In Response to: Lee S,Kanigere MK,Tibrewal P,Dhillon R and Bastiampillai T (2021). The hospitalist movement and the benefits for Australian psychiatry services. Australian and New Zealand Journal of Psychiatry

Response to: Pai N and Vella S (2021) Continuity of care and a functionally split system of care. Australian and New Zealand Journal of Psychiatry 55(3): 239–240.

To the Editor

The hospitalist delivery model was developed to reduce average length of stay and improve patient outcomes. It is a recent natural outgrowth of an environment where there is increasing pressure for hospital utilization to be tightly managed for both quality and cost reasons (Freese, 1999; Wachter and Goldman, 1996). The favoured model should be that which produces the best clinical outcomes and the highest patient satisfaction at the lowest cost. For patients, the greatest concern is interrupting the continuity of a supportive relationship with their regular psychiatrist. Hospitalists may add value by being more available to inpatients, having more hospital experience and expertise, and having an increased commitment to hospital quality improvement. Disadvantages of the hospitalist model include loss of information because of discontinuity of care, patient dissatisfaction, loss of acute care skills by primary care doctors and burnout among hospitalists. The hospitalist model has been shown to be effective in decreasing both community and academic hospital lengths of stay and hospital costs, while the hospitalist does not reduce quality as measured by increases in patient mortality, increases in discharges to subacute care facilities, increases in readmission rates or decreases in patient or physician satisfaction due to lack of continuity between the hospitalist and primary care physicians (Diamond et al., 1998). A variety of models of care are needed to meet the clinical, organizational, financial and political demands of diverse healthcare systems. I do not agree that separating patients from the doctor who knows them best, at perhaps the patient’s moment of greatest need, is desirable.