Transition of a Neurology Subspecialty Service to a Pediatric Hospitalist Model of Care

OBJECTIVES: Pediatric hospitalists have increasingly been relied on to care for hospitalized patients. While hospitalist care models have shown many benefits, studies examining the transition from subspecialist to hospitalist-led teams are lacking. This study aimed to monitor the impact of transitioning an inpatient pediatric neurology service to a hospitalist model on several key outcome measures, with the hypothesis that these measures would be unaffected by the transition. METHODS: In July 2019, the neurology service at a freestanding pediatric academic center transitioned a hospitalist model. Statistical process control charts tracked patient-level outcomes related to quality, safety, and patient/caregiver experience. A medical education-focused survey was distributed to residents before and after service transition with survey responses analyzed using descriptive statistics. RESULTS: During the 42-month posttransition period, seizure length of stay (LOS) improved from 2.42 to 1.96 days, while headache LOS remained unchanged at 1.44 days. The days between both reported safety events reaching a patient and clinical deterioration events remained stable, although 5 clinical deterioration events were observed in the first 12 months after the transition. Top-box response percentage for posthospitalization survey questions about physicians improved from 70% to 81%. Survey-based medical education evaluations showed no significant changes in resident confidence or neurology knowledge around neurological issues. CONCLUSIONS: Our institution successfully transitioned a pediatric neurology subspecialty inpatient service to a hospitalist-led model while monitoring the effect on quality, safety, patient/caregiver experience, and medical education outcome measures. Studying transitions in care models is necessary to understand their impact and value for pediatric patients.