A hospitalist-run short-stay unit: features that predict length-of-stay and eventual admission to traditional inpatient services.
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.
Lucas
Brian P
BP
Division of Hospital Medicine, Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois, USA. brian_lucas@rush.edu
Kumapley
Rudolf
R
Mba
Benjamin
B
Nisar
Imran
I
Lee
Kuenok
K
Ofori-Ntow
Samuel
S
Borkowsky
Shane
S
Asmar
Abdo
A
Lewis
Trevor
T
Bienias
Julia L
JL
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