Background: Vanderbilt University Hospital continues to experience a capacity crisis, leading to a focus on strategies to improve patient flow and length of stay. Other institutions have demonstrated improved throughput by geographically cohorting patients and their respective care teams.
Purpose: To reduce hospital length of stay and increase early discharges through the implementation of a geographic localization initiative among Hospital Medicine (HM) teams at Vanderbilt University Hospital.
Description: The Patient-Centered Teams (PaCT) initiative was designed and implemented by a multidisciplinary team including physician and nursing leaders and representatives from clinical operations, bed management, transition management, and analytics. Phase 1 of PaCT included localization of five HM teams onto five nursing units, for a total of 69 beds, along with the creation of two hospital medicine boarding teams based in the Emergency Department (ED). Phase 2 included the localized assignments of three HM teams to a medicine stepdown unit of 36 beds. Bed management processes were reengineered to assign appropriate patients to ED boarding teams until a bed became available, at which time the corresponding team was designated. Key throughput metrics included average resource length of stay (RLOS; time from admission to discharge including time in observation status), CMI-adjusted RLOS, discharges by 11am, average roomed when ready turnaround time, and median ED boarding times. After implementation, PaCT units/teams represented approximately two-thirds of HM teams and patients. PaCT teams were accurately localized at a rate of >95%. Compared to pre-implementation, PaCT teams saw a reduction in RLOS and an increase in early discharges following localization, without adverse impact on roomed when ready time. PaCT teams performed favorably compared to non-localized HM teams and other medicine teams in these domains (Table 1), though both cohorts of HM teams saw an improvement in CMI-adjusted RLOS. Average daily team census also dropped across all HM teams post-PaCT implementation, which likely contributed to these findings. The median ED boarding times increased across all teams after PaCT implementation, which may reflect factors independent of localization.
Conclusions: Geographic localization of several HM rounding teams at Vanderbilt University Hospital, along with the creation of two ED boarding teams, was associated with improvements in throughput as measured by length of stay and early discharges. Optimization of provider and bed management workflows and assessment of impact on additional patient flow metrics are ongoing.
