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Sexton JR, Kelly-Weeder S. The Role of Pediatric Nurses During Preventable Adverse Event Disclosure: A Scoping Review. J Patient Saf 2024; 20:381-387. [PMID: 38747504 DOI: 10.1097/pts.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
OBJECTIVES Preventable adverse events (PAEs) occur across the healthcare spectrum; and, unfortunately, errors, adverse events, and PAEs are common in pediatric care. Historically, the role of disclosure of PAEs to patients and their families occurred between the dyad of physician and patient, with physicians assuming the responsibility of disclosure. In recent years, a trend toward a multidisciplinary team-based approach has emerged in some institutions, yet the role of pediatric nurses within the team disclosing a PAE is not fully understood. Given the unique relationship between pediatric nurses and their patients and their families, it is essential to understand does the literature tell us about the role of pediatric nurses during PAE disclosure? METHODS The Arksey and O'Malley scoping review method guided this study protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework guided reporting. RESULTS The final sample included five articles for synthesis: none reported or described a specific role for pediatric nurses during PAE disclosure. CONCLUSIONS There is a gap in the literature on the role of pediatric nurses during PAE disclosure. Two themes emerged from this review: the use of a team-based approach to disclosure, and the need to provide emotional support to the pediatric patient and their family. There is a need for additional investigation into the role of pediatric nurses as part of a team-based disclosure process and how pediatric nurses currently provide, or desire to provide, emotional support to the patient and their family.
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Chatterton B, Chen J, Schwarz EB, Karlin J. Primary Care Physicians' Perspectives on High-Quality Discharge Summaries. J Gen Intern Med 2024; 39:1438-1443. [PMID: 38010464 PMCID: PMC11169121 DOI: 10.1007/s11606-023-08541-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Successful transitions of care require communication between inpatient and outpatient physicians. The discharge summary is the main communication tool used by physicians during these transitions. OBJECTIVE With the goal of improving care transitions, we explored primary care physicians (PCPs) perspectives on characteristics of high-quality discharge summaries. DESIGN We conducted semi-structured individual interviews in this qualitative study and surveyed participants for sociodemographic characteristics. PARTICIPANTS PCPs were recruited from multiple health systems in California. APPROACH An interview guide was created by the study authors to solicit PCPs' experiences with discharge summaries and perspectives on four discharge summary templates previously used by large health systems. Interviews were transcribed verbatim and qualitative data were analyzed interactively through thematic analysis. KEY RESULTS Twenty PCPs participated in interviews lasting an average of 35 min (range 26-47 min). Sixty percent were female. Most (70%) had trained in internal medicine (IM); 5% had trained in both IM and pediatrics and 25% in family medicine. Some (45%) participants practiced both inpatient and outpatient medicine; 55% had exclusively outpatient practices. Half worked in university-affiliated clinics, 15% community clinics, 15% public health clinics, 5% private practice, and 15% multiple clinic types. Many PCPs (65%) had been in practice for ≥ 10 years. Participants reported multiple concerns with typical discharge summaries, including frustration with lengthy documents containing information irrelevant to outpatient care. Suggested recommendations included beginning the discharge summary with action items, clear identification of incidental findings requiring follow-up, specifying reasons for any medication changes, and including dates for treatment regimens rather than expected duration of treatment. Participants highlighted the importance of feedback to trainees to assist in crafting succinct discharge summaries containing relevant information. CONCLUSION Clinical training programs and healthcare systems must optimize discharge summaries for PCPs to achieve goals of providing high-quality care that improves population health.
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Affiliation(s)
- Brittany Chatterton
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA.
| | - Jennifer Chen
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Eleanor Bimla Schwarz
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Karlin
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA
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Choi JJ, Evans AT, McNairy ML. Facilitated Peer Mentoring: Filling a Critical Gap in Academic Hospital Medicine. J Hosp Med 2020; 15:563-565. [PMID: 32118569 DOI: 10.12788/jhm.3371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/07/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Justin J Choi
- Section of Hospital Medicine, Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Arthur T Evans
- Section of Hospital Medicine, Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Margaret L McNairy
- Section of Hospital Medicine, Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
- Center for Global Health, Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
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Abstract
EXECUTIVE SUMMARY Hospitals experiencing financial pressures are seeking to gain efficiencies through innovation. One solution is to engage hospitalists to help reduce the average length of stay (ALOS). This study considers whether and to what extent hospitalists affect ALOS and whether an association exists between the number of hospitalists per occupied bed (density) and ALOS. We examined 2,858 hospitals nationwide, including 20,180 hospital-years of data from 2007 through 2015 derived from the American Hospital Association Annual Survey database. Key findings showed that hospitals using hospitalists reported a statistically significant shorter ALOS than hospitals without hospitalists. The results also indicated a statistically significant decrease in ALOS for an increase in hospitalist full-time equivalent per occupied bed. This study is important because of the generalizability of its results and suggests that hospitals may form partnerships with hospitalists to improve hospital efficiency.
