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Navathe AS, Silber JH, Small DS, Rosen AK, Romano PS, Even-Shoshan O, Wang Y, Zhu J, Halenar MJ, Volpp KG. Teaching hospital financial status and patient outcomes following ACGME duty hour reform. Health Serv Res 2013; 48:476-98. [PMID: 22862427 PMCID: PMC3626351 DOI: 10.1111/j.1475-6773.2012.01453.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. DATA SOURCES/STUDY SETTING Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. STUDY DESIGN Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). PRINCIPAL FINDINGS All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 ("Post 1") or year 2 ("Post 2") versus the prereform period, were insignificant: Post 1 OR range 1.00-1.02 and Post 2 OR range 0.99-1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). CONCLUSIONS The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations.
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Affiliation(s)
- Amol S Navathe
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA 19104, USA.
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Saleh KJ, Bozic KJ, Graham DB, Shaha SH, Swiontkowski MF, Wright JG, Robinson BS, Novicoff WM. Quality in orthopaedic surgery--an international perspective: AOA critical issues. J Bone Joint Surg Am 2013; 95:e3. [PMID: 23283380 DOI: 10.2106/jbjs.l.00093] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Quality is a hallmark of health care, although it is difficult to come to a consensus on who gets to define what "quality health care" is. Most health-care workers enter this field with the goal of improving the health of their patients (and the community), and while everyone tries to do the best job possible, we must continuously seek better methods and techniques for achieving better outcomes. The passion for continuous improvement is fundamental, but passion is not sufficient by itself. There is substantial opportunity to improve quality and reduce cost in health care. Multidisciplinary teams that include physicians, nurses, and other ancillary care providers have led to decreased waiting times to see specialists and have also led to better management of chronic disease. By including ancillary care, providers can increase cancer-screening rates and have the potential to decrease readmissions. Moreover, the addition of hospitalists and physician assistants can produce quality and efficiency outcomes that are commensurate with those enjoyed by traditional house staff. However, truly improving performance is difficult due to questions about how we define "quality," design care processes, measure inputs and outputs, develop multi-stakeholder collaborations, and develop incentive programs for delivering "good" care. There is a definite need for more thorough and robust studies of the impact of pay-for-performance programs, with the inclusion of ancillary care providers. Current research has not shown that there is not enough evidence to be able to determine what incentive structure might "work" in a particular health-care system. Payment systems will continue to evolve to incentivize greater collaboration among providers to yield higher-quality, lower-cost care. Future efforts will necessitate the need for strong physician leadership in helping to develop an optimal care team that is as patient-centered as possible. Technology adds dimensions of capability to making improvement real and systematic, as well as providing safer care with fewer errors and better adherence to proven best practices. The drive for quality with technology produces better clinical outcomes and maximizes efficiencies and financial metrics of organizational performance. Technology also adds capabilities for capturing key metrics and reporting them back to clinicians and others. Improved data transparency informs those who can actually do things differently to produce better results and outcomes. While health-care entities strive to focus on quality of care, measuring and reporting such care in a meaningful way are difficult. The best chance of improving overall care for patients is through the adoption of systems that improve coordination and continuity, not by health-care staff working harder. Only through collaboration and integration can health care incorporate a culture for improving quality and patient safety.
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Affiliation(s)
- Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62702, USA.
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Singh S, Tarima S, Rana V, Marks DS, Conti M, Idstein K, Biblo LA, Fletcher KE. Impact of localizing general medical teams to a single nursing unit. J Hosp Med 2012; 7:551-6. [PMID: 22791661 DOI: 10.1002/jhm.1948] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/08/2012] [Accepted: 04/13/2012] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Siddhartha Singh
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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Srinivas SK, Lorch SA. The laborist model of obstetric care: we need more evidence. Am J Obstet Gynecol 2012; 207:30-5. [PMID: 22138138 DOI: 10.1016/j.ajog.2011.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/16/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
Abstract
Literature suggesting improved patient outcomes and patient satisfaction with the hospitalist model of inpatient medical care coupled with the desire to improve provider satisfaction led to the introduction of the laborist in obstetrics. This represents a significant change in the way obstetrics has been experienced and practiced from both a patient and provider perspective. The laborist was designed as a plausible model of obstetric care delivery where hospitals employ physicians to provide continuous coverage of labor and delivery units without other competing clinical duties. Anecdotal use of the laborist model in the provision of obstetric care is growing rapidly, despite the lack of research regarding its impact on maternal outcomes, neonatal outcomes, patient and provider satisfaction, and graduate medical education. We provide an overview of both the positive and negative attributes of this model of obstetric care delivery, discuss the current state of research addressing these attributes, and propose a research strategy to improve understanding of the impact of this model of care delivery.
