In the typical hospital, most clinical service lines operate as distinct entities. That is, they work independently from one another as separate units—rarely coordinating efforts outside of a patient consult or hand-off. This common configuration can be clinically and financially inefficient or hospitals, as well as confusing and frustrating for patients, physicians and administrators.In an ideal world, all hospitals would be clinically integrated—with all relevant departments and healthcare providers working together from the time a patient enters the hospital, throughout their hospital experience and into the post-discharge period. This white paper explores the concept of clinical integration and illustrates how achieving true clinical coordination across the entire hospital enterprise can lead to increased patient satisfaction, improved quality and enhanced hospital operations and finances.
WHAT IS CLINICAL INTEGRATION?
Simply put, clinical integration refers to a scenario in which some or all of a hospital’s clinical service lines work together in a coordinated and cohesive way, across departments, with the goal of delivering high-quality and more efficient patient care. It means removing the departmental “silos” that are typical of today’s hospitals and finding new ways for clinicians to work together.When service lines are integrated, clinicians from across departments communicate with one another to treat patients in a way that considers the patient’s entire hospital experience and potential outcomes, not just the treatment delivered by the individual physician at a fixed point in time.
Among the clinical service lines that hospitals may consider integrating are:
Usually, the first department to see and treat hospitalized patients, emergency physicians make diagnostic and treatment decisions that can affect the rest of the patient’s hospital experience.
After the admission decision is made, the hospital medicine team assumes primary responsibility for patients’ care—essentially serving as the central point of contact to ensure proper coordination.
Specialty hospitalist physicians such as orthopedic hospitalists, general surgery hospitalists and OB/GYN hospitalists provide 24/7 coverage for unassigned patients and emergent conditions and procedures. Close coordination with other clinical service lines can allow for expedited care.
Responsible for pre-surgical testing,pain management and intraoperative care, the anesthesia team can more easily facilitate any needed surgery when working in lockstep with emergency physicians, hospitalists and surgeons.
When all inpatient departments work together, surgical cases can be accelerated—in some cases to the same day—prompting a shift in surgeons’ workflow.
In addition, hospitals with ancillary services such as urgent care centers and medical call centers can integrate those offerings into their care continuum to support clinical integration. Urgent care centers, for example, can fill an important role for both pre- and post-hospital care by helping patients with non-emergent conditions receive prompt treatment without visiting the emergency department (ED). In the case of post discharge patients, this may help patients avoid a readmission. Similarly, medical call centers can provide nurse triage and nurse advice lines, giving patients the convenience of 24-hour clinical support and providing hospitals a convenient way to make post-discharge check-in calls. These services can efficiently reinforce patients’ understanding and compliance with discharge instructions so they avoid unnecessary readmissions.