Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction
- Resource Type
- Authors
- Siva Natanasabapathy; Christine Bryson; Farzan Irani; Reva Kleppel; Mihaela S. Stefan; Greta Boynton; Jane Garb; Anna Stepczynski
- Source
- Hospital practice (1995). 45(4)
- Subject
- medicine.medical_specialty
Attitude of Health Personnel
Interprofessional Relations
Personnel Staffing and Scheduling
030204 cardiovascular system & hematology
Efficiency, Organizational
Tertiary care
Patient Readmission
Job Satisfaction
Teaching hospital
Unit (housing)
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Nursing unit
030212 general & internal medicine
Hospitals, Teaching
Patient Care Team
business.industry
General Medicine
Length of Stay
Intervention studies
Outcome and Process Assessment, Health Care
Massachusetts
Hospitalists
Patient Satisfaction
Family medicine
Models, Organizational
Workforce
business
Hospital Units
- Language
- ISSN
- 2154-8331
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.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.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%).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.