Despite significant overlap in workflow and processes, emergency and hospital medicine programs often share a silo mentality. Operating as separate entities can lead to confusion and frustration for physicians, clinical staff and patients. By combining both programs under a single management group, hospitals may be able enhance physician accountability for shared clinical standards while creating economies of scale and greater operational efficiencies that ultimately improve the patient experience.
1. Improved patient flow. Aligning hospital medicine and ED physicians can improve the workflow of those departments, which can increase the flow of patients into and through the hospital. "When the ED can see more patients, it increases ED volume and potential hospital admissions. Since freeing space in the hospital increases the amount of possible admissions the hospital can handle, it can also increase the hospital's market share," says Mr. Rogers.
2. Fewer duplicated services. When ED and hospital medicine departments integrate, the physicians can better understand and anticipate the other area's needs, potentially eliminating repetitive tests and services, according to Mr. Rogers. There should be no delay or repeats if an ED physician can perform treatment in the ED to prepare a hospital medicine physician to diagnose.
3. Lower costs. Obviously fewer duplicated services mean less tests and less cost. In addition, fewer tests could lead to shorter hospital stays, which would lower costs as well.
4. Fewer readmissions. According to Mr. Rogers, integrating ED and hospital medicine services involves working with physicians to identify appropriate medical treatment for certain patient cases. For this reason, if a patient were to return, the physician would be more likely to conduct necessary treatments and offer appropriate medication without admitting that patient to the hospital. "When an ED can treat return patients on an outpatient basis, the hospital's readmission rate lowers dramatically," says Mr. Rogers.
Regardless of the challenges, integrating ED and hospital medicine services can offer major benefits. In order to achieve synergy and reach those outcomes, Mr. Rogers recommends the following six best practices.
1. Change the mindset. The first thing that needs to change is the historical idea that a physician's responsibility begins and ends in their area. For instance, there is often a backdoor mentality among the hospital staff — the ED physician's responsibility is contained to the ED. "That mentality can no longer exist. It is not applicable," says Mr. Rogers.
2. Highlight shared responsibility. Physicians need to have a shared, mutual responsibility to ensure the flow of patients as they go across the hospital continuum. Integration needs to include effort from both ends, especially to transcend that back door mentality. "Hospital physicians need to take on the responsibility of alleviating boarding and backup in the ED, while ED physicians need to take on the responsibility of assisting when hospital medicine physicians are backed up with patients," says Mr. Rogers.
3. Set clear joint goals. Hospital leaders, service line leaders and other thought leaders within the hospital need to work together and assign appropriate goals for both ED and hospital medicine physicians such as reducing door-to-admit time. According to Mr. Rogers, they should address how to operationalize the goals and develop clear protocols and standing orders as well.
4. Hold both groups accountable. After joint goals are established, each group needs to be held accountable in order to achieve them. "It is not just the ED physician's job to work on admittance rates. The hospital physicians should be equally charged with monitoring and managing a quick door-to-admit rate," says Mr. Rogers.
5. Collect, utilize real-time data. According to Mr. Rogers, hospitals need to have a robust dashboard or some form of measurement tool to collect real-time data across specialties to help physicians meet joint metric goals. "The closer to real-time the data is, the better. You can't rely on retroactive studies. The best integration outcomes will come from real-time data," says Mr. Rogers.
6. Be creative in program design. According to Mr. Rogers, hospital leaders need to be creative in their program design in order to capitalize on the hospital medicine and ED integration. Hospital leaders cannot merely encourage collaboration and expect all the potential outcomes to follow. "For example, full time coverage by a hospital medicine physician at night is not always cost effective. Leaders could consider using mid-level providers to care for patients on the hospitalist service at night, under the supervision of the ED physician, with backup of a hospitalist on call. This could make the program more effective," says Mr. Rogers.
There are many measurable benefits to integrating hospital and ED services: improved patient flow, higher admissions, fewer duplications, lower costs and lower readmissions. In order to achieve these outcomes, physician teams need to realize shared goals and then be held accountable for the overall quality and efficiency of their services. When this occurs, they may have a greater incentive to work together for smoother transitions, faster admittance rates and better patient outcomes.
