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Geographic Wards

Have you ever been on a ward team that had patients on multiple units? Have you ever wondered if there could be a better approach to efficiency, teamwork, and accountability?

In January 2019 we re-designed our ward structures at University Hospital around a geographic ward model that co-locates providers on a single unit to achieve the following goals:

Instead of… …Imagine if

Little or no connection between team members

Personal connections between team members

Lack of interprofessional teamwork

Daily interprofessional team huddles/meetings

Waste in travel time between units

Economy of movement on one unit

Constant multitasking


Lack of defined leadership presence

Effective and well-known unit-based leadership

Lack of improvement infrastructure

Improvement in daily milieu

Lack of team specific data

Unit-based data to drive team performance

Idiosyncratic rounding strategies

Structured interdisciplinary bedside rounding

Uncoordinated scheduling

Coordinating scheduling

Emphasis on process

Emphasis on outcomes

We are not afraid to tackle difficult problems, and we have seen both early successes and challenges with geographic wards. Changes like this are considered complex service interventions requiring many iterations to get right.

The geographic teams have new opportunities to get to know nurses better and have in person discussions with consultants on rounds. We are now in the process of creating standard practice for interdisciplinary communication and workflow and handoffs.

Feedback from residents and faculty have already driven driven major improvements to our initial model and residents are part of a geographic wards steering committee and multiple subcommittees to lead these efforts.

As a part of these groups, you will learn about and work on processes involved with bed assignment, flow through the hospital, and minimizing unnecessary handoffs. You will help determine which data best captures patient safety and experience in our new system, help trial and implement the new interdisciplinary communication huddles on our geographic teams, and identify new quality improvement projects through our quality improvement subcommittee.You will be able to participate in efforts to maximize educational experience through creation of needs assessments and curriculum development as part of our education subcommittee.You will be able to promote wellness and learn to advocate for system change in the wellness subcommittee.

You will also have the opportunity to help shape geographic wards and inpatient education for the residency.The opportunities are endless but here are some goals for the future:

  • Create an infrastructure for residents to participate in and lead new inpatient quality improvement projects
  • Develop a system for residents to receive data related to their patient care outcomes
  • Create an acute care track for residents that includes built in time for quality improvement, education related to specific inpatient systems-based care topics, and mentorship
  • Revamp the day float elective to provide an opportunity for residents to gain knowledge and experience in hospital medicine

Contact Us

University of Cincinnati
Department of Internal Medicine

231 Albert Sabin Way
Medical Sciences Building Room 6058
PO Box 670557
Cincinnati, OH 45267-0557

Fax: 513-558-3878