This, in essence, is process improvement. • All healthcare environments, even those deemed reliable, must continuously improve. There is no human produced system that doesn’t need constant monitoring and improvement. • Every healthcare provider must understand how to develop and participate in learning systems because of ᭺ ᭺ ᭺ ᭺ ᭺ ᭺ ᭺ ᭺ CHAPTER 4 • GENERAL OVERVIEW OF PATIENT SAFETY The goal of process improvement is the application of known knowledge to a system, and the improvement of that system through the application of human factors.

Org) PROCEDURE COMPETENCIES • Procedures competencies include those inpatient procedures that hospitalists are most likely to perform or supervise in their day-to-day care of hospitalized patients. • The individual hospital setting, including local and regional variations, determines who might perform certain procedures depending on many factors, which may include the presence of trainees, specialty support including radiology, and procedure teams. • The procedures included are those frequently performed during the course of routine practice of hospital medicine.

Hospitalist availability and knowledge of the different services may also help expedite timely patient triage into the hospital to the appropriate medical ᭺ ᭺ ᭺ ᭺ ᭺ ᭺ 11 subspecialty service with the potential of reducing diversion time during high census conditions. • The role of the hospitalist is shifting from mostly a clinical consultative role for ED physicians to leading changes in the admission process, which may include: Setting key process targets Developing protocols for patients with selected clinical diagnoses at the ED hospital interface with the ED staff Championing alignment of national performance targets such as venous thromboembolism prophylaxis and smoking cessation so that the network can reach target goals (eg, 90% or higher) Providing attending availability 24/7, in some instances, as a rapid response admission service • Using pay-for-performance incentives for improvements in efficiency: Managing patients who do not yet have a bed available in the hospital Leading RRTs/systems Expediting safe transfers from the ED to other sites within the hospital network ᭺ ᭺ ᭺ ᭺ ᭺ ᭺ ᭺ SUMMARY • The role of the hospitalist is evolving and may include broader roles in managing patients with specific problems relating to other specialties that may The Role of The Hospitalist in Triage And Protocol Development Surgical Services Low-risk patients requiring surgery as the reason for admission Medical Consult Service Intermediate-risk patients with compensated medical problems requiring surgery as the reason for admission Medical Services High-risk patients with acute medical problems driving care Admit to appropriate surgical service Admit to appropriate surgical service with medical consultation Admit to appropriate medical service with surgical consultation FIG.