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 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.

[1]  E. Rich,et al.  Post-call transfer of resident responsibility , 1990, Journal of General Internal Medicine.

[2]  Mark V. Williams,et al.  The effect of hospitalist discontinuity on adverse events. , 2015, Journal of hospital medicine.

[3]  N. Rathlev,et al.  Time series analysis of variables associated with daily mean emergency department length of stay. , 2007, Annals of emergency medicine.

[4]  F. Percival,et al.  Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis , 2013, PloS one.

[5]  S. Desai,et al.  Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. , 2013, JAMA internal medicine.

[6]  Derek Bell,et al.  Effectiveness of acute medical units in hospitals: a systematic review. , 2009, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[7]  Eric Howell,et al.  Active Bed Management by Hospitalists and Emergency Department Throughput , 2008, Annals of Internal Medicine.

[8]  Kenneth Epstein,et al.  The impact of fragmentation of hospitalist care on length of stay. , 2010, Journal of hospital medicine.

[9]  Steven L Bernstein,et al.  The effect of emergency department crowding on clinically oriented outcomes. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[10]  Liability impact of the hospitalist model of care. , 2014, Journal of hospital medicine.

[11]  George Wells,et al.  The effect of hospital occupancy on emergency department length of stay and patient disposition. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[12]  J. Padmore,et al.  Residents’ and Attending Physicians’ Handoffs: A Systematic Review of the Literature , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[13]  Jason M. Stein,et al.  Acute medicine in the United Kingdom: first-hand perspectives on a parallel evolution of inpatient medical care. , 2012, Journal of hospital medicine.

[14]  Vincent Liu,et al.  Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. , 2012, Journal of hospital medicine.

[15]  J. Butler,et al.  Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure , 2008, Circulation.

[16]  Paul Kolm,et al.  Effect of hospitalist workload on the quality and efficiency of care. , 2014, JAMA internal medicine.

[17]  D. Firth.  Bias reduction of maximum likelihood estimates , 1993 .

[18]  P. Austin,et al.  A Modification of the Elixhauser Comorbidity Measures Into a Point System for Hospital Death Using Administrative Data , 2009, Medical care.

[19]  R. Wachter,et al.  Does continuity of care matter? No: discontinuity can improve patient care. , 2001, The Western journal of medicine.