Geographic cohorting of adult inpatient teams: A scoping review

Geographic cohorting (GCh) is a popular model of care that localizes physician teams to a single hospital unit.

We conducted a scoping review identifying the aims, implementation strategies, study methods, and measured outcomes of GCh.

We searched the medical literature analysis and retrieval system online, Embase, and Scopus databases. Eligible citations included English language reports of interventions including GCh in adult patients. Included studies were screened for their aim, GCh implementation strategy, study method, and outcomes measured.

Of 1863 identified citations, 30 met inclusion criteria, representing 27 interventions. Implementation aims varied from specific goals measured by a single metric to multiple outcomes intended to capture wide-ranging effects of GCh. A majority of studies (n = 13, 48.1%) used a pre-post cohort design. GCh was implemented in one of four ways: (1) as a stand-alone intervention, (2) bundled with accountable care unit elements, (3) bundled with care components that did not include all ACU elements, (4) GCh bundled with ACU elements and additional components ("enhanced" ACU). The measured outcomes sorted to eight different categories: patient outcomes, patient safety, patient experience, work flow, workload, clinician experience, communication/team work, and cost.

The current literature on GCh describes implementation as both a stand-alone intervention and bundled with other care elements. Current research has not delineated whether the degree to which GCh is implemented matters, nor what impact it has as part of a bundled care intervention. Future work would benefit from a prospective design that clarifies these questions, facilitating care models tailored to the needs of the practice ecosystem.