Background: Harborview Medical Center (HMC) is a 413-bed academic safety net hospital in Seattle, WA, and a level one trauma center for five states. Over the past seven years, HMC has observed increasingly long length of stay (LOS) resulting in a critically high patient census and limited capacity. To improve LOS, a Care Management department was restructured to include continuity of care nurses, social workers, utilization management and other key members of the discharge team. Physicians were not traditionally actively involved.
Purpose: To integrate physicians into care management at HMC, a Capacity Management Physician (CMP) program was formed. Five clinically active faculty physicians were recruited from across the care continuum: Primary Care, Emergency Medicine/Critical Care, Hospital Medicine, Post-Acute Care and Respite.
Description: In partnership with Care Management, CMPs help provide throughput optimization for all services in the hospital. Each CMP rotates through the role every five weeks. During designated weeks, CMPs round with medical and surgical teams daily to mitigate barriers to discharge and identify treatments that can be expedited. They participate in multidisciplinary census/safety huddles and weekly LOS meetings and provide as-needed consultation for patients with high clinical complexity and challenging discharge barriers. Additionally, CMPs meet monthly for didactics in topics such as post-acute care, respite, public health and community programs for the homeless as well as utilization management, revenue cycle, regulatory requirements, and risk management. They convene with leaders of innovative care programs from across HMC and the community. They also share case-based lessons and develop collective best practices. These efforts provide support to frontline hospital clinicians and aim to optimize patient throughput and advocate for systemic changes that enhance safe, appropriate patient care. In the first eight months, CMPs have attended over 450 discharge huddles and were actively involved in >550 patient hospitalizations. Through participation in rounds, CMPs have identified 85 types of barriers to efficient throughput including practice variation, knowledge gaps about available system resources, and patient factors. CMPs have identified opportunities to standardize practices for specific populations including patients with foot wounds and those requiring prolonged antibiotics that have led to dedicated quality improvement efforts.
Conclusions: The CMP program is a novel initiative that engages clinically active physicians in care management. Bringing together hospitalists with colleagues who practice in other care settings promotes shared expertise allowing CMPs to provide comprehensive advocacy for patients and teams. Together, they help to achieve targeted hospital initiatives such as decreased LOS while maintaining patient-centered, high-quality care.