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IMPROVING PATIENT CARE
This updated and expanded collection of orders can help you admit patients more efficiently and effectively.
In 1999, the 17 family physicians of the Scott & White Clinic in College Station Texas developed a set of standardized orders for use in admitting patients to the hospital. One year prior to this, we had started a hospital service consisting of one of our senior staff physicians working with a second-year resident from the local family medicine residency. Eventually, all of our physicians began to share this responsibility one week at a time, which left each of our doctors having a fairly intensive inpatient experience every three to four months. Because of the wide scope of family medicine, we cared for patients with a wide variety of medical conditions. Many of these patients' problems were relatively routine, while others were less common or more complex and, therefore, more difficult for our admitting physicians to manage.
Our reasons for developing the standardized admission orders were threefold. First, we felt we could reduce unnecessary variability in physicians' approaches to similar disease processes and thereby improve the quality of our care. Like many physicians, we were sometimes basing our care on what we learned in training or from colleagues, rather than on current evidence. Second, we felt that by reducing variability, the orders could also help contain costs. Our practice is approximately 70 percent to 75 percent capitated, so cost reduction is a significant issue for us. As we created the admission orders, we reviewed them with local specialists in the relevant fields and also with our primary hospital to help establish the most cost-effective therapies for our particular hospital practice. For example, in the treatment of UGI bleeding, many of our physicians were using IV HZ-blockers for initial management, although oral medications were as effective yet less costly in patients not actively vomiting.
Our third reason for developing the orders was simply a matter of physician convenience and efficiency. At 2 a.m., locating the correct dose of acetylcysteine for an acetaminophen overdose using our standardized orders is much easier than trying to locate it in a textbook.
The process
Once we decided which conditions we wanted to develop standard orders for, we assigned...