Consults
Similar to testing, consultation should also be prioritized. Obviously, an emergent consult such as a patient suffering an MI requires the immediate attention of cardiology, but patients whose discharge is dependent on a consultant’s recommendation are high priority, too. If consultants simply take patients to be seen in the order given without any idea of priority, patients whose discharge may have been implemented that day will stay in the hospital an additional day. So, Discharge-Dependent Consultation is a key component to efficient team-based care. Proper use of consults is also important, since, like testing, many consultations could be outpatient-based.
Pharmacy
The role of pharmacy in the team-based care model is to assist in determining issues with drug interactions, optimal drug utilization, cost effective drug use, proper dosing, and non-formulary substitutions. They can also be of considerable assistance with patients who wish to take their own medications.
Pharmacists also have a role in unit huddles to be updated on patient discharges. Teaching patients about their medications has become a significant component of the discharge process, resulting in reduced readmissions where it is done well.
Environmental Services
The primary role of environmental services is to keep the unit clean and turn rooms around when patients are discharged. They are a key component in the efficiency of a team-based model. They should be active participants in the huddles to determine which patients are likely to go home that day.
Most discharges do not begin until 10 am and then end by 9 pm at night. By 10 pm, all discharges and bed cleans should be completed unless a patient is transferred for some reason.
I remember one episode when I was a member of a patient flow committee and the Director of Environmental services was scheduled to give a presentation. The Director had decided that rather than use one environmental service person to clean a room, they would use two. This would result in the room being cleaned in 20 min instead of the usual 30. Now I listened to this and thought it somewhat strange. A normal room clean takes 30 min or 2 rooms per h. So, during an 8-h shift, an environmental cleaner should be able to clean 16 rooms (2x8 h). If now the plan was to use 2 cleaners to clean a room, the cleaning pair would be able to clean 3 rooms per h or a total of 24 rooms (3x8 h).
However, if I’m using 2 independent cleaners able to each clean 16 rooms in 8 h, that’s a total of 32 rooms (2 x 16). With this new plan there would be a room cleaning bandwidth loss of 8 rooms. When this factoid was pointed out, the new plan was shelved.
