Background: As a strategy to improve throughput and efficiency, Vanderbilt University Hospital implemented geographic localization across several Hospital Medicine (HM) teams and units. This large-scale structural change presents an opportunity to not only improve efficiency and quality metrics, but to improve other patient-centered outcomes including patient experience.
Purpose: To assess the impact of a hospital medicine-based geographic localization initiative on patient experience.
Description: The Patient-Centered Teams (PaCT) initiative was designed by a multidisciplinary team including hospitalist and nursing leaders and representatives from clinical operations, bed management, transition management, and analytics. Phase 1 of implementation included five strictly localized floor-based HM teams and the addition of two HM boarding teams based in the Emergency Department (ED). No changes were made to nursing staffing or communication expectations between hospitalists and nurses. Case management and social work support remained team-based, as it was prior to PaCT implementation, with concurrent efforts to standardize daily touchpoints between providers and case managers. Patient experience was measured by Press Ganey survey results, based on patient discharge date from PaCT units. Compared to pre-implementation, the five PaCT units showed improvement in top box scores and rankings for hospital rating and key questions pertaining to teamwork and communication (Table 1). Providers, nurses, and case managers report several potential drivers of favorable patient experience, including increased frequency of provider-nurse bedside rounding, increased opportunity for providers to spend time with patients on the unit, and more frequent touchpoints throughout the day between providers and case managers. The PaCT implementation was associated with increased numbers of provider handovers, which are a source of care fragmentation and patient dissatisfaction; however, the enhanced provider availability and care team communication associated with the PaCT model may have offset these potential downsides. Additionally, we hypothesize that having hospitalists assigned to the care of patients boarding in the ED may have yielded improved satisfaction and communication during that often-challenging phase of care, leading to an overall improvement in patient experience scores for the hospital encounter.
Conclusions: Geographic localization of several HM rounding teams and the addition of two hospitalist-staffed ED boarding teams were associated with improvements in patient experience as measured by Press Ganey top box scores and rankings among patients discharged after implementation. Additional work is planned to further enhance multidisciplinary rounding and care coordination in the post-PaCT era.
