Tight clinical integration between hospital medicine clinicians and emergency medicine teams is a proven way to improve quality, lower costs and increase clinician engagement in hospital settings. Yet, launching this type of integration is often easier said than done.
During a Featured Session as part of Becker's Healthcare's 11th Annual Meeting, sponsored by Sound Physicians, Nathan Ruch, MD, the company's emergency medicine chief medical officer, discussed the benefits of clinical integration and shared best practices based on his organization's experiences.
Five key takeaways were:
1. The pandemic and other healthcare trends are driving the need for clinical integration. Nationwide, clinician wellness has suffered during COVID-19, but research suggests that clinical service integration can pay dividends in terms of team member well-being. Even before the pandemic, emergency departments faced rising acuity and this trend has only accelerated with the pandemic. Integration between the emergency medicine and inpatient teams is more important than ever. Finally, the explosion of medical information has driven super-specialization. "Even chronic disease management for routine conditions now requires subspecialists. This has resulted in an increased need for teamwork. Each transition between subspecialists can create problems, if integration doesn't exist across clinical services," said Dr. Ruch.
2. Clinical integration is the antidote to siloed healthcare organizations. Silos in healthcare lead to decreased clinical quality, longer ED wait times, lower market share and revenue due to lost volume, longer lengths of stay which reduce available beds and increased stress for patients and families. "We've found that clinical integration can help with all these issues. Our data from 2018-19 show that integrated hospitals saw a savings of $562 per stay, while the average cost per stay at non-integrated hospitals increased. HCAHPS performance was also 2.4 percent higher on average at integrated programs," said Dr. Ruch.
3. Building a culture of clinical integration can be challenging. A natural tension exists between emergency and hospital medicine teams, due to competing incentives. One way to break that down is by bringing clinicians from each service line together and building empathy for one another's approach to care. Prior to the pandemic, Sound Physicians also encouraged teams to meet socially outside the hospital and build collegial relationships. Dr. Ruch noted that "it's hard to treat a friend poorly."
4. The key to successful clinical integration is thinking across the care continuum. Sound Physicians focuses a lot on transitions of care, since they are the root cause of many bad patient outcomes. To promote thinking across the care continuum, Sound Physicians ensures that clinical education occurs across specialties. It also standardizes work through rapid admission protocols and consensus-based, evidence-backed order sets that guide patients through a standard care pathway. In addition, Sound Physicians embeds clinical performance nurses into teams. Their sole purpose is to improve the clinical process by reducing variability and working in partnership across service lines.
5. Shared goals and accountability are essential. To promote clinical integration, Sound Physicians develops group norms, service line agreements and feedback loops across service lines. It tracks progress using a proprietary system called SoundMetrix which aggregates performance management data from specialties into a single dashboard.