3 Reasons to Combine your Low Volume Hospital’s Emergency and Inpatient Service

The idea that a hospitalist program is cost prohibitive for smaller community hospitals (less than 12,000 annual emergency department visits) is a dated myth. Reaping the benefits of a robust hospitalist program and emergency department without the cost of two full programs is possible. It simply requires innovation. Hybrid emergency department and inpatient care management is that innovative solution.

Emergency medicine and hospital medicine can be integrated by combining the two services into a single patient care service. In this model, inpatient care is provided as an extension of traditional emergency department services by providers who are skilled in both emergency and inpatient care. A single physician (or physician and advanced practice provider team) cares for the same patient throughout their hospital visit.

This model is a good fit for smaller hospitals because it allows for the most efficient use of provider coverage. The staffing model will vary based on your volume trends. When designing your staffing model for a hybrid program you must consider:

·      Arrival and average daily census patterns

·      Physician shift length (12 or 24)

·      How to cover volume surges

·      After midnight admission processes

In our experience, the program works best when there is a backup call schedule arranged for volume surges and physicians work 24 hour shifts, handling rounding in the morning before ED volumes peak for the day and writing H&Ps during rounding time for patients admitted after midnight. 

The hybrid model is a cost-effective and efficient alternative to running separate programs or managing rotating call with community physicians. Below are the top 3 reasons to adopt a hybrid model at your small community hospital, rural hospital, or critical access hospital.

1.     Cost effectiveness.

The price tag associated with running emergency and inpatient programs is typically cost prohibitive for smaller community hospitals. The patient volume in most smaller community hospitals doesn’t financially support two separate programs. The hybrid approach offers a lower cost solution than two programs while also improving admit/ transfer ratios.


2.     Improved care continuity.

In the hybrid ED and hospitalist management model, one physician cares for a single patient as they transition from emergency care to inpatient care. This eliminates the risks often associated with transitions of care, including: communication breakdowns, unnecessary readmissions, poor patient experience, and more. The hybrid model allows you to implement standardized clinical pathways and order sets that transition seamlessly from the ED to inpatient care so the patient has a positive, consistent experience.

3.     Added inpatient care delivery stability and consistency.  

Traditional ED and hospitalist programs can have difficultly aligning performance and patient experience. Additionally, the two common alternatives to two separate programs—rounding by community physicians and reliance on locum tenens providers—make it difficult to ensure consistent, reliable care. A community physician’s primary commitment is to his/her outpatient clinic patients, so rounding often happens outside of clinic office hours. This results in delays to inpatient codes, patient status changes, order clarification and/or changes, and consultations, which increases length of stay. By implementing a dedicated provider or provider team that is committed to both ED and inpatient care, unassigned admissions are reduced because all patients are admitted by the same service line.

A hybrid emergency and hospitalist program is a great alternative to two, high-cost separate programs, relying on community physicians to accommodate rounding in their already-busy schedules, or calling in locum tenens physicians who are not invested in the community to provide inpatient care. The hybrid program adds more continuity to your patient’s experience, shortens length of stay, increases efficiency of the admissions process, and improves admit/transfer ratios, ultimately improving hospital performance overall.