The impact of a hospitalist on role boundaries in an orthopedic environment

Fiona Webster,¹ Samantha Bremner,² Megan Jackson,³ Vikas Bansal,² Joanna Sale<sup>4

1</sup>Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; ²Holland Orthopedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ³Faculty of Social Science, University of Western Ontario, London, ON, Canada; ⁴Mobility Program Clinical Research Unit, St Michael's Hospital, Toronto, ON, Canada

Purpose: Hospitalists specialize in the management of hospitalized patients. They work with several health care professionals to provide patient care. There has been little research examining the perceived impact of the hospitalist's role on staff working in an orthopedic environment. This study examined the experiences of staff across several professional backgrounds in working with a hospitalist in an orthopedic environment.
Participants and methods: A qualitative descriptive approach was taken to investigate the experience of staff working with a hospitalist at a specialized orthopedic hospital. Purposive sampling was used to recruit interview participants including nurses, internists, pharmacists, physiotherapists, anesthetists, senior administration, and orthopedic surgeons to the point of theoretical saturation, which occurred after 12 interviews. Interviews were coded, and these codes were combined into categories and predominant themes were identified.
Findings: Overall, staff believed that the hospitalist role was a positive addition to the facility. The role benefitted patients and supported the clinical well-being and education of staff. Many staff felt the hospitalist had no impact on their workload, but others reported that their work had decreased or increased. Several described the potential for role overlap between the hospitalist and other physicians.
Conclusion: The importance of interprofessional collaboration in the implementation of the hospitalist role was a recurring theme in our analysis. This study demonstrates the importance of educating staff about the hospitalist role boundaries prior to implementing hospitalist care.

Keywords: interprofessional collaboration, qualitative description, hospitalist