Background: As hospital reimbursement models and publicly available CMS ratings place a stronger emphasis on improved patient throughput, safety, and satisfaction, it has become increasingly important for hospitals to develop cohesive care teams aligned with these goals. At our 800-bed quaternary care hospital located in suburban New York, care had historically been quite heterogeneous, with varied models of care delivered not just between units, but also within those units, depending on a number of factors including the attending of record and degree of midlevel support. Hospital administration made a significant investment in our hospitalist group to develop leaders and implement strategies aimed at unifying the care teams on the inpatient medicine wards, with the hope of improving multiple unit-based metrics, and standardizing care across the hospital.
Purpose: Our hospital’s unique “Care Model Redesign” aimed to employ a number of strategies directed at improving the efficiency, effectiveness, and quality of care on nine different medicine units. Our group sought to quantify our performance metrics since completion of the roll-out, and to compare to historical data.
Description: Hospital administration sought to standardize care delivery on nine different medical units between September 2016 and January 2018. A full-time hospitalist physician lead was selected for each unit, tasked with taking ownership over its daily operations and performance. Each unit aimed to decrease excess days per case (ED/case), increase the percentage of discharges by 2PM, and improve patient satisfaction/quality metrics. Each physician lead was kept geographic and had a protected census so that the lead could devote a percentage of their time to administrative activities and oversight of voluntary patients. Physician leads and nurse managers had biweekly meetings with hospital administration for leadership training exercises and to better understand operational metrics. An emphasis was placed on developing structured daily interdisciplinary rounds on each unit, led by the physician lead, in concert with the nurse manager, RNs, NPs, and case management. Daily “tuck-in rounds” were enacted on each unit as well, emphasizing provider-patient communication. Units were also encouraged to focus on improving issues germane to their specific patient populations.
Conclusions: Thus far in 2018, cumulatively our nine units have decreased excess days by 2,993 days. All units have been able to decrease or maintain their average ED/case, despite a higher acuity of patients, as measured by case mix index. Six of our nine units have seen improved scores for “Likelihood to Recommend the Hospital” on HCAHPS surveys; seven units have improved their “Communication with Doctors” rankings. As compared to January, the average percentage of discharges by 2 PM on all units has increased from 16% to 21.4%, and all units but one have an improved 30-day readmission index relative to last year.
By emphasizing collaboration and empowering hospitalist leads on our nine medical units, our hospital has shown preliminary improvements in patient throughput, satisfaction, and quality metrics.