Background: Rising inpatient census, limited physical space and unpredictable admission rates introduce communication inefficiencies among doctors, nurses and patients. Purpose: At UC San Diego Health System, we aimed to streamline communication among physicians, patients and other care team members. Description: Two operational changes were made: 1) establishment of team-based geographic cohorting and 2) segregation of [...]

Background: Interdisciplinary team-based care is a promising concept in hospital medicine in which healthcare team members representing multiple disciplines collaborate to develop patient care plans. Multiple published studies showed that team based care is associated with decreased length of stay (LOS).1,2Patient-Centered Approach to Health (PATH) team was a redesign of the Structured Interdisciplinary Bedside Rounding [...]

Background: Growing antimicrobial resistance, C. difficile infection and cost have triggered a greater reliance on antimicrobial stewardship. Most stewardship models rely upon a central team, often led by ID specialists, to oversee prescribing in an institution. However, there are limitations to this paradigm. Purpose: We believe opportunities exist for hospitalists to drive stewardship by integrating [...]

Background: Traditionally, models of healthcare delivery to hospitalized patients have been indirect and inefficient. The typical hospital system has providers spread between multiple units and nurses interacting with multiple provider teams. Several studies focusing on interdisciplinary rounding (IDR) have shown a variety of positive impacts on hospital-associated metrics such as length of stay (LOS), hospital [...]

Background: While Medicare data demonstrates that healthcare spending is up to four times higher in yearly decedents than survivors, studies demonstrate that early advance care planning (ACP) leads to improved clinical outcomes and reduces cost without increase in patient anxiety or depression. Nationwide the creation of the Physician Order for Life Sustaining Treatment (POLST), a [...]

Background: An estimated 68,000 Americans died of opioid-related overdoses between March 2017-2018. In Monroe County NY heroin/fentanyl deaths are up 200% from 2015- 2017. Guidelines recommending naloxone co-prescription for high-risk patients on opioid pain medications have been issued. The inpatient setting provides unique opportunities for identifying patients at risk for opioid adverse events (OAE) and [...]

Background: Geographic hospitalist staffing and interdisciplinary rounding has been shown to improve staff communication, patient communication, and reduce length of stay. Communication between hospitalist and nurses also play a crucial role in patient safety and hospital throughput. Despite its importance, maintaining geography is difficult and communication between physicians and nurses are often sub-optimal and fragmented. [...]

Background: Admitted Hematologic and Oncologic patients are often complex and have a unique set of challenges. Balancing outpatient care plans with inpatient medical and psychosocial issues can lead to long lengths of stay, patient dissatisfaction, and provider burnout. Hospitalists offer an expertise in managing complex medical problems along with an adept ability to integrate and [...]