Key result
The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay (+0.49 hours, P<0.001) and a decrease in readmissions (OR difference -0.21, P=0.01).
Why the study?
Does an admitter-rounder hospitalist model reduce transfer to critical care, readmission, or length of stay compared to a teaching service in patients admitted from the emergency department?
Cohort (n=19,270)
No
Does an admitter-rounder hospitalist model reduce transfer to critical care, readmission, or length of stay compared to a teaching service in patients admitted from the emergency department?
Effect estimate: odds ratio difference: -0.21
p-value: p=0.01
The admitter-rounder hospitalist model was associated with decreased 30-day readmissions but increased emergency department length of stay compared to a teaching service.
Admitter-rounder models may lower readmissions despite longer ED stays; leaves open optimal hospitalist structure in observational data.
BACKGROUND: Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE: To compare the effect of 2 hospitalist admission service models ("general" and "admitter-rounder") on patient disposition and length of stay. DESIGN: Retrospective observational cohort study with difference-in-difference analysis. SETTING: Large tertiary academic medical center in the United States. PARTICIPANTS: Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013. INTERVENTIONS: Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions. MEASUREMENTS: Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge. RESULTS: The change of hospitalist services to an admitter-rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference-in-difference P = 0.32 and P = 0.87, respectively). The admitter-rounder model was associated with decreased readmissions compared to the teaching service on difference-in-difference analysis (odds ratio difference: -0.21, P = 0.01). Adoption of the hospitalist admitter-rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P < 0.001). CONCLUSIONS: Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016;11:669-674.
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Smith et al. (2016) conducted a cohort in Hospital admission (n=19,270). Hospitalist admitter-rounder admission service model vs. Teaching service admissions was evaluated on Hospital readmission rates ≤30 days postdischarge (odds ratio difference: -0.21, p=0.01). The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay (+0.49 hours, P<0.001) and a decrease in readmissions (OR difference -0.21, P=0.01).
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