A hospitalist-led project to improve bed assignment practices at Baystate Medical Center in Springfield, Mass., reduced errors in patient placements to 3.1% from 9.4%, according to an abstract presentation at HM11.
The project identified incorrect placement of patients in open beds due to incomplete understanding of the patient’s medical picture, explains lead author Christine Bryson, DO, SFHM, Baystate’s associate medical director for hospital medicine. For example, a patient with a diagnosis of pneumonia who was receiving peritoneal dialysis might be admitted to the respiratory unit, but then would need transfer to the renal unit, where the dialysis could be performed. Such incorrect bed placements and lateral transfers were happening eight times a day, at a cost conservatively estimated at $106 each for nursing, a nonphysician patient placement manager (PPM), and housekeeping services and supplies. That puts potential annual cost savings is $232,000, Dr. Bryson explains.
A committee led by Baystate hospitalists examined current admission processes in detail and recommended a new process: ED physicians confer with the PPM, the PPM reviews the chart and discusses the case with the admitting hospitalist, and then the PPM and hospitalist have an informed, three-way phone conversation about placement.
Hospitalists have been directed to return these calls within 15 minutes, which can be an issue all its own. Another identified barrier was the communications technology, so ED physicians have been issued cellphones so they don’t have to wait at a terminal for a callback from the hospitalist. Dr. Bryson says overall booking process time fell, as did the number of placement errors.