Critial Path Network
CMs at hospitalist meetings improves care
Improved communication helps free up beds sooner
When a representative from the case management department began attending the daily meeting of a large hospitalist group at St. Vincent's Medical Center, the Jacksonville, FL, hospital began to see an improvement in patient throughput almost immediately.
"By going to the meetings, I can be a conduit of information between the case managers on the unit and the hospitalists. The improved communication helps us with capacity issues and to free up rooms for patients waiting in the emergency department," says Jamie Zachary, LCSW, the hospital's director of care management.
Two large hospitalist groups admit about 60% of all patients to St. Vincent's Medical Center. All of the patients treated by the hospitalists come from the emergency department. The hospital rotates referrals from the emergency department between the two groups.
"One group of the two groups of hospitalists meets only monthly, so we don't have that forum to be involved. The other group meets every day," Zachary says.
The hospital began the initiative six months ago when one of the hospitalists commented that they could operate more efficiently and effectively if they had one person they could contact every day about discharge plans and other issues.
Zachary started going to their daily meetings the next day.
The hospitalist group meets for 30 minutes every day. Either Zachary or the manager joins the meeting for the last 15 minutes.
"It has created much more effective and timely patient care. Increased communication has been the big factor. It's certainly worth 10 or 15 minutes of our time," she says.
The case managers on the unit leave a voice mail message about any issues or questions they want Zachary to discuss with the physicians.
"We get the information they need and get it back to them as soon as the meeting is over. It's been very effective in getting the information the case managers need back to them in a timely manner," she says.
By attending the meetings, Zachary gets information on patients who are likely to be discharged that day and passes it on to the case managers before the physicians get to the unit for rounds.
"This ensures that all of the plans are in place for patients being discharged and that there is nothing holding up their discharge," she says.
When a physician is planning rounds later in the day, Zachary takes verbal discharge orders for his or her patients.
"Sometimes the physicians don't go to the unit until after noon. With the verbal orders, we can have everything in place, including the patient's transportation, by the time the physician arrives on the unit," she says.
The hospitalist group employs nocturnists who sometimes change the treatment plan overnight.
"Sometimes something has happened with the patient overnight and the nocturnist has made a change in the plan for the patient. I can alert the case manager to the change in the treatment plan first thing in the morning," she says.
When Zachary looked at length-of-stay data on the three units where the hospitalists have a high volume, she found that the length of stay had dropped.
"The length of stay wasn't high to begin with, but the data showed that this hospitalist group practices more efficiently than the independent physicians and that they have reduced their length of stay," she says.
The program started just six months ago, and extensive data is not yet available.
"One of the indicators we're hoping to affect is the number of patients who are discharged before 2 p.m. One of our goals is to move the discharge time up and get people out sooner. We also have the opportunity to communicate to the physicians how many patients are waiting in the emergency department for beds and what type of beds are needed," she says.
Zachary meets with the other hospitalist group once a month to discuss hospital processes, protocols, and administrative issues. She presents information on issues such as length of stay and resource utilization.
When a representative from the case management department began attending the daily meeting of a large hospitalist group at St. Vincent's Medical Center, the Jacksonville, FL, hospital began to see an improvement in patient throughput almost immediately.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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