As hospitals and health systems continue to consolidate, the ability to scale and create efficiencies across sites while improving care delivery is increasingly important.
However, acute care integration faces cultural and operational challenges. Understanding the underlying tensions is key to creating meaningful integration.
Imamu Tomlinson, MD, MBA, helped to build Vituity from a regional emergency medicine group into a national, multispecialty organization. As Vituity’s CEO, he works to align acute care delivery teams at more than 250 sites across the country. He recently sat down with us to answer some of healthcare executives' most pressing integration questions.
We hear from many healthcare leaders who are struggling to align their acute care teams. Why is clinical integration so difficult to achieve?
Dr. Tomlinson: As healthcare leaders, it's important to understand the cultural and operational difficulties our teams face during integration. In order to align, many team members must leave the comfort of their established roles. Integration efforts can also surface conflicting priorities between departments.
Integration also requires a fundamental change in the way physicians have been trained and conditioned to practice. Rather than focusing on traditional roles and responsibilities, integrated providers need to think flexibly and focus on what's best for the patient. Leaders can help by acknowledging these challenges while helping teams identify opportunities for collaboration.
In which part of the hospital do you see the most urgent need for integration?
Dr. Tomlinson: While all departments benefit, the emergency department is often the most logical place to start. EDs function at the front lines of medicine, delivering half of all hospital-based medical care. They're also where patients with the most critical care needs begin their journeys.
In recent years, increasing demand for ED services has resulted in overcrowding and delays in care. In addition, EDs in many parts of the country have limited access to on-call specialists. This means emergency physicians are treating more and more patients with stroke, psychiatric emergencies and other highly complex conditions. As a result, patients admitted through the emergency department are at risk for poorer outcomes and tend to be less satisfied with their care.
Because the emergency department is essentially the hospital's front door, improvements in ED efficiency tend to ripple throughout the organization. Integrating the ED with adjacent departments like hospital medicine, psychiatry, neurology, and surgical services can create complimentary push-pull relationships that improve patient flow throughout the hospital.
Can you share some best practices for ED integration?
Dr. Tomlinson: To thoroughly integrate, you have to manage transitions of care. It's all about sharing information and making sure there are clinical pathways, so care is seamless, no matter which facility or practice line is managing the transition.
One key area to address in the ED is patient flow. At Vituity, some of our most successful throughput initiatives have involved hospitalist integration. When emergency physicians and hospitalists see themselves as part of the same team, the speed and quality of their handoffs improves, and admitted patients leave the ED faster. Culture building, joint meetings, and communication tools can help to create bridges between these key departments.
It's also crucial to ensure that emergency physicians can consult specialists when appropriate. Because relatively few emergency departments have access to in-house specialists or call panels, Vituity now staffs neurohospitalists and psychiatric hospitalists. These providers round on patients, consult with colleagues, and assist with care coordination in all areas of the hospital, including the ED.
In addition, Vituity has had great success integrating telepsychiatry and teleneurology into its EDs. These services provide emergency physicians with 24-7 access to on-demand specialist consults. Because hospitals pay only when the service is used, telehealth is often more cost-effective than maintaining a call panel, especially for smaller hospitals.
Is acute care integration really worth the tremendous effort required?
Dr. Tomlinson: It's not only worth it, I believe it's crucial to the survival of healthcare organizations. Medicare and other key payers are increasingly moving toward bundled payments. Hospitals that remain collections of silos simply can't compete in that environment.
While the process can be challenging, I've seen dozens of hospitals successfully align their teams and integrate the patient's journey. Even small, early collaboration efforts like holding cross-departmental meetings have been shown to positively impact key metrics across the hospital. And while many providers initially resist leaving their silos, research suggests that working in a collaborative, team-based environment ultimately improves job satisfaction.
Imamu Tomlinson, MD, MBA is CEO of Vituity and is a practicing emergency physician at Adventist Health Selma.