Background:
Geographic localization consist of the co‐localization of physician providers and their patients on the same inpatient units. Structured Interdisciplinary Rounding (SIDR) consists of daily, template‐driven interdisciplinary rounding on patients among care providers. Both geographic localization and SIDR have been proposed as methods to optimize interdisciplinary communication and work efficiency. Among medicine inpatients, adoption of geographic localization of Hospitalist teams has been associated with increased provider productivity but a possible increase in length of stay (LOS). In a setting where geographic localization of medicine inpatients was already in place, adoption of SIDR had no impact on length of stay. The impact of concurrent implementation of geographic localization and SIDR on LOS has not been studied. In October 2012, the Department of Internal Medicine at MedStar Georgetown University Hospital (MGUH) concurrently implemented geographic localization and structured interdisciplinary rounding (GSIDR) on all teaching service patients. The purpose of this study to assess the impact of implementation of GSIDR at MGUH on length of stay.
Methods:
A prospective cohort, pre/post intervention study design was employed. All patients admitted to the medicine teaching service six months prior to the implementation of GSIDR and up to six months after the implementation of GSIDR were eligible. The primary outcome was length of stay. The independent variable was GSIDR Status (before/after implementation of GSIDR). Covariates collected included demographics, case mix index, source of admission, and insurance payer status. LOS was log transformed to account for the non‐normal distribution of LOS. Univariate analyses were carried out with student t‐tests for categorical covariates and general linear models for continuous covariates. Multivariable analyses were carried out utilizing ANOVA. All analyses were carried out utilizing SAS.
Results:
1470 patients were admitted to the teaching service in the 6 months prior to implementation of GSIDR. 2006 patients were admitted to the teaching service in the 6 months after implementation of GSIDR. In univariate analyses, implementation of GSIDR was associated with an increased LOS of 0.4 days (p<0.001). In multivariable analyses, there was no difference in LOS.
Conclusions:
Concurrent implementation of geographic rounding and structured interdisciplinary rounding had a neutral impact on LOS. Surrogates of provider work efficiency did improve with an approximately 60% drop in resident pages and 50% decrease in daily resident provider miles walked documented in local, ancillary studies related to this GSIDR intervention. However, a significant rise in overall teaching service census (approximately 30%) was noted in the GSIDR intervention period. A similar increase in census was noted in a prior study of the impact of geographic localization on LOS. Hence, it may be that improvement in work efficiency due to the implementation of GSIDR was attenuated by a concurrent rise in census.
