Background: At our Tertiary Care, Academic, Level 1 Trauma Center, length of stay (LOS) has increased over the past year. This has been associated with increased occupancy, increased boarding in the ED and increased volumes on the Medicine teams. In response, reducing LOS has has been targeted as a strategic priority for the institution. Existing structure included 14 general medical teams including 5 resident based teaching teams and 9 Hospitalist/ APP teams of which 4-5 teams are geographically localized to a pair of units with some overflow patients scattered in available beds across the hospital. Case management, social work and care coordination rounds are unit based leading to medical teams interacting with up to 10 social workers and case managers. We hypothesized that the use of a team based case manager and social worker would increase efficiency and reduce LOS.
Purpose: The purpose of our project was to improve communication between the multidisciplinary inpatient team and reduce length of stay
Description: We conducted an eight week pilot with a case manager and social worker assigned to one hospitalist team, consisting of an Advanced Practice Provider (APP), 1-2 medical students and one Attending Physician. Care Coordination Rounds (CCR) took place daily, in person between 9-930AM and again a touch in occurred in person, or over the phone, at 3PM. Prior to the pilot, unit based CCRs occurred once daily at 11 am. The participants completed a survey daily citing what they felt were barriers to discharge on those who were medically ready and other comments including satisfaction with the system.We saw a reduction in Average Length of Stay (ALOS). When ALOS was analyzed pre pilot and post pilot, there was a reduction in Length of Stay from 5.3 days pre pilot to 4.8 days during the piloted days, excluding outliers with LOS greater than 14 days.The results of the survey indicated that the Hospitalist providers felt that the team based care coordination streamlined communication, improving efficiency and provided better accountability. In contrast, the social worker often felt the case-load was very heavy, frequently requiring the assistance of the case manager in social work tasks. Both the social worker and case manager felt there was a disconnect with the bedside/unit staff, though felt the communication with the hospitalist providers was very good, especially with the twice daily communications
Conclusions: Having an assigned case manager and social work for a medicine team, in a busy, high volume, Tertiary Care, Level 1 Trauma and Academic Medical Center leads to better communication amongst the members of the Hospitalist care team, allowing for efficiency and an overall reduction in Length of Stay. Barriers identified included the perceived workload of the social workers, decreased communication with unit based charge nurses, and allocation of personnel resources.