The effect of geographic rounding on hospitalist work experience: a mixed-methods study.

OBJECTIVES: To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as 'geographic rounding,' and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. METHODS: The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. RESULTS: Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p < 0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p < 0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p < 0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p = 0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. CONCLUSION: Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.

Triaging Inpatient Admissions: an Opportunity for Resident Education.

In the context of internal medicine, "triage" is a newly popularized term that refers to constellation of activities related to determining the most appropriate disposition plans for patients, including assessing patients for admissions into the inpatient medicine service. The physician or "triagist" plays a critical role in the transition of care from the outpatient to the inpatient settings, yet little literature exists addressing this particular transition. The importance of this set of responsibilities has evolved over time as health systems become increasingly complex to navigate for physicians and patients. With the emphasis on hospital efficiency metrics such as emergency department throughput and appropriateness of admissions, this type of systems-based thinking is a necessary skill for practicing contemporary inpatient medicine. We believe that triaging admissions is a critical transition in the care continuum and represents an entrustable professional activity that integrates skills across multiple Accreditation Council for Graduate Medical Education (ACGME) competencies that internal medicine residents must master. Specific curricular competencies that address the domains of provider, system, and patient will deliver a solid foundation to fill a gap in skills and knowledge for the triagist role in IM residency training.