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Goodwin JS, Salameh H, Zhou J, Singh S, Kuo YF, Nattinger AB. Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA Intern Med 2018; 178:196-203. [PMID: 29279886 PMCID: PMC5801052 DOI: 10.1001/jamainternmed.2017.7049] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS We used a 5% sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more. We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97% for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95% CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33% for patients cared for by first-year hospitalists vs 2.96% for second-year hospitalists. (odds ratio, 0.84; 95% CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
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Affiliation(s)
- James S Goodwin
- Department of Medicine, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Habeeb Salameh
- Department of Medicine, University of Texas Medical Branch, Galveston
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | | | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee
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Zacharias R, Belcher S, Rodway-Norman M, Guller D, Chawla A, Hough P, Smith WG. Exploration of a new model of care in a psychiatry unit. Healthc Manage Forum 2017; 30:107-110. [PMID: 28929892 DOI: 10.1177/0840470416658906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The model established at Orillia Soldiers Memorial Hospital involves family physicians as the most responsible physician. They act as "admission gatekeeper" for all unattached patients who are admitted to the psychiatry in-patient unit. A PubMed, EBSCO, OVID Medline, Embase, CINAHL, and Web of Science database review of the last 10 years (2006-2016) was undertaken. A satisfaction survey was undertaken. An intensive literature review found this model to be unique. The model has proved to be extremely efficient and cost-effective.
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Affiliation(s)
- R Zacharias
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - S Belcher
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - M Rodway-Norman
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - D Guller
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - A Chawla
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - P Hough
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - W G Smith
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
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Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study. J Gen Intern Med 2015; 30:1164-71. [PMID: 25822112 PMCID: PMC4510218 DOI: 10.1007/s11606-015-3260-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/05/2015] [Accepted: 02/18/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals. OBJECTIVE We aimed to determine the rate of post-discharge AEs, classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients. DESIGN This was a prospective cohort study of patients at risk for post-discharge adverse events from December 2011 through October 2012. PATIENTS Six hundred and eighty-four patients who were under the care of hospitalist physicians and were being discharged home, spoke English, and could be contacted after discharge, were admitted to the medical service. Patients were stratified as urban/rural using zip code of residence. Rural patients were oversampled to ensure equal enrollment of urban and rural patients. MAIN MEASURES The main outcome of the study was post-discharge AEs based on structured telephone interviews, health record review, and adjudication by two blinded, trained physicians using a previously established methodology. RESULTS Over 28% of 684 patients experienced post-discharge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients (ARR 1.04 95% CI 0.82-1.32 ), but post-discharge AEs were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients. CONCLUSIONS Post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.
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The Prevalence of Burnout and Its Association With Types of Capital Among Female Nurses in West of Iran. ACTA ACUST UNITED AC 2014. [DOI: 10.5812/jjhs.21721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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A qualitative evaluation of geographical localization of hospitalists: how unintended consequences may impact quality. J Gen Intern Med 2014; 29:1009-16. [PMID: 24549518 PMCID: PMC4061372 DOI: 10.1007/s11606-014-2780-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/20/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Geographical localization of hospitalist teams to nursing units may have an impact on the quality of inpatient care. The perceptions of individuals who provide patient care in a localized model of care have not been adequately studied. OBJECTIVE To determine the impact of geographic localization of hospitalist teams by evaluating the perceptions of hospitalists (faculty and physician assistants) localized to a single nursing unit and the nurses who staffed that unit. DESIGN Focus group study. SUBJECTS Six hospitalist faculty and three hospitalist physician assistants who provided patient care while localized to a single nursing unit, as well as 29 nurses who staffed the nursing unit where localization occurred. MAIN MEASURES Themes that emerged from grounded theory analysis of focus group transcripts. KEY RESULTS Participants perceived an overall positive impact of localization on the quality of patient care they provide and their workflow. The positive impact was mediated through proximity to patients and between members of the healthcare team, as well as through increased communication, decreased wasted time and increased teamwork. The participants also identified increased interruptions, variability in patient flow, mismatches in specialization and perverse incentives as mediating factors leading to unintended consequences. A model emerged that can inform future deployment and evaluation of localization interventions. CONCLUSIONS Geographical localization of hospitalist teams is perceived to be desirable by both hospitalists and nurses. Others who attempt localization could use our conceptual model as a guide to maximize the benefit and minimize the unintended consequences of this intervention.
