Hospitalist programs can be improved.
Yet many of these programs bring little if any significant value to their hospitals or patients. They have shown some effectiveness in generating revenue for the hospitalist group and accommodating primary care physicians who prefer not to go to the hospital.
However, they do little to improve patient care or to improve hospital function. All that has changed is the type of physician taking care of the patient.
Little, if anything, has been done to actually improve how care is provided.
If executed properly, a hospitalist program with expanded features and services can return significant value to hospitals and patients. A more comprehensive and intelligently designed model can also significantly help the hospitalist physician by streamlining the process, providing support, and offloading nonclinical duties to nonphysician personnel.
Early in my career as a hospitalist, time-motion studies on the physicians in our group revealed that only 35% of our time was being spent on duties that needed to be done by a physician.
A number of things can be done to improve quality and value in a hospitalist program and at the same time, provide support that allows hospitalist physicians to focus on patient care and satisfaction. Our programs utilize a team approach, where clinical care coordinators manage patient flow, and the physicians make the clinical decisions.
These decisions are driven by hospitalist-authored protocols and orders based on evidence-based medicine. Handheld computers are used to store decision-support materials and to track patients and diagnoses.
Clinical care coordinators do a number of things, such as track and report care delays that are used to prepare reports to the hospital on how to improve patient flow and service. They also audit charts to make sure that evidence-based medicine is being practiced.
Our physicians use a national service center to dictate discharge reports that immediately notify referring primary care physicians about their patient's hospital stay. These reports also are used to gather data on patient care.
Patients are called within 48 hours of discharge to make sure their discharge plan is being accomplished.
The program uses patient satisfaction surveys, primary care physician satisfaction surveys, and hospitalist team surveys to analyze performance and improve team dynamics.
These efforts have helped us reduce readmission rates by up to 40% and reach patient satisfaction levels of 97%-99% in all of our programs.
Data from the program are tied to physician compensation to ensure that the hospital and the hospitalist-physician team are driven by the same incentives.
All of this creates value for the hospital by improving care, leading the charge to meet regulatory standards, and creating return on the dollars that the hospital has spent on the program.
Baptist Hospital in Pensacola, Fla., which is this year's winner of the Malcolm Baldridge Award for Quality, saved $2.6 million on patients in the first 2 years of using our program. The hospital also improved quality of care and hospital patient flow, as well as decreasing readmission rates.
This is what can happen when a hospital with vision recognizes what a well-designed and executed hospitalist program can do to help them meet the challenges of the future.
BY RON GREENO, M.D.
DR. RON GREENO is a hospitalist and chief medical officer of Cogent Healthcare, Irvine, Calif., which implements hospitalist programs across the country.
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|Title Annotation:||Guest Editorial|
|Publication:||Clinical Psychiatry News|
|Date:||Jul 1, 2004|
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