Background: In the throughput arena, one of the most challenging groups of hospitalized patients is the long length of stay (LLOS) patients. Although representing a minority of inpatients, this LLOS population contributes to the majority of excess days. At our urban tertiary academic institution, a LLOS is defined as greater than 15 excess days. In [...]

Background: Limited hospital capacity continues to be one of the major challenges to health care in hospitals in the US and the developed world. This problem manifests in a variety of ways in multiple settings starting with prolonged emergency room wait times and left without being seen rates, prolonged ED boarding time, and elective surgery [...]

Background: Delays in care can lead to patient harm. At our large urban academic medical center, we have been struggling with increasing inpatient volumes and delays, particularly to enter our medicine, observation, and cardiology units. With a desire to provide more timely care, we used a model that employed queuing theory to predict expected delays [...]

Background: Geographic Accountable Care Units (ACUs) have been in existence for years at our institution. The ACUs have demonstrated improved throughput, quality and patient experience metrics. Our hospitalists have embraced the ACU philosophy due to ease of rounding, interdisciplinary approach to patient care and its 7on/7off scheduling, which is not standard at our institution. Overall [...]

Background: The most acute patients presenting to the Emergency Department (ED) requirean admission to the inpatient setting. A timely triage and admission process can improve the outcomes of these critically ill patients. Forty-six percent of admissions through our ED are admitted across multiple medicine services. We originally utilized a rotating Medical Admitting Resident (MAR) to [...]

Background: As hospital reimbursement models and publicly available CMS ratings place a stronger emphasis on improved patient throughput, safety, and satisfaction, it has become increasingly important for hospitals to develop cohesive care teams aligned with these goals. At our 800-bed quaternary care hospital located in suburban New York, care had historically been quite heterogeneous, with [...]

Background: One of the Society of Hospital Medicine (SHM) core competencies (listed as Principle 7) is that Hospitalists provide effective clinical resource utilization. Examples: cost effective care, high-value care, and designing processes that address cost per stay and readmissions. Optimized inpatient throughput has been shown as a strategy to improve overall hospital flow, including streamlined [...]