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Yousefi V, Chong CAKY. Does implementation of a hospitalist program in a Canadian community hospital improve measures of quality of care and utilization? an observational comparative analysis of hospitalists vs. traditional care providers. BMC Health Serv Res 2013; 13:204. [PMID: 23734931 PMCID: PMC3702419 DOI: 10.1186/1472-6963-13-204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 05/22/2013] [Indexed: 11/10/2022] Open
Abstract
Background Despite the growth of hospitalist programs in Canada, little is known about their effectiveness for improving quality of care and use of scarce healthcare resources. The objective of this study is to compare measures of cost and quality of care (in-hospital mortality, 30-day same-facility readmission, and length of stay) of hospitalists vs. traditional physician providers in a large Canadian community hospital setting. Methods We performed a retrospective analysis of data from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database, using multivariate logistic and linear regression analyses comparing performance of four provider groups of traditional family physicians (FPs), traditional internal medicine subspecialists (other-IM), family physician-trained hospitalists (FP-Hospitalist), and general internal medicine-trained hospitalists (GIM-Hospitalist). Results Compared to traditional FPs, FP-Hospitalists and GIM-Hospitalists demonstrate lower mortality [OR 0.881, (CI 0.779 – 0.996); and OR 0.355, (CI 0.288 – 0.436)] and readmission rates [OR 0.766, (CI 0.678 – 0.867); and OR 0.800, (CI 0.675 – 0.948)]. Compared to traditional FPs, GIM-Hospitalists appear to improve length of stay [OR−2.975, (CI −3.302 – -2.647)] while FP-Hospitalists perform similarly [OR 0.096, (CI −0.136 – 0.329)]. Compared to other-IM, GIM-Hospitalists have similar performance on all measures while FP-Hospitalists show a mixed impact. Conclusions Compared to traditional family physicians, hospitalists appear to improve measures of quality and resource utilization. Specifically, hospitalists demonstrate lower in-hospital mortality and 30-day readmission rates while improving (or at least showing similar) length of stay. Compared to traditional subspecialists, hospitalists demonstrate similar performance despite looking after sicker and more complex medical patients.
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Affiliation(s)
- Vandad Yousefi
- Department of Medicine, Lakeridge Health, Oshawa, ON, Canada.
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Goodwin JS, Lin YL, Singh S, Kuo YF. Variation in length of stay and outcomes among hospitalized patients attributable to hospitals and hospitalists. J Gen Intern Med 2013; 28:370-6. [PMID: 23129162 PMCID: PMC3579964 DOI: 10.1007/s11606-012-2255-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/26/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND There have been no prior population-based studies of variation in performance of hospitalists. OBJECTIVE To measure the variation in performance of hospitalists. DESIGN Retrospective research design of 100 % Texas Medicare data using multilevel, multivariable models. SUBJECTS 131,710 hospitalized patients cared for by 1,099 hospitalists in 268 hospitals from 2006-2009. MAIN MEASURES We calculated, for each hospitalist, adjusted for patient and disease factors (case mix), their patients' average length of stay, rate of discharge home or to skilled nursing facility (SNF) and rate of 30-day mortality, readmissions and emergency room (ER) visits. KEY RESULTS In two-level models (admission and hospitalist), there was significant variation in average length of stay and discharge location among hospitalists, but very little variation in 30-day mortality, readmission or emergency room visit rates. There was stability over time (2008-2009 vs. 2006-2007) in hospitalist performance. In three-level models including admissions, hospitalists and hospitals, the variation among hospitalists was substantially reduced. For example, hospitals, hospitalists and case mix contributed 1.02 %, 0.75 % and 42.15 % of the total variance in 30-day mortality rates, respectively. CONCLUSIONS There is significant variation among hospitalists in length of stay and discharge destination of their patients, but much of the variation is attributable to the hospitals where they practice. The very low variation among hospitalists in 30-day readmission rates suggests that hospitalists are not important contributors to variations in those rates among hospitals.
