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Impact of localizing general medical teams to a single nursing unit
Author(s) -
Singh Siddhartha,
Tarima Sergey,
Rana Vipulkumar,
Marks David S.,
Conti Mary,
Idstein Kathleen,
Biblo Lee A.,
Fletcher Kathlyn E.
Publication year - 2012
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.1948
Subject(s) - medicine , confidence interval , medical unit , hospital medicine , intervention (counseling) , unit (ring theory) , emergency medicine , family medicine , nursing , mathematics education , mathematics
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. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine