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HM 14 Special Report: Optimizing Patient Flow: The New Challenge for Hospitalists


Jeffrey Frank, MD, MBA; Joseph Guarisco, MD; David Yu, MD

Hospital medicine groups and emergency physicians are overdue for a paradigm shift in the ways we work together. Going forward, HM and ED groups must be tightly linked and integrated to provide the best care for patients and to be aligned with outcomes for which our hospital systems are being reimbursed under value-based purchasing.

Key Takeaways:

  • Improving patient flow meets the triple aim: improves outcomes, improves patient experience, and reduces costs.
  • The CMS Hospital Compare website publicly reports numerous measures directly related to ED flow time, evaluation by physician, time to pain med for long bone fracture, and LWBS (left without being seen rate). ED TAT (turn-around time) is a surrogate measure for hospital efficiency.
  • CMS including ED throughput as a VBP measure. Healthcare payments projected to fall by about 25% in the near future. With margins shrinking, we must all “step up our game.”
  • ED and HCAHPS Survey scores trend together; decreasing ED wait times improves overall patient satisfaction. Nationwide ED accounts for 70% of hospital admissions, this is trending upward; addressing the ED wait times in partnership with our ED colleagues is critical to our patient satisfaction scores.
  • Decreasing ED wait times requires innovative thinking: the same thinking that got us here, will not solve our problem.

• Increase capacity during peak times by adding lower-cost alternatives to support physicians and keep them practicing at the highest level of our licenses (bring in scribes, personal medical assistants, physician extenders, etc.) Simple addition of more physicians does little toward solving problem of wait times;

• Active bed management and early hospital discharge;

• ED redesign: don’t just add more “beds;” and

• Keep ambulatory patients upright; only the sickest patients require stretcher space.

  • ED and HM groups should meet monthly, not only to task issues as a team but to build and strengthen relationships.
  • The days of ED/HM group culture of “us” vs. “them” are over—it doesn’t work. We’re all playing on the same team and all for the same goal—providing the best care for the patient. When ED and HM groups truly align and integrate they become a powerful force.

Julianna Lindsey, MD, MBA, FHM, is a Principal, COO & Strategist for Synergy Surgicalists, a practicing hospitalist, and a member of Team Hospitalist. Dr. Lindsey worked a number of years as a full-time ED physician.

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