Hosp Pract (1995). 2021 Sep 22. doi: 10.1080/21548331.2021.1985316. Online ahead of print.
ABSTRACT
BACKGROUND: Unit based teams may improve care delivery for hospitalized patients, but can be challenging to implement broadly across all acute care units in a hospital.
OBJECTIVE: To determine the effect of a Lean guided transition to hospital wide unit-based assignment on care delivery outcomes.
DESIGN, SETTING, AND PARTICIPANTS: The study was a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions and length of stay, performed at a 336-bed tertiary academic referral hospital in the Pacific Northwest with approximately 17,000 admissions annually.
INTERVENTION: Implementation of a Lean guided quality improvement intervention included division of hospitalist duties into "admitters" and "rounders," with simulated patient flow exercises to determine the optimal staffing model.
MAIN OUTCOMES AND MEASURES: Discharge efficiency (number of patients discharged by hospitalists divided by the number of hospitalist patient encounter days per month) and 30-day readmissions were compared using the t-test or chi-square, and length of stay was analyzed in a multivariate time series regression model.
RESULTS: The intervention was associated with a significant improvement in discharge efficiency, by 0.014 (from 0.168 to 0.181) discharges/encounter (95%CI =0.024,0.004), p=0.009. Mean length of stay decreased by 0.98 days (95%CI 0.50, 1.47) after adjustment for patient age, patient type (medical versus surgical), critical care admissions, and discharge disposition, without a corresponding change in 30-day readmission rate (12.2% (1948/15902) pre-intervention to 11.7% (397/3379) post-intervention (p=0.42)).
CONCLUSIONS: Dividing hospitalist roles into admitters and rounders enabled implementation of unit based teams across the hospital, with corresponding improvements in discharge efficiency and length of stay.
PMID:34551664 | DOI:10.1080/21548331.2021.1985316