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. 2017 Oct;45(4):135-142.
doi: 10.1080/21548331.2017.1353884. Epub 2017 Jul 28.

Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction

Christine Bryson  1   2 , Greta Boynton  3 , Anna Stepczynski  4 , Jane Garb  1 , Reva Kleppel  1 , Farzan Irani  1   2 , Siva Natanasabapathy  1   2 , Mihaela S Stefan  1   2
Affiliations

Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction

Christine Bryson et al. Hosp Pract (1995). 2017 Oct.

Abstract

Objective: To evaluate whether implementation of a geographic model of assigning hospitalists is feasible and sustainable in a large hospitalist program and assess its impact on provider satisfaction, perceived efficiency and patient outcomes.

Methods: Pre (3 months) - post (12 months) intervention study conducted from June 2014 through September 2015 at a tertiary care medical center with a large hospitalist program caring for patients scattered in 4 buildings and 16 floors. Hospitalists were assigned to a particular nursing unit (geographic assignment) with a goal of having over 80% of their assigned patients located on their assigned unit. Satisfaction and perceived efficiency were assessed through a survey administered before and after the intervention.

Results: Geographic assignment percentage increased from an average of 60% in the pre-intervention period to 93% post-intervention. The number of hospitalists covering a 32 bed unit decreased from 8-10 pre to 2-3 post-intervention. A majority of physicians (87%) thought that geography had a positive impact on the overall quality of care. Respondents reported that they felt that geography increased time spent with patient/caregivers to discuss plan of care (p < 0.001); improved communication with nurses (p = 0.0009); and increased sense of teamwork with nurses/case managers (p < 0.001). Mean length of stay (4.54 vs 4.62 days), 30-day readmission rates (16.0% vs 16.6%) and patient satisfaction (79.9 vs 77.3) did not change significantly between the pre- and post-implementation period. The discharge before noon rate improved slightly (47.5% - 54.1%).

Conclusions: Implementation of a unit-based model in a large hospitalist program is feasible and sustainable with appropriate planning and support. The geographical model of care increased provider satisfaction and perceived efficiency; it also facilitated the implementation of other key interventions such as interdisciplinary rounds.

Keywords: Geographic assignment; hospitalist deployment; provider satisfaction with rounding; unit based rounding.

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Conflict of interest statement

Declaration of Interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1:
Figure 1:
Patient Assignment Process
Figure 2:
Figure 2:
Proportion of Patients Assigned Geographically
Figure 3:
Figure 3:
Proportion of Patients Assigned Geographically in each medical unit
See this image and copyright information in PMC

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References

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