Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay

Abstract

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. © 2016 Society of Hospital Medicine.