A physician-centred intervention to shorten hospital stay: a pilot study

1.   Identify all problems and categorize them as requiring inpatient or    Outpatient investigation:     a. ____________________________    Inpatient    Outpatient   b. ____________________________    Inpatient    Outpatient   c. ____________________________    Inpatient    Outpatient   d. ____________________________    Inpatient    Outpatient   e. ____________________________    Inpatient    Outpatient   f. ____________________________    Inpatient    Outpatient   g. ____________________________    Inpatient    Outpatient   h. ____________________________    Inpatient    Outpatient   2. Call patient's usual physician today, find out previous test results and discuss items in the outpatient category.   3. Let patient authorize file transfer with coordinator today.   4. List all consultants and tests expected to be needed and write requests (they can be cancelled later):   Medical or general surgery consult? Call resident today.   Surgical subspecialty consult? Call staff surgeon today.   Tests likely to be required during stay? Book them today.   5. Special categories   Diabetic? Will need teaching for home? Call endocrinology for teaching today.   CVA? Can patient not walk or swallow? Call pt/ot and apply for placement.   DVT/PE? Start warfarin today unless contraindicated.   IV antibiotics foreseen for over 15 days? Apply today for home IV therapy.   Advanced AIDS? Apply today for placement.   COPD? Need for home O2? Apply today.   6. Consider a geriatrics consult if any of the following apply:   Elderly person living alone?   Delirium or dementia?   Problems with activities of daily living, especially if recent decline (mobility, continence, dressing, hygiene, eating)?   Polypharmacy?   Recent hospital discharge with frequent visits to emergency department?   7. List the factor(s) most likely to delay the date of discharge:   _____________________________________________________________   8. Write proposed date of discharge (Fridays to be avoided for patients requiring home O2, home care, IV antibiotics):   _________________________________________

Fig. 1: Admission planning checklist, used as physician-centred intervention to shorten hospital stays.

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