In one study surveying hospitalists, 85 percent reported geographic localization and rounding was the most efficient care model.³ Studies have shown that when patients are situated in proximity to their care team members, communication is improved, and this translates into improvements in length of stay and decreased total rounding time.⁴ Geographic localization increased the direct communication between members of the care team and increased the likelihood that these team members could correctly identify one another.⁵ When residents have geographic localization, the number of rapid response calls goes down.⁶ Further, geographic localization was viewed to have a positive effect on the resident experience.⁷

Geographic Localization Pro’s

• Better communication among patient care team
• Saves time
• Quick service to patient
• Better HCAHPS scores
• Shorter LOS
• Lower readmission rates
• Reduction in sentinel events
• Reduced time on round
• Higher resident satisfaction at teaching hospitals

Geographic Localization Con’s

• Too many hand-offs
• Interruptions on work rounds
• Load leveling is difficult
• Stationary work environment

The Medical College of Wisconsin reported the responses of their faculty and nurses to the introduction of geographic localization.⁸ 

Geographic localization has been coupled with another innovation: separating the admitting role and the rounding role for hospitalists. Thus, the “triagist” role was born: One hospitalist will admit a patient (the triagist), while another subsequently manages care. Separating these roles improved efficiency and throughput.9 The triagist role allows the patient to be admitted in a timely fashion, and placed on the right unit and team later on. Another related improvement has been the multidisciplinary rounds, particularly those that focus on the discharge of the patient. Geography makes those team rounds more feasible. ¹⁰

Another strategy which optimizes hospital throughput involves adjusting the work schedules of hospitalists.¹¹ Schedules that promote continuity were associated with lower mortality, lower readmission rates, higher rates of discharge to home and lower 30-day post discharge Medicare costs.^12-13

Strategies that help reduce hospital length of stay and improve discharge efficiency and ultimately reduce boarding in the emergency department. Emergency physicians know first-hand the advantages in communication and workflow as most of us work in designated zones and lead care teams dedicated to the patients placed in a particular geographic area.

When hospitalists consider the “geography” question, we can bring an understanding of the issue both in the inpatient and ED universes. Supporting geographic localization strategy helps improve inpatient throughput help create open inpatient beds. And open beds are the only solution to the problem of emergency department boarding!