Background: Patients admitted to the Medicine Service from the Emergency Department (ED) at times when no beds are available pose a particular challenge to workflow, staffing and patient care. Due to the expansion of our clinically integrated network and recruitment of high-volume surgical teams, the hospital daily census surged, causing an increase in the average number of patients admitted to the hospital but physically located in the ED. The Hospitalist program was charged with developing a coordinated strategy to manage these patients.
Methods: In 2015, we created an ED Hospitalist Team composed of a hospitalist and a nurse practitioner to care for patients admitted to the Medicine Service but awaiting beds on the floor. We purposely created this model so that the medicine teams could focus on caring for patients on their own units and not disrupt their workflow by traveling to the ED. We created a Checklist (Figure 1) for this ED Hospitalist Team to ensure that protocols and pathways were followed, just as they would be on the medical floor. We partnered with ED leadership to identify workspace and standardize handoffs, as well as with leadership from Social Work to proactively identify complex situations starting on hospital day 0. Patients requiring ICU level care were excluded (as intensivists were involved immediately). All patients admitted to the medicine service (i.e. patients who would ultimately be cared for on the general medicine, cardiac, oncologic or hepatobiliary teams), were cared for by the ED Hospitalist team until a bed became available on the appropriate unit.
Results: The average number of patients admitted to the hospital, but physically located in the ED increased from 2.1/day in April 2015 to 14.5/day in October 2016 (Figure 2). At least 70% of these patients were admitted to the Medicine Service. Even with this increase, the observed to expected length of stay (O:E LOS) for Medicine patients remained at 0.92. The discharge before noon rate increased from 39% to 43% during this same period.
Conclusions: We have demonstrated a strategic and sustainable approach for managing a growing number of patients who are admitted to the Medicine Service but physically located in the ED. By consolidating our resources in creating an ED Hospitalist team, we are able to maintain our workflow efficiencies on the floor, as demonstrated by the O:E LOS and our improved discharge before noon rate.
To cite this abstract:Hochman, KA; Adler, NM; Bosworth, B . THE ED HOSPITALIST TEAM – A COORDINATED STRATEGY FOR CARING FOR ADMITTED PATIENTS WHO ARE STILL IN THE EMERGENCY DEPARTMENT. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 167. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/the-ed-hospitalist-team-a-coordinated-strategy-for-caring-for-admitted-patients-who-are-still-in-the-emergency-department/. Accessed July 20, 2019.