Design, implementation and impact of a new physician role to address capacity challenges at a large academic medical center

Abstract

Background: Hospitals are experiencing significant strain on inpatient capacity leading to delays in care that threaten their ability to provide safe, high-quality services. We implemented an institutional role called the capacity physician to aid in patient access, progress of care, and discharge at a large academic medical center with significant capacity challenges. Methods: From September 2019 through January 2020, we performed a prospective observational study of the volume of consultations and related challenges, actions, and impact of the capacity physician. Data regarding consultations were collected via survey of physicians in the role. A member of the study team categorized challenges, actions, and impact on capacity based upon common themes. Results: Overall there were 155 consultations from 14 different departments and locations within the hospital. General medicine and surgery accounted for most consultations at 51.6%. Common reasons for consultation were critical capacity levels in the emergency department (ED) (44, 28.4%), communication/ coordination gaps across clinical services (37, 23.9%), and critical capacity levels in the general care wards (29, 18.7%). The most common action taken by the capacity physician was to prioritize a patient and help coordinate their care across services (54, 34.8%). The impact on capacity of consultations included reduction in length of stay (LOS) (78, 50.3%), facilitation of access for hospital transfers (46, 29.7%), and reduction in waiting times for hospital beds (31, 20.0%). Conclusions: The capacity physician was successfully implemented and utilized at a large academic hospital. This role represents a novel approach to addressing the significant quality and safety challenges caused by capacity strain and crowding.