Vernon Jubilee Hospitalists

Hospitalist Service Capacity and Mitigation Plan

Purpose: 

To support hospitalist workload limitations given current resource challenges and patient volumes – to provide guidance to all physicians on most appropriate MRP for patients with select admitting diagnoses Effective October 1, 2024: Hospitalist workload will be limited to a maximum census of 120 patients with the implementation of admission/consult changes as follows. * Goal to start implementation ASAP to achieve census number targets by October 1

General Protocols:

  • Document Most Responsible Provider (MRP) decisions in the patient’s medical record as per the IHA MRP policy
  • Surgical specialties to consider consulting Internal Medicine or subspecialties directly for non-surgical issues
  • Physicians requesting admission/consultation from the hospitalist service may be redirected to another service outside the hospitalist group, collaborate closely
  • Review individual cases if there are disputes on most appropriate MRP
  • Surgical Patients MRP status will default to the respective Department as detailed below

General MRP Guidelines

General Surgery

  • Any diverticulitis requiring admission
  • Bowel obstruction (unless malignant bowel obstruction or palliative care approach)
  • Biliary tract or pancreas disease related to gallstones or obstruction (cholelithiasis, choledocholithiasis, biliary colic, cholecystitis, cholangitis) even if initially managed with antibiotics
  • Appendicitis 
  • Necrotizing fasciitis (perineal/abdominal wall)
  • Post-surgical complications (i.e. bleeding, infection, wound dehiscence, uncontrolled pain, etc.)

 

*General Surgery can be consulted for traumatic Pneumothorax/Large bore chest tube management. If no MRP available transfer to HLOC (KGH)

Orthopedic Surgery

  • Osteomyelitis (if NOT chronic or pre-existing) 
  • Septic arthritis 
  • Appendicular skeletal fractures, including pelvic fractures
  • Non medically complex hip fractures
  • Compartment syndrome
  • Post-surgical complications

ENT

  • Quinsy (peritonsillar abscess)
  • Complicated tonsillitis 
  • Post-tracheostomy complications 
  • Epiglottitis 
  • Epistaxis

Urology

  • Obstructing renal calculi, nephrolithiasis or urolithiasis without sepsis requiring surgical intervention
  • Post-urologic procedure/surgical (TURP, TURBT, laparoscopic nephrectomy, laparoscopic or open prostatectomy, TVT/TVTO/, adrenalectomy) that require admission directly after surgery or returning to hospital with complications (e.g. hematuria, wound bleeding/infection, UTI, pain, etc.)
  • Notes:
    • *If elderly patient presenting with frailty, weakness and associated UTI post-TURP/TURBT, discuss with hospitalist for admission
    • *Consult IM for medical concerns as required (i.e. anticoagulation, hypertension, chest pain, hypoxia, etc.)
    • *If suspected septic shock, consult IM; if sepsis/SIRS suspected admit to hospitalist with urology consult

Internal Medicine

  • Consultation for all acutely decompensating patients (e.g. chest pain, atrial fibrillation, hypoxia, dyspnea), unstable arrhythmia, CHF, patient requiring optiflow/bipap, septic shock, multi-organ system failure, positive MINS protocol, new medical diagnosis on surgical patients 
  • Fill ICU with the most appropriate patients. IM is MRP of all patients physically in ICU.
  • Shift Coordinators to let the Hospitalist Lead know if there are ICU beds available, Hospitalists/IM will collaborate to determine patients who are ICU appropriate
  • Consult all acute BiPap patients to IM to determine admission service

Psychiatry

  • Suicidal ideation once medically stable
  • Polysubstance induced psychosis once medically stable with consult to Vernon Addictions Medicine service or KGH on-call Addictions medicine service 
  • Eating disorders (with consult to RD/Hospitalist if medical support needed)
  • Dementia-related behaviors in patients with established dementia once delirium work-up complete
  • Contact hospitalist on-call (lead/after-hours coverage) for acute medical issues requiring medical advice. Hospitalist service may redirect to other specialists (e.g. Internal Medicine, Orthopedics) as appropriate, but will provide initial support (for all patients with psychiatry as MRP who have no GP with admitting privileges) 
  • Consider consultation with patient’s community GP for management of chronic medical issues

Other Specialities

  • May assume MRP status if their expertise is needed, and the admitting diagnosis is the primary concern. 
  • General guidelines for MRP assignment are provided, but each case will be reviewed individually.

All Rights Reserved Vernon Jubilee Hospitalist PA. 2025

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