Care transitions can negatively impact the patient’s experience, as well as healthcare costs. When emergency medicine and hospital medicine clinicians fail to communicate, for example, patients may feel considerable uncertainty. In addition, patient safety may be at risk.
Research has found that as many as 60% of medication errors occur during transitions of care. A more intentional approach to care integration can enhance collaboration, reduce care delays, and shorten recovery times.
In a Becker’s webinar sponsored by Sound Physicians (Sound), two of the medical group’s leaders — Tony Briningstool, MD, chief executive officer, Sound Emergency Medicine, and Mihir Patel, MD, chief executive officer, Sound Hospital Medicine — discussed the benefits of integrating emergency and hospital medicine teams, as well as actionable strategies for overcoming integration barriers.
Here are four key takeaways from their conversation:
- Emergency medicine clinicians and hospitalists share the work of managing acute care episodes.
To deliver a patient-first approach to care, especially at transition points, many healthcare organizations are integrating their emergency medicine and hospital medicine teams.
Hospital medicine, though a relatively young service line, is one of the fastest growing. Dr. Patel noted that recent studies show that dedicated hospitalist groups drive better clinical and financial outcomes.
When it comes to acute care episodes, both emergency medicine clinicians and hospitalists are responsible for managing patients in the hospital and identifying the appropriate post-acute care setting for them.
With CMS Five-Star rating systems and other pressures, emergency and hospital medicine teams face increased workloads and are expected to do more in less time. “There are lots of checklists and quality work, in addition to delivering patient care,” Dr. Patel said. “Those factors drive challenges around autonomy, scheduling, and turnover.” - People, process, and technology are common obstacles to integrating emergency and hospital medicine.
Misalignment between medical directors and service lines, team cohesion, and team engagement are people-related issues that make integration of emergency and hospital medicine more difficult. When it comes to processes, responsibilities, workflows and outcomes — all need to be aligned. “Without well-defined processes between departments, chaos occurs at the time of admissions,” Dr. Patel said. “Patients suffer and communication barriers can lead to clinically worse outcomes.”
Technology can be both a blessing and curse. Physicians need access to comprehensive information in a timely manner. Problems arise when there is a lack of accountability or coordinated handoffs between emergency medicine and hospital medicine clinicians. - An intentional approach to clinical integration improves patient safety and clinical outcomes.
Sound recognizes that better alignment of teams reduces inefficiency and unnecessary testing. Clinician-to-clinician handoffs based on structured communication can help teams clearly understand and align during care transitions.
To break down organizational silos, Sound offers training boot camps for emergency and hospital medicine medical directors. Dr. Patel describes them as mini-MBA programs. “Medical directors have solid clinical knowledge, but many lack the operational and financial rigor needed to drive outcomes,” he said. “Boot camps set expectations and drive engagement.”
Sound also conducts monthly performance reviews during which clinical, operational, and nursing teams review 30 to 40 KPIs and examine root cause analysis. The goal is to challenge the status quo and make things better.
Effective use of point-of-care technology is also essential for driving better patient outcomes. According to Dr. Briningstool, technologies must be used in a patient-centered way. “We want to make sure technology is creating efficiency and reducing workloads, not increasing confusion and fragmentation of care,” he said.
Sound runs over 45 integrated emergency and hospital medicine programs and the results speak for themselves. All have shown improvement across a range of metrics including left without being seen, ED admit length of stay, percent of observation patients discharged, average length of stay, and patient satisfaction. - Innovative strategies help hospitals and health systems think differently about integrated acute care delivery.
Sound routinely uses a balanced scorecard to evaluate emergency and hospital medicine throughput, as well as the patient experience. This tool identifies silos and processes where change is needed. Dr. Briningstool believes the balanced scorecard is helpful because it creates organizational alignment and helps focus everyone’s priorities.
Another example of innovation in action is the multidisciplinary rounding process that Sound brought to the point of admission at a Level 1 trauma center. Initially, the center averaged 16 to 24 hours of bed hold time per patient in the ED, before moving to the inpatient unit.
“By bringing our best practice processes to the ED and meeting admitted patients where they were, we accelerated care decisions, enhanced care coordination, and reduced admit hold times in the ED by over 40%,” Dr. Briningstool said. “It was transformational.”
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