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

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. Journal of Hospital Medicine 2016;11:669-674. © 2016 Society of Hospital Medicine.

journal_name

J Hosp Med

journal_title

Journal of hospital medicine

authors

Smith GR Jr,Ma M,Hansen LO,Christensen N,O'Leary KJ

doi

10.1002/jhm.2592

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

669-674

issue

eissn

1553-5592

issn

1553-5606

journal_volume

pub_type

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