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Affiliation(s)
- James S Goodwin
- Department of Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
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Holt SR, Ramos J, Harma M, Cabrera F, Louis-Ashby C, Dinh A, Fiellin DA, Tetrault JM. Physician detection of unhealthy substance use on inpatient teaching and hospitalist medical services. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 39:121-9. [PMID: 22992028 DOI: 10.3109/00952990.2012.715703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment for substance use depends on reliable identification. The goal of this study was to determine the rate of detection of unhealthy substance use by physicians on teaching and nonteaching medical services at a community teaching hospital. METHODS This cross-sectional study was conducted from February to June 2009. All new medicine admissions to the Teaching Service or the nonteaching Hospitalist Service were assessed for unhealthy substance use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and Drug Abuse Screening Test (DAST). All patients identified with substance use completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Medical record review was also performed to assess physician documentation. RESULTS Of 442 eligible patients, 414 consented to participate. Patients on the Teaching Service were more likely to be male, younger, unmarried, non-white, uninsured or receiving publicly funded insurance, and current smokers (p < .01 for all comparisons). Overall, the detection rate for unhealthy substance use was 64.3% (63 of 98 confirmed cases), with service-specific rates of 73.4% for the Teaching Service, compared with 47.1% for the Hospitalist Service (p = .011). ICD-9 coding accounted for 53.1% of identified cases on the Teaching Service and 14.7% of identified cases on the Hospitalist Service (p < .001). Assignment to the Hospitalist Service, being married, and isolated unhealthy drug use were independently associated with decreased physician detection rates. CONCLUSIONS Our study suggests that unhealthy substance use is more likely to be detected on a Teaching Service than on a Hospitalist Service.
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Affiliation(s)
- Stephen R Holt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
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Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB. Job characteristics, satisfaction, and burnout across hospitalist practice models. J Hosp Med 2012; 7:402-10. [PMID: 22271510 DOI: 10.1002/jhm.1907] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/14/2011] [Accepted: 11/27/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nearly two-thirds of hospitals in the United States are served by hospitalist physicians. How hospitalist work patterns and job satisfaction vary across various practice models is unknown. METHODS We administered the Hospitalist Worklife Survey to a randomized stratified sample of 3105 potential hospitalists and 662 hospitalist members of 3 multistate hospitalist companies. Details about respondents' hospitalist group characteristics, their work patterns, and satisfaction with 2 global and 11 domain measures were assessed. Factors influencing job satisfaction were also solicited. These factors, job characteristics, job satisfaction, and burnout were compared across predefined practice models. RESULTS The adjusted response rate was 25.6%. Among the respondents, 44% were employed by a hospital, 15% by a multispecialty physician group, 14% by a multistate hospitalist group, 14% by a university or medical school, 12% by a local hospitalist group, and 2% by other. Hospitalists of local groups reported more clinical shifts per month, and hospitalists of local and multistate groups reported more billable encounters per shift compared to other practice models. Academic hospitalists reported fewer night shifts, fewer billable encounters per shift, more nonclinical work hours, and lower earnings compared to other practice models. Differences in clinical and nonclinical responsibilities, and differences in factors most important to job satisfaction, were noted across the 5 models. Despite these differences, levels of global job satisfaction and burnout were similar across the practice models. CONCLUSIONS Work patterns, compensation, and hospitalists' priorities varied significantly across practice models. Overall job satisfaction and burnout were similar across models, despite these differences.
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Affiliation(s)
- Keiki Hinami
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Lee BC, Flores G. The hybrid hospitalist teaching service: an innovative model for individualized learning, patient case-mix, and medical student and resident education. Clin Pediatr (Phila) 2012; 51:321-31. [PMID: 21946252 DOI: 10.1177/0009922811423416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alternative inpatient teams are increasing, but little is known about their impact on patient care and trainee education. PURPOSE To evaluate whether a hybrid hospitalist teaching service meets trainee and attending educational, clinical, support, patient-mix, autonomy, and efficiency needs. METHODS Post pediatric rotations, team members anonymously completed surveys with Likert-scale and open-ended questions. RESULTS In total, 78 of 80 surveys were completed. Trainees rated educational, clinical, support, and case-mix domains highly. Senior residents responded positively for autonomy, education, and opinions of hospitalists, but neutrally on leadership. Attending scores varied for efficiency, teaching, and clinical duties; the service resulted in direct observation and teaching outside of rounds, but poor delineation of roles and expectations impeded clinical task completion, teaching on rounds, and attending meetings. CONCLUSIONS This model is a satisfying, well-accepted means of enhancing trainee education and patient care, but roles and expectations must be clearly defined to maximize efficiency and satisfaction.
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Affiliation(s)
- Benjamin C Lee
- University of Texas Southwestern, Dallas, TX 75235, USA.
