Background: An innovative team of practicing physician leaders launched a Physician on Duty (POD) program in order to provide daily, pro-active clinical leadership to our Mission Control center. Our Mission Control includes, in addition to the physician team, a clinical team performing centralized staffing, bed placement, transfer center, RN care expediting, and ambulance dispatch services for our 8-hospital health system. Mission Control was created to balance capacity across our health system, prevent overcrowding, protect patient safety, and promote growth. On-site physician leadership in Mission Control was needed to address all of these critical issues.
Purpose: Within Mission Control, our goal was to quantify the impact of daily, integrated physician leadership to balance capacity across the health system, reduce patient risk, and decrease lost cases. Over the 12 months prior to launch of Mission Control, we worked to recruit a team of leaders in hospitalist, emergency medicine, and surgical specialties for the physician on duty role. At launch, we had recruited 14 physicians, 12 of which were divided equally between emergency physicians and hospitalists; the cardiovascular and general surgery service line chiefs rounded out the team.
Description: The physician on duty standard work includes making a capacity projections for all hospitals, leading the larger team to a daily agreement on what the plan of the day should be in terms of capacity and transfers, and notifies all hospitals of the plan. In addition, the physician on duty prevents lost cases and increases direct admissions by directly facilitating physician and operational team communication. Throughout the day, the POD works to mitigate critical safety issues in real-time, obtain appropriate downgrades, and reduce boarding by assisting in patient placement decisions according to clinical acuity. The physician also provides clinical reviews of all transfers into our tertiary and full hospitals to ensure clinical appropriateness, and facilitates equivalent alternative plans (for example, a specialist may see the patient at the sending facility by telemedicine, rather than transfer all patients needing consults to the tertiary facility). During the COVID pandemic, the POD leads critical resource triage team drills and reviews all admitted COVID patients daily to speed cohorting and bed placement decisions.
Conclusions: Physician leadership was shown to have a significant return on investment in terms of patient safety and financial outcomes. Through additional admissions and prevention of lost cases alone, the POD program created a contribution margin equal to for 74% of its labor cost in the first year. When considering the additional tertiary capacity created with transfers and reroutes away from our full tertiary center, the contribution margin of that capacity creation is estimated at $3.6M (if entirely back filled) with a total program ROI of 12:1, or 7.4 virtual beds created. Most importantly, practicing physician leadership to identify and solve critical patient safety issues in real time was beneficial, provide clinical expertise to support bed placement and complex transfers. Physician advocacy reduced ED boarding, providing significant benefit to our patients. The Mission Control program ensures timely care for critically ill patients at our teritiary hospitals, while improving occupancy at sites that had been historically underutilized.