- Joined
- Mar 26, 2006
- Messages
- 978
- Reaction score
- 345
Do most of your groups do geographic rounding on patients and if not, how do you guys go about dividing up patients who are admitted
Question for you hospitalists
- Thread starter obiwan
- Start date
- Joined
- Dec 23, 2007
- Messages
- 170
- Reaction score
- 81
We do not do geographic rounding, but that is something our medical director wants to pursue. Right now patients are divided up randomly each morning. We round on patients that are spread out around the hospital. Personally I don't think I'd want to do geographic rounding. I think the nurses would be too obnoxious in that situation. They would be bothering you constantly for stuff that normally they wouldn't page you for. But, that's just me. I'm an introvert and like to keep things as quiet as possible and minimize interruptions.
- Joined
- Oct 22, 2013
- Messages
- 25,533
- Reaction score
- 40,284
The private hospitalists at my program seemed to like it.
- Joined
- Dec 23, 2007
- Messages
- 170
- Reaction score
- 81
That's good to know. I'm open to it, just my gut feeling is that I might not like it.
- Joined
- Apr 25, 2008
- Messages
- 8,827
- Reaction score
- 9,082
I think it depends on how it's implemented. I only really do admitting shifts when I moonlight, but the hospitalists who round where I'm at do geographic rounding with a bit of rebalancing for fairness. If the rebalancing wasn't done, I expect they would be substantially less happy.
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
We do geographic rounding, and I like it. It makes it easier to know which patients you have, since you usually cover 1 floor, the nurses know who the hospitalist for the floor is, which makes things easier. I usually try to stay up on the floors in the mornings so that all the nursing calls and discharge work can be done to minimize pages later on in the day. It also makes rounds easier, I can go through all my patients in one floor and be done fairly quickly. If one floor has an excess amount of patients, usually one of the NPs or docs with a lower census picks up the slack. So, usually things are divided up fairly.
- Joined
- Jul 5, 2016
- Messages
- 245
- Reaction score
- 631
The group that I am with does not do geographic rounding on patients anymore. We tried to implement this but it was taken aware after a lot of the older docs complained. The main problem was high turn over and lack of continuity. Any patient that transferred floors to maybe a higher or lower level of care all of a sudden would be on a different floor taken care of by a different doctor. This lead to a lot of time wasted getting to know a patient that someone may have been taking care of for the whole week. We tried then to implement a rule where you should follow your patient out of your unit to another if you have seen them for more than 48 hours. This lead to some doctors covering 40+ patients per day with an NP helping. Burn out was real and 2 doctors quit over it.
I know when I was rounding on a low acuity unit I would have up to 12 discharges a day which would promptly be filled up by patients waiting in the ER. It really started to wear on me over time. Discharging and having up to half my list as new patients every day was a lot of work. There was also some concern that some hospitalist were only working the ortho floor seeing their consults and not getting any exposure to ICU level patients for months at a time. They were concerned that their skills might degrade over time and liked the variety. At the right facility, I think it can be done well, but for many reasons it did not work the way it was implemented at the facility I work.
To answer your second question we divide overnight patients to make the census equal among the group. At the end of every day each hospitalist is responsible for putting their number of patients listed on the board. If I have 18 patients and everyone else has 21 then I'll get 3 patients from overnight to have the same number as everyone else. We try to limit the number of patients post midnight given to one person since the hospitalist can not bill for that one.
I know when I was rounding on a low acuity unit I would have up to 12 discharges a day which would promptly be filled up by patients waiting in the ER. It really started to wear on me over time. Discharging and having up to half my list as new patients every day was a lot of work. There was also some concern that some hospitalist were only working the ortho floor seeing their consults and not getting any exposure to ICU level patients for months at a time. They were concerned that their skills might degrade over time and liked the variety. At the right facility, I think it can be done well, but for many reasons it did not work the way it was implemented at the facility I work.
To answer your second question we divide overnight patients to make the census equal among the group. At the end of every day each hospitalist is responsible for putting their number of patients listed on the board. If I have 18 patients and everyone else has 21 then I'll get 3 patients from overnight to have the same number as everyone else. We try to limit the number of patients post midnight given to one person since the hospitalist can not bill for that one.
- Joined
- Mar 26, 2006
- Messages
- 978
- Reaction score
- 345
Who is responsible for the distribution of the overnight patients?
- Joined
- Jul 5, 2016
- Messages
- 245
- Reaction score
- 631
We have an overnight person who admits and cross covers from 10pm to 6am. At 6am they distribute the patients among the group of doctors to the best of their ability to ensure that everyone feels that things are done evenly and fairly. No one has complained about this method yet and seems to have been working pretty well. If anyone were to complain there is always the option for anyone in the group to do nights and to be the night admitting doctor dividing the list. I have a feeling this is also why no one complains about the current system 🙂
- Joined
- Aug 24, 2007
- Messages
- 2,199
- Reaction score
- 2,257
Geographic rounding with one tele and one no tele floor so all pts downgraded ideally go to your other floor but if not you still follow then till they get d/c 'd or die
Overnight admits is complicated but beneficial to more efficient docs. Everyone, regardless of census, gets the same # of pts. The overnight nurse also tries to make sure that you get the pts that went to your floor overnight but "equal distribution" is the hand that trumps all.
The equal distribution ensures people don't hold on to pts till their last day and then do a mass discharge ( which was an issue when the "everyone gets topped up to the same census" system was in place)
