Oksana Buksa, PharmD, April Williams, PharmD, BCPS, Michele Moseley, PharmD, BCPS, Anna Cross, PharmD, Erik Roberts, CPhT
Huntsville Hospital – Huntsville, Alabama
Purpose/Background:
Huntsville Hospital has announced the implementation of a hospitalist-led geographic rounding pilot that began on October 1st, 2025, which was designed to allow providers to care for patients within the same inpatient unit, thereby maximizing efficiency and improving continuity of care, with the goal of decreasing hospital length of stay. The service currently spans three inpatient floors and encourages hospitalists to prioritize rounding on patients who are discharging home first, followed by those discharging to post-acute care facilities, and subsequently, all other patients remaining. In addition, Huntsville Hospital has a robust Transitions of Care team that includes pharmacists who play an integral role in facilitating patient discharges by reviewing discharge medication reconciliation and communicating with providers to clarify medication orders as needed, as well as providing essential medication education to patients. The purpose of this research is to evaluate the outcomes of pharmacist-driven interventions within a hospitalist-led geographic rounding model focused on improving patient outcomes and coordination of care. If the results from this pilot demonstrate positive outcomes and are well received by participating rounding physicians, then the program may be expanded to additional inpatient units within the hospital.
Methodology:
This single center, Institutional Review Committee (IRC)–approved pre and post analysis was designed to evaluate the primary outcome, defined as the time from discharge order placement to patient discharge from the hospital. Secondary outcomes include hospital length of stay, total number of discharge reconciliations reviewed by the Transitions of Care pharmacy team per month, average time required to complete individual discharge interventions, and the total number of discharges classified as having significant clinical impact. Pre-implementation data was collected from the following dates: July 1st-September 30th, 2025. Post implementation data was collected from patients discharged by physicians participating in the rounding pilot between November 1st, 2025 and January 31st, 2026. Outcomes were compared between the three month pre and post implementation periods. Baseline characteristics include age, race, sex, and discharge disposition. Statistical analysis was conducted to evaluate categorical and continuous data using descriptive statistics. These analyses aim to evaluate the potential impact of the rounding pilot and pharmacist-driven discharge processes on the timeliness of hospital discharge and overall patient care outcomes.
Results:
A total of 1,201 discharges occurred during the post-implementation period, of which 418 patients (75.3%) were included in the rounding pilot with documented Transitions of Care (TOC) discharge notes. The primary outcome, the time from discharge order placement to patient discharge from facility, decreased overall in the post-implementation period. However, when stratified by discharge disposition, this time increased for home/self-care patients but not for facility discharges, which may be attributable to the higher proportion of facility discharges in the post period, requiring more complex coordination of care. Additionally, duplicate discharge orders were identified, which may have prolonged discharge timing, as these patients were not ready for discharge at the time of initial order placement. For secondary outcomes, patient length of stay did not decrease in the post-implementation period, which could be impacted by seasonal variability and differences in patient acuity between the pre- and post-implementation groups. The average time to complete TOC discharge notes and the number of interventions with significant clinical impact remained similar between groups.
Conclusion:
Although the results from this study did not demonstrate a consistent improvement in the primary outcome across all discharge dispositions, geographic rounding can still enhance patient care through improved coordination and interdisciplinary communication. The integration of Transitions of Care pharmacists into geographic rounding supports earlier involvement in the discharge process and facilitates optimized medication reconciliation, discharge planning, and patient education.
