- A South Carolina-based integrated services client
A South Carolina-based regional hospital faced collaboration and culture issues. These barriers were hampering efforts to enhance quality and had a negative effect on key performance indicators. To improve lagging metrics and enact cultural shifts, the facility partnered with clinical outsourcing provider TeamHealth for the management and staffing of its emergency medicine and hospital medicine departments.
TeamHealth implemented a number of solutions designed to foster performance and culture improvements. Changes included modifying the flow and back-end processes in the emergency department (ED) to boost efficiency and implementing a dedicated transfer center to help attract patients from other facilities and physician practices.
The most critical modification was a new approach to processing overnight admissions. Historically, the hospital’s nocturnist would assign patients to clinicians based on the clinician’s census at the end of the prior shift, which slowed throughput from the ED and created a disincentive for hospitalists to discharge patients at the end of the day. Under TeamHealth’s new process, the nocturnist assigned overnight admissions equally among clinicians, regardless of census, which motivated hospitalists to discharge patients more quickly so they can keep a lower census.
TeamHealth also unblinded its hospitalist metrics and published physician performance on length of stay (LOS) and other measures each month. The results were twofold: clinicians compared their performance with peers, resulting in a friendly competition, and low performers looked to learn from high-performing colleagues.
The hospital now experiences higher volumes and greater efficiency, which has translated to enhanced financial performance. For example, changes in ED back-end processes took 47 minutes off the time required from the decision to admit a patient to when the patient left the department, which helped improve virtual bed capacity as well as patient and nursing satisfaction.
In hospital medicine, the admissions per day has increased from 14 to 17 in a four-year period, and the hospital is forecasting a 62 percent increase in in-bound patient transfers over the prior year.
The changes have been significant for the hospital’s numbers—a 23 percent reduction in the hospital’s average LOS since the partnership began. The average cost of an inpatient day is about $1,602, and the hospital sees an average of 6,205 admissions per year. The 23 percent LOS reduction equates to the hospital saving more than $11.6 million annually.
- 23% reduction in hospital length-of-stay
- 62% projected increase in in-bound transfers
- Improved emergency department efficiency
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