Kevin High, MD, president of Atrium Health Wake Forest Baptist, and Susan Rehm, MD, former associate chief of staff at Cleveland Clinic, explore the business case for in-house infectious diseases experts and why more hospitals and health systems need them.
Why should hospitals and health systems value infectious diseases doctors?
KH: Infectious diseases doctors do the two things I am always looking to achieve as a hospital leader: they improve patient outcomes and reduce costs. The data show that involving an infectious diseases doctor early in a patient’s hospital stay reduces hospital-acquired infections and shortens the patient’s length of stay, meaning they get to return home more quickly.1 Getting that patient discharged opens a bed that a new patient can take, lessening the likelihood of an emergency room boarding or delay for a patient seeking services.
SR: When a patient is being discharged, applying an infectious diseases lens to post-hospital care reduces infection-driven readmissions. Keeping readmissions low helps hospitals avoid penalties from payers and even increases payments in some cases.
How do infectious diseases doctors benefit hospitals and health systems?
SR: It may seem simple, but when infectious diseases doctors focus on preventing and treating infections, it allows heart surgeons to focus on performing heart surgeries and plastic surgeons to focus on performing plastic surgeries. As a hospital leader looking at the financial “big picture,” I want that surgeon focused on surgery as much as possible, not on management of post-surgical issues. Having an infectious diseases expert on staff and embedding them in medical teams ensures everyone is focused on what they are most qualified to do.
KH: Often the best way for an infectious diseases doctor to provide value in a hospital or health system is by placing them in a leadership role that allows them to instill a culture of evidence-based infection prevention and treatment. Through their work in leading infection prevention and antimicrobial stewardship programs, in addition to their day-to-day work with other clinicians on patient care, infectious diseases doctors make hospitals safer places to be, and they help ensure clinicians of all types become more informed, effective stewards.
SR: It can even start earlier – having more infectious diseases doctors at the faculty and leadership level in medical and graduate schools is important. We need to teach the skills and expertise that infectious diseases doctors have to the next generation.
Have you collected or analyzed data at your system that demonstrates the value of infectious diseases doctors?
KH: We’ve analyzed length of stay and readmission rates for certain conditions and diseases, and they both dropped if there was a consult from an infectious diseases doctor. We’ve made optimized protocols part of our care maps and discharge processes for certain conditions.
SR: Hospitals and health systems can measure the value of infectious diseases doctors by collecting the correct metrics, which, unfortunately, many currently do not. Data related to judicious test ordering, thoroughness, and continuity would show the impact infectious diseases doctors have on quality, outcomes and satisfaction.2
Will AI and other advancements take the place of infectious diseases doctors?
KH: There may be some efficiencies introduced as we learn more about the applicability of these advances, but they will never be able to fully replace infectious diseases doctors. For an algorithmic diagnostic to work, there must be an accurate patient history, and in the case of infectious diseases, that’s not very easy. Infectious diseases doctors are incredibly nuanced in their thinking when taking a patient’s medical history. A small detail that seems insignificant might set off alarm bells in an infectious diseases doctor’s mind that others – and AI – might miss.
SR: Artificial intelligence cannot provide the continuity of care that infectious diseases doctors do, which has wide-ranging benefits for both the care team and the patient. They’re often one of the few clinicians who accompany a patient throughout their care journey, from admittance to discharge and beyond. They can track clinical developments closely based on their established history with the patient and communicate those changes to the appropriate team members. Their presence is comforting to patients, who become familiar with them and rely on them as a constant in an often unstable and scary time in their life.
1. McQuillen, D. P., & MacIntyre, A. T. (2017). The Value That Infectious Diseases Physicians Bring to the Healthcare System. The Journal of infectious diseases, 216(suppl_5), S588–S593. https://doi.org/10.1093/infdis/jix326
2. Toll, E. T., & Sinsky, C. A. (2023). The Deep Work of Doctoring-Prioritizing Relationships in Medicine. JAMA internal medicine, 10.1001/jamainternmed.2023.3012. Advance online publication. https://doi.org/10.1001/jamainternmed.2023.3012
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