Impact of localizing general medical teams to a single nursing unit.
BACKGROUND
Localization of general medical inpatient teams is an attractive way to improve inpatient care but has not been adequately studied.


OBJECTIVE
To evaluate the impact of localizing general medical teams to a single nursing unit.


METHODS
Quasi-experimental study using historical and concurrent controls.


METHODS
A 490-bed academic medical center in the midwestern United States.


METHODS
Adult, general medical patients, other than those with sickle cell disease, admitted to medical teams staffed by a hospitalist and a physician assistant (PA).


METHODS
Localization of patients assigned to 2 teams to a single nursing unit.


METHODS
Length of stay (LOS), 30-day risk of readmission, charges, pages to teams, encounters, relative value units (RVUs), and steps walked by PAs.


RESULTS
Localized teams had 0.89 (95% confidence interval [CI], 0.37-1.41) more patient encounters and generated 2.20 more RVUs per day (CI, 1.10-3.29) compared to historical controls; and 1.02 (CI, 0.46-1.58) more patient encounters and generated 1.36 more RVUs per day (CI, 0.17-2.55) compared to concurrent controls. Localized teams received 51% (CI, 48-54) fewer pages during the workday. LOS may have been approximately 10% higher for localized teams. Risk of readmission within 30 days and charges incurred were no different. PAs possibly walked fewer steps while localized.


CONCLUSIONS
Localization of medical teams led to higher productivity and better workflow, but did not significantly impact readmissions or charges. It may have had an unintended negative impact on hospital efficiency; this finding deserves further study.
Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA. ssingh@mcw.edu
Siddhartha
S
Singh
Sergey
S
Tarima
Vipulkumar
V
Rana
David S
DS
Marks
Mary
M
Conti
Kathleen
K
Idstein
Lee A
LA
Biblo
Kathlyn E
KE
Fletcher
D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D017598:Efficiency, Organizational; D005260:Female; D005843:Geography; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D016017:Odds Ratio; D005791:Patient Care; D018709:Statistics, Nonparametric; D014922:Wisconsin; D057188:Workflow