Becker's Clinical Quality & Infection Control

12 QUALITY IMPROVEMENT & MEASUREMENT How this Baptist Memorial hospital rounds 350 patients in 30 minutes By Mariah Taylor I n the spring of 2025, Baptist Memorial Hospital Memphis (Tenn.) leaders launched a new huddle system that improved physician satisfaction, patient experience and cut length of stay. Coming out of the pandemic, the hospital struggled with patient flow and higher length of stay. To fix this, leaders attempted to implement various rounding approaches but were unable to find a sustainable solution, Nirmit Kothari, MD, associate chief medical officer at the hospital, told Becker's. Common techniques such as geographic rounding proved difficult for the 600-bed hospital, with the units divided into four towers. ose rounding events would take an hour or more. "Participation suffered, and when a key member was missing, the whole thing lost effectiveness," Dr. Kothari said. "So we decided to take a different approach. Instead of us designing the solution, we went to the leadership of those areas — hospitalists, case management, and nursing — and said: 'is is the problem. Our length of stay is high, our patient flow is poor. Help us design a solution.'" ey developed a new technique called the dispo expo. is 30 minute daily meeting brings together physicians, nurses, case management and leaders from 10 units to discuss discharge planning and disposition. Dispo expo begins at 10:15 every morning in a large conference room. Charge nurses and case managers from each unit occupy one of the 10 tables, and representatives from ancillary departments such as therapy, imaging and respiratory therapy, sit at an 11th table. Physicians talk with the leaders and specialists needed to review care progression planning for the day, barriers to care, discharge plans and what is needed next for patient care. "e physician, case manager and nurse manager will all know the plan," Dr. Kothari said. "And if something time-sensitive is pending, like an MRI, physicians no longer have to relay that through the nurse to the charge nurse to radiology. We have a radiology representative at the table — they mention it directly, and it gets done." e chief nursing officer, assistant CNO or Dr. Kothari attends each dispo expo so any challenges with a facility, consult or delayed testing can be handled swily. Aer the meeting, the charge nurse and case manager take the information shared back to their unit for a quick huddle, which allows nurses to directly update the patient and family on next steps. e dispo expo allows clinicians across 10 units to cover roughly 350 patients in under 30 minutes. Most physicians spend no more than 15 minutes total, Dr. Kothari said. e dispo expo began on three med-surg units, but now covers 80% of med-surg and step-down patients. e remaining units are overseen with bedside intensivist rounding. Since launching, the hospital has seen a 10% improvement in observed-to-expected length of stay ratio, which helped create enough capacity to support nearly double-digit growth in inpatient discharge volume last year. Patient experience and physician engagement have also improved. "Perhaps the most meaningful outcome is something harder to quantify: we rebuilt relationships that were lost during COVID," Dr. Kothari said. "A front-line hospitalist now knows who to call in radiology — not through three layers of relay, but directly, because they've been in the same room together every morning. at kind of connection pays dividends well outside of the 10:15 huddle." e dispo expo might be expanded to one or two more units, but hospital leaders are primarily focused on leveraging it for quality work. So far, the expo has improved line days for central lines and Foley catheters. "e core principle that guided us — and still does — is that the flow of patients stops when the flow of information stops," Dr. Kothari said. "is is really about timely information, better communication, and connecting the dots between flow and quality." n Image Credit: Baptist Memorial hospital

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