Medical service redesign shares the load saving 6000 bed days and improving morale. Issue 8 (August 2014)

• Record Type: Journal Article
• Authors: Toomath, R.; Szecket, N.; Nahill, A.; Denison, T.; Spriggs, D.; Lay, C.; Wilkinson, L.; Poole, P.; Jordan, A.; Lees, J.; Millner, S.; Snow, B.
• Is Part Of: Internal medicine journal. Volume 44:Issue 8(2014)
• Page Start: 785
• Page End: 790
• Publication Date: 2014-08
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12477
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12477-sec-0001" sec-type="section"> <title>Background and Aims</title> <p>In 2010, demand on the Auckland City Hospital general medical service exceeded capacity. A review by the Royal Australasian College of Physicians was critical of training offered to registered medical officers, and low morale was a problem across the service. Management offered support for an improved model that would solve these problems.</p> </sec> <sec id="imj12477-sec-0002" sec-type="section"> <title>Methods</title> <p>A project to redesign the general medical service was undertaken. Baseline analysis found uneven workload and insufficient capacity at peak times for patient presentations. Workshops involving the entire service led to a new model that splits workload and teams into patients likely to have a short stay from those requiring longer, ward‐based care. Admissions are now distributed over 12 teams on weekdays and 4 on the weekends. There was an increase of approximately 2.5 in consultant full time equivalents but no change in registrar or house officer staffing.</p> </sec> <sec id="imj12477-sec-0003" sec-type="section"> <title>Results</title> <p>Since the introduction of the new model, the average length of stay has fallen from 3.7 to 3.2 days (14%) and the median length of stay by 28%, resulting in a saving of 6000 bed days per year. Readmission, inpatient and 30‐day mortality rates are unchanged. These results have been sustained over 18 months with signs of continuing improvement.</p> </sec> <sec id="imj12477-sec-0004" sec-type="section"> <title>Conclusion</title> <p>This project owes its success to the following factors – management support; iterative engagement of a range of staff; provision of timely data analysis; increases in senior medical officer staffing and reorganisation leading to more predictable and fair work practices. One challenge is discontinuity, whether between doctors and patients or within the medical team.</p> </sec> </abstract>