Primary at two IPR facilities?

[a gray man]

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Anyone here primary at two facilities? I thought I remember reading about it a while back but searched and could not find it. Is it feasible? Has it been done? Strategies to make it work? Thanks folks.

 

[RangerBob]

It's certainly feasible, unless there's something in the bylaws that require you to be on site during business hours, but I've never heard of that.

I think the main issues are how many patients you're covering at each, and how far away they are. Rounding at two facilities isn't hard at all. Taking admits at two facilities on the same day is, as that could require a lot of back and forth. But you do have 24hrs to do your H&P, so you could always round at facility 1, see any admits that have arrived already at facility 1 (or at at the acute care hospital if it's a unit in a hospital), then head over to facility 2 and round, see facility 2 admits. Then you either circle back to facility 1 to catch any remaining admits, or you just see them in the AM when you round.

Dealing with nursing at two facilities, different EMRs, etc, may be a bit of a pain, but are all workable.

Having hospitalist coverage will help significantly as well.

 

[piviti]

Yeah it’s doable, I did round at 2 acute rehabs for a time and knew a few others who did the same. It’s best if you have a consistent schedule where you round at one IPR every morning then another in the afternoon. Luckily the two I rounded at were less than 10 min apart.

 

[a gray man]

Good to hear from you both @piviti and @RangerBob. Any advice on efficiency, scribes, etc that you utilized? Also any tips on negotiating and particulars that might make it more advantageous?

 

[RangerBob]

Good to hear from you both @piviti and @RangerBob. Any advice on efficiency, scribes, etc that you utilized? Also any tips on negotiating and particulars that might make it more advantageous?

I've never used a scribe as I didn't think they'd actually save me money. I think I can type/enter orders more efficiently than with a scribe. With a scribe you have to double check everything--that doesn't appeal to me. Nor did having someone follow me around all morning. Others seem to love them though.

The efficiency piece is entirely dependent on how far apart the facilities are and if they're willing to work with you. It would help if they're both affiliated with the same hospital chain--they're more likely to work with you and schedule team conferences on different days, etc. If they're competitors they have no reason to do so other than to help you out--so being personable/likeable with the program directors at each facility will go a long way.

Otherwise it's all about time management, learning to round efficiently, how to delegate things to the RNs/case managers, hospitalists, etc.

How many patients would you be managing at the two facilities? Would you be a director/associate director at either?

I think doing acute care consults at the hospital of your rehab unit (if it's a sufficiently-sized hospital with lots of internal rehab referrals) would be more interesting/advantageous than managing two separate units.