The advent of hospitalists has greatly improved the afterhours care in the hospital. A majority of the care planning happens when the hospitalists round in the daytime and the afterhours care is limited to ‘putting out fires’ and admitting new patients. Increasing focus on the patient flow, length of stay, and reducing costs demand hospital systems to be lean and efficient. Hence there is a growing need to reengineer the afterhours care to address flow and efficiency.
To reengineer the evening huddle to perform tasks that will improve patient flow.
Each of our hospitalist teams huddle in the evening. These huddles tend to be check out rounds to tally the todo list, plan for the next day and prepare the sign out. We identified three key flow related tasks to be performed during this huddle 1. Retriage the level of care. Triaging down is done mostly during the first half of the day when providers round. Availability of more information by the evening related to diagnostic tests and hospital course provides an opportunity to triage down more patients. This can free up higher acuity beds and prevent extended stays in the emergency department for overnight admissions. 2. Identify patients that are likely to be discharged tomorrow. This enables delegation of some elements of the discharge process to the afterhours team. 3. Perform preliminary medication reconciliation for patients likely to be discharged tomorrow. This enables review of the discharge medications by pharmacists and reduce potential medication prescribing errors. A teaching and a nonteaching team were chosen for the pilot. Currently, our providers identify the anticipated discharge date in the electronic health record. We created an automated patient list with level of care and anticipated discharge date information. During the huddle the teams were asked to review the elements in the patient list and modify as needed. For patients leaving tomorrow, the teams were asked to perform preliminary discharge medication reconciliation. After a 2 week training period the pilot was started on September 15th. The feedback from pilot teams was positive.
Preliminary data suggests that transfers to a lower level of care increased during the later half of the day. We are currently collecting data on impact on prediction of tomorrow discharges. We are also creating new processes for the after hours team to assist with the discharge process. We engaged the pharmacists to review the preliminary discharge medication reconciliation and provide feedback before discharge. This effort will lay foundation to our future efforts to leverage afterhours care team in the patient flow processes. The preliminary results from the pilots are encouraging.
To cite this abstract:Bulger J, Darer J, Leader J, Boell K, Kodali S. Reengineering the Evening Huddleour First Step to Leverage Afterhours Care to Improve Patient Flow. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97760. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/reengineering-the-evening-huddleour-first-step-to-leverage-afterhours-care-to-improve-patient-flow/. Accessed January 17, 2020.