Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay

BACKGROUND Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE To compare the effect of 2 hospitalist admission service models (“general” and “admitter‐rounder”) on patient disposition and length of stay. DESIGN R...

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Bibliographic Details
Published in:	Journal of hospital medicine Vol. 11; no. 10; pp. 669 - 674
Main Authors:	Smith, G. Randy, Ma, Madeleine, Hansen, Luke O., Christensen, Nick, O'Leary, Kevin J.
Format:	Journal Article
Language:	English
Published:	United States Frontline Medical Communications 01-10-2016
Subjects:	Continuity of Patient Care Critical Care - statistics & numerical data Emergency Service, Hospital Female Hospitalists Hospitalists - utilization Hospitalization - statistics & numerical data Hospitals, Teaching - manpower Humans Length of Stay - statistics & numerical data Male Medicine Middle Aged Patient Admission - statistics & numerical data Patient admissions Patient Readmission - statistics & numerical data Retrospective Studies United States
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Summary:	BACKGROUND Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE To compare the effect of 2 hospitalist admission service models (“general” and “admitter‐rounder”) on patient disposition and length of stay. DESIGN Retrospective observational cohort study with difference‐in‐difference analysis. SETTING Large tertiary academic medical center in the United States. PARTICIPANTS Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013. INTERVENTIONS Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions. MEASUREMENTS Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge. RESULTS The change of hospitalist services to an admitter‐rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference‐in‐difference P = 0.32 and P = 0.87, respectively). The admitter‐rounder model was associated with decreased readmissions compared to the teaching service on difference‐in‐difference analysis (odds ratio difference: −0.21, P = 0.01). Adoption of the hospitalist admitter‐rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P < 0.001). CONCLUSIONS Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter‐rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016;11:669–674. © 2016 Society of Hospital Medicine
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	1553-5592 1553-5606
DOI:	10.1002/jhm.2592