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Chandra S, Wright SM, Howell EE. The Creating Incentives and Continuity Leading to Efficiency staffing model: a quality improvement initiative in hospital medicine. Mayo Clin Proc 2012; 87:364-71. [PMID: 22469349 PMCID: PMC3498415 DOI: 10.1016/j.mayocp.2011.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the effect of a hospitalist-developed, continuity-centered hospitalist staffing model on patient outcomes and resource use. METHODS The Creating Incentives and Continuity Leading to Efficiency (CICLE) staffing model was conceived by a group of hospitalists who sought to improve continuity of inpatient care. Using a retrospective, observational, pre-post study design, we compared patient-level data for all discharges from our hospitalist service from 6 months after implementation of the CICLE staffing model (September 1, 2009, through February 28, 2010; n=1585) with data from those same months in the prior year (September 1, 2008, through February 28, 2009; n=1808). We used the number of unique hospitalists who documented an encounter during the admission as a measure of continuity of care. Length of stay and hospital charges per admission constituted the measures of resource use. RESULTS The odds of having a single hospitalist for the entire hospitalization nearly doubled under the CICLE model (odds ratio, 1.87; 95% confidence interval, 1.60-2.2; P<.001). Mean length of stay decreased 7.5% (from 2.92 before to 2.70 days after initiation of the model; P<.001). Mean hospital charge per admission decreased 8.5% (from $7224.33 before to $6607.79 after initiation of the model; P<.001). Thirty-day readmission rates were not substantially affected by the CICLE model (15.0% before to 17.3% after initiation of the model; P=.08). CONCLUSION Improved continuity of care among hospitalists was associated with reductions in length of stay and lower health care costs. These benefits were realized without substantially affecting readmission rates. The staffing model can be achieved by reorganizing existing hospitalists and may not require the hiring of additional personnel. The CICLE staffing model is a viable option for hospitalist groups that are aiming to diminish resource use and improve quality of care.
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Affiliation(s)
- Shalini Chandra
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Holt SR, Ramos J, Harma MA, Cabrera F, Louis-Ashby C, Dinh A, Tetrault JM, Fiellin DA. Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education. Am J Addict 2012; 21:111-9. [PMID: 22332853 DOI: 10.1111/j.1521-0391.2011.00207.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p<.01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p<.01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p<.01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.
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Affiliation(s)
- Stephen R Holt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
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Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med 2012; 27:28-36. [PMID: 21773849 PMCID: PMC3250553 DOI: 10.1007/s11606-011-1780-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/28/2011] [Accepted: 06/14/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The number of hospitalists in the US is growing rapidly, yet little is known about their worklife to inform whether hospital medicine is a viable long-term career for physicians. OBJECTIVE Determine current satisfaction levels among hospitalists. DESIGN Survey study. METHODS A national random stratified sample of 3,105 potential hospitalists plus 662 hospitalist employees of three multi-state hospitalist companies were administered the Hospital Medicine Physician Worklife Survey. Using 5-point Likert scales, the survey assessed demographic information, global job and specialty satisfaction, and 11 satisfaction domains: workload, compensation, care quality, organizational fairness, autonomy, personal time, organizational climate, and relationships with colleagues, staff, patients, and leader. Relationships between global satisfaction and satisfaction domains, and burnout symptoms and career longevity were explored. RESULTS There were 816 hospitalist responses (adjusted response rate, 25.6%). Correcting for oversampling of pediatricians, 33.5% of respondents were women, and 7.4% were pediatricians. Overall, 62.6% of respondents reported high satisfaction (≥4 on a 5-point scale) with their job, and 69.0% with their specialty. Hospitalists were most satisfied with the quality of care they provided and relationships with staff and colleagues. They were least satisfied with organizational climate, autonomy, compensation, and availability of personal time. In adjusted analysis, satisfaction with organizational climate, quality of care provided, organizational fairness, personal time, relationship with leader, compensation, and relationship with patients predicted job satisfaction. Satisfaction with personal time, care quality, patient relationships, staff relationships, and compensation predicted specialty satisfaction. Job burnout symptoms were reported by 29.9% of respondents who were more likely to leave and reduce work effort. CONCLUSIONS Hospitalists rate their job and specialty satisfaction highly, but burnout symptoms are common. Hospitalist programs should focus on organizational climate, organizational fairness, personal time, and compensation to improve satisfaction and minimize attrition.
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Manjarrez E, Newman J. The international hospital medicine scene. J Hosp Med 2011; 6:373-5. [PMID: 21915996 DOI: 10.1002/jhm.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kashiwagi DT, Burton MC, Kirkland LL, Cha S, Varkey P. Do timely outpatient follow-up visits decrease hospital readmission rates? Am J Med Qual 2011; 27:11-5. [PMID: 21835809 DOI: 10.1177/1062860611409197] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is widely believed that timely follow-up decreases hospital readmissions; however, the literature evaluating time to follow-up is limited. The authors conducted a retrospective analysis of patients discharged from a tertiary care academic medical center and evaluated the relationship between outpatient follow-up appointments made and 30-day unplanned readmissions. Of 1044 patients discharged home, 518 (49.6%) patients had scheduled follow-up ≤14 days after discharge, 52 (4.9%) patients were scheduled ≥15 days after discharge, and 474 (45.4%) had no scheduled follow-up. There was no statistical difference in 30-day readmissions between patients with follow-up within 14 days and those with follow-up 15 days or longer from discharge (P = .36) or between patients with follow-up within 14 days and those without scheduled follow-up (P = .75). The timing of postdischarge follow-up did not affect readmissions. Further research is needed to determine such factors and to prospectively study time to outpatient follow-up after discharge and the decrease in readmission rates.
