1
|
Bailey R, Segon A, Garcia S, Kottewar S, Lu T, Tuazon N, Sanchez L, Gelfond JA, Bowling G. Increasing and sustaining discharges by noon - a multi-year process improvement project. BMC Health Serv Res 2024; 24:478. [PMID: 38632568 PMCID: PMC11025149 DOI: 10.1186/s12913-024-10960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
High hospital occupancy degrades emergency department performance by increasing wait times, decreasing patient satisfaction, and increasing patient morbidity and mortality. Late discharges contribute to high hospital occupancy by increasing emergency department (ED) patient length of stay (LOS). We share our experience with increasing and sustaining early discharges at a 650-bed academic medical center in the United States. Our process improvement project followed the Institute of Medicine Model for Improvement of successive Plan‒Do‒Study‒Act cycles. We implemented multiple iterative interventions over 41 months. As a result, the proportion of discharge orders before 10 am increased from 8.7% at baseline to 22.2% (p < 0.001), and the proportion of discharges by noon (DBN) increased from 9.5% to 26.8% (p < 0.001). There was no increase in balancing metrics because of our interventions. RA-LOS (Risk Adjusted Length Of Stay) decreased from 1.16 to 1.09 (p = 0.01), RA-Mortality decreased from 0.65 to 0.61 (p = 0.62) and RA-Readmissions decreased from 0.92 to 0.74 (p < 0.001). Our study provides a roadmap to large academic facilities to increase and sustain the proportion of patients discharged by noon without negatively impacting LOS, 30-day readmissions, and mortality. Continuous performance evaluation, adaptability to changing resources, multidisciplinary engagement, and institutional buy-in were crucial drivers of our success.
Collapse
Affiliation(s)
- Ryan Bailey
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Ankur Segon
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Sean Garcia
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Saket Kottewar
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Ting Lu
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Nelson Tuazon
- University Health, 4502 Medical Drive, San Antonio, TX, 78229, USA
| | - Lisa Sanchez
- University Health, 4502 Medical Drive, San Antonio, TX, 78229, USA
| | | | - Gregory Bowling
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| |
Collapse
|
2
|
Schwatka NV, Keniston A, Astik G, Linker A, Sakumoto M, Bowling G, Auerbach A, Burden M. Hospitalist Shared Leadership for Safety, Health, and Well-Being at Work: United States, 2022‒2023. Am J Public Health 2024; 114:162-166. [PMID: 38354355 PMCID: PMC10916734 DOI: 10.2105/ajph.2024.307573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
We assessed how hospitalists frame workplace safety, health, and well-being (SHW); their perception of hospital supports for SHW; and whether and how they are sharing leadership responsibility for each other's SHW. Our findings highlight the important role of local support for hospitalist SHW and reveal the systemic, hospital-wide problems that may impede their SHW. We believe that positioning hospitalists as leaders for SHW will result in systems-wide changes in practices to support the SHW of all care team members. (Am J Public Health. 2024;114(S2):S162-S166. https://doi.org/10.2105/AJPH.2024.307573).
Collapse
Affiliation(s)
- Natalie V Schwatka
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Angela Keniston
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Gopi Astik
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Anne Linker
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Matthew Sakumoto
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Gregory Bowling
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Andrew Auerbach
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| | - Marisha Burden
- Natalie V. Schwatka is with the Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Angela Keniston and Marisha Burden are with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus. Gopi Astik is with the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Anne Linker is with the Division of Hospital Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Matthew Sakumoto and Andrew Auerbach are with Department of Medicine, University of California San Francisco. Gregory Bowling is with Division of Hospital Medicine, University of Texas Health San Antonio
| |
Collapse
|
3
|
Singh A, Panek T, Tackett S, Paranji S, Gundareddy V, Kauffman R, Wright S, Bowling G, Torok H, Patel H, Alhadeff I, Nogi M, McIlraith T, Robertson T, Kisuule F. Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study. J Gen Intern Med 2022; 37:3925-3930. [PMID: 35657465 PMCID: PMC9165541 DOI: 10.1007/s11606-022-07680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials. OBJECTIVE To understand what elements influence millennial hospitalists' recruitment and retention. DESIGN We developed a survey that asked participants to rate the level of importance of 18 elements (4-point Likert scale) in their decision to choose or remain at an HMG. PARTICIPANTS The survey was electronically distributed to hospitalists born in or after 1982 across 7 HMGs in the USA. MAIN MEASURES Elements were grouped into four major categories: culture of practice, work-life balance, financial considerations, and career advancement. We calculated the means for all 18 elements reported as important across the sample. We then calculated means by averaging elements within each category. We used unpaired t-tests to compare differences in means for categories for choosing vs. remaining at an HMG. KEY RESULTS One hundred forty-four of 235 hospitalists (61%) responded to the survey. 49.6% were females. Culture of practice category was the most frequently rated as important for choosing (mean 96%, SD 12%) and remaining (mean 96%, SD 13%) at an HMG. The category least frequently rated as important for both choosing (mean 69%, SD 35%) and remaining (mean 76%, SD 32%) at an HMG was career advancement. There were no significant differences between respondent gender, race, or parental status and ratings of elements for choosing or remaining with HMGs. CONCLUSION Culture of practice at an HMG may be highly important in influencing millennial hospitalists' decision to choose and stay at an HMG. HMGs can implement strategies to create a millennial-friendly culture which may help improve recruitment and retention.
Collapse
Affiliation(s)
- Amteshwar Singh
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA.
| | - Tiffani Panek
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Suchitra Paranji
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Venkat Gundareddy
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Regina Kauffman
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| | - Scott Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory Bowling
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Haruka Torok
- Division of General Internal Medicine, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Ilan Alhadeff
- Hospitalist Services, Team Health, Hollywood, FL, USA
| | - Masayuki Nogi
- Division of Hospital Medicine, The Queen's Medical Center, Honolulu, HI, USA
| | - Thomas McIlraith
- Department of Hospital Medicine, Mercy Medical Group, Sacramento, CA, USA
| | - Thomas Robertson
- Division of Academic Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Flora Kisuule
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL East 2nd Floor, MD, 21224, Baltimore, USA
| |
Collapse
|