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The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.

BACKGROUND: Localization of general medical inpatient teams is an attractive way to improve inpatient care but has not been adequately studied. OBJECTIVE: To evaluate the impact of localizing general medical teams to a single nursing unit. DESIGN: Quasi‐experimental study using historical and concurrent controls. SETTING: A 490‐bed academic medical center in the midwestern United States. PATIENTS: Adult, general medical patients, other than those with sickle cell disease, admitted to medical teams staffed by a hospitalist and a physician assistant (PA). INTERVENTION: Localization of patients assigned to 2 teams to a single nursing unit. MEASUREMENTS: Length of stay (LOS), 30‐day risk of readmission, charges, pages to teams, encounters, relative value units (RVUs), and steps walked by PAs. RESULTS: Localized teams had 0.89 (95% confidence interval [CI], 0.37–1.41) more patient encounters and generated 2.20 more RVUs per day (CI, 1.10–3.29) compared to historical controls; and 1.02 (CI, 0.46–1.58) more patient encounters and generated 1.36 more RVUs per day (CI, 0.17–2.55) compared to concurrent controls. Localized teams received 51% (CI, 48–54) fewer pages during the workday. LOS may have been approximately 10% higher for localized teams. Risk of readmission within 30 days and charges incurred were no different. PAs possibly walked fewer steps while localized. CONCLUSION: Localization of medical teams led to higher productivity and better workflow, but did not significantly impact readmissions or charges. It may have had an unintended negative impact on hospital efficiency; this finding deserves further study. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

BACKGROUND: Residency reform in the form of work hour restrictions has forced academic medical centers to develop alternate models of care to provide inpatient care. One such model is the use of physician assistants (PAs) with hospitalists. However, these models of care have not been widely evaluated. OBJECTIVE: To compare the outcomes of inpatient care provided by a hospitalist‐PA (H‐PA) model with the traditional resident based model. DESIGN, SETTING and PATIENTS: We conducted a retrospective cohort study of 9681 general medical (GM) hospitalizations between January 2005 and December 2006 using a hospital administrative database. We used multivariable mixed models to adjust for a wide variety of potential confounders and account for multiple patient visits to the hospital to compare the outcomes of 2171 hospitalizations to H‐PA teams with those of 7510 hospitalizations to resident teams (RES). MEASUREMENTS: Length of stay (LOS), charges, readmission within 7, 14, and 30 days and inpatient mortality. RESULTS: Inpatient care provided by H‐PA teams was associated with a 6.73% longer LOS (P = 0.005) but charges, risk of readmission at 7, 14, and 30 days and inpatient mortality were similar to resident‐based teams. The increase in LOS was dependent on the time of admission of the patients. CONCLUSIONS: H‐PA team‐based GM inpatient care was associated with a higher LOS but similar charges, readmission rates, and inpatient mortality to traditional resident‐based teams, a finding that persisted in sensitivity analyses. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.