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Ratanawongsa N, Federowicz MA, Christmas C, Hanyok LA, Record JD, Hellmann DB, Ziegelstein RC, Rand CS. Effects of a focused patient-centered care curriculum on the experiences of internal medicine residents and their patients. J Gen Intern Med 2012; 27:473-7. [PMID: 21948228 PMCID: PMC3304041 DOI: 10.1007/s11606-011-1881-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 08/25/2011] [Accepted: 09/02/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traditional residency training may not promote competencies in patient-centered care. AIM To improve residents' competencies in delivering patient-centered care. SETTING/PARTICIPANTS Internal medicine residents at a university-based teaching hospital in Baltimore, Maryland. PROGRAM DESCRIPTION One inpatient team admitted half the usual census and was exposed to a multi-modal patient-centered care curriculum to promote knowledge of patients as individuals, improve patient transitions of care, and reduce barriers to medication adherence. PROGRAM EVALUATION Annual resident surveys (N = 40) revealed that the intervention was judged as professionally valuable (90%) and important to their training (90%) and offered experiences not available during other rotations (88%). Compared to standard inpatient rotation evaluations (n = 163), intervention rotation evaluations (n = 51) showed no differences in ratings for traditional medical learning, but higher ratings for improving how housestaff address patient medication adherence, communicate with patients about post-hospital transition of care, and know their patients as people (all p < 0.01). On post-discharge surveys, patients from the intervention team (N = 177, score 90.4, percentile ranking 97%) reported greater satisfaction with physicians than patients on standard teams (N = 924, score 86.1, percentile ranking 47%) p < 0.01). DISCUSSION A patient-centered inpatient curriculum was associated with higher satisfaction ratings in patient-centered domains by internal medicine residents and with higher satisfaction ratings of their physicians by patients. Future research will explore the intervention's impact on clinical outcomes.
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Affiliation(s)
- Neda Ratanawongsa
- UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, General Internal Medicine, University of California, San Francisco, CA USA
| | - Molly A. Federowicz
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Colleen Christmas
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Laura A. Hanyok
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Janet D. Record
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - David B. Hellmann
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Roy C. Ziegelstein
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Cynthia S. Rand
- Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Medicine, Baltimore, MD USA
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Szecket N, Wong HJ, Wu RC, Berman HD, Morra D. Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit. J Hosp Med 2012; 7:55-9. [PMID: 21954169 DOI: 10.1002/jhm.926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/25/2011] [Accepted: 03/17/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optimizing hospital operations is a critical issue facing healthcare systems. Reducing unnecessary variation in patient flow is likely to improve efficiency and optimize capacity for hospital inpatients. The objective of this study was to determine whether changing admissions, from a "bolus" system to a "drip" system, would result in a smoothed daily discharge rate, and reduce the length of stay of patients on a General Internal Medicine clinical teaching unit over a period of 1 year. METHODS We conducted a retrospective analysis of the General Internal Medicine inpatient service at Toronto General Hospital for the 6-month periods from March to August during 2 consecutive years. Length of stay distributions and daily discharge rate variations were compared between the 2 study periods. RESULTS There were a total of 2734 discharges, 1446 occurring in the pre-change period, and 1288 in the post-change period. There was overall smoothing of the daily discharge rates, and a reduction of 0.3 days in median length of stay in the post-change period (P = 0.0065). CONCLUSIONS Restructuring the admission system to achieve constant daily admissions to each care team resulted in a smoothing of daily discharge rates and improved operational efficiency with shorter lengths of stay.
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Affiliation(s)
- Nicolas Szecket
- General Internal Medicine, Center for Innovation in Complex Care, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Abstract
OBJECTIVE This study examines the effectiveness of an educational intervention that used audit and feedback to influence physician assistant (PA) antimicrobial utilization in an emergency department (ED). METHODS Twelve ED PAs participated in this pre- and postintervention study. Their prescribing patterns were retrospectively reviewed and classified as appropriate, effective but inappropriate, or inappropriate using a previously developed methodology. A hospitalist physician conducted a 1-hour academic detailing intervention session with each PA that reviewed inappropriate prescribing practices and provided feedback for improvement based on current guidelines. After the meetings, the prescribing patterns of the providers were followed prospectively and comparisons were made between the proportions of antimicrobials prescribed appropriately and inappropriately before and after the intervention. RESULTS The percentage of appropriate prescriptions increased from 64% (95% CI, 58-72) to 81% (95% CI, 75-86), whereas the proportion of inappropriate prescriptions decreased from 36% (95% CI, 31-43) to 19% (95% CI, 14-23) across the study periods (both P < .001). CONCLUSION PA antimicrobial utilization was responsive to an academic detailing initiative that relied heavily on audit and feedback of past performance. Targeting PAs in quality improvement initiatives may be a highly effective way to influence change in health care utilization.
