Background: With the COVID-19 pandemic overwhelming the hospital systems rapidly, our Manhattan hospital was no exception. Supplies were in high demand, donning and doffing was taking precious time from patient care. We implemented geographic teams on several units to prevent the spread of COVID-19, decrease supply usage and time spent outside the patients’ rooms. When the COVID-19 numbers started to improve, we used this opportunity to implement a geographic provider system throughout the hospital, utilizing lean methodology, which will enable us to deal with future waves of COVID-19 and study if this intervention would improve predetermined hospital metrics and care team dynamics.
Purpose: Be prepared for future COVID-19 waves, to evaluate if provider geography improves hospital metrics such as length of stay, discharge before noon, doctor communication, telemetry utilization and job satisfaction.
Description: A hospital medicine driven initiative, utilizing lean methodology, resources and research brought together a team of doctors and APP’s from various departments (IM, ED, Cardiology and geriatrics), bed board staff, nursing and hospital administration leadership for a series of 8 sessions, with each session carrying a different theme/goal led by a lean facilitator. At each session the multidisciplinary group reviewed the current process, the problems or pain points identified during the trial period, ideas for improvement were generated, next steps and action items were discussed and assigned for completion prior to the next meeting. A new procedure (standard work) was edited or developed when action items were approved by all the stakeholders. Some examples of new processes include: provider assignment algorithms and an emergency room based Hospital Medicine team (START: Screening, Triaging, Admitting, Reviewing Team). This process led to the development of new workflows necessary for the creation and successful implementation of provider geography. A smaller, more focused team, continued to meet to ensure workflows are properly followed or revised as PDCA (Plan Do Check Act) experiments proved fitting. The process did not lack errors, but due to the multidisciplinary approach, information was easily disseminated, and concerns/errors were rapidly addressed. This process was verified after a year of implementation to evaluate its success and downfalls.
Conclusions: The implementation of provider geography in our hospital has improved the following outcomes: discharge before noon (increased by 60%), doctor communication score (78.4% to 84.2%), staff communication (84% of staff noted improvement) and job satisfaction. While time to bed assignment also increased, we will be evaluating this metric further once COVID-19 testing is no longer a prerequisite to admission which heavily impacts the data. Provider geography did lead to increased safety reporting’s regarding hand offs, which we plan on addressing in future projects. Provider geography has been attempted in the past and terminated rapidly due to many flaws in the system. Utilizing lean methodology has guaranteed the successful launch of this project: including necessary stakeholders and frontline staff, the structure to raise concerns and tools to address them, as well as the framework for continuous improvement and PDCA thinking. At the time of this submission, we intend to remain geographic. We are continuously improving and adapting the system as needed. We plan on re-evaluating at the two-year mark from implementation.
