{"title":"Interprofessional education and high-fidelity simulation teaching in medical and nursing students in Peking Union Medical College","authors":"Huan Cheng, Liping Wu","doi":"10.21037/jhmhp-21-39","DOIUrl":"https://doi.org/10.21037/jhmhp-21-39","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44470745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Curry, A. Lipitz-Snyderman, D. Rubin, Diane G. Li, Elaine Duck, M. Radzyner, P. Bach
Long-term survival following cancer treatment is a widely accepted metric used to evaluate the quality of cancer care and varies between hospitals (1-3). Long-term survival takes years to evaluate, and these metrics reflect care quality from many years prior. Long-term survival has unknown applicability as a quality measure to evaluate current performance. It is important to determine if the structural lag in measurement limits the value of long-term survival measures meaningless as a tool for assessing current hospital performance. The study assesses the stability of hospitals’ performance over time based on its cancer patients’ fouryear survival. We hypothesized that hospitals’ four-year mortality ratio would be consistent over time, implying that patients could use such information when deciding where to get care. Additionally, since decades of research have demonstrated a relationship between higher surgical volume and better outcomes for hospitals, we set out to explore consistency by hospital volume (1,4).
{"title":"High hospital volume is associated with more consistent long-term mortality rates","authors":"M. Curry, A. Lipitz-Snyderman, D. Rubin, Diane G. Li, Elaine Duck, M. Radzyner, P. Bach","doi":"10.21037/JHMHP-20-118","DOIUrl":"https://doi.org/10.21037/JHMHP-20-118","url":null,"abstract":"Long-term survival following cancer treatment is a widely accepted metric used to evaluate the quality of cancer care and varies between hospitals (1-3). Long-term survival takes years to evaluate, and these metrics reflect care quality from many years prior. Long-term survival has unknown applicability as a quality measure to evaluate current performance. It is important to determine if the structural lag in measurement limits the value of long-term survival measures meaningless as a tool for assessing current hospital performance. The study assesses the stability of hospitals’ performance over time based on its cancer patients’ fouryear survival. We hypothesized that hospitals’ four-year mortality ratio would be consistent over time, implying that patients could use such information when deciding where to get care. Additionally, since decades of research have demonstrated a relationship between higher surgical volume and better outcomes for hospitals, we set out to explore consistency by hospital volume (1,4).","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43223679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Improving outcomes, reducing harm, and decreasing costs in care have been at the forefront of healthcare leaders’ minds for decades. The focus on quality came to a head in 1999 after the release of “To Err is Human” asserting that 44,000 to 98,000 people die each year attributing to billions in hospital cots due to errors resulting from poor processes (1). Hospital practices and processes are evaluated Original Article
几十年来，改善结果、减少危害和降低护理成本一直是医疗保健领导人的首要考虑。1999年，《错误是人》（to Err is Human）一书发布后，人们对质量的关注达到了顶点，该书声称，每年有44000至98000人死亡，原因是由于糟糕的流程导致的错误，导致数十亿人在医院的婴儿床上死亡（1）。对医院实践和流程进行评估原创文章
{"title":"Association between hospital accrediting agencies and hospital outcomes of care in the United States","authors":"Mark Kato, D. Zikos","doi":"10.21037/jhmhp-21-24","DOIUrl":"https://doi.org/10.21037/jhmhp-21-24","url":null,"abstract":"Improving outcomes, reducing harm, and decreasing costs in care have been at the forefront of healthcare leaders’ minds for decades. The focus on quality came to a head in 1999 after the release of “To Err is Human” asserting that 44,000 to 98,000 people die each year attributing to billions in hospital cots due to errors resulting from poor processes (1). Hospital practices and processes are evaluated Original Article","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43391634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert D. Wojahn, J. M. Atencio, Julianne A. Sefko, L. Galatz, J. Keener, K. Yamaguchi, A. Chamberlain
Background: Healthcare is shifting to value-based payment models. Two percent of Medicare reimbursements are currently linked to value measures including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) hospital satisfaction survey. The purpose of this study was to determine if HCAHPS survey results are correlated with validated legacy outcome measures after total shoulder arthroplasty. Methods: A prospective observational study was conducted in 84 patients undergoing elective total shoulder arthroplasty. Baseline 12-item Short-Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Osteoarthritis of the Shoulder Index (WOOS) questionnaires were completed at the time of enrollment. ASES and WOOS scores were collected at 3-months and 1-year post-operatively. Patients were contacted to complete the HCAHPS survey postoperatively. HCAHPS results and baseline functional scores were evaluated for an association with improvements in legacy outcome measures after surgery. Results: HCAHPS scores were higher among males than females (P=0.04). Age, SF-12 physical component scores, SF-12 mental component scores, and pre-operative symptom severity were not associated with HCAHPS results. HCAHPS scores were not correlated with ASES (r=0.09, P=0.44) or WOOS scores (r=−0.17, P=0.13) at one year after surgery. HCAHPS was also not correlated with the absolute improvement in ASES (r=−0.02, P=0.85) or WOOS scores (r=−0.08, P=0.48) from pre- to one year post-operatively. Conclusions: The HCAHPS score, a measure of satisfaction and a determinant of Medicare quality-based reimbursement, showed no correlation with functional outcome measures at one year after total shoulder arthroplasty. Thus, HCAHPS patient satisfaction survey may not be aligned with functional outcomes valued by patients. Further consideration is warranted regarding the assessment of quality, and in turn reimbursements, with survey results.
