The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital.
OBJECTIVE
To evaluate the impact of implementing a hospitalist service with a nurse discharge planner in an academic teaching hospital.


METHODS
Inpatient medicine service was provided by hospitalists, general internists, and specialists. Service personnel were identical except that the hospitalist service also had a nurse discharge planner. Hospitalists attended 4 months per year (compared with the 1 month by most other attending physicians) and had no outpatient responsibilities during the ward months. Patients were admitted alternately based on resident call schedule. Major outcomes included average costs of hospitalization, length of stay, and resource utilization. Quality measures included inpatient mortality, 30-day readmission rates, and satisfaction of patients, residents and students.


RESULTS
Hospitalist-attended services had lower mean (+/- SD) inpatient costs per patient ($4289 +/- $6512) compared with specialist-staffed services ($6066 +/- $7550, P < 0.0001), with a trend toward lower costs when compared with generalist-attended services ($4850 +/- $7027, P = 0.11). Hospitalist services had shorter mean lengths of stay (4.4 +/- 4.0 days), compared with generalists (5.2 +/- 5.2 days) and specialists (6.0 +/- 5.5 days, P < 0.0001 for hospitalists vs. both groups). Readmission rates were similar in all groups. Mortality rates were higher in the specialist group [5.0% (44 of 874)] compared with hospitalists [2.2% (18 of 829)] and generalists [2.6% (20 of 761), P = 0.002 for specialists vs. both groups, P = 0.09 for generalists vs hospitalists]. Satisfaction results were uniformly high in all groups, with no significant differences.


CONCLUSIONS
Hospitalist services with a nurse discharge planner were associated with lower average cost and shorter average length of hospital stay, without any apparent compromise in clinical outcomes or patient satisfaction.
Palmer
H C
HC
Department of Medicine, West Virginia University, Morgantown, Pennsylvania, USA.
Armistead
N S
NS
Elnicki
D M
DM
Halperin
A K
AK
Ogershok
P R
PR
Manivannan
S
S
Hobbs
G R
GR
Evans
K
K
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D015276:Health Care Rationing / Q000191:economics; D017052:Hospital Mortality; D020445:Hospitalists / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010343:Patient Admission / Q000191:economics; D005791:Patient Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics*; D017060:Patient Satisfaction / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*