BACKGROUND Unit based teams may improve care delivery for hospitalized patients, but can be challenging to implement broadly across all acute care units in a hospital. OBJECTIVE To determine the effect of a Lean guided transition to hospital wide unit-based assignment on care delivery outcomes. DESIGN, SETTING, AND PARTICIPANTS The study was a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions and length of stay, performed at a 336-bed tertiary academic referral hospital in the Pacific Northwest with approximately 17,000 admissions annually. INTERVENTION Implementation of a Lean guided quality improvement intervention included division of hospitalist duties into "admitters" and "rounders," with simulated patient flow exercises to determine the optimal staffing model. MAIN OUTCOMES AND MEASURES Discharge efficiency (number of patients discharged by hospitalists divided by the number of hospitalist patient encounter days per month) and 30-day readmissions were compared using the t-test or chi-square, and length of stay was analyzed in a multivariate time series regression model. RESULTS The intervention was associated with a significant improvement in discharge efficiency, by 0.014 (from 0.168 to 0.181) discharges/encounter (95%CI =0.024,0.004), p=0.009. Mean length of stay decreased by 0.98 days (95%CI 0.50, 1.47) after adjustment for patient age, patient type (medical versus surgical), critical care admissions, and discharge disposition, without a corresponding change in 30-day readmission rate (12.2% (1948/15902) pre-intervention to 11.7% (397/3379) post-intervention (p=0.42)). CONCLUSIONS Dividing hospitalist roles into admitters and rounders enabled implementation of unit based teams across the hospital, with corresponding improvements in discharge efficiency and length of stay.
Focusing hospitalist roles on either admitting or rounding facilitates unit-based assignment and is associated with improved discharge efficiency.