Impact of localizing general medical teams to a single nursing unit

Abstract

Background: Localization of general medical inpatient teams is an attractive way to improve inpatient care but has not been adequately studied.

Objective: To evaluate the impact of localizing general medical teams to a single nursing unit.

Design: Quasi-experimental study using historical and concurrent controls.

Setting: A 490-bed academic medical center in the midwestern United States.

Patients: Adult, general medical patients, other than those with sickle cell disease, admitted to medical teams staffed by a hospitalist and a physician assistant (PA).

Intervention: Localization of patients assigned to 2 teams to a single nursing unit.

Measurements: Length of stay (LOS), 30-day risk of readmission, charges, pages to teams, encounters, relative value units (RVUs), and steps walked by PAs.

Results: Localized teams had 0.89 (95% confidence interval [CI], 0.37-1.41) more patient encounters and generated 2.20 more RVUs per day (CI, 1.10-3.29) compared to historical controls; and 1.02 (CI, 0.46-1.58) more patient encounters and generated 1.36 more RVUs per day (CI, 0.17-2.55) compared to concurrent controls. Localized teams received 51% (CI, 48-54) fewer pages during the workday. LOS may have been approximately 10% higher for localized teams. Risk of readmission within 30 days and charges incurred were no different. PAs possibly walked fewer steps while localized.

Conclusion: Localization of medical teams led to higher productivity and better workflow, but did not significantly impact readmissions or charges. It may have had an unintended negative impact on hospital efficiency; this finding deserves further study.