Background: Stepdown units were introduced to provide an alternative for patients with needs not met by a general ward unit but did not require an intensive care unit. Current research indicates that these beds promote greater flexibility in patient triage, increase accessibility to limited intensive care resources, and provide a cost-effective alternative for patients. The establishment of stepdown beds allows for more critical care admissions without an increase in mortality and shortens the length of stay in the ICU. Despite having the American College of Critical Care Medicine guidelines for stepdown bed use, there is great variability between hospitals in the utilization of these units between different hospitals. Anecdotal experience indicates that stepdown status is frequently unknown due to the flexible nature of these beds. Limited data exists on assessing physician awareness of patients’ inpatient bed status.
Purpose: A single-center, quality improvement study at a university-affiliated teaching hospital aimed to improve provider awareness of patients’ inpatient bed status.
Description: Method: Supervising physicians and senior residents (PGY2 and greater) were selected as participants from academic teaching teams. The study was approved by the university’s internal review board. Surveys were populated with patient names, ages, and genders with three options for level of care status: stepdown, med/surg, and new to me. Data was obtained in front of the surveyor before rounds once weekly and transcribed into the RedCap software. The primary endpoint, congruence, was utilized to evaluate the accuracy of responses between the physician’s perceived level of care and the actual level of care. Subgroup analysis assessed congruence by provider type, patient’s physical location, and actual level of care. After four weeks of data collection, interventions were implemented. The primary intervention included the introduction of inpatient bed status on the EPIC storyboard, an educational session for residents, and emails with updates on results from survey data. After the final email intervention, data was collected for an additional eight weeks to assess the endurance of interventions. A chi-squared test was performed, and p < 0.05 was used to evaluate statistical significance. Results: A total of 590 unique patients were utilized for this study with a total of 1350 patient responses collected from which 715 responses were obtained from attending physicians and 635 responses from resident physicians. Congruence was calculated and charted, as seen in Figure 1. Baseline data from four weeks indicated a total congruence of 78.2%. Subgroup analysis indicated a statistically significant difference in congruence by providers and the physical location of patients. There was no statistically significant difference in congruence by actual level of care. Post-intervention data indicate a statistically significant increase in overall congruence of 83.4% (P = 0.367). Subgroup analysis post-interventions did not indicate a statistically significant difference in congruence by providers and patient location. However, there was a statistically significant difference in incongruence by actual level of care.
Conclusions: Our quality improvement study was able to successfully increase provider awareness of patient’s inpatient bed status. Our research encourages further studies to evaluate stepdown utilization and how provider awareness can ultimately affect stepdown utilization in hospitals.
