How do your patients get assigned to providers every day? If you’re doing it manually with the help of a good friend named Excel, or in your EHR, there’s a lot more than meets the eye when it comes to the creation of daily rounding lists.
We gathered information on a mid-size hospital to tell the operational story of the amount of work (and people!) involved in creating your daily rounding lists manually.
The first chart tells the operational story of a hypothetical hospital – let’s call it Hospital A. As you can see, without the help of an automated patient assignment solution, Hospital A is experiencing a huge amount of operational and labor difficulties.
In the second chart, you’ll see Hospital B, which has implemented Assign as their automated rounding list solution. Now, it’s much easier for them to operate more efficiently, there are fewer delays in patient care, reduced physician burnout, and of course, they now enjoy a balanced rounding list without having to put it together manually.
Hospital A: Creating the Rounding List Manually
|Who’s Involved in Creating the Lists?
|5:30-7 AM||The patient assignment process begins.||Nocturnist staff are creating rounding lists. The day hospitalists are coming in early, or clinical administrative staff may also be responsible for putting together the daily assignments. This process can sometimes include other doctors if resources are short.||Manual spreadsheets and the current EHR are being used.
|The process may involve using a hard copy of yesterday’s rounding sheet and picking up where they left off by doing manual assignments.
Patient analysis needs to be done and questions asked such as, “Who needs to be seen? What happened last night regarding new admittances?”
You’ll also find staff printing and dropping off face sheets from one staff member to another.
|Hospitalists must spend time on this manual work instead of patient care. No hospitalist wants to waste time creating a list and deciding their coworkers’ workloads for the day. It’s also impossible to consider factors such as geography, continuity of care, workload balancing, etc., while putting together the list manually.
This manual process delays getting the day started for all other staff. When the hospital is short staffed, physicians must step in to create this list which in turn is very stressful and often results in unbalanced lists and decreased patient satisfaction.
|7 AM-7:30||Shift turnover – new hospitalists and nurses begin their shifts.||Day hospitalists, doctors, and list makers.||Day hospitalists, doctors, and clinical staff are using the EHR or email to create rounding lists. These are either delivered via hardcopy or email, both are static so as things change, they must be manually updated.||Providers are getting rounding lists for their shifts. Registration needs to find out from the list makers who are the day hospitalists that will be taking over patients from the nocturnists.||If the rounding list is delayed, this creates a chain reaction: Nurses can’t put in orders for patients; rounding is delayed; patients aren’t seen in a timely manner.|
|7 AM-9AM||Nurses begin their shifts.||Nurses and bed management are involved at this stage.||Communication in this stage primarily happens via email and is centered around registration needing information so they can, in turn, update information on changes throughout the night before||Nurses need to know which physician is responsible for which patients.||If the list is delayed, nurses don’t know which doctor is responsible for which patients and who to contact to put in orders – this delays patient care significantly.|
|9 AM-7 PM||Census management is done throughout the day until 7 PM, then the process repeats the next morning.||Typically, this stage includes the hospital medicine group –
(ICU, ER, clinical administrative staff, etc.)
|The hospital medicine group uses their existing EHR and tools such as TigerConnect to communicate, take clinical notes, share updates, etc.||New admits are coming in, providers are rounding on current patients using a manual list.||Delays and confusion here can create burnout, patient care being missed, cramming in more rounding with less time, unbalanced list. The ripple effect continues.|
|7 PM –5:30 AM||Nocturnists and new doctors and nurses come in for their shifts.
Nocturnists are responsible for all care, admissions, etc. from 7 PM-7AM. Without knowing what happened at night, they often can’t tell the story in the morning.
|Nocturnists and the hospital medicine group (ICU, ER, clinical admin staff, etc.) are involved in starting to put the next day’s list together.||The hospital medicine group uses their existing EHR and tools such as TigerConnect to communicate, take clinical notes, share updates, etc.||New admittances are coming in, and providers are rounding on current patients. If the morning rounding list was late, providers’ schedules can be impacted by delays.
|This can create burnout, or reduced time with patients, cramming in more rounding with less time, and an unbalanced rounding list.
Hospital B: Using Assign to Automate the Patient Assignment Process
|Time||Operational Story||Who||Technology||Process||Impact / Value|
|5:30 AM –7 AM||The Patient Assignment Process begins.||Nocturnists, day hospitalists, clinical admin staff.||Assign, your automated patient assignment solution.||No more manual creation or dropping off physical materials. This can be done in 30 minutes versus 2+ hours, with a click of a button.||No more manual burden or delays for physicians. Instead of multiple people being involved, now there is only one clinical administrator who is just verifying the list that Assign creates.
Using an automatic interface instead of having to create manual spreadsheets results in labor savings. Hospitalists and doctors now have more time for their other tasks.
|7 AM||A true changeover with staff is happening now. The night shift is leaving, and the day shift is arriving.||Nocturnists are leaving, and new-day hospitalists are arriving and need rounding lists.||Instead of printed or email lists, they will have access to digitally updated rounding lists, directly in their EHR.||Doctors are getting rounding lists on time.||Improved patient care, and doctors are on schedule and can start rounding right away. Their workloads are more evenly balanced and continuity of care is preserved, which improves patient care. All this can positive impact important hospital concerns like safely improving discharge rates and reducing avoidable days.|
|7- 9 AM||Nurses begin their shift.||Nurses||Medaptus automatically updates the new attending relationships and team assignments in your EHR instantaneously via an electronic interface. This results in labor savings (Seconds vs hours).
Automation takes this task away from bed management or providers having to do it.
|Nurses and providers don’t need to rely on getting their information from Registration. Assign manually updates all new admits from the night before.||Nurses now know which physician is rounding on which patient. This results in faster patient care and less delays in relaying information and rounding on patients.|
|9 AM – 7 PM||Census management is done until 7 PM.||Physicians, nurses.||Medaptus clients continue current assignments throughout the day, or some opt in to use our census manager solution (a mobile feature that allows physicians to see the status of all patients in one view).||Providers are rounding on patients on time.||Providers rounding on patients on time results in less patients being missed, reduced physician burnout, and more time for rounding on patients. Medaptus’ Assign creates more balanced rounding lists within providers.
|7 PM – 7 AM||Nocturnists, new doctors and nurses come in for their shift.
Nocturnists are responsible for all care, admissions, etc. from 7PM – 7 AM.
|Nocturnists, night shift physicians and nurses.||Assign collects information from a real time patient interface (ADT) feed for all data and events that happened overnight (discharges, attending updates, transfers, location changes, etc.) The list maker who comes in the next morning isn’t relying on all the overnight activity for updates and changes anymore.||Staff won’t need to manually search for information – everything is up to date.||Providers will spend less time looking up patient information in their chart, have real-time up-to-date information readily available in a few clicks versus hours.|
If you’re still creating rounding lists and doing the patient assignment process manually, you’re definitely not alone! But there is a better way, as you can see above. It will not only impact your patients but reduces work for all your staff – from hospitalists to nurses to administrative and clinical personnel.
The healthcare organizations we work with who have automated their patient assignment process have said it helps them with:
- Reducing manual labor
- Increasing clinical rounding time
- Reduced delays in rounding
- Increased patient satisfaction
- Improved discharges rates, and fewer delayed discharges,
- Decreasing risk of adding an avoidable day
- Decreased provider burnout
- And more!
Learn more about how to automate your patient assignment process here – book a 15-minute conversation to see how it can help you.