{"title":"Hospital satisfaction does not predict functional outcome one year after total shoulder arthroplasty","authors":"Robert D. Wojahn, J. M. Atencio, Julianne A. Sefko, L. Galatz, J. Keener, K. Yamaguchi, A. Chamberlain","doi":"10.21037/JHMHP-20-51","DOIUrl":"https://doi.org/10.21037/JHMHP-20-51","url":null,"abstract":"Background: Healthcare is shifting to value-based payment models. Two percent of Medicare reimbursements are currently linked to value measures including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) hospital satisfaction survey. The purpose of this study was to determine if HCAHPS survey results are correlated with validated legacy outcome measures after total shoulder arthroplasty. Methods: A prospective observational study was conducted in 84 patients undergoing elective total shoulder arthroplasty. Baseline 12-item Short-Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Osteoarthritis of the Shoulder Index (WOOS) questionnaires were completed at the time of enrollment. ASES and WOOS scores were collected at 3-months and 1-year post-operatively. Patients were contacted to complete the HCAHPS survey postoperatively. HCAHPS results and baseline functional scores were evaluated for an association with improvements in legacy outcome measures after surgery. Results: HCAHPS scores were higher among males than females (P=0.04). Age, SF-12 physical component scores, SF-12 mental component scores, and pre-operative symptom severity were not associated with HCAHPS results. HCAHPS scores were not correlated with ASES (r=0.09, P=0.44) or WOOS scores (r=−0.17, P=0.13) at one year after surgery. HCAHPS was also not correlated with the absolute improvement in ASES (r=−0.02, P=0.85) or WOOS scores (r=−0.08, P=0.48) from pre- to one year post-operatively. Conclusions: The HCAHPS score, a measure of satisfaction and a determinant of Medicare quality-based reimbursement, showed no correlation with functional outcome measures at one year after total shoulder arthroplasty. Thus, HCAHPS patient satisfaction survey may not be aligned with functional outcomes valued by patients. Further consideration is warranted regarding the assessment of quality, and in turn reimbursements, with survey results.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43715446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew Oberle, Dajun Tian, K. Hayes, Steven W. Howard, V. Moran
Background: Helping survivors of traumatic injuries achieve optimal recovery is a crucial global health issue. Traumatic injuries present major implications for the health of patients, care systems, and world economies. Focusing on the improvement of structures and processes that influence hospitalized trauma patient experience is a potentially important way to improve outcomes and health-related finances. The purpose of this study is to determine if there are associations between patient experience and clinical outcomes for hospitalized trauma patients. Methods: The study used a cross-sectional design. Primary data was collected in March and April 2020. Potential participants were 95 trauma patients who received care for traumatic injuries at a United States urban Level I trauma center from November 2018 to January 2020 and consented to be contacted for future research. Phone surveys were used to collect quantitative and qualitative data on participants’ patient experiences and health outcomes related to their hospitalization. Additional health outcomes were collected from participants’ electronic health records. General linear and Poisson regressions were used to analyze associations between experience and outcomes. Differences between injury severity groups were analyzed using chi-square and t-tests. Results: Thirty participants completed the phone survey, a response rate of 31.6%. Positive nurse communication was associated with a significantly lower risk of hospital-acquired complications compared to negative nurse communication (−33%; 95% CI, −61% to −5.5%). Patients with severe injuries had a lower risk of 30-day readmissions when reporting positive nurse communication (−56% decrease; 95% CI, −88% to −23%), positive doctor communication (−50%; 95% CI, −81% to −19%), and positive overall hospital rating (−56%; 95% CI, −99% to −13%) when compared to severely injured patients who reported negative nurse and doctor communication and overall rating. Conclusions: This study shows that aspects of patient experience, especially those related to communication with providers, are significantly associated with clinical outcomes for acute trauma patients, with potential implications for Continuous Quality Improvement and value-based reimbursement. Additional research would confirm if these associations exist for larger samples and patients treated for traumatic injuries in non-urban settings.
