Geographic cohorting may increase patient interactions, but with potential risks

An observational study used geotracking to determine the time that 17 hospitalists spent in direct patient care (defined as time in patient rooms) and indirect care (defined as other locations).


Geographic cohorting, which assigns a hospitalist to a single inpatient unit, may increase clinicians' interaction with patients but could also negatively affect workload, according to a recent observational study.

Researchers at an academic hospital in the Midwestern U.S. studied hospitalists who worked in geographic cohorts and those who did not. The hospital had implemented geographic cohorting in 2012, and teams aimed to maintain at least 80% of their patients on their assigned unit. The study used geotracking to determine the time that 17 hospitalists spent in direct patient care (defined as time in patient rooms) and indirect care (defined as other locations). In addition, four hospitalists who worked in geographic cohorts and four who did not were each observed in person for a workday.

The researchers used multilevel modeling to analyze associations between time spent in direct and indirect care, as well as characteristics of teams and workdays. Results of the study were published Nov. 20 by the Journal of Hospital Medicine.

Of the 17 hospitalists in the study, seven were observed only in the geographic cohorting model, one was observed only in the nongeographic cohorting model, and nine were observed in both. A total of 10,522 direct care episodes were noted via geotracking, with an average duration ranging from 4.1 to 5.8 minutes. An association was seen between geographic cohorts and longer patient visits, as well as between increasing patient loads and shorter visits. Geographic cohorts, increasing patient loads, and increasing unit visits were associated with time spent in indirect care.

In the 3,032 minutes of data obtained via in-person observations, geographic cohort hospitalists spent 56% of their day in computer interactions compared with 39% for nongeographic cohort hospitalists (P<0.005). Time spent multitasking in each group was similar (18% vs. 14%; P>0.05). Hospitalists in each group were frequently interrupted, but the highest rate, once every eight minutes in the afternoon, was seen in the geographic cohort group, which had a total of 139 interruptions versus 102 for the nongeographic cohort group.

The researchers noted that their study was done at a single center and did not address clinical outcomes or clinician, patient, or nursing satisfaction, among other limitations. They concluded that while geographic cohorting may increase hospitalists' interactions with patients, these gains may be offset by suboptimal patient loads and ineffective cohorting structure.

“Our work underscores the importance of paying careful attention to specific components and monitoring for unintended consequences in a complex intervention such as cohorting to allow subsequent refinement,” the authors wrote. They called for additional studies to examine the interplay between models of care and their effect on such factors as interruptions, errors, and burnout.