AMEEVA LLC

Inappropriate length of stay

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This can be physician related, system related or both. Few of the physician related causes of increased length of stay can be

• Increased patient load

• Cumbersome discharge process, Inadequate consultants support,

• Inappropriate  sign-outs

• Unclear physician documentation possibly due to complicated EMR documentation systems, Lack of communication between case managers, nurses and hospitalists

• Lack of motivation in the hospitalists, case managers and other staff

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

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Solutions to inappropriate length of stay have to be individualized and depend on which category the problem falls in. This can become clear in the analysis phase after meeting with the hospitalists, medical director, case managers, director case management and looking at various ratios and analyzing patterns. The solution will be specific for each problem for example-

• Educating the hospitalists as to why the  appropriateness length of stay is important for the hospitalists and patients and not only the hospital

• Making sure that the discharge process is streamlined

• Stepwise plan for starting multidisciplinary rounds which can be hospital-based or floor-based

• Disrupting the weekend pattern of low discharges by providing adequate support to the hospitalist on the weekends e.g. case manager and physical therapy support etc

• Certain shift structure changes, scheduling changes and changes in patient assignment can lead to stabilization of the hospitalist workload

• Innovative scheduling models that lead to better continuity of patient care and alleviate somewhat the effect of staffing shortages due to recruitment challenges

• increased motivation in the hospitalist workforce

 

Low early-morning discharges

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Some of the reasons include

• Increased workload

• Cumbersome discharge process

• Inappropriate sign-outs

• Increased number of early calls to the hospitalists when they are starting their shifts

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The solutions will again need to be specific after we analyze problem. Some of the solutions may include

• Recommending strategies to better manage the  Census load

• Making the discharge process efficient and less time-consuming

• Possible changes in the shift structure,

• Reducing phone calls to the hospitalists so that they can focus on the early AM discharges

• Using midlevel practioners and nurse navigators to help with discharge process

 

Increased transit times for the hospitalist patients from the ED

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Reasons

• Increased number of rounding patients due to which the hospitalists cannot respond adequately to ED physicians

• Multiple point calls from ED MD to Hospitalist Service

• Inadequate Hospitalist resources at when ED is busy usually in evenings and early nights

• Inadequate sign out between ED physician and Hospitalists

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Solutions

• Developing one step call process between hospitalist and ED Physician

• Realigning the hospitalist resources so that there is help at high admit times

• Starting a three point bridge order process from ED to Floors

• May need a system with dedicated admitters with back up support from rounders