Gaby Berger, MD; Aaron Hamilton, MD, FHM; Christopher Kim, MD, SFHM; Eduardo Margo, MD; Vikas Parekh, MD, FACP, SFHM; Anneliese Schleyer, MD, SFHM; Emily Wang, MD
This HM17 workshop brought together academic and community hospitalists to share effective strategies for improving hospital patient flow.
The presenters, each a leader in this work at his or her institution, briefly reviewed how capacity constraints may adversely impact quality, safety and patient experience. They then discussed the important role hospitalists can play in improving hospital throughput, focusing on the following strategies: expedited discharge, length of stay reduction management, facilitation of transfers, short stay units, and hospitalist quarterbacks.
This was followed by a break-out session, in which hospitalists were encouraged to further explore these and other strategies for improving patient flow.
Key takeaways for HM
- Expedited discharge: Identify patients who can be safely discharged before noon. Consider creating standard work to ensure that key steps in discharge planning process, such as completion of medication reconciliation and discharge instructions and communication with patient and families and the interdisciplinary team, occur the day prior to discharge.
- Length of stay reduction strategies: Partner with utilization management to identify and develop a strategy to actively manage patients with long length of stay. Several institutions have set up committees to review such cases and address barriers, escalating requests for resources to executive leadership as needed.
- Facilitate transfers: Develop a standard process that is streamlined and patient-centered and includes established criteria for deciding whether interhospital transfers are appropriate.
- Short Stay Units: Some hospitals have had success with hospitalist-run short stay units as a strategy to decrease length of stay in observation patients. This strategy is most ideal for patients with a predictable length of stay. If you are thinking of starting an observation unit at your hospital, consider establishing criteria and protocols to expedite care.
- Hospitalist Quarterback: Given their broad perspective and clinical knowledge, hospitalists are uniquely positioned to help manage hospital, and even system-wide, capacity in real time. Some hospitals have successfully employed this strategy in some form to improve throughput. However, hospitalists need tools to help them electronically track incoming patients, integration with utilization management resources, and support from executive leadership to be successful.
Dr. Stella is a hospitalist in Denver and an editorial board member of The Hospitalist.