Many large hospital medicine groups utilize nurse case managers to enhance efficiency and extend the capability of hospitalists to manage larger volumes of patients. As part of an ongoing time–work flow study, we evaluated the impact of implementing use of a nurse care coordinator (NCC) on hospitalists' activities and how this altered the distribution of their time and efforts. The NCC role was introduced with the goal of facilitating the discharge process and coordinating daily patient care (arranging tests, labs, and draws; helping floor nurses; providing patient education, etc.).
Trained observers shadowed each of 24 hospitalists for 2 full‐day shifts using Workstudy+® software installed on a handheld device, a Palm TX. The software allowed observers to record the frequency and duration of activities performed by hospitafists. Of the 48 days of observation, 18 included an NCC, and 30 did not. The distribution of time spent across activities was compared between these groups using the t test to assess the significance of differences for the major categories of communication, electronic medical record (EMR) usage, patient contact, other indirect patient care, personal, professional development, travel, and waiting. Length of the workday and patient volumes were also compared using the Wilcoxon 2‐sample test.
EMR usage and personal time markedly differed between the NCC and non‐NCC groups (P < 0.01 and P = 0.04, respectively). Hospitalists who worked with an NCC spent 43 ± 14 fewer minutes per day interacting with the EMR. This difference can be attributed to the greatly reduced amount of time spent writing both progress notes and discharge instructions (24 ± 7 and 12 ± 6 minutes, respectively). Furthermore, those hospitalists gained an additional 17 ± 9 minutes of personal time per day above the 30 ± 25 minutes in the comparison group. There were no significant differences in the other categories of work effort. With an NCC, the average length of the workday also was shortened by 30 ± 14 minutes from 631 ± 56 minutes at baseline (P = 0.07), whereas the patient volumes were nearly identical in the groups.
To our knowledge, this is the first study that documents how the addition of an NCC to the care team provides hospitalists with more time for other tasks. In response, patient volume was increased for hospitalists rounding with an NCC. A cost‐effectiveness analysis is needed to assess the value of this intervention, but anecdotally it appears to increase hospitalist satisfaction and the quality of patient discharges.
N. Kulkarni, none; D. Malkenson, none; M. Tipping, none; D. Magill, none; V. Forth, none; M. Williams, none.
To cite this abstract:Malkenson D, Kulkarni N, Tipping M, Magill D, Forth V, Williams M. Impact of a Nurse Care Coordinator on Hospitalist Work Flow. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 64. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/impact-of-a-nurse-care-coordinator-on-hospitalist-work-flow/. Accessed September 16, 2019.