A Team Approach

EmCare uses specially designed software in its “Door to Discharge” program to integrate emergency and hospital medicine services, meant to improve physician collaboration, increase “throughput” times from the ED to an inpatient bed, and reduce incidents when patients leave the ED without getting treatment. Throughput times using the model average about 45 minutes. “They don’t sit in the ER for three to four hours,” Hamm said. “We’re changing the efficiencies of the hospital.”

At TeamHealth, based in Knoxville, which serves more than 860 facilities and physician groups and began as an emergency-medicine company, about 50 hospitals have signed on for both emergency medicine and hospital medicine services.

“We have seen an increase over the past few years in interest from hospitals who want a combined ED and HM program,” said Tracy Young, TeamHealth’s marketing and communications vice president.

John Proctor, MD, MBA, president of TeamHealth Central Group, said there’s a big advantage in “having those two groups of physicians function as colleagues who are accountable to the same folks and are striving for the same goals.”

TeamHealth uses a proprietary “integrated scorecard” that jointly assesses emergency medicine and hospital medicine. “I think it’s important to look at things not in silos,” said Jasen Gundersen, MD, MBA, president of TeamHealth Hospital Medicine. The scorecard looks at things like observation rate, throughput times, and patient experience.

“The single biggest thing we see from the balanced scorecard from our dashboard now is just a much cleaner and stronger understanding between the two service lines of what happens on the other side and a much larger sense of ownership of the entire continuum,” Dr. Gundersen said. “The ED folks can see what’s happening on the inpatient side, and the inpatient docs can see what’s happening on the ED side.”

It’s becoming more and more common for emergency physicians to work simultaneously as hospitalists in the nation’s smallest hospitals—generally those with no more than 10,000 to 12,000 ED visits per year. It’s a subset of a trend toward a single company providing a hospital with both emergency physicians and hospital medicine physicians.

Quality Improvements

There’s been a “significant improvement” in readmission rates in places where the two sides are under TeamHealth, he said. There’s also been an improvement in throughput times. And as patients wait less in the ED to go to a room, there’s a trend—though not yet statistically validated—toward improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) scores.