I spoke with an old medical school friend of mine the other day. They're having issues with emergency department throughput. He's an emergency room doctor who works in a hospital in which hospitalists cap their service at 15 patients a day. He asked me whether I thought that was reasonable. In his community, there are no primary care physicians who come to the hospital anymore. They are also a large referral center for multiple Native American reservations. When the hospitalists cap their service, they often have to divert patients to other facilities or have them parked in the ED for hours, sometimes a day or more which interrupts emergency department throughput.
Do I think hospitalist programs have hospitalist caps? No, not at all. I thinks instituting caps is a horrible policy. Caps are a disruption to patient flow and can create animosity between doctors. They can create emergency department throughput complications. Many academic programs have instituted caps as a way of reducing work load for residents. I think that's a shame. In real estate the mantra is location, location, location. For medical training it's volume, volume, volume.
EMR Comparison
Successful software implementation starts with choosing the right system. This checklist contains over 50 of the most important features to look for when evaluating:
Other useful information is available at my EHR Resource Center.
It's bad patient care to have them parked in the emergency room for hours when we all know that ED nurses and ED docs are not trained to manage floor activities well. Their goal is volume. Volume drives income, both for the hospital and for the emergency room physicians. If you have patients occupying emergency rooms because the doctors won't accept them upstairs, there are no winners. This is terrible for emergency department throughput.
Successful software implementation starts with choosing the right system. This checklist contains over 50 of the most important features to look for when evaluating:
- electronic medical records
- medical billing software
- scheduling software
- technology, security and certifications
Other useful information is available at my EHR Resource Center. Studies have shown that maximum hospitalist efficiency for hospitalists occur in the 15-17 patient per day range. Depending on the complicated patient load, It could take me anywhere from 5-8 hours to see that many patients and feel good about the quality work I provide.
Do I do the hospital, the patient or my relationship with other physicians any good if I tell them no, I will not accept that patient sitting in your ED or wanting to be transferred directly from a small town because I feel I'm too busy? No. There are no winners in this capped model of care.
The solution lies within the ability of administration to realize that a great hospitalist care model that provides top quality service and runs at maximum efficiency will be one in which the patient load does not succeed 15-17 patients a day. That's total encounters per day. When administration realizes that the powerful benefits of hospitalist programs are achieved when these standards are maintained, they understand that future growth of the program through the hiring of more physicians is the only possible solution to preventing all the negative aspects of capped hospitalist programs.
Those administrations that choose not to pony up the cash to support such a model are the ones who wonder why all their hospitalists leave after a year and why they show no benefit in resource utilization or length of stay. Just like everything else in this world, you get what you pay for. If you want to run a hospitalist program on the cheap, you will never realize the back end savings of your front end investment.
Happy's hospitalist group is a testament to the massive success hospitalists can be to hospital systems across a multitude of markers, whether it's economic savings, patient satisfaction, nursing satisfaction, or physician satisfaction, when you do something well and you support great work, the return on investment is enormous.
If you have to cap a hospitalist program, you have to hire more docs. It's as simple as that.
