At this 328‐bed hospital there were 8 hospitalists rounding on up to 9 units per day. This prevented efficient and effective communication with nurses, patients, and families. Physicians spent more than 30 minutes of travel time per day. Length of stay and census per physician were high; patient satisfaction was low. With a deadline of 3 months, a multidisciplinary team was assembled to design a unit‐based hospitalist system using patient location to drive the hospitalist team assignments. In addition, we implemented multidisciplinary bedside rounds at the bedside of each patient.
To develop a more patient‐centered care delivery for the hospital and more efficient work flow for hospitalists.
The intent was to create a unit‐based system for all 8 hospitalists working per day and to have daily bedside patient care rounds. Weekly meetings were held with the leadership of the hospitalist group, the chief nurse executive, and directors of the medical units, ED, and case management. The admitting department and ICU physicians were consulted as needed. The medical units have up to 32 beds, and so we assigned 16 rooms per physician. The intensivists agreed to have primary responsibility for the ICU patients. This reduced the demand in the ICU so that the geographic assignments could be primarily in the med‐surg units. The hospitalist group gave input about how patient assignments would be made and whether to include ICU and rehab as part of the unit‐based model. The work flow of the admitting hospitalist was changed so that the hospitalist team was assigned after the room number was determined. Changes were made in the admitting department and in the hospitalist sign‐out system. Times for multidisciplinary rounds were coordinated with hospitalists, nursing and case management. Communication tools, including scripting, were created for the different participants.
After planning for 3 months, the hospital's med‐surg units became more than 94% unit based. The new assignment structure has reduced the number of units the hospitalist rounds on per day by half. By eliminating travel time between units, we were also able to implement multidisciplinary patient care rounds at the bedside. The patient and family see the team collaborating in an organized manner. The bedside communication boards are more complete as the case manager documents the discharge date during rounds. Feedback from hospitalists, nurses, and case managers shows increased satisfaction in the new model. Length of stay has decreased from 4.08 to 3.93. Patient satisfaction is unchanged. We believe this is an example of rapid cycle change resulting in fundamental improvement in how our hospitalist group provides care. With committed and visionary multidisciplinary leadership, large change can be instituted in a short time frame.