Is a Lack of Physician Alignment Eroding the Foundation of Your Patient Flow Management?

By Bob Gleason-Moore, RN, MN

Originally Published December 19, 2018

When a foundation is not optimized, it may weaken or even collapse the structure it is meant to support. In the hospital, physicians play a cornerstone role in the foundation of optimizing patient flow and on-time patient progression.  So, why is it that physicians are often misaligned with the organization when it comes to these crucial components of the patient stay?  How do you find out if this is a problem in your hospital?  

Here's a checklist to determine how well physicians are integrated into your organization’s care progression:

Are Length of Stay targets determined without physician input?

Physicians need to know your length of stay (LOS) targets, be involved in determining them, and accept partial ownership in achieving them. Physicians who understand the targets and are involved in creating them are more likely to support them.

Do your physicians have a solid understanding of the relationship between LOS targets and reimbursement?

Your physicians must have an understanding that LOS targets aren't just arbitrary goals, but instead are one of the most important factors in optimizing reimbursement.

Are your physician order sets in conflict with discharge plans and patient progression plans?

Your overarching plan for patient progression and your physicians’ role in it must be in sync. Since physicians create patients’ order sets, why wouldn’t they have a seat at the table with the development of patient progression plans?

Patient progression plans should include elements like logistics, discharge planning steps, clinical treatment orders (i.e. order sets), and more. Therefore, synchronization with order sets is critical to achieving length of stay goals. Maybe it's even time to re-evaluate the order sets themselves. Key clinical leaders, such as department chairs and other physicians, need to be directly involved in the development process for the order sets relevant to their specialties.

Is there a lack of communication between physicians and patient progression leaders?

Daily, consistent, open communication with physicians is crucial for efficient care progression.  The physician's current plan must be aligned with the current patient progression plan.  There is nothing worse for optimizing patient flow and patient progression than having different members of the clinical team working toward conflicting goals.

On the unit, the patient progression leader actively identifies and addresses logistical and treatment barriers for each patient.  Is a delayed diagnostic test preventing us from moving the patient to a lower level of care? Are we waiting for a physician consult for discharge?  How is this being communicated to the physician?

The physician brings a different perspective and additional knowledge about the patient.  What barriers does the physician see that will cause delays?  Has the physician communicated this to the nurse or patient progression leader?

The right communication tools and processes must be in place to bring the physicians and progression leaders together regularly.  One hospital went as far as introducing a "no physician rounds alone" policy.  When a physician rounds on a nursing unit he or she must speak with a nurse.

So, how does your foundation look?

If any one of the checklist items above is true for your hospital, perhaps it is time to shore up your own patient flow foundation.  Don't forget your physicians!