The hospital is an urban facility with 453 licensed beds. The hospitalist group is the only hospitalist service operating in the hospital and will perform over 14,000 admissions in 2011. In 2009, we recognized that the traditional model, where a rounding hospitalist team cares for patients scattered across various floors while starting with a high census, was not working. The staffing model was composed of 11 rounding teams and 5 admitting Hospitalists responsible for an average daily census of 185 patients and 30 admissions per day. Hospitalists struggled to perform admissions, discharges, or downgrades in a timely manner. The hospital was frequently at capacity, causing the ED to go on divert status. Patient safety, quality of care, and average length of stay (ALOS) all suffered. Morale among hospitalists was low and burnout was rampant.
The Team was charged with designing and implementing a new model to radically transform care, and it looked to a Unit Based Care model [UBC] for the solution. We also wanted to see if lowering the daily census by adding more rounding teams would actually increase through put thus be financially positive.
A Team of Nurses, Care Coordinators, Physical Therapist, and Hospitalists piloted the UBC model in April 2010 on a paired telemetry and general medicine unit designated UB1. With early success, the Team spread this model to an additional pair of units in October 2010, designated UB2. Each hospitalist’s average daily starting census is 12.5 patients (down from 17 to 20 prior to UBC model), with each hospitalist expected to perform up to two admissions (average patient encounter of 1415 patients per day). Each UBC team is composed of four rounding hospitalist, 2 nursing teams, two care coordinator RNs, one social worker, and unitdesignated therapists. Some of the important lean tools used by the UBC teams include: (a) Multi disciplinary rounding with visual management and standardized work with white board. (b) Daily patient level metrics.
The UB model has been in place now for 18 months on UB1 and 12 months on UB2. The following results reflect data collected from 4/2010 through 9/2011. 1. Decrease in Monthly ALOS: UB1 decreased 0.4 days [10.2%] UB2 decreased 0.46 days [11.8%] 2. Increase in Monthly Patient Volume UB1 increased 13.1% UB2 increased 21.3% 3. Downgrades to a Lower Level of Care from the Telemetry Units UB1 increased 19% UB2 increased 40% 4. Increases in all five (5) Press Ganey Patient Satisfaction indicators 5. $2.5 million Financial Benefit including cost of additional rounding teams. The Unitbased Model has been so successful and widely accepted by the hospitalist, nurses, and ancillary staff, that the lean methods and strategies were adopted by a third Unit Base Care Team [UB3] in October 2011. UB 4 is in the planning stages on the Cardiac units to integrate the round cardiologist into the Unit Base Model.
To cite this abstract:Yu D, Sanches S. Lean Inpatient Unit Base Care Model. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97706. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/lean-inpatient-unit-base-care-model/. Accessed May 23, 2019.