Director of Inpatient Medicine Consult and Co-Management Services: Mike Rudy, MD
Director of Preoperative Clinic: Paul Grant, MD

Hospitalists in our division are leaders in perioperative medicine, hospital medicine consultation, and surgical co-management. 

Hospital Medicine Consult Service

Staffed by a faculty hospitalist, the inpatient consult service serves many roles:

• Provide inpatient medical consultation to both surgical and non-surgical patients
• Co-management with selected orthopedic surgery services:
  • elective hip/knee replacement patients with medical co-morbidities
  • acute hip fracture patients
• Physician lead on the Rapid Response Team (RRT)
• Educate Internal Medicine residents who choose Hospital Medicine Consultation as an elective rotation

General Medicine Preoperative Clinic

Hospital Medicine faculty run the Medicine Preoperative Clinic for medically complicated surgical patients. The clinic serves many functions:

• Provide evidenced-based preoperative risk assessment and risk reduction strategies for patients undergoing a wide array of major surgeries.
• Educate Internal Medicine and Family Practice residents who are rotating in our clinic.

Director: Matt Luzum, MD, MPH
Assistant Director: Emily Jacobson, MD

This service provides care to medical patients that require a brief hospital stay, expected to be less than 48 hours. The MSSU has two service locations, the 18-bed Maize Unit adjacent to the Emergency Department and a 22-bed unit located in the hospital. Both locations are closed units with full geographic alignment of primary medical and nursing teams. The medical team consists of physicians and advanced practice providers, including nurse practitioners and physician assistants. They collaborate closely with a dedicated staff of nurses, case managers, social workers, unit clerks, and a clinical assistant. 

The MSSU is committed to continue to innovate and to pioneer team-based approaches to deliver safe, high-quality and efficient care to its patients. As a fully functioning accountable care unit (ACU), the MSSU team is the first at Michigan Medicine to conduct daily structured interdisciplinary bedside rounds (SIBR), during which the plan of care is reviewed with every patient, with participation from all members of the healthcare team. This promotes patient-centeredness and allows efficient and effective multidisciplinary team communication.

Advanced Practice Provider (APP) Program

The advanced practice provider (APP) program in the Medical Short Stay Unit (MSSU) in one comprised of both physician assistants (PAs) and nurse practitioners (NPs). In collaboration with the onsite MSSU attendings, APPs provide comprehensive evaluation and treatment of adult Internal Medicine patients who are observation or inpatient status. Patient care is provided in two units; MSSU Maize (18 beds) and MSSU Blue (22 beds). In addition, the MSSU APPs partner with the MSSU triaging physician to conduct history and physicals and complete admissions for patients in the Emergency Department accepted for admission to the MSSU. The MSSU physician-APP relationship is based on a teamwork model of shared medical decision making. 

Director: Jigisha Patel, MD
Assistant Directors: Irina Khurana, MD and Stephen Lichtenstein, MD

Growing from eight faculty in 2003, the service is now staffed by more than 60 faculty, discharging over 8,000 patients per year, with dedicated nocturnists who admit most of our new patients in the evenings and at night. Our maximum number of patients per faculty hospitalist is 11, allowing adequate time for high quality care for our complex patient population.

To support our clinical activities, the service is complemented by dedicated case managers, clinical assistants, and a number of dedicated clinical pharmacists. Daily multidisciplinary discharge rounds for all service patients focus on aspects such as reason for hospitalization, barriers to care delivery, transition issues, and expected day of discharge to facilitate collaborative care. Pharmacy rounds occur on weekdays and cover myriad aspects including appropriate antibiotic use, management of anti-coagulants, intravenous antibiotics, intravenous nutrition, and medication dosing.

As the largest service in the hospital, we participate in many ongoing quality improvement initiatives such as priority discharge (identifying 20 patients a week that could be discharged early the next morning), antibiotic stewardship, and pharmacy-physician medication reconciliation for patients with high LACE sore at high risk for re-admissions. The MFH faculty mentor teaches and closely supervises a variety of learners including medical students, in addition to students from the Acute Care Nurse Practitioner (ACNP), Physician Assistant (PA) and biomedical engineering programs at the University of Michigan.

The Renal Transplant Team was successfully created in 2011 with a goal to improve quality by consolidating kidney transplanted patients into a highly knowledgeable multidisciplinary team. The team consists of a hospitalist with an assigned transplant nephrologist participating in daily rounds. Patients are admitted to this team with a variety of illnesses such as acute kidney injuries, urologic infections, transplant rejection, medication side effects, and other infections (some rare). This service also admits general medicine patients providing even more of a variety of maladies.

Director: Julieann Grant, MD, PhD

The Medicine Hematology Physician Assistant (MHP) service is an expansion of the Division and serves as a model for the successful delivery of inpatient specialty care by General Medicine Hospitalists. The service provides care to patients with malignant hematological diseases in close collaboration with each patient’s hematologist at Michigan Medicine. Care provided on the service frequently includes consolidation or re-induction chemotherapy, chemotherapy on clinical trials, care after complications from chemotherapy (e.g., neutropenic fever), and end of life care. Hospitalists within the Division attend year-round on this service, complemented by four full-time physician assistants, a Heme/Onc clinical pharmacist, a clinical assistant, social worker, and care manager.

