AOD Role
Administrator of the Day Proposal Section of Hospital Medicine Vanderbilt University Medical Center May 12, 2025
Situation:¶
The Section of Hospital Medicine at VUMC has become increasingly complex such that the demands of administrative services (triage, admin of the day, census management, transfer requests, etc.) have become too great to "add on" to providers already stretched by clinical demands.
Background:¶
During FY25 so far, Hospital Medicine at VUH has cared for an average of 233 patients daily or about 27% of all patients in either inpatient or observation status at VUH. The Section of Hospital Medicine also provides triage assistance for all patients admitted to services in the Medicine and Cancer PCCs. Over time, the approach to managing ancillary services (triage, OSH transfer calls, direct admissions, etc.) has been to assign these tasks to primarily clinical providers closely aligned to the ancillary service or with perceived bandwidth to assist. This has resulted in these ancillary services being distributed to multiple providers across multiple service lines within hospital medicine. For example, the consult attending assists with triage during the day.
One of these ancillary services is the Hospital Medicine Admin of the Day, which is an internal position tasked with responding to issues that arise during the day, i.e. callouts, all manner of escalations, census management, admit bolus management, etc. These are generally hospitalists who have leadership roles and/or have significant institutional knowledge to be able to assist the team.
Assessment:¶
Due to variety of reasons, but mostly due to the increasing size of hospital medicine and the constant demand for medicine as the primary service, these ancillary services have now become unmanageable by the individuals assigned to primary, RVU-generating, clinical roles.
Recommendation: Create an FTE-supported Administrator of the Day position within the Section of Hospital Medicine. See the attached role description.
Description:¶
The Hospital Medicine Administrator of the Day (AOD) is a nonclinical position with a provider responsible for responding to issues that may arise during the day that can directly and indirectly impact clinical workflow and patient care for Hospital Medicine and, by extension, other services under the Department of Medicine. This position will be filled by providers who have leadership roles and/or a high level of institutional knowledge. Providers will work a 10-hour shift, 6AM-4PM for 1.0 clinical FTE with the following responsibilities:
Callouts/Census Back-up¶
6-7AM: notify Riven Backup by phone call if being called in\ Notify Census Back-up & Morgan attendings of surge implementation, if necessary, as outlined in HM Surge Plan\ If either of the above occurs, notify MAC RN, TMO administrator on call, and pharmacy, in addition to emailing Anne Axon to ensure appropriate credit given\ Brief email/text update to providers on service regarding census, back-up, etc\ 4-5PM: review total HM census for likelihood of Census Back-up the following day
Patient Distribution¶
6-7AM: Ensure balanced numbers and appropriate localization across Riven teams\ Check in with MAC RN regarding holdover admissions and available teaching spots, proactively triggering Admission Surge Plan as appropriate
ED Triage¶
Responds to triage questions (appropriate service, level of care, etc.) for patients requested admission to Medicine, utilizing Service Designation List\ Proactively works with MAC RN to direct patients to appropriate provider teams, based on team census, expected discharges, admitting capacity\ Active presence in ED to assist with potential discharges from the ED with appropriate outpatient disposition for intended admissions (rapid ED follow-up)
Off-service transfers¶
Fields requests through the MAC for transfer of patients on non-medicine services to Medicine teams with acceptance contingent on census and reason for transfer
Outside hospital transfers¶
Morgan attendings will continue to field OSH transfer requests and write brief update utilizing templated note\ AOD can/should assist with back transfer policy
Direct admission requests¶
Field requests through the MAC for direct admissions and connect with admitting provider to obtain information and ensure appropriate disposition\ Write brief clinical update with reason for admission and recommended action plan for admitting provider
Capacity Management (Future Role)¶
Identify priority discharges and assist with >11AM discharges (call to expedite tests/procedures, consultant recommendations)\ Work directly with patient flow nurse, CM/SW, OCC, PT/OT to arrange the best realistic DC plan more quickly
Data Tracking¶
Fill out Input Tracker shared with all AOD providers - Total Night Admissions to HM (N1, N2, N3, Scoville Admit + Other Scoville), # of Holdover Admissions at 7:00 AM - 7 AM Total HM Census (based on shared list) - Called in Census Backup/Riven Backup? - Total Day Admissions to HM (APP Admit, Obs, VICP, other ICU Transfers (MAC) - Off-service Transfers, accepted/requests (AOD + MAC if universally rejecting all transfers due to census - 4 PM Total HM Census (based on shared list)