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Hassan NE, Winters J, Winterhalter K, Reischman D, El-Borai Y. Effects of blood conservation on the incidence of anemia and transfusions in pediatric parapneumonic effusion: a hospitalist perspective. J Hosp Med 2010; 5:410-3. [PMID: 20629017 DOI: 10.1002/jhm.700] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with pneumonia may develop parapneumonic effusion (PNE). The associated inflammatory process and nutritional compromise can blunt erythropoesis. Traditional treatment for these children with PNE includes repeated phlebotomy and surgical intervention, resulting in ongoing blood losses. Blood transfusions used to treat acquired anemia are associated with multiple complications. OBJECTIVES This study evaluated the effect of hospitalists' implementation of blood conservation guidelines (BCG) on the incidence of anemia and transfusion requirements in children with PNE. DESIGN Retrospective cohort study of hospitalized children with PNE. SETTINGS University affiliated Children's Hospital. PATIENTS Children who were admitted to the hospital with PNE and managed using BCG (Group I) were compared to simultaneous no intervention group (S) and historical no intervention group (H). Group (I) and (S) were admitted from year 2000 to 2004 and the Group (H) were admitted from year 1997 to 1999. MEASUREMENTS Phlebotomy frequency and volume, measured hemoglobin (Hgb) levels, and the need for red blood transfusions. RESULTS Children in the BCG group (n = 24) compared to simultaneous no intervention group (n = 28) and historical no intervention group (n = 29) had lesser phlebotomy volumes (14 ± 8, 18 ± 14 and 69 ± 66 mL; P = 0.001), trend toward lesser Hgb drop (1.7 ± 1.4, 2.1 ± 1.2 and 2 ± 1.4 gm%; P ≤ 0.37), and lesser incidence of transfusion (8%, 18% and 31%; P = 0.11). Transfused children were younger (3.5 ± vs. 6.4 ± 4 years; P = 0.001) and had lower initial Hgb (9.9 ± 1 vs. 11.4 ± 1 gm%; P = 0.001), more phlebotomy (5.9 ± 7 vs. 1.1 ± 1 mL/kg., P = 0.001), longer hospitalization (18.7 ± 5 vs. 11.1 ± days; P = 0.001), and slightly higher (pediatric risk of mortality [PRISM]) scores (3.4 ± 5.7 vs. 1.6 ± 2.7; P = 0.25). CONCLUSION Implementing BCG lowers phlebotomy losses and the need for transfusion.
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Affiliation(s)
- Nabil E Hassan
- Helen DeVos Children's Hospital, Grand Rapids, Michigan 49503, USA.
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Abstract
The Michael E. DeBakey Veterans Affairs (VA) Medical Center inpatient psychiatry program underwent a series of substantial changes that led to a shift from a continuity of care (COC) model to a hospitalist environment in 2007. Although similar changes in other fields of medicine (general medicine, pediatrics, surgery, cardiology, and neurology) have been associated with several care benefits, no studies to date have evaluated the potential effects of such a change in models in psychiatry. The shift at the Michael E. DeBakey VA Medical Center thus provided a unique opportunity to compare these two models of care and gather evidence about which model may be more beneficial to patients. Data were derived retrospectively from two separate periods of time, one representative of the COC model (July-December 2006) and one representative of the hospitalist model (July-December 2008). The total number of discharges increased significantly from the first to the second period. Although the average length of stay remained similar, the number of readmissions occurring within 30 days of discharge was much lower during the hospitalist period. In addition, patients discharged in the hospitalist period were more likely to attend their outpatient mental health appointments. Findings suggest a preference for the hospitalist model over a COC model.
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Abstract
PURPOSE OF REVIEW Critical care medicine (CCM) is expensive. CCM costs have continued to rise since they were first calculated in the 1970s. By 2005, CCM costs in the US were estimated to be $81.7 billion accounting for 13.4% of hospital costs, 4.1% of the national health expenditures and 0.66% of the gross domestic product. RECENT FINDINGS This review first addresses the methodology and inherent limitations of calculating global CCM costs using the Russell equation and the challenges of defining critical care in the US when universal definitions of intensive care unit (ICU) bed types do not exist. Studies and concepts recently put forth to control CCM costs are then discussed. These include rationing ICU care, caring for patients in non-ICU locations, regionalizing care, changing the ICU workforce, imposing care protocols and bundles, and adjusting long-term ICU traditions. Many of these programs have benefits but may also have unintended expenses. Even documenting ICU costs themselves may be quite challenging as costs are frequently shifted between the ICU and its supporting clinical and hospital services. SUMMARY Cost containment is difficult to attain in critical care as the programs proposed to achieve cost control may be so pricey, that potential cost savings are offset. Some CCM cost saving methodologies may benefit patient care, whereas others may be detrimental to society. CCM cost containment may prove as illusory in the future as it has been in the past.
