The positive impact of initiation of hospitalist clinician educators

Abstract

Objective: Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation.

Design: Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents (N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service.

Results: Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged.

Conclusion: Hospitalist clinician educators as inpatient teaching attendings effectively reduce length of stay and resource utilization while improving resident education at community-based teaching hospitals.

FIGURE 1

Length of stay by diagnosis related group: hospitalist clinician educators versus private physicians for fiscal year 2000. In descending order of prevalence, the bars represent percentage increases or decreases in length of stay for HCEs as compared to private physicians (P = .002). Diagnosis related group for pneumonia = 89, congestive heart failure + shock = 127, cerebrovascular accident = 14, gastrointestinal miscellaneous = 182, pancreatic diseases (not cancer) = 204, toxic effects of drugs = 449, alcohol/drug abuse/dependency = 434, chest pain = 143, alcohol liver disease = 202, diabetes with complications (age >35), arrhythmias = 138.

FIGURE 2

Cost per case by diagnosis related group: hospitalist clinician educators versus all other MDs for fiscal year 2000. In descending order of prevalence, the bars represent the relative percentage increases or decreases in cost per case for the HCEs as compared to the private physicians (P = .01). Diagnosis related group for pneumonia = 89, congestive heart failure + shock = 127, cerebrovascular accident = 14, gastrointestinal miscellaneous = 182, pancreatic diseases (not cancer) = 204, toxic effects of drugs = 449, alcohol/drug abuse/dependency = 434, chest pain = 143, alcohol liver disease = 202, diabetes with complications (age >35), arrhythmias = 138.

FIGURE 3

Resident perception of hospitalist clinician educators’ impact on educational activities. Residents were asked to assess the effect of HCEs on several parameters of their inpatient experience on a 5-point Likert scale.

FIGURE 4

Resident perception of hospitalist clinician educators’ impact on resource utilization. Residents were asked whether use of evidence-based medicine, cost awareness, ancillary studies (labs, X-rays), and subspecialty consults was “increased,”“unchanged,” or “decreased” by the presence of HCEs. Percentages of each response are shown above.

FIGURE 5

Resident perception of hospitalist clinician educators’ impact on resident behavior. Residents were asked whether their sense of responsibility, level of control, team leadership, and time spent with families was “increased,”“unchanged,” or “decreased” by the presence of HCEs. Results are shown by percentage for each response.