The Effect of Geographic Cohorting of Inpatient Teaching Services on Patient Outcomes and Resident Experience

Klein, Andrew J.; Veet, Clark A.; Lu, Amy C; Kennedy, Amy J.; Agonafer, Etsemaye P.; Grau, Thomas; Rothenberger, Scott D.; Corbelli, Jennifer

doi:10.1007/s11606-021-07387-z

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Therefore, geographical cohorting of provider teams, patients and other clinical team members is a proposed solution for some of the inefficiencies of care which contribute to worsened LOS, readmissions and other quality metrics. Most geographical cohorting studies have shown no beneficial effect on LOS or readmissions [12][13][14][15][16][17] except for Maniaci et al, 18 who combined geographical cohorting with multidisciplinary rounds (MDRs) and showed a reduction in LOS and a reduction in quality 'at-risk events' with no change in readmissions. Most of the remaining studies that showed no effect on LOS or readmissions used geographical cohorting of providers and patients alone without paired MDR.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Additional benefits of geographical cohorting may include improvements in the quality of care, the learning experience of students and residents, communication between providers and nurses, teamwork, and efficiency. 14 Non-geographical placement of general medicine patients on non-general medicine units may be associated with higher mortality. 19 At Duke University, there has been a consistent rise in the LOS for patients in the General Medicine service, a trend that predates the COVID-19 pandemic.…”

Section: What This Study Addsmentioning

confidence: 99%

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Impact of geographical cohorting, multidisciplinary rounding and incremental case management support on hospital length of stay and readmission rates: a propensity weighted analysis

Jolly Graham,

Platt,

Knutsen

et al. 2024

BMJ Open Qual

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Hospital length of stay (LOS) in the USA has been increasing since the start of the COVID-19 pandemic, with numerous negative outcomes, including decreased quality of care, worsened patient satisfaction and negative financial impacts on hospitals. While many proposed factors contributing to prolonged LOS are challenging to modify, poor coordination of care and communication among clinical teams can be improved.Geographical cohorting of provider teams, patients and other clinical staff is proposed as a solution to prolonged LOS and readmissions. However, many studies on geographical cohorting alone have shown no significant impact on LOS or readmissions. Other potential benefits of geographical cohorting include improved quality of care, learning experience, communication, teamwork and efficiency.This paper presents a retrospective study at Duke University Hospital (DUH) on the General Medicine service, deploying a bundled intervention of geographical cohorting of patients and their care teams, twice daily multidisciplinary rounds and incremental case management support. The quality improvement study found that patients in the intervention arm had 16%–17% shorter LOS than those in the control arms, and there was a reduction in 30-day hospital readmissions compared with the concurrent control arm. Moreover, there was some evidence of improved accuracy of estimated discharge dates in the intervention arm.Based on these findings, the health system at DUH recognised the value of geographical cohorting and implemented additional geographically based medicine units with multidisciplinary rounds. Future studies will confirm the sustained impact of these care transformations on hospital throughput and patient outcomes, aiming to reduce LOS and enhance the quality of care provided to patients.

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Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Impact of geographical cohorting, multidisciplinary rounding and incremental case management support on hospital length of stay and readmission rates: a propensity weighted analysis

Jolly Graham,

Platt,

Knutsen

et al. 2024

BMJ Open Qual

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“…No study has demonstrated an association of geographic cohorting with hospital readmission rates (19)(20)(21)(22)(23)(24)(25).…”

Section: Readmissionsmentioning

confidence: 99%

“…Patient satisfaction scores, measured via standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, associated with cohorting have been unchanged (20,23,25,32). No studies have designed and administered surveys to patients to specifically capture their reflections on cohorting.…”

Section: Satisfactionmentioning

confidence: 99%

Geographic cohorting by clinical care team: a narrative review

Bressman¹,

Kohn²,

Song³

et al. 2023

Ann Palliat Med

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Background and Objective: Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such criterion that has been commonly discussed and studied since the early days of the hospitalist movement in the US is a patient's assigned clinical care team. Because implementing cohorting of this type requires substantial operational investment, it is important to understand the benefits and the tradeoffs associated with bringing patients into closer spatial proximity with their full team of providers and allowing clinicians to work within a defined clinical space.Methods: We conducted a narrative review of the evidence around geographic cohorting of patients by clinical care team. We performed a comprehensive search of the PubMed, Embase, Cinahl and Scopus databases, identifying relevant English language articles. We used an inductive approach to developing thematic domains for categorization of article content.

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The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center

Leung,

Andersen,

Wilson

et al. 2023

Support Care Cancer

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The Effect of Geographic Cohorting of Inpatient Teaching Services on Patient Outcomes and Resident Experience

Cited by 3 publications

References 17 publications

Impact of geographical cohorting, multidisciplinary rounding and incremental case management support on hospital length of stay and readmission rates: a propensity weighted analysis

Impact of geographical cohorting, multidisciplinary rounding and incremental case management support on hospital length of stay and readmission rates: a propensity weighted analysis

Geographic cohorting by clinical care team: a narrative review

The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center

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