The Inherent Weaknesses of the Manual Patient Assignment Process

Physician burnout survey continues to show it's a major problem in healthcare

Ever since the emergence of hospitalists 20 years ago, the process of assigning patients to physicians has been an operational staple in hospital medicine. In fact, it hasn’t changed much in those years. A person or group (which could be administrative assistants or physicians) arrive early and match up each physician with all of the patients that need to be seen for that day.

The process is all done manually, by hand or on a spreadsheet.

In some cases, little thought is given to the nature or complexity of the cases. Instead, each physician is given an equal number of patients and the entire process takes just a few minutes to complete.

In other circumstances, the person or group making the assignments tries to incorporate different variables into the matching process. Thus, the location of each patient might be factored in or whether or not that patient was seen by a physician the day before. If the assigning person or group makes a concerted effort to incorporate multiple factors, the assignment process may take 90 minutes or more.

What is the main advantage of this approach?

Simplicity. Not that much thought is needed for each assignment and, as a result, the staff can get on with the rest of the day.

But there are also some significant problems and weaknesses associated with this approach. They revolve around:

  • Continuity
  • Patient Safety
  • Financial Performance
  • Sub-optimal Communication
  • Physician and Patient Satisfaction

Let’s take a look at each one of these.

CONTINUITY

There is strong evidence to suggest that continuity of care benefits both the physician and patient. It makes sense. If a physician has seen a patient before, that familiarity not only translates into better treatment, but it speeds everything up. It takes time for a physician to get to know a patient. If a physician has seen a patient before and understands that person’s clinical history, then the entire process is going to go a lot smoother.

On the patient side, that familiarity brings an added level of comfort and confidence. Patients don’t like it when they have to see new physicians on a regular basis and it is often reflected in their satisfaction scores.

And yet, implementing continuity of care into a manual assignment process is a nightmare. Aside from trying to accurately keep track of which physician saw which patient previously the day before, it’s even more complicated when the patient was last seen by the physician weeks, months or even years before. The reality is — the manual assignment process is simply not equipped to handle that level of complexity. As a result, even though continuity may be a much-desired goal of a hospital medicine team, actually implementing it is nearly impossible with a manual assignment system.

PATIENT SAFETY

When assignments are done manually, there’s fairly high probability that a patient will fall through the cracks and not be seen by a physician. For example, it’s not all that unusual for a busy hospital to have a nocturnist’s patient not be assigned the next morning as part of the daily morning assignments because nobody knew about the patient. There could also be a situation where a patient has stayed in ED and not been assigned and goes the entire day without seeing an attending physician. Either situation increases risks for the hospital.

In addition, when patient assignments have to be handled manually and moved around several times for workload balancing, errors are bound to happen. For example, nurses may have trouble paging the right doctor or give the wrong orders to the wrong physician because the assignment list is inaccurate or not

PATIENT AND PHYSICIAN SATISFACTION

Manually assigning patients also has the potential for fomenting physician dissatisfaction and staff manipulation. Patients with complex cases require more time and care. If those patients aren’t factored into each physician’s rounding schedule, then an overburdened physician is going to get frustrated and complain. There’s also a good chance that he or she will intervene and manipulate schedules to get more preferential treatment, causing a cascading effect of disruption, dispute and even animosity.

This environment can be an even bigger concern if administrative assistants are assigning patients and physicians are putting pressure to change their list, putting the lower-paid staff members in awkward or stressful situations.

FINANCIAL IMPACT

Finally, the manual assignment process can have a negative impact on a hospital’s bottom line. For example, if patients are missed by the physicians, then that means that the charges that can be attached to that interaction are missed as well. While a few missed charges here and there may not seem like much, but when it’s a number of physicians multiplied by a 365 days a year, the missed revenue starts to add up.

There’s one other financial impact associated with a sub-optimal patient assignment process. Disgruntled physicians can mean high turnover, which in turns means significantly added costs for replacements. In addition, research has supported the notion that overburdened or burnt out physicians impact others around them, causing a loss of productivity among the entire team. Some studies suggest replacing a single physician can cost a $1 million or more.

AN ALTERNATIVE APPROACH

Is there a better way? Is there a way to make the assignment process much more efficient and effective?

One approach that is showing promise is automated and intelligent patient assignments as the result of rules-based software. The idea is to build in a set of rules and algorithms that can handle the enormous complexity associated with trying to match physicians and patients while applying multiple variables, such as continuity, geography, patient weighting and others. Like it does it other circumstances, this software also typically handles computations in a fraction of the time it would take to do the same calculations manually. Thus, what normally took 90 minutes to two hours to complete, the software can do the same job in minutes.

The other big advantage of a computer-assisted patient assignment approach is that the workloads are balanced, not by an equal number of patients, but by other factors. Thus, the software can take into account the complexity of a patient’s condition and balance workloads accordingly, preventing any one physician from having a disproportionate workload.

From the outside looking in, patient assignments seems like a pretty straightforward process. If the goal is to simply give every physician the exact same number of patients each day, then manually assigning those patients is relatively easy and quick.

But if the goal is to provider better patient care and satisfaction, while still providing balanced workloads that take into account different variables, then the assignment process is neither easy nor fast. The patient assignment process is akin to air traffic control, and the better the tools that are made available (including sophisticated software), the safer and more efficient hospitals will be. There’s really no excuse for not improving patient assignments since it improves patient care, revenue and patient and physician satisfaction. The savvier hospitals are just now starting to figure that out.

MedAptus has developed a rules-based software program that automatically and intelligently matches the right patient with the right physician. Now being used by more than 500 hospitals, ASSIGN for Physicians is the most comprehensive patient assignment software program to handle multiple variables, such as continuity, geography, patient weighting and others to improve rounding operations. MedAptus also offers patient assignment software for nurses called ASSIGN for Nurses and is developing software for other providers as well.