Inefficient hospital operations at large public teaching hospitals result in late discharge times, bottle necks in patient flow, poor anticipation of discharges, and significant out of network costs related to ambulance diversion.
The purpose of the Physician On Duty (POD) pilot was to dedicate a daytime hospitalist to ensure judicious utilization of limited hospital resources, improve discharge forecasting among physicians and nurses, and improve turn‐around time for repatriation of capitated patients. While performing prescribed duties, the POD also sought to actively identify unrecognized opportunities for quality and safety improvement.
During the four‐month POD pilot, the POD actively rounded on patients and prompted an average of 2.3 patients per day for downgrade off cardiac telemetry and continuous pulse oximetry. There was no significant reduction in bed tracking wait times, possibly due to variables in how these requests are logged at our institution. Due to the POD bridging communication between nurses and care teams, we saw in increase in accurately forecasted discharges, improving from 36% of daily discharges being anticipated the day prior to 56% post intervention. During the course of this short pilot, there was no significant impact on discharge times, possibly a reflection of larger systems barriers in place. In addition to analyzing impact on internal metrics, the POD significantly improved repatriation times from out‐of‐network hospitals resulting in a 3.5 hour turn‐around time from when our hospital is made aware of the patient to the time that the patient arrives to our inpatient unit. A significant component of the shorter turn‐around times is a decrease in physician to physician communication times from 50 to 30 minutes post‐intervention, a 40% decrease. Finally, and potentially most importantly, the POD has significantly improved perceived satisfaction of our physician, nursing and administrative staff by providing an attending level provider to problem‐solve patient flow and resource utilization issues both gradually and in real time.
Our pilot demonstrates that providing a dedicated daytime hospitalist familiar with the intricacies of patient care and hospital systems improved interdisciplinary communication, discharge forecasting, turn‐around times for patient repatriation, as well as perceived support and satisfaction among multidisciplinary providers. This pilot represents first steps at our institution towards significant improvements in patient care and cost‐savings. Multiple systems barriers remain in place that hinder optimal patient flow and resource utilization, but this pilot allowed a better, data‐driven understanding of these issues, and this information that will serve as a rich foundation for future quality and safety improvements.
To cite this abstract:Ortiz G, Haber L, Dubbin L, Schmidt J, Dentoni T, Critchfield J. The “Physician on Duty” — a Non‐Traditional Hospitalist Role to Improve Patient Flow and Resource Utilization. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 257. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/the-physician-on-duty-a-nontraditional-hospitalist-role-to-improve-patient-flow-and-resource-utilization/. Accessed March 28, 2020.