Systematically improving physician assignment during in-hospital transitions of care by enhancing a preexisting hospital electronic health record

Background: The nationwide expansion of the hospitalist movement brings rapid change in communication and work processes in many hospitals. While our fast-growing hospitalist program has greatly improved length of stay and quality measures, it has also faced complex operational challenges affecting the whole organization rather than just our division: assigning and tracking hospitalist coverage of admitted patients was one of these challenges. Methods: We integrated a system of algorithms and interface solutions into our hospital's preexisting electronic health records (EHR) program to act as a decision support tool and computerized safety net during admission and patient distribution. Its main structural elements include: (1) algorithms that identify patients for hospitalist coverage and monitor coverage during transitions of care; (2) EHR data fields that enable hospitalists to assign and update each patient's coverage information in real time; and (3) a combination of display solutions to inform users of coverage arrangements and alert for potentially misassigned patients. Our system assists with correct attending selection on admission. It also assures continuity of coverage during transitions within the hospitalist program and across care settings. Results: Our enhancements to the EHR received unanimously positive assessment by users and added an important layer of patient safety and organizational efficiency for our hospitalist program. Discussion: Adaptations of our toolsmay provide similar opportunities for improvements in a variety of hospitalist settings; an integrated computerized physician order entry (CPOE) system is not a prerequisite.We demonstrate how the presented innovations can be used to enhance other EHR functions as well.