SHM Converge Scientific Abstract ePoster Gallery-Collaborating for Capacity: A Hospital Medicine and Emergency Department Initiative

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Vanderbilt University Adult Hospital faced growing emergency department (ED) boarding and hospital capacity strain. To reduce unnecessary admissions, the hospital medicine (HM) team partnered with ED leadership to use a daytime hospitalist admitter stationed in the ED. This hospitalist evaluated patients initially recommended for admission and, when safe, redirected them to home or other noninpatient care with timely follow-up and resource coordination.<br /><br />The hospitalist worked directly with ED clinicians to resolve barriers to discharge, provide treatment recommendations, arrange outpatient follow-up, coordinate procedures in the ED, and help with transfers to psychiatric care when needed. Common diagnoses managed this way included skin and soft tissue infections, acute kidney injury, cirrhosis with ascites, venous thromboembolism, urinary tract infection, anemia, and hypertensive urgency.<br /><br />From September 8–30, 2022, the hospitalist redirected 21 intended medicine admissions to outpatient care. Chart review of 17 cases showed that 88.2% remained out of the hospital for at least 7 days; 5.9% returned to the ED within 3 days but were not admitted; and 5.9% ultimately required hospitalization.<br /><br />Lessons learned included that this model is safe and effective for “borderline” admissions and improves communication between HM and ED teams. Institutional leadership recognized its value and considered dedicated funding. Challenges included frequent reassignment of the admitter to cover staffing gaps and limited confidence among junior faculty. Next steps include stabilizing staffing and providing coaching/resources for less experienced hospitalists.<br /><br />Operationally, the service saved bed days, reduced observation and inpatient stays, and improved contribution margin, especially when staffed daily.

Asset Subtitle

Allison L. Schwall

Meta Tag

Author List Allison L. Schwall, Kathleene T. Wooldridge, Kelly E. Cunningham, Nathan I. Krishnan

Category Innovations

Concept Admission

Concept Borderline Admission

Concept Hospital Medicine

Concept Emergency Department

Concept Admitter Model

Distinguished Non-Finalist

Presenter Organization Vanderbilt University Medical Center

Presenting Author Allison L. Schwall

Track Value in Hospital Medicine

Keywords

emergency department boarding

hospital capacity strain

hospitalist admitter

unnecessary admissions

outpatient care redirection

ED-hospital medicine collaboration

borderline admissions

bed days savings

discharge coordination

hospital operations

Admission

Borderline Admission

Hospital Medicine

Emergency Department

Admitter Model