Washington University physician Christine Hrach, MDIn July, the SHARP hospitalist admitting service started 10 years ago at St. Louis Children’s Hospital became the standard practice for overseeing all inpatient care on generalmedicine floors. The change is designed to ensure all referring physicians receive comprehensive and prompt communication about their patients at three key junctures:

  • Admission
  • Status changes or milestones that occur during a patient’s stay
  • Discharge 

“Initially SHARP—Service for Hospital Admissions by Referring Physicians—was created to aid referring physicians during the months-long period when Interstate 64 was closed for major construction. At that time, it was common practice for referring physicians to round on their hospitalized patients. Their ability to do so was complicated by the construction,” says Washington University physician Christine Hrach, MD, director of SHARP. “Our commitment to the referring physicians who requested SHARP coverage was that a pediatric hospitalist on staff at Children’s Hospital would personally oversee the inpatient care for their patients.”

Over the years, the initial group of 20 community physicians requesting the SHARP service for their patients grew to more than 200. That volume combined with a new approach to staffing attending physician positions on general medicine services resulted in the adoption of the SHARP model for all patients on these floors.

“Dr. Gary Silverman has had a particular interest in having senior pediatric hospitalists take over the role of general pediatric ward attending for all of the floors,” says Dr. Hrach. Dr. Silverman is the Harriet B. Spoehrer Professor and chairman of the department of pediatrics at Washington University School of Medicine. “Our goal would be for the hospitalists’ ongoing presence to help foster better communication with the referring community physicians, as well as with nursing staff and families; and to promote participation in quality improvement projects and provide consistency for educating medical students and residents.”

To achieve this goal, four general medicine teams have been restructured:

  • In the hospital’s new tower, 10100 will serve general medicine patients as well as those admitted to the gastroenterology team. The 11100 ward will serve general medicine patients in addition to those on the renal and endocrine service.
  • The 12th floor will serve general medicine and will provide co-coverage for select neurosurgery patients.
  • 10E and 10W will cover general pediatric patients and will be available to provide co-coverage for surgical patients.

The teams on 10100 and 11100 include a hospitalist attending, a senior resident and three interns. The 12th floor team consists of a hospitalist attending and two nurse practitioners. The 10E and 10W team (Silver team) will consist of a hospitalist attending and two to three interns and resident physicians.

“An important new element to our ensuring timely communication with referring physicians is the rollout of the Epic health care software system at Children’s Hospital,” says Dr. Hrach. “This system allows us to eliminate the need to dictate discharge summaries and instead begin creating them while patients are still in the hospital. Within 12 hours of discharge, referring physicians will have a faxed copy of the summary, in time for their patients’ follow-up visits to them in their offices.”

Dr. Hrach notes that referring physicians may at times receive patient progress phone calls from resident physicians rather than the hospitalists, but that fits with the goals of the residency training program.

“We know our referring physicians understand the importance of our resident physicians learning how to communicate effectively,” she says. “It’s a vital part of their training.”

As the teams become more skilled at using Epic, there is the possibility of sending secure messages to referring physicians who also use the system, or for keeping track of how individual physicians wish to receive updates; e.g., through fax or phone, on a daily basis or simply as needed. Referring physicians may easily contact the hospitalist attendings by calling Children’s Direct at 800.678.HELP (4357).

“We are really pleased to offer the same level of communication and care that has been the hallmark of our SHARP service,” says Dr. Hrach. “It has become the standard by which we operate on a daily basis for all of our referring physicians and their patients.” 

To speak with Dr. Hrach, call Children's Direct at 800.678.HELP (4357).