title: Implementing a Hospitalist Program in a Critical Access Hospital.
abstract: OBJECTIVE
  The hospitalist model of inpatient care has rapidly expanded, but little is known about hospitalist care in critical access hospitals (CAHs). We aimed to determine the impact of a hospitalist model of care on staff satisfaction, patient volumes, patient satisfaction, length of stay, and care quality in a CAH.
  
  
  METHODS
  We initiated a hybrid rotating hospitalist program in September 2008 at Winneshiek Medical Center (Decorah, Iowa), a 25-bed rural CAH. We reviewed patient volumes, Centers for Medicare and Medicaid Services core quality measures, acute length of stay, and staff satisfaction for primary care-hospitalist physicians and inpatient and clinic nurses. Patient volume and length of stay were compared with CAH data reported by the Iowa Hospital Association.
  
  
  RESULTS
  Patient volumes (acute, skilled, and observation) increased by 15% compared with a 17% decrease for statewide CAHs. Length of stay decreased from 2.88 to 2.75 days and remained lower than the average stay for Iowa CAHs (3.05 days). In the year after implementation, we observed no deterioration in core quality measures (range, 93%-100%) or patient satisfaction (86th percentile). Inpatient nurse satisfaction and primary care-hospitalist satisfaction improved. Early clinic nurse skepticism showed improved satisfaction at the 5-year review.
  
  
  CONCLUSIONS
  Hospitalist care contributed to ongoing delivery of high-quality care and satisfactory patient experiences while supporting the mission of a CAH in rural Iowa. Implementation required careful consideration of its effects on the outpatient practice. Broader implementation of this model in CAHs may be warranted.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Dougan
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Carlson
mesh_terms: D020445:Hospitalists / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa; D007902:Length of Stay / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000592:standards* / Q000706:statistics & numerical data; D016730:Program Development / Q000379:methods*; D011788:Quality of Life / Q000523:psychology
keywords: critical access hospital; hospitalist; job satisfaction; nursing staff; personnel staffing and scheduling