Continuity of Care: Hidden Cost of Manual Patient Assignment

Continuity of Care

One major danger patients and hospitals face with a manual rounding list process is the lack of continuity of care. If a patient is admitted on Monday and is seen by Hospitalist A, that patient will want to continue seeing Hospitalist A until they’re discharged. Hospitalist A knows the patient’s medical history, current situation, etc. – creating a more fluid process than if a different hospitalist were to round on the patient. However, the stars do not always align when putting together rounding lists manually.

Patients can easily be assigned a new hospitalist to round on them, especially as patients are transferred to different rooms, floors, or areas. The newly assigned hospitalist will need to learn about the patient’s status, medical history, etc. – a task Hospitalist A already completed. Patient dissatisfaction is a real factor in these situations as the patient will have to start the process over and repeatedly explain their medical situation to the next hospitalist in line. The more time the patient spends bouncing around hospitalists, the slower the process becomes to care for the patient and ultimately discharge them. When a hospital lacks continuity of care with their patients, length of stay can increase, which directly affects patient flow and access to care.

Continuity of care is not only important for an initial hospitalization from a patient but also during subsequent hospitalizations. The patient’s medical history will be in the hospital’s medical records as well as the hospitalist they had seen during their initial admission. It would be ideal for the patient to be assigned to the hospitalist who previously cared for them, given the hospitalist is still rounding at the same hospital. When putting together rounding lists manually, it would be impossible to look at every patient’s record and determine who they were seen by last time, and if that hospitalist is on call today.

A March 2021 JAMA study looked at the impact of continuity of care measures like length of stay and patient care. They noted, “We compared patients cared for by hospitalists who usually worked 5 or 7 days in a row with those cared for by hospitalists whose schedules were more intermittent, such as working every third day. Patients cared for by hospitalists with intermittent schedules were much more likely to see multiple hospitalists during their stay… In our study, patients cared for by hospitalists in the top quartile of continuous schedules had significantly lower post-discharge mortality, readmission rates, and costs and higher rates of discharge home compared with patients cared for by hospitalists with discontinuous schedules,” noting that the hospitalists with discontinuous schedules often meant they were not able to preserve continuity of care for their patients.

Patient Safety Concerns

We don’t want to admit it, but…have you ever lost a patient? Not missing in the hospital somewhere, but missing from the daily list? Due to some mix-up, it’s possible they didn’t get rounded on that day. Perhaps a patient was transferred from another hospital or admitted overnight and did not get added to the next day’s rounding list. Perhaps the personnel that knew the patient was admitted is no longer present to pass along the information. If a patient is not added to a rounding list, they will not be seen by a hospitalist.

When a patient is missed, it poses serious safety risks. All patients need to be accounted for and when they’re not, the probability of the patient’s health declining increases. Missing on rounding a patient can be fatal, so having reliable processes for patient assignment is vital for the best possible care for patients.

The Hidden Costs of Manual Patient Assignment eBook

Creating patients lists manually comes at a cost – for your staff and your patients. In this eBook, we’ll learn about how it costs your hospital medicine teams revenue, causes burnout, impacts patient safety; and how to solve these challenges.