AMEEVA LLC

Some of the clinical challenges are

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1. Deficiencies in clinical core metrics

2. Poor patient satisfaction scores

3. Increased 30 day readmission of hospitalist patients.

4. Lack of adherence with evidence based clinical guidelines.

5. Over consulting or underconsulting the specialists.

6. Lack of collaborative relationships between hospitalists and other services g surgical, orthopedics, neurosurgery, oncology and cardiology etc.

7. Lack of timely and adequate perioperative care.

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Most of the clinical challenges can be secondary to increased patient volume, staffing inconsistencies, lack of mutual trust between various specialties, physician orkflow disruptions and various other issues.

 

Let’s look few of these challenges

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Core Measure Deficiencies

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Some of the reasons include

• Inadequate Documentation

• Physicians may not be aware of the new metrics which need documentation

• Inadequate census management

• Multiple disruptions in physician’s workflow which may breakdown of physician attention.

• Lack of knowledge of post-acute care resource availability for physicians.

• EMR related challenges

As always the solutions will be specific for each program. Some of the solutions may include

• Educating physicians about core measures and metrics

• Educating physicians about the process of documenting the core measures correctly

• Assuring physician and program leadership presence in all RCAs

• Census management and assuring manageable patient volume ranges for each shift

• Process improvement to remove all unnecessary distractions (e.g. phone calls, EMR clicks) that disrupt physician attention while engaged in patient care

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Increased 30 day readmissions

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Some of the reasons include

• Lack of knowledge among the hospitalists about outpatient resources for patients

• Lack of knowledge among the hospitalists about need for reducing readmissions

• Excessive admissions from ED due misaligned incentives and processes.

• Inadequate communication between hospitalists and care management/discharge planning teams

• Excessive patient volume combined with cumbersome time consuming discharge processes.

Some of the solutions may include

• Creating time efficient processes which assure adequate communication between hospitalists, care management teams and patients/families at time of discharge for all patients all of the times

• Identifying high risk readmit patients at time of admission at the time they present to ED and are seen by ED physician.

• Exploring the feasibility of having “transitionalists” in ED and “SNFists” at time of discharge.

• Hospitalist census management

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Poor satisfaction Scores

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The various reasons include

• Excessive patient volumes leading to inadequate time the hospitalists spends with each patient.

• Inadequate knowledge of best practices that lead to better patient satisfaction.

• Mistrust of the hospitalists and also lack of understanding of various tools used to measure patient satisfaction

• Scheduling and staffing inefficiencies leading to different hospitalists covering same patient every 1-2 days.

• Cumbersome documentation practices/EMR inefficiencies that lead to decreased face to face time between hospitalists and their patients.

• Lack of knowledge about the importance of patient satisfaction as a critical part of patient care.

Solutions

Ameeva will present specific for each program in stepwise time bound steps for each stakeholder for this important issue. Some of the basic solutions will include

• Using innovative staffing and scheduling strategies which are accepted by the hospitalists so that better patient volumes can be achieved for each hospitalist. This is critically important.

• Process improvement leading to increased face to face times between hospitalists and patients.

• Changes in processes so that the hospitalists have the will and time for post discharge phone calls.

• Educating hospitalists about time efficient best practices for improving patient satisfaction.