Our hospitals are under more duress than ever before, making the smooth flow of patients between emergency departments and inpatient units even more vital. It is imperative that emergency physicians and hospitalists collaborate when it comes to care delivery, process improvement, and performance targets. Last month, we wrote about establishing multi-disciplinary peer review for emergency physicians and hospitalists to evaluate individual cases, patient outcomes, and quality indicators together. A mutual peer review process can and should be a part of a Joint Operating Committee, or “JOC”, which is a broader platform for both specialties to share ideas and discuss how to improve flow, quality, and patient experience.
Emergency physicians are measured in minutes and hospitalists are measured in days, so there is a natural disconnect when talking about metrics. It is important for these physicians to hear from both sides and to better understand each other’s priorities. A JOC should incorporate, at minimum, the medical directors of both programs and representatives from administration and nursing leadership. There should be a regular meeting (monthly or quarterly) with a rolling agenda so that attendees can create action plans and remove or add agenda items. Of course, one of the most important aspects of shared performance is patient flow.
One of the major drivers of hospital flow is the number of admitted patients being held in the ED (boarders), and ED overcrowding correlates with the boarding of admitted patients more than any other metric. The makeup of the JOC makes it the ideal place to address the multi-factorial issue of boarding and to start improvement projects. For example, in most cases, an experienced emergency physician or nurse will know if a patient needs hospital admission within minutes of entering the patient’s room and performing a brief assessment. In the ED team’s eyes, this patient could go upstairs almost immediately. However, in the HM team’s eyes, this patient may need several hours of testing first.
The JOC allows both teams to better understand what drives the other and to work together to achieve goals. When possible, incentive structures can also be designed that tie the teams together (i.e. the HM team has an incentive based on admitted ED length of stay and the EM team has re-admissions tied to theirs). The emergency physicians and hospitalists want to work together for the benefit of patients and their family members, but in some cases need the structure and opportunity that a Joint Operating Committee can provide. Not only can a JOC be a forum for establishing goals; it can also help drive the creation of operational parameters and pre-defined criteria for admissions or observations that simultaneously foster efficient processes and high-quality care.
Seamless patient care from the emergency department to inpatient treatment and discharge is possible. Core Clinical Partners offers an integrated ED/Inpatient management program to ensure that both groups work together as one. This model results in a coordinated admission process, open communication, less patient boarding, shared goals, and better relationships. Please contact us to find out more.