Unit-based medical teams improve cohesiveness and communication among team members and increase time spent with patients. At the University of Iowa Hospitals and Clinics, physician teams had patients in 5-6 different units on an average day. This geographic dispersion led to wasted physician time and poor coordination with ward-based support staff. We hypothesized that improving regionalization would lead to more efficient care, manifesting as a decreased average length of stay (ALOS).
Purpose: To implement a model for assigning physician teams to a limited number (3-4) of geographically localized units and achieve 80% regional assignment of all patients in the team to those preferred units. The goal was to decrease length of stay by improving inter-professional communication. The primary outcome was average medical inpatient ALOS on preferred units. Secondary outcomes included the percentage of medical inpatients assigned to regionalized units and ALOS of all medicine patients.
Description:
The project was implemented in 3 phases. Phase 1: We met with the Admissions and Transfer Center (ATC) personnel responsible for assigning beds to new patients and provided a list of preferred units based on the team assignment. Phase 2: Hospital Medicine Triage officers were encouraged to actively communicate with ATC and determine appropriate team assignment based on the units with bed availability. After several weeks of implementation of phase 1 and 2, we observed no change in ALOS or regionalization. Phase 3: Cards identifying the preferred units for each team were printed, distributed to triage officers as well as ATC personnel and displayed in all work room areas. We reinforced the project with both ATC and triage officers and encouraged bidirectional communication to determine appropriate unit and team assignment for each new patient.
After the implementation of the third phase, we observed a significant increase in regionalization of patients to preferred units and observed a corresponding decrease in LOS for regionalized patients for the following 20 weeks. Acute patient ALOS in the preferred units decreased from 5.3 days to 4.6 days (p < 0.001). Patients assigned to preferred units increased from 72% to 77%. (p= 0.022)
Conclusions:
Interventions to improve regionalization of patients and physician teams to a limited number of units can have a significant impact on LOS and improve patient care.