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The increasing scrutiny on both the quality and the cost of health care in the United States promotes value driven health care or the highest quality of care at the lowest cost. The perception that hospitalists provide high-value health care impels the continued growth in the field of Hospital Medicine. As the U.S health care system proceeds to reshape itself, hospitalists will continually be challenged to justify this perception by providing high-quality care in a cost-effective manner. The term cost-effective does not mean never spending any money or resources to diagnose, treat, and manage diseases. It does require being smart with decisions on how, when, and where to invest resources. The shotgun approach—ordering an entire battery of tests to rule out a multitude of diagnoses—does not generate cost-effective or even high-quality care. Ordering the right tests at the right time to safely diagnose conditions without needless waste entails not only critical thinking to ask the right questions to get the right information but also easily accessible decision-making support and multidisciplinary teamwork. Delivering cost-effective care in a complex hospital system with lots of moving parts starts with recognizing the relationship between the moving parts and identifying opportunities for improvement. This chapter will use examples to demonstrate how communication, multidisciplinary teamwork, and measurement can be incorporated into a hospitalist practice to deliver cost-effective care (Table 31-1).

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Practice Point
  • The term cost effective does not mean never spending any money or resources to diagnose, treat, and manage diseases. It does require being smart with decisions on how, when, and where to invest resources.
Table 31-1 Principles of Cost-Effective Hospitalist Care

  • The single biggest problem in communication is the illusion that it has taken place.” (George Bernard Shaw, 20th-century Irish playwright)

The Pager

Most clinicians rely on the pager as an essential communication tool. A telephone line open for the recipient to return the page and an assumed response time for answering the page before leaving the area if an unreasonable amount of time has passed rest on both spoken and unspoken rules. What is considered a reasonable amount of time is subject to interpretation and to the urgency of the situation. Despite the foibles of numeric paging, it remains a vital system of communication in the American health care system because of its reasonable cost and lack of acceptable alternatives. Unlike numeric paging, text paging allows providers to send ...

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