A simple change

March 17, 2006

This FP was inundated by unassigned ED patients?until his hospital committee came up with an innovative quality improvement idea.

My hospital requires physicians to be available to admit patients from the ED who have no previously designated physician. Our 200-bed community hospital averages three to five of these "service patients" a day, and occasionally we get more than 10.

For years, we worked under a rotating system whereby one physician was assigned to a particular day and did all the admissions for that day. As a result, the assigned physician would have a large number of patients added to his hospital rounds, disrupting his outpatient office practice. This situation was a continuing and contentious agenda item at our family medicine department monthly meetings.

Finally, we decided to form a subcommittee to review the problem. On analysis, we realized that the hospital's assignment system was akin to giving bolus medication. But there are many clinical situations where patients will benefit from a slow infusion, instead. So we decided to suggest changing the policy so that once a physician was assigned one service admission, that doctor's name would go to the bottom of the list, and he or she wouldn't be due for another service patient until the entire list repeated itself. With this system, no physician would get more than a single unassigned admission in any one day.

Before the pilot, we'd asked all the physicians involved to rate their overall satisfaction with the hospital's service admissions policy. On a scale of one to 10 (with 10 being totally satisfied), the average was three. When we repeated the survey after the pilot, the satisfaction rating went up to seven. Just as telling: The issue completely disappeared from the agenda of our monthly department meetings.

Although the overall number of service admissions didn't go down, this one simple change in workflow-from a large bolus to a continuous infusion-allowed us to increase physician satisfaction at our hospital. Perhaps it could work at yours as well.