{"title":"Associations between patient experience and clinical outcomes at a level I trauma center: a cross-sectional survey-based study","authors":"Andrew Oberle, Dajun Tian, K. Hayes, Steven W. Howard, V. Moran","doi":"10.21037/jhmhp-21-65","DOIUrl":"https://doi.org/10.21037/jhmhp-21-65","url":null,"abstract":"Background: Helping survivors of traumatic injuries achieve optimal recovery is a crucial global health issue. Traumatic injuries present major implications for the health of patients, care systems, and world economies. Focusing on the improvement of structures and processes that influence hospitalized trauma patient experience is a potentially important way to improve outcomes and health-related finances. The purpose of this study is to determine if there are associations between patient experience and clinical outcomes for hospitalized trauma patients. Methods: The study used a cross-sectional design. Primary data was collected in March and April 2020. Potential participants were 95 trauma patients who received care for traumatic injuries at a United States urban Level I trauma center from November 2018 to January 2020 and consented to be contacted for future research. Phone surveys were used to collect quantitative and qualitative data on participants’ patient experiences and health outcomes related to their hospitalization. Additional health outcomes were collected from participants’ electronic health records. General linear and Poisson regressions were used to analyze associations between experience and outcomes. Differences between injury severity groups were analyzed using chi-square and t-tests. Results: Thirty participants completed the phone survey, a response rate of 31.6%. Positive nurse communication was associated with a significantly lower risk of hospital-acquired complications compared to negative nurse communication (−33%; 95% CI, −61% to −5.5%). Patients with severe injuries had a lower risk of 30-day readmissions when reporting positive nurse communication (−56% decrease; 95% CI, −88% to −23%), positive doctor communication (−50%; 95% CI, −81% to −19%), and positive overall hospital rating (−56%; 95% CI, −99% to −13%) when compared to severely injured patients who reported negative nurse and doctor communication and overall rating. Conclusions: This study shows that aspects of patient experience, especially those related to communication with providers, are significantly associated with clinical outcomes for acute trauma patients, with potential implications for Continuous Quality Improvement and value-based reimbursement. Additional research would confirm if these associations exist for larger samples and patients treated for traumatic injuries in non-urban settings.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41980985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: It is projected that the United States will experience a shortage of 21,100 to 55,200 full-time equivalent primary care physicians by the year 2032. The shortage has been sparked by the passage of the Patient Protection and Affordable Care Act and has continued to grow due to the United States’ aging population, population health initiatives, and physician workload. While primary care physicians are responsible for more than half of all physician office visits in the United States, primary care physicians make up approximately 28% of the workforce. Recently, research has cited compensation as the primary reason for the shortage of primary care physicians. Primary care physicians have historically made less than physicians who specialize in other disciplines. Over the last 10 years, primary care physician compensation has increased. However, the shortage also continues to increase. The purpose of this research is to determine the relationship between primary care physician demand and compensation, and to compare that relationship with other specialties. Methods: Physician supply and demand data were collected utilizing the Association of American Medical Colleges (AAMC) reports, The Complexities of Physician Supply and Demand . Compensation data was collected utilizing Modern Healthcare’s Physician Compensation database. Results: When analyzing physician compensation with the employment cost index, primary care physician compensation was 1% higher than projected with inflation. Despite earning more than projected, it was determined that demand has little to no impact on primary care physician compensation. Conclusions: With more physicians moving towards employment with hospitals and hospital systems, there is an increased need for human resources initiatives. Hospital and hospital systems’ human resources departments should develop initiatives that increase pay for primary care physicians such as the standardization of compensation regardless of specialty within a healthcare organization.
