The first award recipients, announced in July 2013, Jose Figueroa, MD, MPH, and Bram Geller, MD, Internal Medicine residents at Brigham and Women’s Hospital. Their project, “Educating and Incentivizing Housestaff on Early Discharges – An Intervention at Cost Containment.” Robert Boxer, MD, PhD, associate director for the BWH Hospitalist Service and leader of a care redesign initiative in the General Medicine Service, served as their faculty representative. The project is embedded in a large hospital-wide program to improve inter-professional teamwork by ensuring that health care teams and the patients under their care are co-localized to a single unit, as opposed to spread out throughout the hospital.
Figueroa and Geller, who were selected for the award from among six nominees, are working closely on their project with fellow residents Vinod Nambudiri, MD, MBA, Corrine Kliment, MD, PhD, and Judson Englert, MD, PhD. Their faculty representative is Robert Boxer, MD, PhD, associate director for the BWH Hospitalist Service and leader of a care redesign initiative on the General Medicine Service, within which this project is embedded.
Early discharges (before 12:00 p.m.) are important for a number of reasons:
1- To improve the flow of patients through the hospital and reduce Emergency Department backflow.
2- To increase efficiency and reduce medical costs.
3- To improve the patient experience and increase satisfaction.
4- To serve as an integral part in the success of regionalization, a large hospital-wide effort to co-localize all of the core members of a patient’s healthcare team, which has been shown to reduce adverse events by 50% in other hospital systems.
Drs. Geller and Figueroa designed and implemented a quality improvement intervention that directly involves a group of 25 residents, who are on the “front-lines” of patient care and often have a better understanding of day-to-day workflow. Historically, General Medicine Services (GMS) had an average monthly early discharge rate of less than 5%. Through regionalization, and this intervention in particular, GMS aimed to reach a goal of greater than 12.5% early discharge rate.
Since completing his work with Dr. Figueroa, inaugural Rappaport Awardee Bram Geller, MD, has completed his residency at BWH and received a prestigious cardiology fellowship through the University of Pennsylvania. This three-year program at Penn Medicine allows gifted clinicians to pursue intensive subspecialty training within the framework of a general cardiology fellowship so they can cultivate expertise in their chosen specialties without sacrificing the breadth of experience offered through a general cardiology curriculum. Dr. Geller is currently pursuing a specialization in treating advanced cardiovascular disease.