Application of Integrated Medical Care Model (Hospitalist) in Emergency Department and its Efficiency and Outcome: 4 years' Experience in Taiwan

Abstract

Background: The hospitalist model (HOS) setting at wards can improve quality of patient care and shorten length of stay, however, their efficacy at emergency department (ED) is still lacking in Taiwan.Objective: To realize if HOS is working at ED in a designed academic care program.Design/setting: Before-and-after intervention of HOS in a 1200-bed tertiary medical center in Taiwan. Measurement:A three-shift duty with 8 internal subspecialists was adapted for their working schedule in 3:1:1 physicians round. From 2012~2016, 4 years data was collected retrospectively such as length of stay, over-waiting (>48 h) period, mortality, 6 and 24 h deterioration after hospitalization and satisfaction questionnaire were analyzed before and after HOS intervention was compared.Results: There was no significant difference in patient number, age and sex before and after HOS program at ED. In total, 4 years data analyzed (520,409 ED visitors, 111,949 hospitalized) was shown that decline of waiting time, over-waiting (>48 h), mortality rate, post-hospitalized 6 and 24 h transferring to intensive care unit were statistically significant (ANOVA, p ≦ 0.05 individually). In average 55-60 patients per month discharged from holistic care unit without admission. Satisfactory questionnaire for pre-hospitalized care in disease explanation, service attitudes, symptom relief and overall impression about healthcare reached 90% in two times survey (427 and 459 sample sizes).Conclusion: HOS at ED can lessen over-crowded conditions, shorten pre-hospitalized length, decline mortality, and improve quality of care and patient satisfaction. Although data comes from a single medical center, it still shows good efficiency and outcome since HOS implemented at emergency. of care model, hospitalist program-HOS, was launched by the hospital administrators to solve the over-crowded situations and cared pre-hospitalized patients in advance at ED. Application of Integrated MedicalThe HOS was established in United Stated (US) in 1996 and the field of hospital medicine has grown rapidly worldwide recently. At present hospitalists on staffs reach 50,000 physicians, more than cardiologists, in almost all medical centers in US [9][10][11][12]. The advantages of HOS include a more rapid, effective and precise dealing with problems no matter in diagnoses, prescription of medications, therapeutic strategies or the communications with patients by sharing decision making with attending physicians rather than by residency in advance [13,14]. Several studies have reported that HOS model at wards provides shorter length of stay and improves quality of care [11,[14][15][16]. From patient point of views,

Evaluating the Outcome of Multi-Morbid Patients Cared for by Hospitalists: a Report of Integrated Medical Model in Korea

“…The reductions in LOS associated with hospitalist care was more prominent in older patients and those who developed complications 93234. The implementation of hospitalist-operated system, like that utilized in our institute, was effective in patients visiting the ED 141536. Unlike with pneumonia, no statistical difference in LOS was found with UTI between HG and NHG in the current study.…”

“…The integrated medical model is a recently emerging model, which involves the collaboration of different subspecialists or hospitalists in order to provide quality care to patients in an independent department 13. A similar model with an integrated medical model has been used in foreign countries 15…”

Hospitalists at Emergency Department Can Improve the Effectiveness of Pre-hospitalized Patients Care

“…There are other additional advantages of HOS setting at ED [15]. First, unlikely the internal physicians at wards with full-time responsibility for patients, the working hours in HCU team are reasonable including 20 shift-works by 8 hours in each to avoid burnouts and share their family life.…”