Moving Beyond Traditional Hospital Operations: The Value of Integrating Service Lines

By now, most hospital leaders have realized that traditional strategies of running a hospital will not be sufficient to reach their quality and revenue goals. New models such as accountable care organizations and patient-centered medical homes are forcing hospitals to collaborate with others to coordinate care more efficiently and safely. To improve coordination of care with outside organizations such as other hospitals and health systems, however, hospitals need to first improve coordination of care within their own institution.

Oliver Rogers, president of hospital-based services, and Jeff Wood, vice president of hospital-based services at TeamHealth, explain how integrating anesthesia, emergency medicine and hospital medicine can improve quality and efficiency and prepare hospitals for changes under healthcare reform.

Breaking down silos

"With the coming changes in the healthcare bill, it's incumbent on all of us to rethink historical processes and silos that exist among specialties," Mr. Rogers says. "We don't have the ability in healthcare to afford that anymore."

In contrast to silos, integration forms connections between different service lines to facilitate communication and eliminate inefficiencies. "We have to find ways to create new efficiencies and decrease duplication of cost," Mr. Rogers says. "That's what service line integration is all about — how to knock down historical boxes and reconfigure patient processes."

To break down silos, hospital leaders must discuss integration with physicians and staff of different service lines. Mr. Rogers suggests soliciting ideas from these individuals on how to improve processes. Providing forums for discussion between service lines allows physicians and staff to brainstorm improvements without assigning blame.

Driving accountability across service lines

When the physicians and staff determine key goals for integration, they should become jointly accountable for reaching these goals. "The most successful ways to break down silos is to have folks mutually responsible for outcomes, so it's not just the anesthesiologists' or surgeons' responsibility for how the hospital does on [Surgical Care Improvement Project] measures, it's everyone's responsibility," Mr. Rogers says.

Hospitals can make service lines accountable for quality and efficiency goals by creating incentives. New value-based payment models such as bundled payments and other shared risk pool models can make physicians and staff accountable because everyone shares the savings for meeting certain quality metrics.

Creating collaborative teams

Successful integration of hospital services requires physicians and staff form collaborative teams that work toward common goals.

Platforms for communication
One way to encourage collaboration between service lines is holding regular meetings between different groups to help people understand another service line's perspective. Mr. Wood says TeamHealth requires one member of a service line to attend the provider meeting of another service line. For example, the medical director of the hospital medicine program might attend the emergency department provider meeting.

"Within that venue is an opportunity for the leader of one service line to hear concerns and compliments that relate to the interfaces between the two service lines," Mr. Wood says. TeamHealth hospitals have cross-service line meetings quarterly at minimum, but often monthly, according to Mr. Wood.

In addition to provider meetings by service line, hospitals should also hold regular meetings between physician and nurse leaders to address challenges and successes of the integrated service line model. Similarly, leadership of the integrated services can meet with the hospital executive team annually to establish goals, and then quarterly to explain progress toward the goals. "[These meetings] provide a great venue for collaboration," Mr. Wood says. "By setting clear goals and understanding each other's priorities, we're able to provide the right resources to come to a beneficial solution."

Transitions of care

Teamwork among service line providers is particularly valuable during transitions of care, such as from the emergency department to surgery, surgery to inpatient care and inpatient care to post-discharge. For example, Mr. Wood says a patient could present to the ED with a hip fracture and need to be transferred to the operating room immediately. After the surgery, the patient will then need to be transferred to post-operative care. Integrating anesthesia, emergency medicine and hospital medicine can facilitate these transitions.

Safety during handoffs

Patient handoffs during transitions of care are vulnerable for errors that can jeopardize patient safety. It is therefore necessary providers communicate clearly. If service lines involved in the transition of care are integrated, the providers can more easily and safely transfer patients to different levels of care. "We've found when we have a team that knows each other and has agreed-upon care guidelines, the transition of care is expedited and is safer," Mr. Wood says.

For example, integrating anesthesia with emergency medicine enables anesthesiologists to manage ED patients' pain more effectively. Similarly, integrating anesthesia with hospital medicine allows anesthesiologists to provide pain management throughout the inpatient unit instead of only to surgical patients. "Anesthesiologists often have a tremendous skill set around managing and alleviating patient pain. We've found their expertise working in coordination with hospitalists for inpatient service, and for patients who present in the ED, has been a real value," Mr. Wood says.

Patient flow
In addition to providing safer transitions of care, integrated services can improve patient flow. Frequent communication and collaboration between services helps speed care, creating efficiencies and reducing costs. One strategy for improving patient flow through integrated services is parallel processes.

"Oftentimes patients are treated within a sequential manner, and we order tests and provide services one after the other," Mr. Wood says. "We've found improving length of stay can often occur through more parallel processing, where you're doing multiple things for patients at same time, thus driving down length of stay and improving coordination of care."

Integration also avoids duplication of services, such as two different providers unknowingly ordering the same imaging test for a patient. Communication between service lines and establishing common processes eliminates the need for a patient to wait for an unnecessary, duplicated test. "[Integrated services] is focused on reducing cost, improve quality, driving duplication out of the system and streamlining processes so we can get patients in and out quicker," Mr. Rogers says.

Furthermore, improving patient flow in one area, such as between the emergency department and OR, can affect patient flow through every area of the hospital. "It's not only the flow of patients through the emergency room," Mr. Rogers says. "It has a large impact on the whole house."

Improving quality

Another key value of integrating services such as anesthesia, emergency medicine and hospital medicine is improved quality. "Around quality, we find if we have venues where leaders of hospital medicine, emergency medicine and anesthesia service lines can get together and review cases, better results occur for patient care," Mr. Wood says.

Collaborating on patient care ensures every provider is aware of the patient's condition. For instance, Mr. Wood says a best practice is to have physician leaders of the integrated service lines round on patients together to hear directly from patients how they experience care across the service lines. In addition, coordination between integrated service lines can improve the discharge process, which can in turn reduce readmissions.

Value of integration

By breaking down silos between service lines, hospitals can create collaborative teams that can effectively improve patient safety, especially during transitions of care, and quality. The many intersections between anesthesia, emergency medicine and hospital medicine make them ideal services to integrate, and physicians and staff from these service lines can work together to reach common goals of efficiency and quality. This integrated model will be a key feature of hospitals on the cutting edge of care delivery as the healthcare industry moves toward a more coordinated system of care.

More Articles on Hospital Service Lines:

6 Best Practices for Integrating ED, Hospital Medicine Physicians
What Hospital Cardiovascular Co-Management Looks Like in Action

Hospital Data Collection Boosts Value of Orthopedic Service Line

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