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Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures. BMC Med 2011; 9:58. [PMID: 21592322 PMCID: PMC3123228 DOI: 10.1186/1741-7015-9-58] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 05/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. METHODS Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. RESULTS The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). CONCLUSIONS Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality.
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Abstract
Since its inception, physician assistants (PAs) have been and continue to be successfully integrated into many critical care (CC) departments across the nation. The combination of both a projected shortage of intensivists and the recent house staff work hour restrictions, enforced by the Accreditation Council for Graduate Medical Education (ACGME), will increase the demand for PA coverage. Prior success in integrating PAs into ICUs has proven that PAs can fill the large gap created by the aforementioned factors and do so in an efficient and cost-effective manner. Given that PA naïve institutions still exist specifically within the field of CC medicine, this article aims to introduce and describe how PAs can be incorporated into an ICU. In addition, areas of focus will highlight hiring, training, credentialing/billing, and evolving continuing education.
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Affiliation(s)
- Danny Lizano
- Division of Critical Care Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, Bronx, New York
| | - Gargi Mehta
- Division of Critical Care Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, Bronx, New York
| | - David Keith
- Division of Critical Care Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, Bronx, New York
| | - Ariel L. Shiloh
- Division of Critical Care Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, Bronx, New York
| | - Richard H. Savel
- Division of Critical Care Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, Bronx, New York,
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Singh S, Fletcher KE, Schapira MM, Conti M, Tarima S, Biblo LA, Whittle J. A comparison of outcomes of general medical inpatient care provided by a hospitalist-physician assistant model vs a traditional resident-based model. J Hosp Med 2011; 6:122-30. [PMID: 21387547 DOI: 10.1002/jhm.826] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Residency reform in the form of work hour restrictions has forced academic medical centers to develop alternate models of care to provide inpatient care. One such model is the use of physician assistants (PAs) with hospitalists. However, these models of care have not been widely evaluated. OBJECTIVE To compare the outcomes of inpatient care provided by a hospitalist-PA (H-PA) model with the traditional resident based model. DESIGN, SETTING AND PATIENTS We conducted a retrospective cohort study of 9681 general medical (GM) hospitalizations between January 2005 and December 2006 using a hospital administrative database. We used multivariable mixed models to adjust for a wide variety of potential confounders and account for multiple patient visits to the hospital to compare the outcomes of 2171 hospitalizations to H-PA teams with those of 7510 hospitalizations to resident teams (RES). MEASUREMENTS Length of stay (LOS), charges, readmission within 7, 14, and 30 days and inpatient mortality. RESULTS Inpatient care provided by H-PA teams was associated with a 6.73% longer LOS (P = 0.005) but charges, risk of readmission at 7, 14, and 30 days and inpatient mortality were similar to resident-based teams. The increase in LOS was dependent on the time of admission of the patients. CONCLUSIONS H-PA team-based GM inpatient care was associated with a higher LOS but similar charges, readmission rates, and inpatient mortality to traditional resident-based teams, a finding that persisted in sensitivity analyses.
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Affiliation(s)
- Siddhartha Singh
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Khanna R, Wachsberg K, Marouni A, Feinglass J, Williams MV, Wayne DB. The association between night or weekend admission and hospitalization-relevant patient outcomes. J Hosp Med 2011; 6:10-4. [PMID: 21241035 DOI: 10.1002/jhm.833] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 02/15/2010] [Accepted: 07/02/2010] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Nights and weekends represent a potentially high-risk time for hospitalized patients. Data regarding night or weekend admission and its impact on outcomes is limited. We studied the association between night or weekend admission and outcomes. METHODS We reviewed 857 admissions to the general medicine services from the emergency department (ED) at our tertiary care hospital for demographic information, time and day of admission, and hospitalization-relevant outcomes (length of stay [LOS], hospital charges, intensive care unit [ICU] transfer during hospitalization, repeat ED visit within 30 days, readmission within 30 days, and poor outcome [ICU transfer, cardiac arrest, or death] within the first 24 hours of admission). Outcomes were compared between groups using univariate and multivariate modeling. RESULTS Complete data for analysis were available for 824 patients. A total of 58% of patients were admitted at night and 22% were admitted during the weekend. Patients admitted at night as compared to those admitted during the day had similar a LOS (4.1 vs. 4.3, P = 0.38), hospital charges (25,200 vs. 27,500, P = 0.17), ICU transfer during hospitalization (3% vs. 6%, P = 0.06), 30 day repeat ED visit (22% vs. 20%, P = 0.42), 30 day readmission (20% vs. 17%, P = 0.23), and poor outcomes within 24 hours of admission (1% vs. 2%, P = 0.15). Patients admitted during the weekend as compared to those admitted during the week had lower hospital charges and lower likelihood of an ICU transfer but were otherwise similar. CONCLUSION Night or weekend admission was not associated with worse hospitalization-relevant outcomes at our tertiary care hospital.