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Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 2010; 38:65-71. [PMID: 19730257 DOI: 10.1097/ccm.0b013e3181b090d0] [Citation(s) in RCA: 557] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To analyze the evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005. DESIGN Retrospective study of data from the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, Maryland). SETTING Nonfederal, acute care hospitals with critical care medicine beds in the United States. SUBJECTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed hospital and critical care medicine beds, bed types, days, occupancy rates, payer mix (Medicare and Medicaid), and costs. Critical care medicine costs were compared with national cost indexes. Between 2000 and 2005, the total number of U.S. hospitals with critical care medicine beds decreased by 12.2% (from 3,586 to 3,150). Although the number of hospital beds decreased by 4.2% (from 655,785 to 628,409), both hospital days and occupancy rates increased by 5.1% (from 145.1 to 152.5 million) and 13.7% (from 59% to 67%), respectively. Critical care medicine beds increased by 6.5% (from 88,252 to 93,955), days by 10.6% (from 21.0 to 23.2 million), and occupancy rates by 4.5% (from 65% to 68%). The majority (90%) of critical care medicine beds were classified as intensive care, premature/neonatal, and coronary care unit beds. The percentage of critical care medicine days used by Medicare decreased by 3.8% (from 37.9% to 36.5%) compared with an increase of 15.5% (from 14.5% to 16.8%) by Medicaid. From 2000 to 2005, critical care medicine costs per day increased by 30.4% (from $2698 to $3518). Although annual critical care medicine costs increased by 44.2% (from $56.6 to $81.7 billion), the proportion of hospital costs and national health expenditures allocated to critical care medicine decreased by 1.6% and 1.8%, respectively. However, the proportion of the gross domestic product used by critical care medicine increased by 13.7%. In 2005, critical care medicine costs represented 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of the gross domestic product. CONCLUSIONS Critical care medicine continues to grow in a shrinking U.S. hospital system. The critical care medicine payer mix is evolving, with Medicaid increasing in its percentage of critical care medicine use. Critical care medicine is more cost controlled than other healthcare indexes, but is still using an increasing percentage of the gross domestic product. Our updated and comprehensive critical care medicine use and cost analysis provides a contemporary benchmark for the strategic planning of critical care medicine services within the U.S. healthcare system.
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Affiliation(s)
- Neil A Halpern
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
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25
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Freed GL, Dunham KM, Lamarand KE. Hospitalists' involvement in pediatrics training: perspectives from pediatric residency program and clerkship directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1617-1621. [PMID: 19858826 DOI: 10.1097/acm.0b013e3181bb1f0d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To explore the use and perceived impact of pediatric hospitalists as teaching attendings among pediatric residency and clerkship programs. METHOD Between November 2007 and February 2008, the authors conducted a mail-based survey of all pediatric residency program directors (170) and pediatric clerkship directors (131) in the United States as identified by the Association of Pediatric Program Directors and Council on Medical Student Education in Pediatrics. The surveys focused on the responsibilities of pediatric hospitalists in training programs and their perceived impact on the roles of pediatric residents and medical students. RESULTS The response rate for residency directors was 86% (146/170) and 87% (114/131) for clerkship directors. One hundred thirteen (77%) residency programs and 91 (80%) clerkship programs used hospitalists as teaching attendings. Among these programs, 65% (73) of residency program directors and 64% (58) of clerkship directors reported that pediatric hospitalists are responsible for all general inpatient services. The majority of residency (76%, 84) and clerkship directors (71%, 64) reported that hospitalists are more accessible to trainees than traditional attendings. A minority of residency program directors (36%, 39) reported that use of hospitalists has decreased senior resident autonomy. CONCLUSIONS The role of hospitalists in resident and student education will likely continue to evolve over the next decade.Additional refinement of the roles and responsibilities of hospitalists will address lingering concerns in some programs about resident autonomy.
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Affiliation(s)
- Gary L Freed
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI 48109-0456, USA.
