Background:
Increasing cost is one of the biggest challenges for present day health care systems. Standardized admission processes help in reducing length of stay (LoS) which in turn can reduce health care cost significantly.
We developed a standardized process of admitting patients by developing dedicated admission teams called Patient Centered Admission Teams (P-CAT). The main objective of this retrospective study is to analyze the effect of standardized admission process using P-CAT on length of stay.
Methods:
Each dedicated admission team called Patient Centered Admission Team (P-CAT) is a multidisciplinary team which includes a physician (hospitalist), a clinical pharmacist, two nurses, one patient care technician, and a scribe. The teams are provided work space near the emergency room, from where most patients are admitted. After being notified of admission, team goes to evaluate the patient. Physician completes history taking and physical exam at bedside. Scribes are trained to enter history and exam findings in electronic health record at bedside itself as physician keeps on explaining findings to patient. Physician then comes back to workspace where he starts working on completing orders. In the meantime, clinical pharmacist gets details from patient and his/her pharmacy/primary care doctor/pill bottles/family to complete medication reconciliation. Once the orders are finalized by physician, pharmacist reviews all medication orders with the goal of preventing medication errors and reducing medication costs. On-site availability of clinical pharmacist also helps in dosing of antibiotics, renal or hepatic dosing of medications and also with low cost substitutes or generic medications. Nurses and patient care technician quickly draw all labs and administer medications. Goal is to complete the admission process in less than 60 minutes.
Data was gathered from admissions done by Rochester General Hospitalist Group over the period of 10 months from January 2014 through October 2014.
Analysis of admission data for past many years in our hospital has consistently demonstrated that mean LoS for more than 75% of our admitted patients has been about five days. We thus took a cohort of patients with LoS of five or lesser days from the same period of ten months (January 2014 through October 2014). The data was then divided into two groups on the basis of whether the admission was done by PCAT team or not.
Mean values and standard deviations were calculated for LoS in both groups. LoS was then compared using independent samples t test. P value was considered significant for value less than 0.05
Results:
Retrospective data analysis showed that a total of 11,249 patients were admitted by Rochester General Hospitalist Group over the period of ten months from January 2014 through October 2014. 8,258 patients who had LoS of five days or lesser were included in the study. Out of these 8258 patients, 2198 were admitted through standardized admission process using P-CAT team. Remaining 6060 patients were labeled as non-P-CAT group.
The mean LoS for P-CAT group was 2.84 ± 1.34 days and that for non-P-CAT group was 3.02 ± 1.38 days (p value < 0.0001). 95% confidence interval is 0.11 to 0.25
Conclusions:
Standardized admission process using multidisciplinary patient centered admission team (P-CAT) can significantly reduce the length of stay.