The Zhos – an Innovative Approach to Psychiatric Co-Management

Background:

ZHH is an inpatient psychiatric facility with an average daily census of 220 patients. It is located adjacent to LIJ, our tertiary medical center. On average, 300-400 cases are transferred from LIJ to ZHH each year, as well as 200-300 cases transferred from ZHH to LIJ. Traditionally, there were 3 internists covering medical consults at ZHH. Starting in October 2014, the LIJ hospitalists began rotating at ZHH to implement a new co-management service.

Purpose:

Our purpose is to streamline transfers between the two hospitals, to improve access to and quality of medical services at ZHH, and to decrease readmission rates at both hospitals by 25%.

Description:

Starting in October 2014, one of our hospitalists started rotating at ZHH. In June 2015, we formally took over Medical Services, and now have two hospitalists rotating at ZHH at any given time. Currently 10 hospitalists rotate throughout the year, with the plan for all new hires to rotate there as well. Hospitalists who rotate at ZHH are known as “ZHOS.”

The two ZHOS are in house on the ZHH campus from 8am to 6pm. They are on pager call until 8pm, and can be reached via one dedicated job code pager. After 8pm, the nocturnists at LIJ are available for any questions.

A transfer policy was developed by the ZHOS to reduce delays in medical clearance and discharge time, and to efficiently transfer patients from LIJ to ZHH. Patients transferred from LIJ to ZHH are seen by the ZHOS within 24 hours; after a direct verbal handoff is provided by the LIJ inpatient team. A transfer worksheet is filled out for each patient that is being transferred. A post-acute care note is also completed for each patient upon evaluation after transfer. If it is deemed that continued medical follow up is warranted, the ZHOS will continue to follow the patient.  

The ZHOS also review paperwork from outside facilities requesting transfer of patients to ZHH, and communicate directly with the physicians at the outside facility on an as needed basis.

Inpatient psychiatrists/residents/NPs from all units are able to contact the ZHOS for medical consultations on any existing patients that the ZHOS are not already following.

Conclusions:

Transfers from LIJ to ZHH

Transfers from ZHH to LIJ

Based on data through June 2015, 30 day readmission rates at both sites decreased by 31-50%. We expect this number to continue to improve, as we only began to fully staff ZHH starting in June 2015.