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. 2014 Feb;9(2):106-10.
doi: 10.1002/jhm.2138. Epub 2013 Dec 31.

Tempering pediatric hospitalist supervision of residents improves admission process efficiency without decreasing quality of care

Eric A Biondi  1 , Michael S Leonard, Elizabeth Nocera, Rui Chen, Jyoti Arora, Brian Alverson
Affiliations

Tempering pediatric hospitalist supervision of residents improves admission process efficiency without decreasing quality of care

Eric A Biondi et al. J Hosp Med. 2014 Feb.

Abstract

Background: Many academic pediatric hospital medicine (PHM) divisions have recently increased in-house supervision of residents, often providing 24/7 in-house attending coverage. Contrary to this trend, we removed mandated PHM attending input during the admission process. We present an evaluation of this process change.

Methods: This cohort study compared outcomes between patients admitted to the PHM service before (July 1, 2011-September 30, 2011) and after (July 1, 2012-September 30, 2012) the process change. We evaluated time from admission request to inpatient orders, length of stay (LOS), frequency of change in antibiotic choice, and rapid response team (RRT) calls within 24 hours of admission. Data were obtained via chart abstraction and from administrative databases. Wilcoxon rank sum and Fisher exact tests were used for analysis.

Results: We identified 182 and 210 admissions in the before and after cohorts, respectively. Median time between emergency department admission request and inpatient orders was significantly shorter after the change (123 vs 62 minutes, P < 0.001). We found no significant difference in LOS, the number of changes to initial resident antibiotic choice, standard of care, or RRTs called within the first 24 hours of admission.

Conclusion: Removing mandated attending input in decision making for PHM admissions significantly decreased time to inpatient resident admission orders without a change in measurable clinical outcomes.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Admission process for patients admitted to PHM service in pre- and post-intervention cohorts.
See this image and copyright information in PMC

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