SHM Converge Scientific Abstract ePoster Gallery-Geolocalization Improves Length of Stay and Ed Throughput

Pdf Summary

This process improvement project at a 700-bed academic level 1 trauma center examined whether geographic localization of hospital medicine teams could reduce emergency department boarding and length of stay.<br /><br />Geographic localization means assigning physician and advanced practice provider teams to patients on the same inpatient unit. The institution identified poor localization as a major contributor to ED boarding and prolonged LOS. The project was implemented in three phases:<br /><br />- PDSA 1: Each of the 11 hospital medicine teams was assigned a designated unit, with bed planning placing patients in their team’s unit.<br />- PDSA 2: A “bed before team” model was refined by creating an ED-based team to manage patients until transfer.<br />- PDSA 3: Specific contiguous beds were assigned to each team, further improving localization.<br /><br />The intervention also included twice-daily structured multidisciplinary discharge planning rounds on each localized unit.<br /><br />Results showed improved efficiency despite rising ED volume. ED visits increased from 5,662.5 to 6,177.5 patients per month, though this increase was not statistically significant. The proportion of patients correctly localized to the intended floor improved from 40% at baseline to 78% in PDSA 3. Average length of stay decreased from 7.8 to 7.3 days, and observed-to-expected LOS decreased from 1.1 to 1.05. Monthly ED boarding time also fell significantly, from 23,767 hours at baseline to 19,245 hours in PDSA 3.<br /><br />Interrupted time series analysis confirmed statistically significant reductions in LOS and observed-to-expected LOS during PDSA 3.<br /><br />Importantly, quality outcomes were maintained: 30-day readmission, risk-adjusted readmission, risk-adjusted mortality, and patient satisfaction were similar before and after the intervention.<br /><br />Overall, the project found that geographic localization improved ED throughput and reduced hospital LOS without harming other patient outcomes.

Asset Subtitle

Soniya Abraham

Meta Tag

Author List Ankur Segon, Ed Banos, Jonathan Gelfond, Soniya Abraham

Category Research

Concept Geographic Localization

Concept PDSA Cycle

Concept Emergency Department Boarding Time

Concept Observed-to-Expected Length of Stay

Concept Hospital Medicine Team

Distinguished Non-Finalist

Presenter Organization Uthscsa

Presenting Author Soniya Abraham

Track Quality Improvement

Keywords

geographic localization

hospital medicine teams

emergency department boarding

length of stay

PDSA cycle

bed planning

multidisciplinary discharge rounds

academic trauma center

interrupted time series

patient throughput

Geographic Localization

PDSA Cycle

Emergency Department Boarding Time

Observed-to-Expected Length of Stay

Hospital Medicine Team