Effect of a neurohospitalist service on outcomes at an academic medical center.
OBJECTIVE
To study the effect of a neurohospitalist service on length of stay, cost, patient satisfaction, and education at an academic medical center.


METHODS
This was a retrospective cohort study using administrative data, educational surveys, and standardized patient satisfaction surveys to compare outcomes in the 21 months before (n = 343) and 27 months after (n = 436) the introduction of a neurohospitalist service in October 2006 at a single tertiary care academic medical center.


RESULTS
The most common diagnoses treated in both periods were demyelinating disease, neuromuscular disease, seizure, CNS infection, and cerebrovascular disease. Mean length of stay was reduced during the neurohospitalist period compared with that during the preneurohospitalist period (4.6 days vs 6.3 days; p < 0.001), but there was no difference in median cost ($6,758 vs $7,241; p = 0.25) or in-hospital mortality (1.6 vs 1.2%; p = 0.61). After adjustment for diagnosis, admission source, and severity of illness, both length of stay (coefficient -1.85, 95% confidence interval [CI] -2.47 to -1.24) and cost (coefficient -1,558, 95% CI -2,645 to -470) were reduced during the neurohospitalist period. Thirty-day readmission rates were not different between the 2 periods in adjusted analysis. There were no differences in patient satisfaction or resident trainee satisfaction between the 2 periods, but medical student satisfaction was higher on standard educator evaluations after the neurohospitalist program was introduced.


CONCLUSIONS
The introduction of a neurohospitalist service at an academic medical center coincided with a reduction in length of stay and cost and a nonsignificant trend toward improvement in medical student satisfaction without affecting mortality, readmission rates, or patient satisfaction.
Department of Neurology, University of California, San Francisco, USA. vanja.douglas@ucsf.edu
Vanja C
VC
Douglas
Brian J
BJ
Scott
Geraldine
G
Berg
William D
WD
Freeman
S Andrew
SA
Josephson
D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D004501:Education, Medical; D005260:Female; D017052:Hospital Mortality; D020445:Hospitalists; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009462:Neurology; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013337:Students, Medical