title: Caring for patients in a hospitalist-run clinical decision unit is associated with decreased length of stay without increasing revisit rates.
abstract: BACKGROUND
  Observation medicine is a growing field with increasing involvement by hospitalists. Little has been written regarding clinical outcomes in hospitalist-run clinical decision units (CDUs).
  
  
  OBJECTIVE
  To determine the impact of a hospitalist-run geographic CDU on length of stay (LOS) for observation patients. Secondary objectives included examining the impact on 30-day emergency department (ED) or hospital revisit rates.
  
  
  METHODS
  Retrospective cohort study with pre- and post-implementation analysis.
  
  
  METHODS
  Urban, academic, 600-bed teaching hospital in Camden, New Jersey.
  
  
  METHODS
  Observation patients discharged from medical-surgical units before and after CDU opening and those discharged from the CDU after CDU opening.
  
  
  METHODS
  Creation of a hospitalist-run, 20-bed geographic CDU, adjacent to the ED with order sets, protocols, and priority consults and testing.
  
  
  METHODS
  Median LOS for observation patients was calculated for 7 months pre- and post-CDU implementation. ED and hospital revisits requiring an observation or inpatient stay within 30 days of discharge were measured.
  
  
  RESULTS
  CDU observation patients had a lower median LOS than medical-surgical observation patients during the same period (17.6 hours vs 26.1 hours, P < 0.001). CDU LOS was lower than medical-surgical observation LOS in the 7 months 1 year prior to CDU implementation (17.6 hours vs 27.1 hours, P < 0.001). CDU patients had a similar 30-day ED or hospital revisit rate compared with observation patients pre-CDU.
  
  
  CONCLUSIONS
  Implementing a hospitalist-run geographic CDU was associated with a 35% decrease in observation LOS for CDU patients compared with a 3.7% decrease for medical-surgical observation patients. CDU LOS decreased without increasing ED or hospital revisit rates.
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Cooper University Hospital, Camden, New Jersey; Department of Medicine, Division of Hospital Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Kara S
authors.initials: KS
authors.lastname: Aplin
authors.forename: Susan
authors.initials: S
authors.lastname: Coutinho McAllister
authors.forename: Eric
authors.initials: E
authors.lastname: Kupersmith
authors.forename: Jean-Sebastien
authors.initials: JS
authors.lastname: Rachoin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends*; D005260:Female; D020445:Hospitalists / Q000592:standards / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods / Q000592:standards / Q000639:trends*; D010359:Patient Readmission / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies