Hospitalist service moves to 24-hour care model
Joni Chenoweth is latest addition to successful inpatient care team 
RANDOLPH, Aug. 25, 2008 – Physician assistant Joni Chenoweth has joined Gifford Medical Center’s hospitalist team, expanding the inpatient care service to a 24-hour, seven-day-a-week model that is garnering significant attention.
Gifford’s hospitalist team of Dr. Martin Johns and now three physician assistants has been featured in national publications and is even drawing the attention of other hospitals that are looking toward Gifford as a successful model to replicate.
Among the unique characteristics of Gifford’s hospitalist program is using physician assistants to expand hospitalist care to weekends and nights.
Open one of those national publications on hospitalist medicine and among the latest being discussed is the idea of using “mid-level providers” to expand hospitalist care, Gifford hospitalist physician assistant Sue Burgos says.
Gifford’s already doing that.
“We’re pretty much on the cutting edge,” Burgos says.
Dr. Johns agrees, calling Gifford’s program “unique and exciting, especially for a small hospital.”
“I’m extremely excited for Gifford and the level of commitment to the community this 24-hour coverage model provides,” Dr. Johns says. “This compares to national programs in much larger medical centers.”
Twenty-five-bed Gifford began providing hospitalist service in 2006, making it one of the first small hospitals in the state to do so.
A hospitalist cares for hospitalized patients, or inpatients. Previously, hospitalized patients were visited by their primary care doctors at the beginning or end of the day. Nurses then provided inpatients care for the remainder of their hospital stay. With the addition of Dr. Johns in 2006, hospitalized patients got the care of a doctor up-to-date on the latest in inpatient medicine and dedicated just to them. Primary care providers were then freed up to spend more time in their always-busy outpatient clinics.
“Medicine is changing. The outpatient doctors don’t have the time or the capacity to see all of their patients in the hospital and all of their patients in the clinic,” Dr. Johns notes.
With hospitalists, Gifford can also care for far sicker patients who would previously have had to go to a larger facility, like Dartmouth-Hitchcock Medical Center in neighboring New Hampshire. And quality, as measured by the Centers for Medicare and Medicaid Services (CMS), for example, shows marked improvements over prior years.
With the help of the hospitalist program and numerous other quality initiatives, Gifford collected difficult-to-achieve “100 percents” on CMS measurements for heart attack, heart failure and pneumonia patients in preliminary data for April of this year, meaning every patient got exactly the right care every time.
“We provide personalized, yet high-quality care for folks who want to remain at Gifford and remain close to home and still have the type of care that they’d get at a larger hospital,” Dr. Johns says.
Around-the-clock care through the edition of physician assistants is the latest improvement in Gifford’s hospitalist program.
Physician assistants are part of a category of health care providers known in the industry as “mid-level providers.” Nurse practitioners also fall into this category and generally are medical professionals who have advanced training, but have not received a doctor of medicine degree.
Burgos, for example, spent many years as an inpatient nurse before attending a graduate education program and earning her certification as a physician assistant. As a physician assistant, she saw a large number of patients in the outpatient setting at Gifford for years before joining the hospitalist team last year with fellow physician assistant Fred Staples.
Both are now trained in hospital medicine, just like a hospitalist physician. They provide direct care to hospitalized patients and admit patients into the hospital. They treat all but the most highly complex of cases, which could require backup expertise from an on-call doctor. They also have the support of a substantial team.
The hospitalists work closely with both surgeons, whose patients may recover in the hospital, and primary care providers. Daily intake rounds where patients’ needs are discussed among a diverse group of caregivers, including pharmacists; social workers; physical, occupational and respiratory therapists; dietitians; nurses and doctors, have also been implemented.
The addition of Chenoweth (see sidebar below), a former social worker, moves Gifford to the 24-hour hospitalist care model and brings new experience to the team.
“Joni’s a compassionate, caring and extremely competent provider whose life experience has made her a valuable asset in caring for and addressing the physical and psychosocial needs of our community members when they’re admitted to the hospital,” Dr. Johns says.
The next step for Gifford is the hiring of a second doctor to its hospitalist team, a move that will reduce the need for primary care physicians to provide on-call back-up on weekends and evenings while physician assistants are on duty. A hospitalist physician would instead be providing that backup.
The hospital is currently recruiting for a doctor certified in family medicine or both internal medicine and pediatrics to fill this role.
Introducing Joni Chenoweth, PA-C
Physician assistant Joni Chenoweth started at Gifford Medical Center in the spring and since has undergone an extensive training process.
Chenoweth lives in East Barre. She’s married to Gil Kujovich, a Vermont Law School constitutional law teacher; enjoys animals, swimming, gardening and painting in her free time; and has a lengthy background in social work.
She spent 22 years as a clinical social worker and cognitive behavioral therapist. In Vermont, she worked at Washington County Mental Health and in private practice.
Chenoweth went on to complete her master of health science degree at Quinnipiac University in Hamden, Conn., last year. She’s also studied biology in Indiana, was in the Honors Society while attending the post-baccalaureate Pre-Med Program at the University of Vermont from 2000-2002, and has a master’s degree in social work from Indiana University.
She is certified by the National Commission on Certification of Physician Assistants and did her clinical rotations at hospitals and medical practices in primarily Connecticut.
Now back in Vermont and at Gifford, Chenoweth says, “I’m delighted to be here. I can’t get over what a nice environment it is.”
“I feel honored to have been asked to work at Gifford, and I am very excited about being a part of this hospital,” she adds.
Working with hospitalist Dr. Martin Johns is another honor.
“Martin is someone you want to emulate and you want to learn from,” she says.
Chenoweth is not alone in that stance. Dr. Johns has been interviewed for numerous articles on hospitalist medicine, was published in the American Journal of Cardiology and later this year will speak at the Society of Hospital Medicine in Atlanta on “Co-Management of Surgical Patients in a Critical Access Hospital.”
Gifford is one of those hospitals designated by the federal Centers for Medicare and Medicaid Services as critical to the rural area it serves.