The hospital medicine (HM) program at a West Virginia hospital was experiencing elevated length-of-stay (LOS) times that hospital administration linked to excessive consults, a lack of consistency in admissions criteria and patient care, insufficient documentation practices, lack of coordination with and support of administration’s goals, and inadequate communication between the hospitalists and other departments.
In coordination with the hospital, TeamHealth brought on board an HM medical director who was particularly proficient in program leadership and communications.The new medical director immediately focused on three key program improvement areas.
(1) Leadership. The prior lack of leadership had resulted in a fragmented department and provider uncertainty regarding departmental processes. The TeamHealth medical director established and communicated a collaborative strategy that encompassed all tasks needed to achieve the department’s goals of patient focus and continuity inpatient care. To ensure a cohesive team, she met one-on-one with nurses to ensure that nurses and physicians were working together in a synergistic manner.
(2) Communication. Knowing that communication translates to productivity, customer satisfaction, and employee satisfaction, the medical director instituted daily multidisciplinary rounds, ensuring that the department’s activities were targeted toward and consistent with achieving the hospital’s daily operational goals. Rounding participants include a bed-control representative, case manager, social worker, pharmacy, home healthcare, physical therapy, the documentation specialist, and others. The medical director also orchestrated monthly meetings with administration to discuss the department’s goals and challenges and to facilitate an atmosphere of openness and trust between administration and the hospital medicine team.
(3) Documentation. Prior to TeamHealth’s involvement, all documentation was being dictated, and physicians were only completing progress notes via computer, resulting in inconsistent documentation practices. After TeamHealth assumed the program, the medical director used information from TeamHealth’s Hospital Medicine Playbook to set up electronic templates and ensure timely, accurate, and thorough documentation.The documentation specialist then conducted extensive documentation and compliance training with all users. The department now completes 100 percent of its documentation electronically.
By immediately addressing the areas of leadership, communication, and documentation, the program saw a number of significant metric improvements.
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