To be clinically effective, the hospitals needed to find ways to take care of critically ill patients successfully outside the intensive care unit. "Rather than work harder and harder, we needed to work smarter. And, we needed to work smarter with the same resources," he said.
To meet these goals, the hospital looked at a process redesign. A 13-bed progressive care unit was created and staffed by hospitalists with experience in critical care. Hospitalists were reassigned to be floor-based and charged with coordinating care and ensuring quality for patients on their assigned floor--in addition to their own patient panel.
Then, hospitalist-led multidisciplinary rounds were conducted on each of the floors daily. Rounds included nurses, care managers, pharmacists, dieticians, and physical/occupational therapists. The goal was to "predict who would do poorly and then proactively [identify them] so they don't become candidates for rapid response [teams]," Ravikumar said.
To assist in this area, they used a "hawk" (high risk) and "dove" (low risk) system of stratification for patients they saw on their rounds. "This had to be simple," he says. Patients whose providers had to look after actively on an ongoing basis were designated as "hawks"—since staff would have to "watch them like a hawk." Patients doing well at the time of rounds were called doves--"which meant they [would likely] 'fly peaceably away' soon like doves," he said.