IN THE WORLD of hospital medicine, unit-based care elicits strong feelings. Its proponents say that limiting how far hospitalists have to travel to treat patients can be transformative, boosting not only physician efficiency but their career satisfaction. But it seems like there are just as many doctors who find implementing unit-based care to be so difficult that they walk away from the model altogether.
In this month’s cover story, we revisit the topic of unit-based care. While this isn’t the first time we’ve covered it, this month’s article sheds new light on how some hospitalist programs are making the model work.
What I found interesting was that many of the people we talked to identified this key to succeeding with unit-based care: taking a flexible approach. “Plasticity” is the word one program director used to describe his group’s strategy. Far from a purist take, group members avoid getting bogged down in hard concepts of having doctors based on only one unit.
He was not alone. Other programs say they consider unit-based care a success if they’re able to localize in a few units a majority—even just a slim one—of each physician’s patients. For these programs, a partial success with unit-based care is way better than having no localization at all.
As our article points out, however, not all programs can make unit-based care work, even with a flexible approach. They run into major pitfalls, from too much patient movement to a census that’s just too high. And even programs with a more casual take needed to make some hard-and-fast changes to make unit-based care work. Still, programs that give unit-based care a try all come away with valuable lessons on how to improve care, even if the model doesn’t stick.
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