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Enhancing Collaboration Between Hospitalists and Emergency Departments: A Comprehensive Project Overview

This project aims to investigate how hospitalists spend their time within the Emergency Department (ED), focusing on their roles and decision-making processes regarding patient admissions and discharges. We will gather data through direct observation, self-documentation, and surveys of hospitalists and ED physicians. The project also explores the educational needs of residents in triage roles, highlighting the importance of communication and collaboration in improving patient care and satisfaction. Insights gained will inform strategies to enhance hospitalist-ED interactions.

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Enhancing Collaboration Between Hospitalists and Emergency Departments: A Comprehensive Project Overview

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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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