With recent duty‐hour restrictions for internal medicine residencies, hospitals are increasingly hiring hospitalists to meet the demand of higher patient volumes not on the teaching services. This creates an interesting dilemma about how newly admitted patients will be distributed between the nonresident hospitalist services and the resident teams. Both services often have unique rules about the number and timing of admissions at any time. Because of this confusion, there were problems with handoffs between Emergency Center physicians and internal medicine physicians. There were several cases of patients admitted to the internal medicine service without any notification, leading to potential compromise in patient care and safety.
To create a novel electronic method to assign patients in a systematic fashion to the teaching and nonresident hospitalist teams. In addition, the electronic process would automatically notify the admitting internal medicine provider that a new patient has been added to their service.
Using Microsoft Excel and programming with Visual Basic, a monthly admissions schedule was created that incorporated all the restrictions in the number and timing of admissions. Clinical case managers were trained in the Emergency Room to place every admitted patient in a separate slot on this log called the Medicine Admissions Record (MAR). Each slot also provided information regarding the team assignment and pager number. Once the medical record number (MRN) and diagnosis were entered in the slot, the clinical case managers could send an admissions text page with the following information: MRN, admission diagnosis, name of emergency room physician, and callback number to receive handoff. A survey was sent to all the admitting providers to provide feedback about how the MAR and the admissions text paging process affected patient care.
Nineteen internal medicine admitters including the residents on the teaching service and the nonteaching hospitalists responded to the survey. On average, they each noted that checking the MAR prevented a problem with patient handoffs 4.4 times per month per admitter. An additional 4.5 patient handoff problems were prevented per month per admitter with the admission text page. The majority of respondents agreed to each of these statements: “I routinely look at the MAR when I am scheduled to admit new patients (90%),” “I am better able to manage my time because I can look at the MAR to see when my next admission is (90%),” “I routinely open the chart of the admitted patient before or during my conversation with the ER for handoff (95%),” “I am able to ask better questions of the ER physician because I received the admission text page (90%),” “I would recommend continuing the MAR (95%)”, and “I would recommend continuing the admission text paging system to notify me of the admission (74%).” This unique innovation has substantially improved the admissions process by preventing problems with patient handoffs.
To cite this abstract:Shah C. Who Gets the Next Admission? An Innovation to Create a Systematic Process for Team Assignment While Improving Patient Handoffs. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 152. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/who-gets-the-next-admission-an-innovation-to-create-a-systematic-process-for-team-assignment-while-improving-patient-handoffs/. Accessed April 21, 2019.