Philip Vaidyan, MD, director of hospital medicine in the department of internal medicine at St. Mary's Health Center in St. Louis and practice group leader with IPC The Hospitalist Company, shares five best practices that have helped the hospitalist unit at St. Mary's Health Center achieve improved clinical outcomes and patient satisfaction.
1. Establish regular meetings for care providers. Providing a quality continuum of care requires hospitalists, physicians, nurses and other staff members such as social workers to communicate frequently. Dr. Vaidyan says the hospitalist unit at St. Mary's has daily meetings to ensure every individual involved in the care of a patient is up-to-date.
"We have a hand-off meeting every day at 9 a.m.," Dr. Vaidyan says. "It helped improve staff chemistry because now everybody has a holistic view of a patient. If there is a patient that has diabetes, everything is discussed to better understand where the patient is coming from. We can pull up EMRs, X-rays, CT scans, everything."
2. Ensure hospitalist leaders interact frequently with other leaders within the hospital. Hospitalists attend weekly pod meetings to discuss finances and business development issues. Executive personnel and other hospital leadership, such as the nutritionist manager or emergency room director, join the meeting, creating a forum on business practices between disciplines.
"I direct these pod meetings, where we discuss internal business opportunities and financial issues, and at some point, we can be joined by the hospital system CEO, COO or ER director," Dr. Vaidyan says. "This gives all disciplines an opportunity to be face-to-face and share valuable information, which we use to improve the hospital and care."
3. Strengthen coordination of care between hospitalists and nurses. Patient care and efficient communication can be greatly improved by focusing on the relationship between the physician and the nurse. Quarterly meetings with nurse managers and the nurse director give both hospitalists and nurses at St. Mary's a chance to address any issues that may exist.
"For example, any nurse should be able to communicate all of a patient's information to an on-call hospitalist in less than a minute," Dr. Vaidyan says. "We've done role playing to improve upon effective conversation and relaying key information about a patient."
4. Follow-up with primary care physicians and patients. Following up with patients and their primary care physicians after discharge is essential to providing the full continuum of quality care. Hospitalists and nurses at St. Mary's work to make sure patients make post-discharge appointments as soon as possible, as adverse events can happen within that week.
"There should be a free flow of communication from hospitalists back to the primary care physicians," Dr. Vaidyan says. "The hospitalists use a system to send a discharge summary within 24 hours to primary care physicians. A copy also goes to a care manager, who uses that information for a follow-up phone call to that patient. The current problem with healthcare discharge processes is the information falls into a black hole."
5. Encourage hospitalists to take ownership of quality care. As physicians start to cut back on time spent in the hospital, hospitalists should step up and play the role of a leader by cultivating relationships and taking ownership of quality patient care, Dr. Vaidyan says.
"Hospitalists have to be like a quarterback, coordinating care between disciplines, building relationships with staff members and patients and effectively articulating information to patients," he says. "Patients may hear different things from different people, and that's the one downfall of hospitalists. If they don't take ownership of building relationships and articulating information between everyone, it can lead to poor [clinical and patient satisfaction] outcomes."
1. Establish regular meetings for care providers. Providing a quality continuum of care requires hospitalists, physicians, nurses and other staff members such as social workers to communicate frequently. Dr. Vaidyan says the hospitalist unit at St. Mary's has daily meetings to ensure every individual involved in the care of a patient is up-to-date.
"We have a hand-off meeting every day at 9 a.m.," Dr. Vaidyan says. "It helped improve staff chemistry because now everybody has a holistic view of a patient. If there is a patient that has diabetes, everything is discussed to better understand where the patient is coming from. We can pull up EMRs, X-rays, CT scans, everything."
2. Ensure hospitalist leaders interact frequently with other leaders within the hospital. Hospitalists attend weekly pod meetings to discuss finances and business development issues. Executive personnel and other hospital leadership, such as the nutritionist manager or emergency room director, join the meeting, creating a forum on business practices between disciplines.
"I direct these pod meetings, where we discuss internal business opportunities and financial issues, and at some point, we can be joined by the hospital system CEO, COO or ER director," Dr. Vaidyan says. "This gives all disciplines an opportunity to be face-to-face and share valuable information, which we use to improve the hospital and care."
3. Strengthen coordination of care between hospitalists and nurses. Patient care and efficient communication can be greatly improved by focusing on the relationship between the physician and the nurse. Quarterly meetings with nurse managers and the nurse director give both hospitalists and nurses at St. Mary's a chance to address any issues that may exist.
"For example, any nurse should be able to communicate all of a patient's information to an on-call hospitalist in less than a minute," Dr. Vaidyan says. "We've done role playing to improve upon effective conversation and relaying key information about a patient."
4. Follow-up with primary care physicians and patients. Following up with patients and their primary care physicians after discharge is essential to providing the full continuum of quality care. Hospitalists and nurses at St. Mary's work to make sure patients make post-discharge appointments as soon as possible, as adverse events can happen within that week.
"There should be a free flow of communication from hospitalists back to the primary care physicians," Dr. Vaidyan says. "The hospitalists use a system to send a discharge summary within 24 hours to primary care physicians. A copy also goes to a care manager, who uses that information for a follow-up phone call to that patient. The current problem with healthcare discharge processes is the information falls into a black hole."
5. Encourage hospitalists to take ownership of quality care. As physicians start to cut back on time spent in the hospital, hospitalists should step up and play the role of a leader by cultivating relationships and taking ownership of quality patient care, Dr. Vaidyan says.
"Hospitalists have to be like a quarterback, coordinating care between disciplines, building relationships with staff members and patients and effectively articulating information to patients," he says. "Patients may hear different things from different people, and that's the one downfall of hospitalists. If they don't take ownership of building relationships and articulating information between everyone, it can lead to poor [clinical and patient satisfaction] outcomes."