Background: Delays in medical care are frustrating for all stakeholders involved, including patients, their families, and the clinical teams responsible for moving their care forward. These delays, particularly in inpatient care, not only extend hospital stays but also have a cascading effect on patient throughput and inpatient bed availability. Hospitalists regularly navigate these challenges and are affected by the associated reimbursement denials. Despite the impact, there is a shortage of real-time visibility and understanding of the effects of inpatient delays on hospital throughput.
Purpose: Delays in medical care are frustrating for all stakeholders involved, including patients, their families, and the clinical teams responsible for moving their care forward. These delays, particularly in inpatient care, not only extend hospital stays but also have a cascading effect on patient throughput and inpatient bed availability. Hospitalists regularly navigate these challenges and are affected by the associated reimbursement denials. Despite the impact, there is a shortage of real-time visibility and understanding of the effects of inpatient delays on hospital throughput.
Description: From Oct 2022 to Oct 2023, we have received 502 inbound expediter requests, in the last month, they have averaged 2-3 weekday requests. The phased rollout began with the Department of Medicine (91% of total requests), followed by Neurology (6% of total requests) and Surgery (3% of total requests). Though we initially advertised a 24-hour turnaround time, 98% of requests are expedited on the same day. Preliminary data reveals that these requests span various service areas, including MRI (36%), Procedure (15%), CT (6%), Echo (7%), and discharge-related barriers (including durable medical equipment and home care) (7%). This does not capture the denominator of the requests within the hospital, which is an ongoing area of study. Additionally, there is a small percentage of requests that cannot be resolved/expedited despite escalation to leadership often due to intractable discharge barriers or imaging capacity limitations. Many procedure-related delays required intricate coordination across different divisions, exemplified by cases such as Cardiac MRI for patients with pacemakers necessitating general anesthesia. The data is aggregated and reviewed weekly and presented every month to the individual service area. This allowed the formation of local quality improvement projects based on aggregated data. The response from clinicians was overwhelmingly positive. We are now conducting more formal exit surveys and analyzing our data for impact on throughput and variables such as ED boarding and length of stay.
Conclusions: Given this early success, we are growing our Expediter office to develop more proactive workflows based on the estimated day of discharge to identify potential delays and implement a more robust escalation platform. We are also working to offer more outpatient scheduling options to offload inpatient needs. The Expediter program may be a best practice adaptable to other institutions to improve system efficiency, decrease denial days, and optimize inpatient bed utilization.