Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring

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Abstract

Background: Academic medical centers are increasingly employing hospitalists to staff teaching wards. Although studies have demonstrated reduced lengths of stay (LOSs) associated with hospitalist care, it is unclear which patients are most likely to benefit. We sought to determine whether patients with specific diagnoses or discharge needs account for the association between hospitalist care and reduced LOS. Methods: Hospital admissions were divided into the following 2 groups based on type of attending physician: teaching hospitalist (full-time faculty hospitalist with no outpatient responsibilities) vs nonhospitalist (full-time or voluntary faculty contributing 1 or 2 months of teaching service per year). We included all patients discharged from an academic teaching service for a 2-year period. Data were extracted from the Montefiore Medical Center's clinical information system and the Social Security Death Registry. Results: Mean LOS was lower for teaching hospitalists than for nonhospitalists (5.01 vs 5.87 days [P<.02]). The reduction in LOS was greatest for patients requiring close clinical monitoring (patients with congestive heart failure, stroke, asthma, or pneumonia) and for those requiring complex discharge planning. There were no significant differences between the groups in readmission, in-hospital mortality, or 30-day mortality. Conclusion: Teaching hospitalist care was associated with shorter LOS in patients requiring close clinical monitoring and complex discharge planning, without adversely affecting readmission or mortality rates.

Original languageEnglish (US)
Pages (from-to)1869-1874
Number of pages6
JournalArchives of Internal Medicine
Volume167
Issue number17
DOIs
StatePublished - Sep 24 2007

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Hospitalists
Patient Discharge
Length of Stay
Teaching
Mortality
Social Security
Physiologic Monitoring
Hospital Mortality
Information Systems
Registries
Pneumonia
Outpatients
Asthma
Heart Failure
Stroke
Physicians

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring",
abstract = "Background: Academic medical centers are increasingly employing hospitalists to staff teaching wards. Although studies have demonstrated reduced lengths of stay (LOSs) associated with hospitalist care, it is unclear which patients are most likely to benefit. We sought to determine whether patients with specific diagnoses or discharge needs account for the association between hospitalist care and reduced LOS. Methods: Hospital admissions were divided into the following 2 groups based on type of attending physician: teaching hospitalist (full-time faculty hospitalist with no outpatient responsibilities) vs nonhospitalist (full-time or voluntary faculty contributing 1 or 2 months of teaching service per year). We included all patients discharged from an academic teaching service for a 2-year period. Data were extracted from the Montefiore Medical Center's clinical information system and the Social Security Death Registry. Results: Mean LOS was lower for teaching hospitalists than for nonhospitalists (5.01 vs 5.87 days [P<.02]). The reduction in LOS was greatest for patients requiring close clinical monitoring (patients with congestive heart failure, stroke, asthma, or pneumonia) and for those requiring complex discharge planning. There were no significant differences between the groups in readmission, in-hospital mortality, or 30-day mortality. Conclusion: Teaching hospitalist care was associated with shorter LOS in patients requiring close clinical monitoring and complex discharge planning, without adversely affecting readmission or mortality rates.",
author = "Southern, {William N.} and Berger, {Matthew Alan} and Bellin, {Eran Y.} and Hailpern, {Susan M.} and Arnsten, {Julia H.}",
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