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Free form: Checklist for evaluating a surgical hospitalist schedule

Hospitalist Leadership Connection, July 13, 2010

A meaningful system for measuring and reporting program performance is one of the most important tools available to ensure the effective functioning of a surgical hospitalist program.

Descriptive metrics do not measure performance in and of themselves, but they are valuable in understanding the scope and nature of the surgical hospitalist practice, and they help inform the analysis of other types of metrics.

Descriptive metrics include basic information such as patient volume (number of cases), top surgical procedures performed (by CPT code), top diagnosis-related groups (DRG), case-mix index (CMI), number of surgical hospitalist shifts or hours worked, number of full-time equivalents (FTE) payer mix, and similar items.

The checklist below lists a variety of sample descriptive metrics for consideration when evaluating a surgical hospitalist schedule:

• Number of cases or number of patient encounters by type (e.g., admissions, consultations, surgical procedures, subsequent inpatient visits, follow-up clinic visits, etc.)
  • Total for a defined period
  • Average, high, and low daily volume during the period
  • Average daily starting census for the program
• OR minutes
  • Average minutes per case
• Average hours of ED or trauma diversion per week or per month
• Types of patients cared for by the program
  • Top 25 surgical procedures performed (by CPT code)
  • Top 10 DRGs
  • All DRGs constituting 80% of program volume
  • Proportion of patients with surgeon as attending physician vs. surgeon as consultant
  • Proportion of teaching patients vs. nonteaching patients on the service
• Patient source
  • Number of trauma service patients
  • Number of unassigned emergency patient admissions
  • Number of regional transfers
  • Payer mix by volume or revenue
• Patient acuity/complexity
  • Medicare CMI for patients managed by surgical hospitalists
  • APR-DRG or other severity-adjusted data, if available
• Surgical hospitalist resources deployed
  • Number of shifts or hours worked by shift type (e.g., days vs. nights)
  • Number of surgical hospitalists FTEs
  • Number of clinical and/or nonclinical support staff FTEs
• Surgical volume growth over time
  • Trauma service grown
  • Growth in transfers from other hospitals

The above excerpt is adapted from The Surgical Hospitalist Program Management Guide: Tools and Strategies for Executives and Physicians, by John Nelson, MD, FACP, SFHM; John Maa, MD, FACS; and foreword by Robert M. Wachter, MD, SFHM.
 

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