Background:

Assignment of a patient to a ward team is a challenging task. If one were to take into account every variable involved in order to maximize quality of care, placing a patient on a team would be overly burdensome. To counter this, some groups retrospectively assign patients in the morning when teams arrive. Retrospective assignment eliminates crucial trust building opportunities with the patient, for example, “Your Doctor will be ….” If prospective patient assignment is employed, then a “Round Robin” or a “Load Leveling (LL)” approach is often employed to pass out patients based mostly on total number of patients, a single variable. Appropriate team assignment can be compromised by single–variable methods and using more variables becomes time consuming and burdensome.

Purpose:

To develop a CPA tool that would allow quick and easy prospective team assignment based on multiple variables.

Description:

The CPA tool is a web based application hosted on a secure, HIPPA compliant server. This tool is updated with current team information before the nighttime shift. Individual patients are assigned an Intensity Score (IS) based significantly on room location, i.e. ICU, SNF, etc…. The teams are assigned an aggregate IS based on sum of patients, provider preferences, and agreed upon group parameters. Potential admissions to the team and their impact on baseline IS is tabulated per team. The potential admissions are then sorted into a rank ordered list and given to the nighttime doctor(s). Patients are then admitted to teams in this order. This overall process takes approximately 5 minutes.

Conclusions:

After using CPA for 10 months, an evaluation was done using a retrospective survey of providers and before and after implementation metrics. We found a majority of providers preferred CPA over strict LL. CPA eliminated patient reassignment in the morning. There was an average time savings of 14 minutes per doctor, per night shift. Additionally, no patients were missed. CPA can improve coordination of care and save time in the process.

Table 1Measured Variables

  Before After
Preferred Method 3 12†
AM Patient Reassignment average times per doc / per shift 0.93 0*
Time spent coordinating team assignment average minutes per doc / per shift 18.87 4.67†
Percent of patients satisfied with Doctor 98.64 98.89
Average doctor efficiency (Total Discharges + Total Followups / Total Discharges) 3.39 3.20†
Number of patients missing after AM handoff 0 0
* P < 0.001. †P < 0.01.