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Hospitalist/ED Project

Hospitalist/ED Project. February 25, 2014 Sadie T. Velásquez , MD Emily Wang, MD. Goals Today. Identify Specific Project(s) Determine Type/Method of obtaining data. Project IDEAS PARt 1. How Do Hospitalists Spend Their Time?.

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Hospitalist/ED Project

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  1. Hospitalist/ED Project February 25, 2014 Sadie T. Velásquez, MD Emily Wang, MD

  2. Goals Today • Identify Specific Project(s) • Determine Type/Method of obtaining data

  3. Project IDEAS PARt 1

  4. How Do Hospitalists Spend Their Time? • Specifically: Role of the Triagistand how they spend their time: • Total time in the Emergency Department • Time coordinating outpatient care on discharge • Actual Patient care • Discussing management/recommendations with ED staff • Discharging patients from the ED/Writing consults for ED • Seeing downgrades from ICU • Accepting transfers and direct admissions from clinic/assessing appropriateness

  5. Proposed Project • History/Current Literature • Ways we plan to look at this: • Online documentation of time at the end of the day • Direct observation by volunteers following Hospitalist around • Paper documentation attached to triage sheet

  6. Project IDEAS PART 2

  7. What determines when we decide NOT to admit a patient? Hospitalist Perspective • How frequently does this occur? • Differ depending on individual hospitalist experience ie. Years of practice, prior outpt experience? • Other factors that might influence this decision: Systems issues, Time of day, Patient diagnosis, Team caps, personal feelings, fear of adverse outcome, time involved (easier just to admit) • If you recommend dc: do you f/u on the patient’s chart, call PCP • Patient wishes taken into consideration? • Did you discuss with ED MD: did not discuss at all, before or after evalpt?

  8. What determines when we decide NOT to admit a patient? ER MD Perspective • What determines ED physician will discharge a patient after Hospitalist consultation? • Rapport with Hospitalist (opinions) • Reputation of the Hospitalist/years of experience • Personal clinical experience/adverse events • High risk diagnosis and what are these or use the top 7 from that article by Gabayan 2013 in Academic EM • Recent admission in the last 30-90 days • ED MD – what type of training: IM, ER, FP • Do Hospitalist discuss with the ED physician their concerns, recommendations and discharge plans – do you actually talk with the ED MD • Has the ED physician asked the patient if they want to be admitted? • Was the patient handed off to you?

  9. Proposed Project • History/Current Literature • Pollack, CV et al. Emergency Medicine and Hospital Medicine: A Call for Collaboration. Journal of Emergency Med and American Journal or Medicine. 2012 • Survey ED MD’s and Hospitalists at UHS and VA • VA and UHS will be very different due to acuity, population of pts, background of ED MD’s?

  10. Other Questions • Patients admitted from ED? • Factors that influence this (they may be sicker, ER MD uncomfortable discharging a patient they were told to admit or haven’t evaluated)? • Multiple handoffs in ED

  11. Project Ideas Part 3

  12. Resident Educational Aspect of Triagist: • is this a skill that is needed? • do residents need training in it? • How do residents feel about it? Do they want more opportunities to “hold the pager”? – Survey residents? • What determines if a Hospitalist will discharge a patient from the ED (consult vs admit)? • Patient Satisfaction Aspect • (also use same list as above with ED physician) • Do EM/IM differ from EM and IM?

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