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Affiliation(s)
- Raman Khanna
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Burton MC, Kashiwagi DT, Kirkland LL, Manning D, Varkey P. Gaining efficiency and satisfaction in the handoff process. J Hosp Med 2010; 5:547-52. [PMID: 20717894 DOI: 10.1002/jhm.808] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/15/2010] [Accepted: 05/17/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Handoffs, or transfers of patient care responsibility, occur frequently on hospitalist teams. The reliability and efficiency of the handoff process is a national and local concern. Most studies in the literature regard physicians-in-training. We studied the morning handoff process of hospitalist teams comprised of staff physicians and nurse practitioner and/or physician assistants. METHODS An improvement team observed morning handoffs. Four problems were identified: unpredictable start and finish times, inefficiency, poor environment (hallway noise and distracting in-room conversations), and poor communication. The team restructured the process and observed post-intervention behavior at 15 and 90 days. A participant-provider survey was conducted before and after the intervention regarding wasted time, total time-in-report, and satisfaction with the process. RESULTS Pre-intervention 60.5% of providers (23/38) believed morning handoff was performed in a timely fashion compared to 100% (15/15) post-intervention (P = 0.005). Average time spent in morning report was 11 minutes, compared to 5 minutes after the intervention (P < 0.0028). Pre-intervention 6.5 minutes were believed wasteful, compared to 0.5 minutes post-intervention (P < 0.0001). CONCLUSIONS This study identifies deficiencies in the handoff process that were addressed by enhancing the physical environment (smaller room, noise reduction, closed door), assigned seating (visual cues by table tent cards), non-clinicians providing printed materials, standardization of written updates, team times (consistent & precise daily time for each team report), culture change including deference of attention to team receiving report with opportunity for questions, and minimization of side conversations. This intervention package resulted in an improvement in satisfaction and timeliness of clinicians involved.
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Affiliation(s)
- M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Singh S, Fletcher KE, Pandl GJ, Schapira MM, Nattinger AB, Biblo LA, Whittle J. It's the writing on the wall: Whiteboards improve inpatient satisfaction with provider communication. Am J Med Qual 2010; 26:127-31. [PMID: 20870743 DOI: 10.1177/1062860610376088] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although keeping patients informed is a part of quality hospital care, inpatients often report they are not well informed. The authors placed whiteboards in each patient room on medicine wards in their hospital and asked nurses and physicians to use them to improve communication with inpatients. The authors then examined the effect of these whiteboards by comparing satisfaction with communication of patients discharged from medical wards before and after whiteboards were placed to satisfaction with communication of patients from surgical wards that did not have whiteboards. Patient satisfaction scores (0-100 scale) with communication improved significantly on medicine wards: nurse communication (+6.4, P < .001), physician communication (+4.0, P = .04), and involvement in decision making (+6.3, P = .002). Patient satisfaction scores did not change significantly on surgical wards. There was no secular trend, and the authors excluded a trend in overall patient satisfaction. Whiteboards could be a simple and effective tool to increase inpatient satisfaction with communication.
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Affiliation(s)
- Siddhartha Singh
- Clinical Cancer Center, 5th Floor, Division of General Internal Medicine, Froedtert & the Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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66
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Abstract
BACKGROUND Outpatient clinic activity represents a major workload for clinicians. Unnecessary outpatient visits place a strain on service provision, resulting in unnecessary delays for more urgent cases. GOALS We sought to determine both the impact and economic benefit of employing phone follow-up and physician assistant (PA) triage systems on attendances at a gastroenterology outpatient department. STUDY We performed a retrospective chart review of all patients attending a gastroenterology outpatient clinic over a 2-week period. Patients were categorized into new or follow-up attendees and the follow-up patients were further subcategorized into 1 of 4 groups: (1) those attending to receive results of investigations requiring no further treatment (group A); (2) those attending to receive results of investigations requiring further treatment (group B); (3) those attending with a chronic gastrointestinal disease requiring no active change in management (group C); (4) those attending with a chronic gastrointestinal disease requiring active change in management (group D). It was assumed that patients in group A could be managed by phone follow-up in place of clinic attendance and patients in group C could be triaged to see a PA. RESULTS Out of a total of 329 outpatient attendees, 40 (12%) required no active intervention (group A) and would have been suitable for phone follow-up. A further 58 (18%) had stable disease, requiring no change in management and hence, could have been triaged to see a PA. Implementation of phone follow-up and patient review by PA could reduce salary expenses of outpatient practice by 17%. CONCLUSIONS Our findings support routine prescreening of outpatient attendees to enhance the efficiency of gastroenterology outpatient practice.
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Affiliation(s)
- Vikas I Parekh
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-0376, USA.
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