Five Questions With: Dr. Sajeev Handa

DR. SAJEEV HANDA is head of hospital medicine at Rhode Island Hospital, which is marking the hospitalist program’s 20th anniversary this year. / PBN FILE PHOTO
DR. SAJEEV HANDA is head of hospital medicine at Rhode Island Hospital, which is marking the hospitalist program’s 20th anniversary this year. / PBN FILE PHOTO

Dr. Sajeev Handa is head of hospital medicine at Rhode Island Hospital, a Lifespan facility. He helped to found the hospitalist program, in which physicians practice exclusively in a hospital setting; the program is marking its 20th anniversary this year.

A graduate of the Royal College of Surgeons in Ireland, Handa completed his residency in internal medicine at the Tufts University School of Medicine in Boston. After completing his fellowship in infectious diseases at The Warren Alpert School of Medicine of Brown University, he joined Rhode Island Hospital in 1996 to establish the state’s first hospital medicine program, where he also serves as medical director for clinical integration at Lifespan.

A charter member for the National Association of Inpatient Physicians, now known as the Society of Hospital Medicine, where he is a senior fellow, Handa spoke recently with Providence Business News about the evolution and growth of the hospital’s hospitalist program.
PBN: You helped to establish the hospitalist program at Rhode Island Hospital. Explain what the program is, and what was the motivation and perceived need for such a program?

HANDA: Early in 1996, prior even to the term ‘hospitalist’ being coined, Lifespan had a vision of creating a dedicated inpatient group whose responsibilities would be to care from admission through discharge for medical patients whose primary-care physicians did not have admitting privileges at Rhode Island Hospital. The role of this new group would be to ensure that communication between the hospital and the primary-care physicians was optimized to ensure that patients received the best care possible.

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PBN: How has the hospitalist system at Rhode Island Hospital grown and evolved during the past decade; did other Lifespan hospitals follow Rhode Island Hospital’s lead?

HANDA: At the time of its inception in August 1996, the program had three physicians; currently there are 35 with an additional five advanced practice providers. Several factors have contributed to the growth of the program. For those PCPs who were actively admitting their own patients to Rhode Island Hospital, it was becoming apparent this was a more complex endeavor: Patients were sicker, and busier outpatient practices made it difficult for a primary-care physician to coordinate care in two different settings. That, coupled with the drive for shorter length of stays, necessitated the existence of individuals who were adept at understanding hospital systems and their processes. In addition, Rhode Island Hospital is a major teaching affiliate for The Warren Alpert School of Medicine at Brown University, and as changes in work-hour regulations came into effect, the number of patients that could be covered by the teaching services was reduced, creating a gap that hospitalists were able to fill.

The hospitalist program at Rhode Island Hospital was also the first to officially become a recognized independent division within the hospital’s department of medicine as well as the first to develop its own dedicated inpatient care unit. Currently, the program manages approximately 10,000 patients per year.

PBN: How do patients respond to having a hospitalist – and not their primary-care physician – coordinate their care during their hospitalization?

HANDA: In the early years, patients expressed their concern that they would not see their PCPs in the hospital when they were at their most vulnerable. It was difficult to conceive that their care would be transitioned to someone not familiar with their medical history, and so forth. Our goal, therefore, in the inpatient setting was to make them feel as comfortable as possible and to let them know that we would be in communication with their PCPs, who would be involved with their care. Also, patients have realized that having a dedicated inpatient group has its advantages, particularly in that there is always someone available to attend to them.

PBN: Apart from using electronic medical records, how do hospitalists and patients’ primary-care physicians and/or specialists coordinate patients’ care?

HANDA: We view the electronic medical record as an adjunct to communication. Nothing can fully replace a conversation directly with a patient’s PCP and that is what is encouraged at the time of admission, discharge and during the course of the patient’s stay. The patient’s overall care really revolves around his or her PCP and so it is critical that the PCP is kept apprised of key elements of a patient’s treatment. Likewise, with specialists both in an inpatient and outpatient setting, verbal communication is strongly encouraged.

PBN: What data, if any, is there to evaluate the health outcomes of patients treated by hospitalists? Is there data showing that hospitalists actually benefit patients?

HANDA: Data early on from researchers comparing outcomes and costs for patients cared for by hospitalists and those cared for by traditional physicians found that hospitalist-attended patients had lower costs, shorter lengths of stay and better medical outcomes, including higher survival rates. Dedicated inpatient physicians are adept at care coordination from within the hospital and are readily available when patients need them.

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