The MHP team works closely with Dale Bixby, MD, PhD, who is the team’s hematologist liaison with the Hematology/Oncology division. In addition to providing care to the patients on the MHP service, the MHP attending leads adult codes and responds to adult rapid response calls requiring back-up that occur in the C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital. At night, one nocturnist covers the MHP and Bone Marrow Transplant services and the emergency response responsibilities at C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital.

Director: Jonathan Sebolt, MD
Assistant Director: Michael Adams, MD

The Medicine Procedure Service (MPS), a new service within the Division of Hospital Medicine beginning July 1, 2021, was implemented to improve patients' experience and comfort by providing diagnostic and therapeutic procedures (ultrasound-guided paracentesis, thoracentesis, and lumbar puncture) that are timely, delivered at the bedside, and in close collaboration with inpatient teams to maximize quality of care.

Staffed by advanced practice providers and physicians, MPS performs procedures on patients cared for by all adult inpatient services. In collaboration with other specialties including Pulmonology, Interventional Radiology, and Thoracic Surgery, MPS provides support for bedside evaluation, consultation, and procedure performance.

Michigan Hospitalists at Chelsea

Director: Marcus Calderon, MD

The joint venture between Michigan Medicine and Trinity Health has fostered the integration of several Michigan Medicine services at Chelsea Hospital, including the Michigan Hospitalists at Chelsea (MHC) service. Staffed by Michigan Medicine hospitalists, this service provides care for general medicine patients and houses the Chelsea Heart Failure Program. 

At discharge, patients are enrolled in the Michigan Medicine Heart Failure Bridges and Transitions Program. This program provides patients with close monitoring and education during the first month after discharge. With several interventions, this program seeks to minimize the risk of repeat hospitalization and set patients on the path to long-term success.

Michigan St. Joe's (MSJ) Service

Director: Ruby Marr, MD
Assistant Director: Paul S. Caseley, MD

In collaboration with St. Joseph Mercy Ann Arbor (SJMAA or St. Joe’s) and Michigan Medicine, select patients are admitted to a Michigan Medicine staffed 26-bed inpatient unit on the 4th floor of St Joe’s, known as Michigan St. Joe’s (MSJ). This service is an expansion of the former Acute Care for Elders (ACE) Unit, which offers an expanded scope of care designed for all adult patients with general inpatient medical needs, in addition to elderly patients who can benefit from a rounding geriatrician and Nurses Improving Care for Healthsystem Elders (NICHE) certified registered nurses.

MHC and MSJ Services

Patients presenting to the Michigan Medicine Emergency Department, and likely need to be admitted for inpatient care, are actively screened by emergency physicians and hospitalists for transfer to both MHC and MSJ. In addition, patients can be directly admitted from Michigan Medicine clinics and the St. Joe’s Emergency Department. Both services provide timely, high-quality care in a comfortable community setting. Patient care incorporates interdisciplinary care teams led by Michigan Medicine hospitalists (and geriatricians for MSJ), in collaboration with St Joe’s nursing, pharmacy, nutrition, case management, social work, and support staff. A dedicated clinical assistant is also part of the team to support transitions of care, facilitate post-discharge follow-up, and assist the patient.

The VA Ann Arbor Healthcare System (VAAAHS) Medicine Service strives to deliver the highest quality care to Veterans while fostering a culture of scholarship, continuous improvement, and excellence in medical education. Each general medicine team is multi-disciplinary with representation from medical providers, care coordinators, pharmacists, social workers, and other health professionals. Learners rotate with renowned leaders and educators chosen based on the merits of their superb teaching abilities.

The Hospital Outcomes Program of Excellence (HOPE) focuses on enhancing patient safety, efficiency, communication, and education. The VA’s numerous educational offerings include daily senior report, lunchtime conferences, intern report, and multi-disciplinary morbidity and mortality conferences, covering topics relevant to all medical subspecialties. Medical students enjoy immersive, interactive educational sessions with health system leaders including Chief of Medicine Rounds and the M3 Preceptorship series. Hospitalist leaders guide the M4 Hospital Medicine sub-internship, a unique clinical rotation complete with an integrated quality improvement project. The VA Chief Resident of Quality and Safety leads improvement efforts and educates colleagues in ensuring safe and effective patient care. The VA consult fellow of the month program recognizes outstanding service and communication from consulting fellows on subspecialty services.

Members of the section of Hospital Medicine provide direct care for Veterans on the “Blue Medicine” inpatient service and in the short stay unit. Hospitalists field all outside hospital transfer requests. In addition to their clinical duties, all members have individual protected time for quality improvement efforts to improve patient care processes at the VAAAHS and Michigan Medicine as well as to further their own academic pursuits.