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Invited Article: Is it time for neurohospitalists?

From the Department of Neurology (W.D.F., B.H.E.), Mayo Clinic, Jacksonville, FL; and the Department of Neurology (G.G.), University of Kansas, Kansas City, KS.

Address correspondence and reprint requests to Dr. William D. Freeman, Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 freeman.william1{at}mayo.edu

Background: Explosive growth of hospital-based medicine specialists, termed hospitalists, has occurred in the past decade. This was fueled by pressures within the American health care system for timely, cost-effective, and high-quality care and by the growing chasm between inpatient and outpatient care. In this article, we sought to answer five questions: 1) What is a neurohospitalist? 2) How many neurohospitalists practice in the United States? 3) What are potential advantages of neurohospitalists? 4) What are the challenges of implementing a neurohospitalist practice? 5) What effect does a neurohospitalist have on clinical outcomes?

Methods: We queried biomedical databases (e.g., PubMed) by using the search terms "hospitalist," "neurohospitalist," and "neurology hospitalist." We also searched the Society of Hospital Medicine and the American Academy of Neurology Dendrite classified advertisement Web sites for hospitalist and neurology hospitalist growth by using the same search terms.

Results: We defined neurology hospitalists (neurohospitalists) as neurologists who devote at least one-quarter of their time managing inpatients with neurologic disease. Although the number of hospitalists has grown considerably over the past decade, limited data on neurohospitalists exist. Advertisements for neurohospitalist positions have increased from 2003 through 2007, but accurate assessment of growth is limited by the lack of a central organizational affiliation and unifying terminology.

Conclusion: Health care pressures spawned the growth of medicine and pediatric hospitalists, who provide efficient, cost-effective care by reducing the length of hospitalization. Because neurologists experience the same pressures, we expect neurohospitalists to increase in number, especially within areas that have sufficient inpatient volume and resources.

Abbreviations: ED = emergency department; rtPA = recombinant tissue plasminogen activator; tPA = tissue plasminogen activator.

e-Pub ahead of print on March 12, 2008, at www.neurology.org.

Supported in part by the Robert H. and Clarice Smith/M.L. Simpson Foundation Trust (W.D.F.).

Disclosure: Drs. Freeman and Eidelman report no conflicts of interest. Dr. Gronseth is a member of Boehringer Ingelheim Pharmaceutical’s speaker’s bureau.

Received June 28, 2007. Accepted in final form November 9, 2007.

Correspondence: