The effect of nonteaching services on the distribution of inpatient cases for internal medicine residents.
OBJECTIVE
Nonteaching services (NTSs) are becoming increasingly prevalent in academic hospitals. This study was designed to determine whether the presence of an NTS is associated with higher acuity and altered case mix on the teaching service.


METHODS
The authors carried out a retrospective, cross-sectional analysis of data about all general medical admissions between January 1, 2005 and June 30, 2005 to either of two teaching hospitals in Rochester, New York. A total of 6,907 inpatients were studied, of whom 1,976 (29%) were admitted to medicine resident services and 4,931 (71%) were admitted to NTSs. Hospital billing databases were used to determine patient demographics, ICD-9 diagnoses, Charlson Comorbidity Index scores, and patient disposition.


RESULTS
Compared with NTS patients, patients on resident services had higher median Charlson Comorbidity Index scores (3.0 versus 2.0, P < .001) and numbers of comorbidities (9.0 versus 8.0, P < .001) and were more likely to require intensive care (15.5% versus 7.6%, P < .001) and to die in the hospital (8.2% versus 4.5%, P < .001). Patients on the resident services were more likely to have acute renal failure, respiratory failure, septicemia, and HIV. Residents were less likely to care for patients with primary diagnoses of chest pain, cellulitis, alcohol withdrawal, and sickle cell crisis. The differences in patients' conditions between resident services and NTSs were similar in the two hospitals and also among patients who had not received intensive care.


CONCLUSIONS
Patients on resident services may be more medically complex and more likely to have high-acuity diagnoses than patients on NTSs. How these differences affect residents' education, residents' career decisions, and practice styles deserves further study.
O'Connor
Alec B
AB
Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. alec_oconnor@urmc.rochester.edu
Lang
Valerie J
VJ
Lurie
Stephen J
SJ
Lambert
David R
DR
Rudmann
Andrew
A
Robbins
Brett
B
Bordley
Donald R
DR
D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016526:Workload