Face‐to‐Face At‐the‐Bedside Weekend Signout: A Patient Centric Hospitalist Model That Decreases Length of Stay and Increases Weekend Discharges

Background:

Transition of care from the weekday hospitalist to the weekend hospitalist is typically not performed at the bedside, a model which leads to provider reluctance to discharge on the weekend and poor patient satisfaction scores. Creating a sign out model which occurs at the bedside on Fridays with both the weekday and weekend hospitalist has not been described. We sought to determine whether instituting a Face‐to‐Face At‐the‐Bedside Weekend Sign Out model would affect observed to expected length of stay (O:E LOS), the percentage of patients discharged on the weekend, and patient satisfaction scores.

Methods:

On July 1, 2012, the hospitalist group at a 705‐bed academic medical center adopted a new sign out model whereby the weekday hospitalist and the weekend hospitalist rounded together and at the bedside on Friday for four hours. In this model, there were six hospitalist led teams (four house staff, one nurse practitioner, and one hybrid cardiology team). Each team rounded with a separate weekend hospitalist, thereby creating a seven‐day staffing model (Table 1). Hospitalists were scripted to discuss the importance of the new model with patients at the bedside, with a particular focus on patient safety and care transitions. The weekend hospitalists also directed weekend interdisciplinary rounds with care managers and social workers, both on hospitalist and non‐hospitalists patients. The weekend hospitalist then gave verbal sign out to the weekday hospitalist on Sunday evening.

O:E LOS, percentage of patients discharged on the weekend, and patient satisfaction scores were compared for the twelve months prior to the intervention with the twelve months after.

Results:

After instituting the Face‐to‐Face At‐the Bedside Weekend Sign Out Model, the percentage of all patients discharged on the weekends increased from 14% to 18%. The O:E LOS for the hospitalist patients dropped from 1.03 to 0.88. Patient satisfaction scores did not change.

Conclusions:

Our Face‐to‐Face At‐the Bedside Weekend Sign Out Model contributed to an increase in the percentage of patients discharged on the weekend and lowered the O:E LOS significantly. By focusing on the bedside signout and ensuring a point person to direct interdisciplinary rounds, we were able to effectively improve two important hospital metrics. Although there was no change in patient satisfaction scores, this is a complex measure that is likely influenced by several variables.