title: A hospitalist-run short-stay unit: features that predict length-of-stay and eventual admission to traditional inpatient services.
abstract: BACKGROUND
  Short-stay units (SSUs) provide an alternative to traditional inpatient services for patients with short anticipated hospital stays. Yet little is known about which patient types predict SSU success.
  
  
  OBJECTIVE
  To describe patients admitted to our hospitalist-run SSU and explore predictors of length-of-stay (LOS) and eventual admission to traditional inpatient services.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Large public teaching hospital.
  
  
  METHODS
  Consecutive admissions (n = 755) to the SSU over 4 months.
  
  
  METHODS
  Hospitalist attending physicians prospectively collected data from patients' histories, physical exams, and medical records upon admission and discharge.
  
  
  METHODS
  Risk assessments were made for patients with our most common provisional diagnoses: possible acute coronary syndrome (ACS) and heart failure. Patient stays were considered successful when LOS was less than 72 hours and eventual admission to traditional inpatient services was not required.
  
  
  RESULTS
  Of 738 eligible patients, 79% (n = 582) had successful SSU stays. In a multivariable model, the provisional diagnosis of heart failure predicted stays longer than 72 hours (P = 0.007) but risk assessments were unimportant. Patients who received specialty consultations were most likely to need eventual admission (odds ratio [OR], 13.1; 95% confidence interval [CI], 6.9-24.9), and the likelihood of long stays was inversely proportional to the accessibility of diagnostic tests.
  
  
  CONCLUSIONS
  In our hospitalist-run SSU, the inaccessibility of diagnostic tests and the need for specialty consultations were the most important predictors of unsuccessful stays. Designs for other SSUs that care for mostly low-risk patients should focus on matching patients' diagnostic and consultative needs with readily accessible services.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois, USA. brian_lucas@rush.edu
authors.forename: Brian P
authors.initials: BP
authors.lastname: Lucas
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kumapley
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mba
authors.forename: Imran
authors.initials: I
authors.lastname: Nisar
authors.forename: Kuenok
authors.initials: K
authors.lastname: Lee
authors.forename: Samuel
authors.initials: S
authors.lastname: Ofori-Ntow
authors.forename: Shane
authors.initials: S
authors.lastname: Borkowsky
authors.forename: Abdo
authors.initials: A
authors.lastname: Asmar
authors.forename: Trevor
authors.initials: T
authors.lastname: Lewis
authors.forename: Julia L
authors.initials: JL
authors.lastname: Bienias
mesh_terms: D054058:Acute Coronary Syndrome; D000368:Aged; D002641:Chicago; D017598:Efficiency, Organizational; D005260:Female; D006333:Heart Failure; D020445:Hospitalists; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019370:Observation; D016017:Odds Ratio; D010343:Patient Admission; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment