Implementation of a hospitalist-run observation unit and impact on length of stay (LOS): a brief report.
BACKGROUND
While the impact of hospitalists on length of stay (LOS) for inpatient medicine services has been studied, there has been little work on the impact of hospitalist involvement in short-stay or observation units.


OBJECTIVE
The primary objective was to examine the impact of a hospitalist-run observation unit on LOS. The secondary objective was to assess utilization of the unit through examining case-weight and LOS.


METHODS
Retrospective cohort study with a preimplementation/postimplementation analysis.


METHODS
University Hospital, the 604-bed teaching hospital for Bexar County, San Antonio, Texas.


METHODS
All patients discharged from the inpatient medicine and observation units with diagnoses of chest pain, asthma, syncope, cellulitis, and pyelonephritis.


METHODS
Creation of a hospitalist-run, nonteaching, 10-bed "Clinical Decision Unit" (CDU).


METHODS
The overall LOS of the "top 5" most common diagnoses was compared for the 12 months preimplementation and postimplementation of the unit.


RESULTS
The overall LOS for all patients decreased from 2.4 to 2.2 days (P = 0.05) between the 12 months preimplementation and postimplementation. The greatest decreases were seen for cellulitis (2.4-1.9 days; P < 0.001) and asthma (2.2-1.2 days; P < 0.001).


CONCLUSIONS
Implementation of a hospitalist-run observation unit was associated with a significantly decreased LOS for all patients regardless of location, suggesting that the unit has led to more efficient care.
Leykum
Luci K
LK
South Texas Veterans' Health Care System, University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Hospital Medicine, 7703 Floyd Curl Drive, Room 5.070R Dental, San Antonio, TX 78229-3900, USA. Leykum@uthscsa.edu
Huerta
Vincent
V
Mortensen
Eric
E
D001249:Asthma; D002637:Chest Pain; D015331:Cohort Studies; D020445:Hospitalists; D006785:Hospitals, University; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D016730:Program Development; D012189:Retrospective Studies; D013781:Texas; D057832:Watchful Waiting