When an acute care hospital in Birmingham, Alabama, noticed an increased length of stay (LOS), TeamHealth hospitalist leadership shifted the inpatient culture to bring metrics into the desired range.
- Facility: A 300+ bed hospital in Birmingham, Alabama, part of a national, non-profit health system
- Services: Hospital Medicine
The hospital’s LOS was higher than desired, hovering around 6.2 days on average. In addition, the emergency department (ED) had seen several diversion periods that lasted longer than the teams wanted. To begin, they performed a root cause analysis. The analysis uncovered barriers to timely care, namely a culture of over-consultation, transport delays and communication issues. The team tried different tactics and ultimately decided to focus on their processes and reaffirm the necessity of maintaining high performance.
Solution: Cultural Connections
The first step in alleviating these concerns was enhancing the team culture. First, the team adjusted consultation processes to ensure they happened up front and in the morning to avoid delays. Leadership also empowered physicians as experts in the inpatient unit, ensuring they only requested consultations when required. In addition, the inpatient leadership also asked clinicians to explain why they embarked on their healthcare careers. The facility medical director then directly connected each clinician’s “why” with the initiative’s importance. These qualitative correlations proved valuable in enhancing team performance.
Solution: Adapted Techniques
To address processes, the team had to adapt standard techniques to their situation. Hospital leadership desired a different approach than traditional multi-disciplinary rounds, and in response, the hospitalist team created a unique workflow. Nurses and physicians began rounding together to decrease unnecessary back and forth and to decrease repeated questions – and frustrations – from the patients. The team also shared each patient’s anticipated discharge the day before to help the process run smoother. The team then utilized a med-to-bed process to ensure patients had the pharmacy deliver their medications to the patient’s bedside before discharge.
Solution: Ongoing Education
In an effort to maintain performance, the team engaged in ongoing education. TeamHealth’s national chief clinical officer of hospitalist services, Dr. Rohit Uppal, came on-site for education sessions. Perhaps the most valuable education area was documentation. Previously, the team had tried to funnel all documentation directly to the case manager, but this workflow was unsustainable. Instead, after education and trials, the team devised a new system for the team to learn. This involved reminders from the site coordinator, who then sent documentation to the case managers and chief medical officer. The chief medical officer helped ensure compliance with case managers, who then completed the cycle with the hospital.
Solution: Enhanced Communication
The team emphasized enhanced communication as a vital component of performance. First, better communication with transport helped decrease delays to ensure patients flowed through the facility without delay. Then, a 9 a.m. huddle to discuss patients and observation delays helped continuity of communication and strengthened teamwork. In addition, the department held a monthly meeting and shared unblinded data to increase accountability and evaluate team performance. This also allowed leadership to celebrate the top performers and mentor those who need additional support. Finally, leadership presented performance data to the facility leadership and brought back their comments to the team.
The team has seen impressive results, and this experiential success continued to increase compliance with new and best practices. Patients now move more efficiently through the facility with the team leveraging the same resources. Notable improvements include:
- LOS reduced from an average of 6.2 days to below 5 days in 2023
- Left without being seen (LWBS) rates have dropped dramatically this year
- ED has only seen one period of diversion in three months, which lasted only two hours
- Year-to-date admits are up from 60 to 80
The team’s impressive results show the value of the close partnership between TeamHealth and the hospital. The facility trusts the department and leadership to maintain performance, as evidenced by the broadening partnership between TeamHealth and the system. TeamHealth offers a cycle of support empowered by our breadth of partnerships and scale. From local boots-on-the-ground leadership to regional and national resources, we have the experience and expertise to enhance care delivery in facilities across the country. To learn more about partnering with us, please reach out to our team.