A hospitalist‐run short‐stay unit: Features that predict length‐of‐stay and eventual admission to traditional inpatient services

Abstract

BACKGROUND: Short‐stay units (SSUs) provide an alternative to traditional inpatient services for patients with short anticipated hospital stays. Yet little is known about which patient types predict SSU success. OBJECTIVE: To describe patients admitted to our hospitalist‐run SSU and explore predictors of length‐of‐stay (LOS) and eventual admission to traditional inpatient services. DESIGN: Prospective observational cohort study. SETTING: Large public teaching hospital. PATIENTS: Consecutive admissions (n = 755) to the SSU over 4 months. INTERVENTION: Hospitalist attending physicians prospectively collected data from patients' histories, physical exams, and medical records upon admission and discharge. MEASUREMENTS: Risk assessments were made for patients with our most common provisional diagnoses: possible acute coronary syndrome (ACS) and heart failure. Patient stays were considered successful when LOS was less than 72 hours and eventual admission to traditional inpatient services was not required. RESULTS: Of 738 eligible patients, 79% (n = 582) had successful SSU stays. In a multivariable model, the provisional diagnosis of heart failure predicted stays longer than 72 hours (P = 0.007) but risk assessments were unimportant. Patients who received specialty consultations were most likely to need eventual admission (odds ratio [OR], 13.1; 95% confidence interval [CI], 6.9‐24.9), and the likelihood of long stays was inversely proportional to the accessibility of diagnostic tests. CONCLUSIONS: In our hospitalist‐run SSU, the inaccessibility of diagnostic tests and the need for specialty consultations were the most important predictors of unsuccessful stays. Designs for other SSUs that care for mostly low‐risk patients should focus on matching patients' diagnostic and consultative needs with readily accessible services. Journal of Hospital Medicine 2009;4:276–284. © 2009 Society of Hospital Medicine.

Development and validation of a tool to select patients for admission to medical short stay units

“…Data were collected on 14 different variables that might have affected length of stay. Some variables have previously been shown to predict a 'failed' short stay, that is, admission for >72 h. These include: inability to independently mobilise, ongoing active treatment, need for specialty consultation, requirement of multidisciplinary assessment, inaccessibility of diagnostic tests, weekend admissions and transfer to intensive care units 4,10,11 . Increasing age has been shown by some to be associated with increased length of stay 4 but not others.…”

“…Data were collected on 14 different variables (Table 1) using a data collection proforma. These variables were chosen because they had either previously been shown to affect length of stay 4,7,10,11 or were thought to be relevant after discussion with the multidisciplinary team.…”

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

“…35 Historically, SSU have been under the domain of the ED; however, there is an emerging role for hospitalistrun SSU. 36 Despite demand for SSU, little research has been performed on hospitalist-led SSU. In 2000, Abenhaim and colleagues showed that a hospitalist-run SSU at a university-affiliated teaching hospital had a shorter LOS and lower rates of complications and readmissions when compared to medicine teaching services.…”

“…Lucas and colleagues found that whether or not SSU patients required assistance of specialists was the strongest predictor of unsuccessful stays (>72 hours or inpatient conversion) in SSU. 36 Whether SSU are run by hospital medicine or emergency medicine is decided at an institutional level. Location of SSU in a specifically designated area is crucial, as it allows physicians to round efficiently on patients and to work with staff trained in observation services.…”

The selection of acute medical admissions for a short-stay unit

“…There are only a few medical SSU reports in other countries, namely United States (US), United Kingdom (UK) and Canada [1][2][3]. SSU descriptions have also been reported for groups of patients with specific diagnoses such as asthma, head injuries or chest pain [4][5][6].…”