Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction. Issue 4 (8th August 2017)

• Record Type: Journal Article
• Authors: Bryson, Christine; Boynton, Greta; Stepczynski, Anna; Garb, Jane; Kleppel, Reva; Irani, Farzan; Natanasabapathy, Siva; Stefan, Mihaela S
• Is Part Of: Hospital practice. Volume 45:Issue 4(2017)
• Page Start: 135
• Page End: 142
• Publication Date: 2017-08-08
• Subjects: Geographic assignment -- unit based rounding -- hospitalist deployment -- provider satisfaction with rounding; Medicine -- Periodicals; Hospital care -- Periodicals; Hospitals; Medicine; Médecine -- Périodiques; Soins hospitaliers -- Périodiques; Hôpitaux -- Périodiques; Hospital care; Medicine; Periodicals; 616.005
• DOI: 10.1080/21548331.2017.1353884
• Languages: English
• ISSNs: 2154-8331

Abstract

ABSTRACT: Objective : To evaluate whether implementation of a geographic model of assigning hospitalists is feasible and sustainable in a large hospitalist program and assess its impact on provider satisfaction, perceived efficiency and patient outcomes. Methods : Pre (3 months) – post (12 months) intervention study conducted from June 2014 through September 2015 at a tertiary care medical center with a large hospitalist program caring for patients scattered in 4 buildings and 16 floors. Hospitalists were assigned to a particular nursing unit (geographic assignment) with a goal of having over 80% of their assigned patients located on their assigned unit. Satisfaction and perceived efficiency were assessed through a survey administered before and after the intervention. Results : Geographic assignment percentage increased from an average of 60% in the pre-intervention period to 93% post-intervention. The number of hospitalists covering a 32 bed unit decreased from 8–10 pre to 2–3 post-intervention. A majority of physicians (87%) thought that geography had a positive impact on the overall quality of care. Respondents reported that they felt that geography increased time spent with patient/caregivers to discuss plan of care (p < 0.001); improved communication with nurses (p = 0.0009); and increased sense of teamwork with nurses/case managers (p < 0.001). Mean length of stay (4.54 vs 4.62 days), 30-day readmission rates (16.0% vs 16.6%) and patient satisfaction (79.9 vs 77.3) did not change significantly between the pre- and post-implementation period. The discharge before noon rate improved slightly (47.5% – 54.1%). Conclusions : Implementation of a unit-based model in a large hospitalist program is feasible and sustainable with appropriate planning and support. The geographical model of care increased provider satisfaction and perceived efficiency; it also facilitated the implementation of other key interventions such as interdisciplinary rounds.