Eight Ways to Deliver High-Quality Care in Hospital Medicine
- Apeksha Desai, MD
In hospital medicine, delivering high-quality care is a complex balancing act between goals and constraints. Hospitalists strive to make evidence-based clinical decisions, facilitate seamless transitions of care, and allocate time for difficult patient conversations within a full shift.
When I think “high quality care,” my focus is on providing the best care to my patients that will meet their goals in a timely, cost-effective way. Data analytics provides a helpful window into tactical ways to improve the efficiency and effectiveness of care for hospitalist teams and individuals.
Here are eight ways that hospitalist leaders can foster high-quality inpatient care:
- Optimize census: One of the big challenges is the sheer volume of patients that hospitalists manage each shift. Most of these patients are critically ill and require a lot of time and communication. As the number of patients increases, so does the stress level. Sometimes, increasing hospitalist workload is associated with higher length-of-stay and costs.
- Improve patient handoffs: Hospital medicine is the specialty that formalized the art of high-quality patient handoffs. However, multiple provider changes increase the risk of miscommunication, errors, duplicative work, and over-utilization. Analyzing the impact of handoffs at your institution is a good starting point for improvement.
- Prioritize medication reconciliation: This cannot be emphasized enough. Taking time to review medications with both patients and their families is a crucial step to reducing medication errors, related iatrogenic complications, and readmissions. Time is a major constraint so I must rely on pharmacists to assist with this crucial aspect of care. My facility, Good Samaritan Medical Center, provides 24/7 pharmacist support to aid physicians. Measuring and improving medication reconciliation before discharge should be a priority for every hospitalist program.
- Determine ideal length of stay and utilization: High-quality care is an optimization challenge. A physician must determine the appropriate length of stay and utilization of resources to provide the best care and reduce the likelihood of a readmission. It is a balancing act that needs to be coordinated carefully since haphazard reduction might increase readmissions.
- Incorporate end of life care: As our population ages and we get better at taking care of patients outside the hospital, we manage sicker and sicker patients in the hospitals. Many of these patients need end of life care and comfort measures. In order to appropriately allocate time for difficult discussions with patients and families, we need to embrace a new approach to high-quality care.
- Pursue patient wellbeing (vs. satisfaction): Hospitalists have a very short time to develop a rapport with their patients and generally do a very good job in spite of this constraint. However, at times there are conflicts between patient safety and satisfaction, and weak relationships with patients makes this more challenging.
- Reduce interruptions: Various interruptions during a complex task in the form of pages from nursing staff, social workers and the ER naturally affect attention and focus. Interruptions during history taking, entering orders, discharging patients, and family conversations can increase the risk of making errors and physician stress.
- Acknowledge physician burnout: Hospital medicine is a specialty that deals with critically ill, hospitalized patients on a daily basis. Compassion fatigue is inevitable. It is essential to design schedules to allow physicians restore their joy in medicine and compassion for patients. A well-rested physician is far more likely to deliver high-quality care than a tired one.
- Above all, most physicians are intrinsically motivated by the goal of providing best care to their patients, intellectual curiosity to learn and grow, and to have a healthy work-life balance. In order to achieve these goals, hospitalists need greater transparency into data that matters, not metrics for metrics’ sake. We need actionable insights that help us take better care of our patients and ourselves.