Published in the August 2017 issue of Today’s Hospitalist
HOSPITALISTS ARE KNOWN for taking a team approach in the hospital, in part because of the complexity of the issues they face. In this month’s issue, two articles take a look at how teamwork can make or break key quality improvement initiatives: early discharges and unnecessary readmissions.
Our cover story looks at initiatives that aim to discharge patients (or have doctors file discharge orders) in the morning. Hospitals around the country are experimenting with early-discharge strategies, with mixed results.
Hospitalists themselves can be part of the problem, intentionally gaming such metrics by keeping patients who could be discharged the day before in the hospital overnight to claim credit for an early discharge.
But getting a real handle on early discharges requires looking beyond individual physicians to other members of the hospital team. If patient transportation isn’t ready when patients are discharged, or if empty beds can’t be cleaned quickly for the next patient, hospitalists’ efforts will fail.
There’s a similar theme in our story, which looks at one hospital’s initiative to reduce unnecessary readmissions. The Massachusetts hospital we talked to has reduced readmissions by building a mobile readmissions team that follows high-risk patients into their homes.
The team includes a palliative care PA, a pharmacist, a nurse case manager and a social worker. One team member holds morning huddles and rounds (with hospitalists) in the hospital to identify high utilizers. Team members also visit patients at home (or in skilled nursing facilities) after discharge.
In this case, expanding the team has meant expanding the mission. Team members address issues that aren’t necessarily related to acute care like transportation, access to medications and diet. It’s a testament to hospitalists’ ability to team up with others to get the job done.
Editor & Publisher