Benefits of ED and hospital medicine program integration
According to Oliver Rogers, president of TeamHealth's hospital-based services, integrating ED and hospital medicine programs can provide better process flow and coordination of care, which in turn helps improve patient safety and satisfaction. Integrating these services can offer the following four measureable benefits.1. Improved patient flow. Aligning hospital medicine and ED physicians can improve the workflow of those departments, which can increase the flow of patients into and through the hospital. "When the ED can see more patients, it increases ED volume and potential hospital admissions. Since freeing space in the hospital increases the amount of possible admissions the hospital can handle, it can also increase the hospital's market share," says Mr. Rogers.
2. Fewer duplicated services. When ED and hospital medicine departments integrate, the physicians can better understand and anticipate the other area's needs, potentially eliminating repetitive tests and services, according to Mr. Rogers. There should be no delay or repeats if an ED physician can perform treatment in the ED to prepare a hospital medicine physician to diagnose.
3. Lower costs. Obviously fewer duplicated services mean less tests and less cost. In addition, fewer tests could lead to shorter hospital stays, which would lower costs as well.
4. Fewer readmissions. According to Mr. Rogers, integrating ED and hospital medicine services involves working with physicians to identify appropriate medical treatment for certain patient cases. For this reason, if a patient were to return, the physician would be more likely to conduct necessary treatments and offer appropriate medication without admitting that patient to the hospital. "When an ED can treat return patients on an outpatient basis, the hospital's readmission rate lowers dramatically," says Mr. Rogers.
6 best practices for integrating ED and hospital medicine services
While integrating ED and hospital medicine services offers beneficial outcomes, there can be challenges. "The biggest challenge is that you are dealing with individuals and trying to get folks on the same page when they have different jobs. The ED physicians historically treat episodic periods of care and then transfer patients to the appropriate area in the hospital for follow-up. While they may have a different perspective than a hospital medicine physician, each side needs to understand the other and where they come from," says Mr. Rogers.Regardless of the challenges, integrating ED and hospital medicine services can offer major benefits. In order to achieve synergy and reach those outcomes, Mr. Rogers recommends the following six best practices.
1. Change the mindset. The first thing that needs to change is the historical idea that a physician's responsibility begins and ends in their area. For instance, there is often a backdoor mentality among the hospital staff — the ED physician's responsibility is contained to the ED. "That mentality can no longer exist. It is not applicable," says Mr. Rogers.
2. Highlight shared responsibility. Physicians need to have a shared, mutual responsibility to ensure the flow of patients as they go across the hospital continuum. Integration needs to include effort from both ends, especially to transcend that back door mentality. "Hospital physicians need to take on the responsibility of alleviating boarding and backup in the ED, while ED physicians need to take on the responsibility of assisting when hospital medicine physicians are backed up with patients," says Mr. Rogers.
3. Set clear joint goals. Hospital leaders, service line leaders and other thought leaders within the hospital need to work together and assign appropriate goals for both ED and hospital medicine physicians such as reducing door-to-admit time. According to Mr. Rogers, they should address how to operationalize the goals and develop clear protocols and standing orders as well.
4. Hold both groups accountable. After joint goals are established, each group needs to be held accountable in order to achieve them. "It is not just the ED physician's job to work on admittance rates. The hospital physicians should be equally charged with monitoring and managing a quick door-to-admit rate," says Mr. Rogers.
5. Collect, utilize real-time data. According to Mr. Rogers, hospitals need to have a robust dashboard or some form of measurement tool to collect real-time data across specialties to help physicians meet joint metric goals. "The closer to real-time the data is, the better. You can't rely on retroactive studies. The best integration outcomes will come from real-time data," says Mr. Rogers.
6. Be creative in program design. According to Mr. Rogers, hospital leaders need to be creative in their program design in order to capitalize on the hospital medicine and ED integration. Hospital leaders cannot merely encourage collaboration and expect all the potential outcomes to follow. "For example, full time coverage by a hospital medicine physician at night is not always cost effective. Leaders could consider using mid-level providers to care for patients on the hospitalist service at night, under the supervision of the ED physician, with backup of a hospitalist on call. This could make the program more effective," says Mr. Rogers.
There are many measurable benefits to integrating hospital and ED services: improved patient flow, higher admissions, fewer duplications, lower costs and lower readmissions. In order to achieve these outcomes, physician teams need to realize shared goals and then be held accountable for the overall quality and efficiency of their services. When this occurs, they may have a greater incentive to work together for smoother transitions, faster admittance rates and better patient outcomes.
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