Impact of localizing general medical teams to a single nursing unit. J Hosp Med 2012 Sep;7(7):551-6
Date
07/14/2012Pubmed ID
22791661DOI
10.1002/jhm.1948Scopus ID
2-s2.0-84865996959 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
BACKGROUND: Localization of general medical inpatient teams is an attractive way to improve inpatient care but has not been adequately studied.
OBJECTIVE: To evaluate the impact of localizing general medical teams to a single nursing unit.
DESIGN: Quasi-experimental study using historical and concurrent controls.
SETTING: A 490-bed academic medical center in the midwestern United States.
PATIENTS: Adult, general medical patients, other than those with sickle cell disease, admitted to medical teams staffed by a hospitalist and a physician assistant (PA).
INTERVENTION: Localization of patients assigned to 2 teams to a single nursing unit.
MEASUREMENTS: Length of stay (LOS), 30-day risk of readmission, charges, pages to teams, encounters, relative value units (RVUs), and steps walked by PAs.
RESULTS: Localized teams had 0.89 (95% confidence interval [CI], 0.37-1.41) more patient encounters and generated 2.20 more RVUs per day (CI, 1.10-3.29) compared to historical controls; and 1.02 (CI, 0.46-1.58) more patient encounters and generated 1.36 more RVUs per day (CI, 0.17-2.55) compared to concurrent controls. Localized teams received 51% (CI, 48-54) fewer pages during the workday. LOS may have been approximately 10% higher for localized teams. Risk of readmission within 30 days and charges incurred were no different. PAs possibly walked fewer steps while localized.
CONCLUSION: Localization of medical teams led to higher productivity and better workflow, but did not significantly impact readmissions or charges. It may have had an unintended negative impact on hospital efficiency; this finding deserves further study.
Author List
Singh S, Tarima S, Rana V, Marks DS, Conti M, Idstein K, Biblo LA, Fletcher KEAuthors
Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of WisconsinSergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Academic Medical CentersAdult
Aged
Aged, 80 and over
Confidence Intervals
Efficiency, Organizational
Female
Geography
Humans
Inpatients
Intensive Care Units
Length of Stay
Male
Medical Staff, Hospital
Middle Aged
Models, Organizational
Nursing Service, Hospital
Odds Ratio
Patient Care
Statistics, Nonparametric
Wisconsin
Workflow
