Background: Hospitalists and hospitals face unprecedented challenges with growing demand for acute care. Academic medical centers must also provide a superior learning experience for the future healthcare workforce. With executive sponsorship from our health system and school of medicine, we undertook a major initiative (Project ELEVATE) to completely re-imagine and transform how hospital medicine care is delivered, taught, and experienced at the Hospital of the University of Pennsylvania.
Purpose: 1. To develop a data-driven demand model to proactively plan for capacity and support decisions about resource needs2. To develop and implement innovative models of care to reduce friction and enhance provider and trainee experience3. To optimize processes including ED time to team assignment, length of stay, and provider interruptions due to asynchronous communication
Description: We began work in February 2025 with support from an external consultant group (Chartis) to convene stakeholders at the highest organizational levels. The leadership for this initiative was comprised of HUP executives (CEO, CMO, Chief for Advanced Practice), Department of Medicine leaders (Chair, COO, Vice-Chair for Quality, Residency Director) and Division of Hospital Medicine (Chief, Associate Chiefs, APP Manager and Practice Leads, Division Administrator). We leveraged health system data resources to describe 24-hour demand from all sources (ED, MICU downgrades, outside transfers, etc) and model gaps in team capacity to meet these demands year-round. We discovered that although midnight census was often below max capacity, daytime census exceeded team capacity on 68% of days in the year. We also determined that patients were cohorted according to their assigned teams only about 60% of the time with the remainder of patients scattered across different units. Finally, we observed that communication via the EMR secure chat function had reached levels that were highly disruptive to all team members which impacted provider as well as resident satisfaction. In July 2025, we launched several initiatives for Project ELEVATE based on these findings: 1) development of a robust, inter-disciplinary ED-based admissions team with triage attending, admitting resident, and 2 admitting APPs, 2) step-wise, strict geocohorting of each team to a single assigned unit, 3) launch of streamlined in-person multi-disciplinary rounds on each unit with direct participation of bedside nurse for each patient. As of late November 2025, we have achieved a 70% increase in early admissions (before noon) from the ED. We have also achieved 95% strict geocohorting with plan to reach 100% in January 2026. As shown in Figure 1, length of stay has dropped significantly with largest results seen for teams that were first cohorted (O:E LOS reduction of 0.16). As shown in Figure 2, team communication patterns have also improved with a significant reduction in use of EHR secure chat messaging (32% fewer interruptions). We will present extended data trends for all teams through early 2026 and planned FY27 implementations based on these data.
Conclusions: We initiated a large-scale systems re-design for hospital medicine at our largest hospital to elevate patient care, provider experience, and value for the health system. Engagement and partnership of highest-level leaders for all stakeholders is essential for rapid piloting and implementation of models such as ED-based admitting teams, geocohorted ward teams, and efficient multi-disciplinary team communication.
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