The Effect of Full-Time Faculty Hospitalists on the Efficiency of Care at a Community Teaching Hospital

BACKGROUND: Hospitalists are increasingly being used for inpatient care. OBJECTIVE: To investigate whether the use of hospitalists is beneficial. DESIGN: Retrospective cohort study. SETTING: Inpatient medical service of a 500-bed community teaching hospital. PARTICIPANTS: 1620 patients in the study group, seen during the hospitalist year; 1679 patients from the same outpatient practice as the study group, seen during the previous year (prehospitalist year); an unselected comparison group of 3413 patients seen during the prehospitalist year and 3223 patients seen during the hospitalist year; and a subset of the unselected comparison group, cared for by outpatient practices, who had a prehospitalist length of stay similar to that of the study group (743 patients in the prehospitalist year and 786 in the hospitalist year). INTERVENTIONS: Full-time faculty hospitalists cared for the study group, were in the hospital during normal working hours, and made decisions throughout the day. In the prehospitalist year and in the comparison groups, primary care physicians managed their own hospitalized patients. MEASUREMENTS: Length of stay; cost of care; costs of hematology and chemistry evaluation, pharmacy, and radiology; and readmissions were determined for the prehospitalist and hospitalist years. RESULTS: In the study group, median length of stay decreased from 6.01 to 5.01 days (P < 0.001). Median cost of care decreased from $4139 to $3552 (P < 0.001), and the 14-day readmission rate decreased from 9.9 to 4.64 readmissions per 100 admissions (P < 0.001). In the comparison groups, length of stay decreased but both cost of care and readmission rates increased. CONCLUSION: Hospitalists may improve the efficiency of inpatient care. Further study in various settings is needed to verify these findings.