Association of Hospital Admission Service Structure With Early Transfer to Critical Care, Hospital Readmission, and Length of Stay

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Abstract

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.

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