Healthcare Team

Inpatient medical care is complicated. It takes many different staff members all with different area and levels of training working towards the common goal of patient improvement.

Healthcare has been affected by staffing problems like most of the country (in some areas worse). It is usual to see several different provides of any given type while in the hospital. While we like to keep patient-provider continuity as much as possible; the reality of staffing shortages cause us to often fall short. Hospitals don’t close, we can’t turn people away, someone’s level of illness dictates their need for resources and there is a finite pool of providers. If 50 more people are admitted to the hospital one night (not rare at Chippenham) the next day the same number of doctors must see them.

Members of the Healthcare Team and their roles:

Hospitalist – Internal Medicine (or Family Medicine) trained doctor who specializes in the care of a hospitalized patient. Often the primary or “attending” physician. Diagnoses and treats the patient, coordinates with specialist and other members of the healthcare team (ie: nurse, therapist, case manger, other doctors, radiology, etc).
Specialist – Doctor who after an Internal Medicine or Family Residency went study a specific field of medicine further for a few years in fellowship. Heart = Cardiologist, Lung = Pulmonologist, Kidney = Nephrologist, Gl system = Gastroenterologist, etc.
Surgeon – Surgeon’s specialist in operating on the human body. After medical school they do a surgical residency (different than Internal or Family Medicine). They can be a general surgeon (as l am a general Internist) or specialize in a particular field.
Nurse – a provider who is trained to provide care at the bedside. Nurses are the front line of hospital medicine. They are at the bedside more than any other provider. They administer medications, assist in cleaning, bathing, toileting the patient. Perform wound care. Mobilize the patient. Are the eyes/ears for the doctors when there is a change in patient condition. Nurses embody empathetic care and are the best resource when you need something.
Levels of nursing: The term nurse references to their profession, not solely their education which can be varied
Licensed practical nurse (LPN) Provides basic care and hands-on tasks, but doesn’t require the same level of education as a registered nurse (RN)
Certified nursing assistant (CNA) Requires a certification from a six-week course, rather than nursing school
Associate of Science in Nursing (ASN) or Associate Degree in Nursing (ADN) An entry-level degree that can be completed in two years. This gives an RN.
Bachelor of Science in Nursing (BSN) An undergraduate degree for RNs that can help advance their skills and knowledge
Master of Science in Nursing (MSN) An advanced-level postgraduate degree for RNs, and an entry-level degree for nurse educators and managers
Doctor of Nursing Practice (DNP) A practice-based doctorate degree that represents the highest level of academic training in nursing

Nurse – primary bedside caretaker. Provide direct care to patients, administers medications, monitors for changes.

CNA / LPN – assist nurse in providing patient care like toileting, eating assistance, checking vital signs, etc.

Charge Nurse / Nursing Directors – Nurse who supervises nursing care on a particular hospital ward. Any issues with nursing care are directed to them for remedy.

Hospitalist – An Internal or Family Medicine board certified doctor who specializes in the care of the acutely ill hospitalized patient. Generally the primary or attending physician; serves also in a consultant role for other providers (ie: surgeons, subspecialist). Often likened to a team “quarterback.” Hospitalist directly care for the patient but also collaborate with specialist on patient care. They guide patients and their families through the hospitalization and transition of care at discharge.

Consultants – subspecialist (Cardiology, Pulmonary, Surgery) called to see a patient for a specific condition.

Radiologist – perform and interpret imaging studies in the hospital. Interventional Radiology also provide perform invasive procedures using various imaging techniques (CT scans, ultrasounds, etc.).

Ancillary Staff: PT, OT, Speech, Wound Care nurse, Phlebotomist

Physical therapy (PT) & Occupational Therapy (OT) – therapist trained in movement. They work with patients to improve movement, balance, strength, walking, coordination and overall conditioning. Treat both sudden illness (ie: strokes) and more chronic or progressive illness (ie: hospital acquired deconditioning).

68% of patients leave the hospital weaker than on admission. (Falvey JR, Mangione KK, Stevens-Lapsley JE. Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift. Phys Ther. 2015;95(9):1307-1315. doi:10.2522/ptj.20140511)¹

Hospitalized patient generally spend < 7% of their time active (Scott J, Abaraogu UO, Ellis G, Giné-Garriga M, Skelton DA. A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field. Eur Geriatr Med. 2021;12(2):227-238. doi:10.1007/s41999-020-00414-y)¹

Therapy assessments guide recommendations for services after discharge such as home therapy, inpatient rehab and skilled nursing facilities.

Speech therapy – therapist who specialize the the mechanics of speech and swallowing. Often see patients for trouble swallowing from both recent (ie: stroke) and long term (ie: dementia) causes. Difficulty swallowing (dysphagia) leads to choking (aspiration) which can lead to pneumonia. To reduce the risk for choking speech therapist alter the type of food and liquids and educate on different eating strategies.

Wound Care nurse – nurse with specialize training in preventing and treating wounds on the skin. They perform a comprehensive evaluation of the skin and make recommendations to the doctors on how to treat current wounds and prevent new ones.

Case Managers – generally trained in nursing or social work they coordinate the logistics for any additional services. Arranging for home therapy, durable medical equipment (ie: walker, bedside commode, etc), coordinating with rehab facilities and insurance companies, hospice evaluations, and other services requested by the doctor.

Phlebotomist – a member of the medical lab who draws blood from patients. Morning labs are generally drawn early in the morning so results are available to make treatment decisions for physician rounds.

Environmental Services – provide cleaning and janitorial services for the hospital.

Food service – take a food orders and delivers the food to the patient’s room. Food is made in the hospital cafeteria and restricted to the dietary orders placed by the physician.