Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring.
BACKGROUND
Academic medical centers are increasingly employing hospitalists to staff teaching wards. Although studies have demonstrated reduced lengths of stay (LOSs) associated with hospitalist care, it is unclear which patients are most likely to benefit. We sought to determine whether patients with specific diagnoses or discharge needs account for the association between hospitalist care and reduced LOS.


METHODS
Hospital admissions were divided into the following 2 groups based on type of attending physician: teaching hospitalist (full-time faculty hospitalist with no outpatient responsibilities) vs nonhospitalist (full-time or voluntary faculty contributing 1 or 2 months of teaching service per year). We included all patients discharged from an academic teaching service for a 2-year period. Data were extracted from the Montefiore Medical Center's clinical information system and the Social Security Death Registry.


RESULTS
Mean LOS was lower for teaching hospitalists than for nonhospitalists (5.01 vs 5.87 days [P < .02]). The reduction in LOS was greatest for patients requiring close clinical monitoring (patients with congestive heart failure, stroke, asthma, or pneumonia) and for those requiring complex discharge planning. There were no significant differences between the groups in readmission, in-hospital mortality, or 30-day mortality.


CONCLUSIONS
Teaching hospitalist care was associated with shorter LOS in patients requiring close clinical monitoring and complex discharge planning, without adversely affecting readmission or mortality rates.
Southern
William N
WN
Department of Medicine, Weiler Hospital of Albert Einstein College of Medicine, 1825 Eastchester Rd, Bronx, NY 10461, USA. wsouther@montefiore.org
Berger
Matthew A
MA
Bellin
Eran Y
EY
Hailpern
Susan M
SM
Arnsten
Julia H
JH
D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000628:therapy; D017052:Hospital Mortality; D020445:Hospitalists; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000628:therapy; D020521:Stroke / Q000628:therapy; D000078329:Workforce