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Independence at home: community-based care for older adults with severe chronic illness. Clin Geriatr Med 2009; 25:155-69, ix. [PMID: 19217500 DOI: 10.1016/j.cger.2008.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
By most clinical and economic measures, our health care system is not providing effective or affordable care to Medicare beneficiaries with severe chronic illness. Two million elders, constituting most of the 5% who account for nearly half of Medicare costs, have multiple chronic conditions, functional disability, and average per capita costs of over $50,000 per year. Prior reforms aimed at this population did not change the flawed delivery system, which remains centered in the doctor's office, hospitals, and nursing homes. This article describes a model of coordinated home-based medical care, called Independence at Home (IAH), which operates on a limited basis in many US communities and in the Veterans Affairs system. IAH-type teams deliver a full range of medical and social services at home to seriously ill elders and thereby reduce overall health care costs. We review the evidence that this approach can lower total costs by 25 percent or more while improving patient satisfaction and outcomes. We discuss funding for the new model, which also produces net savings for Medicare. A Medicare reform bill, called the Independence at Home Act, was introduced in the US House and Senate in 2008 to promote replication of this mobile elder care model.
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Kuo YF, Sharma G, Freeman JL, Goodwin JS. Growth in the care of older patients by hospitalists in the United States. N Engl J Med 2009; 360:1102-12. [PMID: 19279342 PMCID: PMC2977939 DOI: 10.1056/nejmsa0802381] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND National and population-based information on the increase in patient care by hospitalists in the United States is lacking. METHODS Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999, and the period from 2001 through 2006, we identified 120,226 physicians in general internal medicine who were providing care to older patients in 5800 U.S. hospitals. We defined hospitalists as general internists who derived 90% or more of their Medicare claims for evaluation-and-management services from the care of hospitalized patients. We then calculated the percentage of all inpatient Medicare services provided by hospitalists and identified patient and hospital characteristics associated with the receipt of hospitalist services. RESULTS The percentage of physicians in general internal medicine who were identified as hospitalists increased from 5.9% in 1995 to 19.0% in 2006, and the percentage of all claims for inpatient evaluation-and-management services by general internists that were attributed to hospitalists increased from 9.1% to 37.1% during this same period. Accompanying the increase in care by hospitalists was an increase in the percentage of all hospitalized Medicare patients who were treated by general internists (both hospitalists and traditional, non-hospital-based general internists), from 46.4% in 1995 to 61.0% in 2006. In a multilevel, multivariable analysis controlling for patient and hospital characteristics, the odds of receiving care from a hospitalist increased by 29.2% per year from 1997 through 2006. In 2006, there was marked geographic variation in the rates of care provided by hospitalists, with rates of more than 70% in some hospital-referral regions. CONCLUSIONS These analyses of data from Medicare claims showed a substantial increase in the care of hospitalized patients by hospitalist physicians from 1995 to 2006.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and the Sealy Center on Aging, University of Texas Medical Branch, Galveston 77555-0460, USA.
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Salottolo K, Slone DS, Howell P, Settell A, Bar-Or R, Craun M, Bar-Or D. Effects of a nonsurgical hospitalist service on trauma patient outcomes. Surgery 2009; 145:355-61. [PMID: 19303983 DOI: 10.1016/j.surg.2008.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The American College of Surgeons criteria for Level I trauma centers calls for >90% of trauma patients to be admitted directly by a trauma surgeon or surgical subspecialist; however, the efficiency of the trauma system may be increased if patients presenting with comorbid conditions and minor injuries are treated by a hospitalist team (nonsurgical Trauma MEDical [TMED] service). We hypothesized outcomes would be equivalent for patients treated under TMED versus a surgical service. METHODS This retrospective review compared mortality, hospital length of stay (LOS), Emergency Department (ED) LOS, placement to rehabilitation facilities, and complication rates for patients who could have been treated by TMED as identified by an algorithm. The study population for 2003 (pre-TMED) was compared with the study population for 2006 (post-TMED). Univariate analyses and multivariate logistic and linear regression were used to identify outcomes that were different for patients treated in 2003 versus 2006. Sensitivity, specificity, and percent kappa agreement were calculated for patients who were treated by the TMED team in 2006 versus patients in 2006 who were identified using the algorithm. RESULTS The algorithm had reasonable sensitivity (78%) and specificity (90%); the kappa agreement was excellent (0.88). No differences were found in mortality (P = .31), rate of complications (P = .08), ED LOS (P = .77), or placement to rehabilitation facilities (P = .29) for patients identified in 2003 versus 2006. Hospital LOS was increased in 2006 (3.7 vs 4.1 days; P = .02). CONCLUSION These data support admission of trauma patients with nonsevere, single-system injuries to a nonsurgical hospitalist service. We hypothesize that overall system efficiency may be improved by applying this alternative model in other trauma centers.
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Affiliation(s)
- Kristin Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, CO 80113, USA
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Dunn A. Hospital medicine in high-def: importance of defining mission of hospitalist groups. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2008; 75:415-417. [PMID: 18828161 DOI: 10.1002/msj.20068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Andrew Dunn
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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