SHM Converge Scientific Abstract ePoster Gallery-Culture Eats Strategy: Challenges to Implementation of an Ed Hospitalist Role

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OHSU’s Division of Hospital Medicine (DHM) tested an Emergency Department (ED)-based hospitalist pilot to address rising ED boarding, prolonged waits for inpatient beds, and delays in transfers to community hospitals. The goal was to improve interim care for boarded Medicine patients, support capacity-based transfers, and strengthen multidisciplinary coordination in the ED.<br /><br />In October 2024, DHM launched a dedicated hospitalist role (CHS E) to manage all CHS-assigned ED boarders and provide temporary care for patients awaiting transfer elsewhere. This hospitalist joined daily rounds with ED nurse management and case management. The plan was for patients to move off the ED hospitalist service once inpatient beds opened, preserving capacity for new admissions.<br /><br />However, implementation faced major cultural and operational barriers. OHSU’s hospitalist teams were historically organized around a level-loading, non-geographic model, with strong expectations for continuity of care. Because of this, transitioning patients from CHS E to inpatient teams was difficult. In February 2025, the service briefly shifted to a geography-based assignment model to better cohort ED boarders, but this increased handoffs, reduced continuity, and raised provider concerns about cognitive load and patient safety. Although no rise in reported safety events occurred, hospitalists remained dissatisfied. The geography-based model and ED hospitalist pilot were discontinued in late March 2025.<br /><br />The main conclusion was that strong cultural preferences for level-loading and continuity can significantly limit implementation of an ED hospitalist with primary care responsibilities. Health systems without geographic team assignment may struggle to cohort ED boarders on one team. A triage-only ED hospitalist model might reduce these barriers, but it would require more resources.

Asset Subtitle

Angela E. Alday

Meta Tag

Author List Angela E. Alday, Kellie Littlefield, Kelsi E. Manley, Michael J. Hendricks, Patty Ritze

Category Innovations

Concept Emergency Department Hospitalist

Concept Capacity Management

Concept Boarding

Concept Patient Transfer

Concept Patient Safety

Distinguished Finalist

Presenter Organization Oregon Health & Science University

Presenting Author Angela E. Alday

Track Other

Keywords

Emergency Department boarding

hospitalist pilot

inpatient bed delays

community hospital transfers

interim care

capacity-based transfers

multidisciplinary coordination

level-loading model

geography-based assignment

patient continuity

Emergency Department Hospitalist

Capacity Management

Boarding

Patient Transfer

Patient Safety