title: Tempering pediatric hospitalist supervision of residents improves admission process efficiency without decreasing quality of care.
abstract: BACKGROUND
  Many academic pediatric hospital medicine (PHM) divisions have recently increased in-house supervision of residents, often providing 24/7 in-house attending coverage. Contrary to this trend, we removed mandated PHM attending input during the admission process. We present an evaluation of this process change.
  
  
  METHODS
  This cohort study compared outcomes between patients admitted to the PHM service before (July 1, 2011-September 30, 2011) and after (July 1, 2012-September 30, 2012) the process change. We evaluated time from admission request to inpatient orders, length of stay (LOS), frequency of change in antibiotic choice, and rapid response team (RRT) calls within 24 hours of admission. Data were obtained via chart abstraction and from administrative databases. Wilcoxon rank sum and Fisher exact tests were used for analysis.
  
  
  RESULTS
  We identified 182 and 210 admissions in the before and after cohorts, respectively. Median time between emergency department admission request and inpatient orders was significantly shorter after the change (123 vs 62 minutes, P < 0.001). We found no significant difference in LOS, the number of changes to initial resident antibiotic choice, standard of care, or RRTs called within the first 24 hours of admission.
  
  
  CONCLUSIONS
  Removing mandated attending input in decision making for PHM admissions significantly decreased time to inpatient resident admission orders without a change in measurable clinical outcomes.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of Rochester, Rochester, New York.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Biondi
authors.forename: Michael S
authors.initials: MS
authors.lastname: Leonard
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nocera
authors.forename: Rui
authors.initials: R
authors.lastname: Chen
authors.forename: Jyoti
authors.initials: J
authors.lastname: Arora
authors.forename: Brian
authors.initials: B
authors.lastname: Alverson
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D020445:Hospitalists / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D008297:Male; D009934:Organization and Administration / Q000592:standards*; D010343:Patient Admission / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D016896:Treatment Outcome; D016526:Workload / Q000592:standards