID-19 pandemic, the two groups partnered with Yale New Haven Health and YSM management to change hospital processes, physically relocate entire units, and help determine how best to care for patients. This teamwork led to Healthgrades naming YNHH has one of the leading hospitals when it comes to early COVID care.

William Cushing, PA-C, MHA, SFHM, executive director of the Hospitalist Service at YNHH, recalled the evolution of the partnership. “The Department of Medicine has evolved over the past 20 years. Historically, many patients were covered by their primary care physician when admitted to hospital. This model evolved during the 2000s to a new paradigm where the treating physician is now a hospitalist or faculty member of residency teams,” Cushing explained.

He congratulates the leaders of the hospital and the School of Medicine, such as the chief of internal medicine, Gary V. Desire, MD, Paul B. Beeson Professor of Medicine; vice-president of faculty development and diversity; and Chairman, Internal Medicine, YSM; and Keith Churchwell, MD, President, YNHH, and others for their shared vision. “When you are admitted to an internal medicine ward, it doesn’t matter whether you are in one of the many practices we have in medicine or on the hospital team, you can expect the same signature of care. Recently we heard a cohesive view from Chris O’Connor and Dean Brown. This vision was reinforced by Keith and Alan Friedman of the hospital, as well as Gary, Patrick [O’Connor]Vinny [Quagliarello]and Lynn [Tanoue] on the university side. That shared message really started to coalesce within the department,” Cushing explained.

Cushing cites the COVID-19 pandemic as an extreme example, but other challenges like solving staffing constraints and increasing patient volumes have further united these groups.

“Now we try to solve all the problems that arise in the Department of Medicine together, which has created a culture of collaboration that seeks to improve the experience of patients and providers. We seek to achieve our goals as a department and there is a unified commitment to pursue this strategy in the future,” he said.

Sankey is excited about the future of hospital medicine at Yale. “Another exciting future undertaking for the Hospital Medicine Program would be to create, implement, and then manage a Hospital Medicine Fellowship Program. I’m excited to think about it and update it in the years to come,” commented Sankey.

“We are indeed in exciting times for hospital medicine at Yale,” said Patrick G. O’Connor, MD, MPH, Dan Adams and Amanda Adams Professor and Chief of General Internal Medicine at Yale. “Collaborations across the medical center led by Chris, Anisha, Will and many others, as evidenced by the system-wide response to COVID-19, the new hospital medicine enterprise, and research efforts in the hospital medicine program led by Sarwat Chaudhry, clearly demonstrate Yale’s unique strengths in leading hospital medicine nationally. The rapid evolution of the YNHH Care Signature program led by Deborah Rhodes, MD, Professor of Medicine and Vice President of Care Signature, YNHH, will surely provide many more opportunities to further strengthen hospital medicine at Yale.

Sankey took over the reins of the Hospital Medicine program in September 2020 and led it through its recent rebranding and programmatic growth. The Hospital Medicine program has four senior faculty, in addition to Sankey: Sarwat Chaudhry, MDassociate professor of medicine (general medicine); Angela Kang-Giaimo, MD, MPHinstructor (general medicine); Sharon Ostfeld-Johns, MD, Assistant Professor of Clinical Pediatrics (Hospital Medicine); and Thilan Wijesekera, MD, MHSassistant professor of medicine (general medicine).

For the NEMG, leadership in hospital medicine includes Thomas Donohue, MD, Vice President, Medicine; Cushing; Medical Directors Lirim Ameti, MD, and Jensa Morris, MD; Advani Associate Directors; Adam Ackerman, MD; Leah Burke, MD; Rupert Dogbey, MD; Skerdi Fotjadhi, MD; and APP managers Stacy Adil, PA-C and Heather Carney, PA-C.

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