A model of a hospitalist role in the care of admitted patients in the emergency department

Briones, Alan; Markoff, Brian; Kathuria, Navneet; Jagoda, Andy; Baumlin, Kevin M.; Hill, Scot; Mumm, Lawrence; Jervis, Ramiro; Dunn, Andrew

doi:10.1002/jhm.636

Cited by 9 publications

(23 citation statements)

References 29 publications

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“…14 The HMED team improved throughput and decreased ED diversion while improving timeliness of care and perception of care quality for patients boarding in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Howell and colleagues improved throughput in the ED by implementing a service which provided active bed management without clinical responsibilities, 13 while Briones and colleagues improved clinical care of patients boarded in the ED without affecting throughput. 14 The HMED team improved throughput and decreased ED diversion while improving timeliness of care and perception of care quality for patients boarding in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…The increased proportion of boarded patients discharged from the ED by the HMED team is consistent with Briones and colleagues' clinically oriented team managing boarding patients in the ED. 14 Potential adverse effects of our intervention included increased returns to the ED, increased ICU transfer rate, and decreased housestaff satisfaction. There was no increase in the 48-hour return rate and no increase in the ICU transfer rate for patients cared for by the HMED team.…”

Section: Discussionmentioning

confidence: 99%

“…13 Briones and colleagues dedicated a hospitalist team to patients boarded in the ED and improved their quality of care. 14 Denver Health Medical Center (DHMC) is an urban, academic safety net hospital. In 2009, the ED saw an average of 133 patients daily and an average of 25 were admitted to the medical service.…”

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confidence: 99%

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Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Chadaga

Shockley

Keniston

et al. 2012

Journal of Hospital Medicine

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“…14 The HMED team improved throughput and decreased ED diversion while improving timeliness of care and perception of care quality for patients boarding in the ED.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Chadaga

Shockley

Keniston

et al. 2012

Journal of Hospital Medicine

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“…In some models of care, hospitalist physicians successfully facilitate appropriate placement of ED patients with positive outcomes 6,7,8. In large, complex organizations, however, proper bed assignment and placement of inpatients is often delegated to case management in collaboration with ED and admitting physicians.…”

Section: Discussionmentioning

confidence: 99%

Reducing Patient Placement Errors in Emergency Department Admissions: Right Patient, Right Bed

Rathlev¹,

Bryson²,

Samra³

et al. 2014

WestJEM

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IntroductionBecause lack of inpatient capacity is associated with emergency department (ED) crowding, more efficient bed management could potentially alleviate this problem. Our goal was to assess the impact of involving a patient placement manager (PPM) early in the decision to hospitalize ED patients. The PPMs are clinically experienced registered nurses trained in the institution-specific criteria for correct unit and bed placement.MethodsWe conducted two pilot studies that included all patients who were admitted to the adult hospital medicine service: 1) 10/24 to 11/22/2010 (30 days); and 2) 5/24 to 7/4/2011 (42 days). Each pilot study consisted of a baseline control period and a subsequent study period of equal duration. In each pilot we measured: 1) the number of “lateral transfers” or assignment errors in patient placement, 2) median length of stay (LOS) for “all” and “admitted” patients and 3) inpatient occupancy. In pilot 2, we added as a measure code 44s, i.e. status change from inpatient to observation after patients are admitted, and also equipped all emergency physicians with portable phones in order to improve the efficiency of the process.ResultsIn pilot 1, the number of “lateral transfers” (incorrect patient placement assignments) during the control period was 79 of the 854 admissions (9.3%) versus 27 of 807 admissions (3.3%) during the study period (P<0.001). We found no statistically significant differences in inpatient occupancy or ED LOS for “all” or for “admitted” patients. In pilot 2, the number of “lateral transfers” was 120 of 1,253 (9.6%) admissions in the control period and 42 of 1,229 (3.4%) admissions in the study period (P<0.001). We found a 49-minute (352 vs. 401 minutes) decrease in median LOS for “admitted” ED patients during the study period compared with the control period (P=0.04). The code 44 rates, median LOS for “all” patients and inpatient occupancy did not change.ConclusionInclusion of the PPM in a three-way handoff conversation between emergency physicians and hospitalist providers significantly decreased the number of “lateral transfers.” Moreover, adding status determination and portable phones for emergency physicians improved the efficiency of the process and was associated with a 49 (12%) minute decrease in LOS for admitted patients.

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Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making

et al. 2018

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A model of a hospitalist role in the care of admitted patients in the emergency department

Cited by 9 publications

References 29 publications

Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Hospitalist‐led medicine emergency department team: Associations with throughput, timeliness of patient care, and satisfaction

Reducing Patient Placement Errors in Emergency Department Admissions: Right Patient, Right Bed

Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making

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