Background: New hospitalists can often feel overwhelmed by learning system practices, navigating difficult dispositions, and managing difficult patient and family relationships. This can lead to increased length of stay1, increased burn out, and a feeling of lack of mentorship.
Purpose: We hypothesized that weekly meetings between a hospitalist director and a junior faculty hospitalist to discuss patients with an extended length of stay (defined as >= 7 days) or anticipated complex discharge would lead to reduced length of stay, reduced burn out, identification of system issues, and a feeling of increased support.
Description: Hospitalists were surveyed for years of experience, subjective feeling of support in navigating and escalating challenging patient cases, and self-assessed burnout. The intervention targeted two direct care hospitalist teams with an average patient census of 12-15 patients. Each week, one of the directors met with the attending on service of the respective teams to discuss 1-2 patients with length of stay >= 7 days or an anticipated complex discharge. The hospitalist pre-selected the patients to give time for the director to review the cases beforehand. During each session, the hospitalist and director discussed the cases and filled out a survey in real time to document why the case was selected, what the anticipated barriers to discharge were from the mentee and the director’s perspective (including strategies for management of patient behavior/expectations, increasing consultants on board/improving collaboration with consultants already on board, issues with pain management, escalation for administrative support, and case management/social work issues). The junior hospitalist could suggest any system changes that would facilitate the discharge process and note what concrete plans were made from the session held that day.Between February and May 2023, 23 sessions were held and 39 patient cases discussed with 15 different junior faculty hospitalists. Mean daily census was 12.5 patients, with 4.6 patients with a LOS>7 days and 1.8 patients chosen for discussion. The most frequently identified issues included need for escalation for case management/social work issues, goals of care discussions, and strategies for management of family dynamics and patient behavior/expectations. The conversation took a mean of 15 minutes and led to concrete planned actions in 89.7% of patients. System wide issues were also identified and addressed, for example in the creation of a chronic pain management work group. 66% of participating hospitalists completed a follow-up survey, with half finding the sessions “valuable”, half “somewhat valuable”, and all stating they would seek out the opportunity to discuss cases in a similar format again.
Conclusions: A brief, structured meeting between a hospitalist group director and a junior faculty hospitalist to discuss patients with extended LOS or anticipated complex discharge is feasible, acceptable, and in most cases leads to concrete actions based on the discussion. Next steps include scaling the intervention and measuring impact on LOS, burnout, and perceptions of leadership support.