7 January 2016

Improved Care through ED-Hospitalist Integration

Improving communication and collaboration between emergency department physicians and inpatient doctors, such as hospitalists and intensivists, has numerous benefits to physicians, hospitals and patients. An integrated model increases patient throughput and patient satisfaction, decreases costs stemming from redundant treatments, and improves patient safety and quality outcomes.

The transition of care from the emergency department to an inpatient bed is a complex process with numerous steps and moving parts, and is consequentially a difficult process to streamline. Hospital departments have traditionally operated within separate silos, focusing on the state of their intradepartmental communication rather than interdepartmental communication. This lack of interdepartmental communication and teamwork has been thrust into the spotlight recently due to regulations changing the way hospitals are reimbursed for the care they provide.

With these changes, there is increased pressure to put patients in the right level of care (inpatient, outpatient, observation) based on that patient’s diagnosis. Hospitals that do not correctly level patients stand to lose money by not being reimbursed fully by insurers for the care provided. Additionally, patients are often hit with surprisingly high medical bills if they are leveled incorrectly, contributing to dissatisfaction. Ineffective communication during the transition may also lead to duplicated testing or treatments by the other department, resulting in wasteful redundancies for the hospital.

Therefore, hospitals have a lot riding on the quality of communication between ED and inpatient departments. How can hospital leaders increase the amount of integration between these two departments? Below are several ideas:

  • Ensure that each department understands the other’s goals, challenges and metrics. Establishing mutual goals and measurements of success can accelerate this process by making each department’s performance dependent on the others.
  • Reassess the communication channels at your facility. Do the members of each department have easy access to the members of the other department and, if not, what needs to change in order to make that possible?
  • Have department leadership attend the meetings of other departments. This keeps each department up to date on the needs, challenges and goals of the other department. Additionally, each will have a voice in the planning processes of the other and therefore an incentive to stay engaged.
  • Hold a time and space for members of different departments to get to know each other on a more personal level. This can improve trust and overall morale within and between departments.
  • Create a standardized criteria for patient leveling. Even if the communication lines are open and the trust between departments is strong, department collaboration will break down without a standard definition of inpatient admission versus observation admission, etc. Standardized admission criteria alleviates confusion about which department is responsible for a patient and increases the timeliness of decisions — creating a smoother flow of patients and improving patient satisfaction and quality outcomes.

Emergency and inpatient departments have a lot of overlap and are mutually dependent on one another to provide the highest quality outcomes for patients. Integrating these two teams of physicians can be one way to ensure that this overlap is seamless and to realize all the benefits that come with enhanced intradepartmental teamwork.