Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction

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.

KEYWORDS:

• Geographic assignment
• unit based rounding
• hospitalist deployment
• provider satisfaction with rounding

Acknowledgments

The authors would like to thank the following health care professionals for their contributions: Carmen Sanderson and Britt Arlin for their help with data collection; Michael Rosenblum, MD and Andy Artenstein, MD for their support for this performance improvement effort. We want to thank the entire hospitalist group for their commitment to the implementation of this intervention.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Definitions

‘Unit’ a particular area in a hospital where patients are boarded, also referred to as a ‘floor’ or ‘ward’.

‘Geographic Assignment’ – number of patients on a provider’s list who are located in the assigned area in the hospital (i.e. on a particular hospital unit)

‘Flex teams’ extra provider team responsible for seeing patients who are on a floor that already has a provider, but that provider is at their patient limit. This flex provider usually ends up with 3-5 patients on 3 – 4 floors

‘Hospitalist Group’ – a blend of academic and non-academic providers who care for all medicine patients in the hospital except in the ICUs

‘Unit Medical Director’ hospitalist who has been assigned a leadership position and paired with a nurse manager for one medical unit in the hospital

Supplemental data

Supplemental data for this article can be accessed here.

Additional information

Funding

Dr. Stefan is supported by grant 1K01HL114631-01A1 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.