Background:
Hospitalists are increasingly an integral component of the programs, services, and quality improvement initiatives within their hospital system. The utilization of “peer hospitalists” during the orientation (i.e., on‐boarding) period may enhance adaptation of group policies and priorities, and support career advancement. The traditional approach to on‐boarding focuses on informational items, such as how to use the EMR or billing system, and may not emphasize the elements that are essential for the group to perform efficiently. In addition, it is unknown if an on‐boarding program that begins even before new hospitalists “go live” with a full patient panel can improve the quality and efficiency of care in early practice.
Purpose:
To establish a rigorous on‐boarding program that uses peer hospitalists as mentors and incorporates an early and well‐embedded emphasis on quality.
Description:
Each hospitalist was appointed a peer mentor who conducted a full day of in‐person on‐site on‐boarding. The process was standardized and conducted with the use of a newly created checklist tool and an on‐line hospitalist resource manual developed by hospitalist faculty. The checklist tool was created to encompass core practice guidelines and focused on enhancing quality markers such as the role of interdisciplinary rounds in patient care and safety, early exposure to proper billing, and methods to optimize early discharge. In addition a unique early work initiation program was developed to allow for a monitored “go live day” where new hospitalists assume formal care for 60% of their service working under the guidance of the hospitalist whose census they will be taking over. The checklist is reviewed again within one week of the official start date. We compared the performance for hospitalists in their initial 3 months for those hired using our standard on‐boarding process in the baseline period (2010‐2012) with those who underwent the peer‐mentoring process (2013). Outcomes included length of stay, patient satisfaction, and discharges before 11:00am.
Conclusions:
A total of 11 hospitalists were identified during the baseline period and 4 hospitalists during the intervention period. The hospitalists during the standard on‐boarding process saw a total of 612 patient cases over their initial 3 months and had a LOS observed:expected (O:E) ratio of 1.24, compared to an LOS O:E ratio of 1.00 over 172 cases for the hospitalists undergoing the peer‐mentoring on‐boarding process (p<.01). This corresponds to a 1.01 days decrease in LOS. No difference in patient satisfaction or discharges before 11:00am was found, though this may be due to the small number of hospitalists who have undergone the new program. We found that using an innovative on‐boarding program with an early emphasis on quality is associated with decreased LOS during the initial 3 months performance of a new hospitalist. Further data collection on other quality markers is required to evaluate for a broader benefit.