{"title":"Examination of the relationship between physician shortages and compensation rates in primary care versus other specialties","authors":"A. Michaels, L. Clack","doi":"10.21037/JHMHP-20-154","DOIUrl":"https://doi.org/10.21037/JHMHP-20-154","url":null,"abstract":"Background: It is projected that the United States will experience a shortage of 21,100 to 55,200 full-time equivalent primary care physicians by the year 2032. The shortage has been sparked by the passage of the Patient Protection and Affordable Care Act and has continued to grow due to the United States’ aging population, population health initiatives, and physician workload. While primary care physicians are responsible for more than half of all physician office visits in the United States, primary care physicians make up approximately 28% of the workforce. Recently, research has cited compensation as the primary reason for the shortage of primary care physicians. Primary care physicians have historically made less than physicians who specialize in other disciplines. Over the last 10 years, primary care physician compensation has increased. However, the shortage also continues to increase. The purpose of this research is to determine the relationship between primary care physician demand and compensation, and to compare that relationship with other specialties. Methods: Physician supply and demand data were collected utilizing the Association of American Medical Colleges (AAMC) reports, The Complexities of Physician Supply and Demand . Compensation data was collected utilizing Modern Healthcare’s Physician Compensation database. Results: When analyzing physician compensation with the employment cost index, primary care physician compensation was 1% higher than projected with inflation. Despite earning more than projected, it was determined that demand has little to no impact on primary care physician compensation. Conclusions: With more physicians moving towards employment with hospitals and hospital systems, there is an increased need for human resources initiatives. Hospital and hospital systems’ human resources departments should develop initiatives that increase pay for primary care physicians such as the standardization of compensation regardless of specialty within a healthcare organization.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45204288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The first cases of coronavirus disease (COVID-19) were recorded in China in late 2019. By February 2020 the disease had begun to spread to other Asian countries and then throughout Europe, where Italy was the first country to be hit by the pandemic. Overall, the country’s national health service is reputed to provide quality health services. Indeed, nearly all Italian residents are registered with the NHS, which covers most of the medical costs in hospitals and physician consultations (OECD 2019), and hospitals are described as providing high-quality treatment for patients requiring acute care. As Morciano and Caredda (1) state, “Italian prevention services are largely public and free at point of delivery. Immunisation and screening programmes represent priorities in the public health area, although with differences in services between regions”. Yet there remain wider issues that hinder NHS performance. Italy has a decentralized healthcare system organized by region and a weak governance structure that generates inequalities, with poor national coordination between the country’s 20 regions (2). There is also the problem that the pandemic response plan appeared to be outdated when the crisis emerged (The Guardian, 13 August 2020 https://www.theguardian.com/world/2020/ aug/13/italy-pandemic-plan-was-old-and-inadequatecovid-report-finds). The infection rate rose rapidly after the first recorded case of COVID-19 (23 February 2020), with nearly 3,000 new infections and 100 deaths occurring in less than two weeks. The Italian government issued a Decree of the President of the Council of Ministers (DPCM) announcing a national lockdown shortly thereafter (11 March through 3 May 2020), followed suit by other European countries over the subsequent weeks. The pandemic had gone global, escaping the control of many countries. And it continues to spread by variants. Presently, the number of COVID-19 cases has begun to increase again in Italy, and localized lockdowns were issued between October 2020 and the first half of 2021. While the situation had stabilized during the second half of 2021, the emergence of the new omicron variant aroused renewed alarm in early 2022. The pandemic has created numerous challenges for the Italian NHS. The national recovery plan will need to address several, among which the following are of particular importance.
{"title":"Revitalizing the Italian NHS: remarks on the 2021–2026 national recovery plan (next generation EU)","authors":"E. Vendramini, F. Lega","doi":"10.21037/jhmhp-21-78","DOIUrl":"https://doi.org/10.21037/jhmhp-21-78","url":null,"abstract":"The first cases of coronavirus disease (COVID-19) were recorded in China in late 2019. By February 2020 the disease had begun to spread to other Asian countries and then throughout Europe, where Italy was the first country to be hit by the pandemic. Overall, the country’s national health service is reputed to provide quality health services. Indeed, nearly all Italian residents are registered with the NHS, which covers most of the medical costs in hospitals and physician consultations (OECD 2019), and hospitals are described as providing high-quality treatment for patients requiring acute care. As Morciano and Caredda (1) state, “Italian prevention services are largely public and free at point of delivery. Immunisation and screening programmes represent priorities in the public health area, although with differences in services between regions”. Yet there remain wider issues that hinder NHS performance. Italy has a decentralized healthcare system organized by region and a weak governance structure that generates inequalities, with poor national coordination between the country’s 20 regions (2). There is also the problem that the pandemic response plan appeared to be outdated when the crisis emerged (The Guardian, 13 August 2020 https://www.theguardian.com/world/2020/ aug/13/italy-pandemic-plan-was-old-and-inadequatecovid-report-finds). The infection rate rose rapidly after the first recorded case of COVID-19 (23 February 2020), with nearly 3,000 new infections and 100 deaths occurring in less than two weeks. The Italian government issued a Decree of the President of the Council of Ministers (DPCM) announcing a national lockdown shortly thereafter (11 March through 3 May 2020), followed suit by other European countries over the subsequent weeks. The pandemic had gone global, escaping the control of many countries. And it continues to spread by variants. Presently, the number of COVID-19 cases has begun to increase again in Italy, and localized lockdowns were issued between October 2020 and the first half of 2021. While the situation had stabilized during the second half of 2021, the emergence of the new omicron variant aroused renewed alarm in early 2022. The pandemic has created numerous challenges for the Italian NHS. The national recovery plan will need to address several, among which the following are of particular importance.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44906412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Safavi, M. Bravard, Brian J. Yun, W. Levine, P. Dunn
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.
{"title":"Design, implementation and impact of a new physician role to address capacity challenges at a large academic medical center","authors":"K. Safavi, M. Bravard, Brian J. Yun, W. Levine, P. Dunn","doi":"10.21037/jhmhp-21-48","DOIUrl":"https://doi.org/10.21037/jhmhp-21-48","url":null,"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.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49148349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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