HMS 15 - Stepdown Service
Bridging the gap between intensive care and the medical ward through hospitalist-led, multidisciplinary care for complex metabolic conditions and chronic ventilator-dependent patients.
The Hospital Medicine Service (HMS) 15 Stepdown Service provides specialized, high-acuity care for patients with complex metabolic conditions and chronic ventilator-dependence that require closer monitoring than can be provided on a general medical ward. The service focuses on managing diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), moderate hyponatremia, hyperkalemia in patients with CKD stage 3 or greater, and chronic ventilator-dependent patients. By bridging the gap between standard inpatient and intensive care, HMS 15 ensures patients receive timely, evidence-based management in a safe and collaborative environment.
In addition to its clinical mission, HMS 15 serves as a core educational experience for internal medicine residents in the Hospitalist Training Program and electively for Advanced Practice Fellows. Learners gain hands-on experience in managing high-acuity medical conditions, interpreting complex laboratory and physiologic data, and working within a multidisciplinary team to deliver coordinated, patient-centered care. The service emphasizes clinical reasoning, communication, and collaboration—skills that are essential for success in hospital medicine.
Through strong collaboration with nursing, respiratory therapy, nephrology, endocrinology and critical care teams, the HMS 15 enhances hospital flow, prevents ICU overutilization, and promotes smooth transitions of care. This model supports the broader mission of Hospital Medicine by delivering high-value, specialized care for medically complex patients.
Service Details
- Hours: 24/7 coverage by hospital medicine providers
- Location: Medical Progressive Care Unit
- Focus Areas: DKA/HHS management, electrolyte derangements, ventilator care
Directors
Co-Director
Jason John, MD
Co-Director
Katarina Sanford, PA-C