Effectiveness of a Nephrohospitalist Program at Two Large Tertiary Care Teaching Hospitals: Fellows Perspective Survey

Background: In 2021-2023, we experienced a substantial increase in demand for inpatient nephrology consultation and related services. To address this, we created a non-teaching, inpatient nephrology attending-only (nephrohospitalist) service at both of our large teaching hospitals in 2024. Each nephrohospitalist assumed responsibility for ~15-20 patients from the existing teaching services, on weekdays. We assessed the impact of our newly created nephrohospitalist service on our fellows-in-training. Methods: An anonymous survey was created on-line and distributed to all senior fellows who had worked at both hospitals before and after the implementation of our nephrohospitalist program. Results: The survey had a 100% completion rate. Prior to the program implementation, 83% of the fellows had reported a diminished ability to learn, 67% a negative impact on patient care quality and/or safety, and 67% reported difficulties communicating with referring and consulting physicians. Following program implementation, all surveyed fellows reported improvements. Specifically, 83% felt that their ability to learn and read improved, high-quality and safe patient care was enhanced and communication with providers was easier. Regarding service size reduction, 50% of respondents saw a decrease of over 30%, with another 50% reporting a decrease between 20-30%, and another 50% experiencing a decrease between 30-40%. The additional time afforded by the program was utilized in various ways: 83% experienced improved work-life balance, 50% engaged in more scholarly activities, and 67% fellows felt spent more discussing cases. Conclusion: Overall, the responses suggest that by reducing our inpatient teaching service sizes by implementation of nephrohospitalist services positively impacted learning ability, quality of care, communication, work-life balance, personal wellness, and scholarly involvement for our fellows-in-training. Our experience highlights some potential benefits of a dedicated nephrohospitalist service in large teaching hospitals.