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Background: With changing ACGME work-hour restrictions, residency programs across the country have continued to work on optimizing admission and workflow processes. Prior to our institutions new inpatient service structure, nighttime medicine admissions were handled by one upper-level resident (post-graduate year 2 or 3) on a night-float rotation, and one intern who was from one of the inpatient ward teams. Day call responsibilities in the old structure included performing daytime admissions as well as medical intensive care unit (MICU) transfers. To improve workflow, our residency program instituted two major ward structure modifications. The first change involved the creation of a two-resident night-float team, with the rotating intern returning to daytime coverage only. The second change was the uncoupling of daytime admissions and MICU transfers into two separate call days. Purpose: The major goals in modifying our inpatient ward structure were to improve throughput from the Emergency Department (ED) to inpatient wards services, decrease the number of hand-offs of patients between admitting teams, and create a more even distribution of patients on inpatient ward teams. Description: Data was collected before and after implementation of the above interventions. When compared to the previous system, the new system was associated with decreased numbers of daily patient hand-offs between admitting teams (5.60 vs. 3.07 patients, p = 0.021) and decreased ED-to-admission times (historical average 5.5 hours vs. new system average 2.9 hours). There was a moderate increase in number of daily admission evaluations (15.50 vs. 16.56 patients, p = 0.56) and number of daily admissions performed (10.75 vs. 12.62 patients, p = 0.18). There was a minimal change in the daily distribution of patients on medicine ward team censuses over the two study periods (11.23 +/- 2.29 vs. 10.21 +/- 3.11 patients). Average inpatient ward censuses were not different over the two study periods (old system 81.46 patients vs. new system 81.7 patients, p = 0.917). Conclusions: Creation of a two-resident night-float team and separating daytime admission and MICU-transfer responsibilities over two teams was associated with improved overall workflow in our resident medicine ward system.'


Presented at Society of Hospital Medicine, 03/30/2015, National Harbor, MD.