ansitional Care Unit, of Spokane, says it has taken the unusual step of providing full-time, on-site medical oversight during the weekdays, as well as 24-hour access to hospitalists from the adjacent Providence Sacred Heart Medical Center & Children's Hospital.

St. Joseph now has an advanced registered nurse practitioner, or ARNP, working full time, primarily during daytime hours Monday through Friday, says Sally Denton, administrator of the 162-bed skilled-nursing center. Denton says the ARNP works under the direction of a Sacred Heart hospitalist physician, who is assigned to St. Joseph quarter time. During evening hours and on weekends, other hospitalists from Sacred Heart are available to visit St. Joseph quickly when needed, giving the care center 24-hour access to a hospitalist, she says.

Both St. Joseph Care Center and Sacred Heart are part of the Providence Health Care network, which also includes Providence Physician Services, which employs the hospitalists.

"Having a nurse practitioner or hospitalist at our facility greatly impacts our ability to respond quickly to residents' changing medical conditions and to sort out complex medical issues, particularly in the first day or two after a resident is admitted," says Denton. "This is especially important because our facility has one of the highest patient acuity levels in the state, while maintaining excellent ratings on state surveys."

She adds, "The new medical oversight program has already demonstrated that it significantly reduces complications, rehospitalizations, and emergency department visits."

St. Joseph says that in recent years, the national trend has been away from primary-care physicians making hospital rounds to supervise the care of their patients, and that instead, hospitalists are taking over that role. That trend, it says, now is expanding to skilled nursing centers. St. Joseph says primary-care physicians still have the option of supervising their patients' care at the facility.