Similar to national trends, the emergency department (ED) at our 960‐bed institution faced increasing volume and overcrowding, resulting in delays in treatment, lower patient satisfaction, and concerns about quality. Between January 2009 and June 2009, the number of patients treated in the ED rose by 24.5% compared with 2008, causing an increase in internal medicine (IM) admits. The high volume of admissions combined with ACGME rules in the setting of limited inpatient providers resulted in a patient cap on the teaching IM ward and non–house staff hospitalist services by July 2009. This led to a bottleneck of patients waiting in the ED for team assignments, perpetuating the crisis of overcrowding. To decrease holdovers and provide more timely care, a “hospitalist of the day” (HOD) was established to triage all calls for admits on non–critical care medicine patients.
In October 2009, 2.4 FTEs were dedicated for HOD shifts Monday–Friday from 6 AM to midnight. The HOD answered all calls for IM admits from the ED and clinics and triaged them to appropriate IM services (diabetes, hematology–oncology, teaching IM wards, transplant, or hospitalist); evaluated and assisted with discharging patients who were deemed to not require admission; wrote consult/preoperative notes for patients better served on a surgical service; assigned unstable patients to critical care teams; arranged elective admits for nonemergent patients on alternate days based on bed capacity; performed diagnostic or therapeutic bedside interventions (e.g., large‐volume paracentesis) on patients whose sole indication for admission was the procedure. A prospective cohort of 88 HOD shifts was analyzed from July to October 2010 and compared with a historical control of 81 shifts over the same 4 months in 2009.
The HOD was contacted an average of 42.9 times/day over the 4‐month study period. Of these, the HOD discharged an average of 2.3 patients/day (5.3%), triaged 2.2 patients/day (5.1%) to nonmedicine services (e.g., ED observation, neurology, surgery), and triaged 2.2 patients/ day (5.0%) to non–general internal medicine teaching/hospitalist services (e.g., cardiology, hematology). Overall, the HOD altered the disposition of 6.7 patients per day, which accounted for 15.4% fewer admissions that would have otherwise been admitted to the teaching IM ward/hospitalist services. In addition, there was a 47.6% decrease in the number of holdovers after implementation of the HOD (81.7% vs. 34.1%, P < 0.0001; RR, 0;42; CI, 0.31–0.57).
A program of having a hospitalist triage all proposed IM admissions from the clinic and ED on weekdays from 6 AM to midnight resulted in a more rationale allocation of patients to the inpatient service best fitted to their clinical needs, reduced the number of inappropriate admits, and decreased holdovers and overcrowding in the ED. Because of this, we have been asked to expand the HOD shift from 18 to 24 hours on weekdays and begin a 10‐hour shift on Saturdays.
M. Shah ‐ none; A. Stream ‐ none; K. Alvarez ‐ none; K. James ‐ none; G. Reed ‐ none; R. Abraham ‐ none; S. Harder ‐ none; P. Tran ‐ none; B. Treichler ‐ none; E. Halm ‐ none
To cite this abstract:Shah M, Stream A, Alvarez K, James K, Reed G, Abraham R, Harder S, Tran P, Thiele D, Treichler B, O’Connell E, Halm E. Robodoc: Impact of a Hospitalist Triage Cop on Medicine Admissions and Ed Overcrowding. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 112. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/robodoc-impact-of-a-hospitalist-triage-cop-on-medicine-admissions-and-ed-overcrowding/. Accessed April 1, 2020.