Background:
Localization of medical teams to a hospital unit is an attractive way to organize hospitalist services but its operational impact on work flow has not been examined.
Methods:
Between April 1, 2010, and July 10, 2010, we localized patients assigned to 2 hospitalist–physician assistant (HPA) teams on 1 nursing unit. We concurrently compared the operational outcomes of these localized teams with 2 similar HPA teams with patients dispersed throughout the hospital to more than 10 units (the usual practice). A hospitalist faculty admitting medical officer (AMO) was asked to assign at least 5 admissions to each nonlocalized team every day. Nonlocalized teams did not take new patients beyond a maximum census of 16 patients each. The AMO assigned new patients to the localized teams to keep the nursing unit patient census (32) full. Beyond these guidelines the AMO was asked to consider the team's perceived workload and use judgment in deciding assignment. We collected billing information to determine total encounters for providers on these teams as a measure of clinical workload. We determined number of pages to each provider during work hours (from 7 AM to 6 PM) through our telecommunication records. For the final 15 days of the intervention period, we asked the physician assistant (PA) on each team to wear a pedometer and record steps taken during her or his workday as a measure of non‐value‐added work. We used generalized estimating equations to determine the effect of localization on the number of patient encounters per day by the HPA team, number of pages during work hours to the HPA team, and number of steps taken by the PAs while accounting for repeated measures per provider. This study was reviewed by the institutional review board and granted an exemption as a quality assurance project.
Results:
Nonlocalized teams performed an average of 11 billable patient encounters and received 28 pages between 7 AM and 6 PM, and the nonlocalized PAs took 5554 steps during the workday. In comparison, localized HPA teams averaged 0.99 more billable patient encounters a day (CI, 0.41–1.58; P = 0.001) and received 11.93 fewer pages every day (CI, 10.95–12.91; P < 0.001). PAs on localized teams walked 1182 fewer steps during the workday (CI, 2215 to 2580; P = 0.097).
Conclusions:
Our study shows that localizing HPA teams to 1 nursing unit allowed them to perform more clinical work while decreasing the number of interruptions from pages. Fewer pages may also mean that localized HPA teams communicated more with nurses directly—a safer and richer mode of communication than phone communication or orders. In addition, the pedometer data suggest that non‐value‐added work represented by number of steps walked per day may have been lower on localized teams. In summary, localizing HPA teams to 1 nursing unit has a dramatically positive impact on their work flow.
Disclosures:
S. Singh ‐ none; V. Rana ‐ none; C. Jenks ‐ none; K. Idstein ‐ none; D. Marks ‐none