Caring for patients in a hospitalist‐run clinical decision unit is associated with decreased length of stay without increasing revisit rates

Abstract

BACKGROUND Observation medicine is a growing field with increasing involvement by hospitalists. Little has been written regarding clinical outcomes in hospitalist‐run clinical decision units (CDUs). OBJECTIVE To determine the impact of a hospitalist‐run geographic CDU on length of stay (LOS) for observation patients. Secondary objectives included examining the impact on 30‐day emergency department (ED) or hospital revisit rates. DESIGN Retrospective cohort study with pre‐ and post‐implementation analysis. SETTING Urban, academic, 600‐bed teaching hospital in Camden, New Jersey. PATIENTS Observation patients discharged from medical–surgical units before and after CDU opening and those discharged from the CDU after CDU opening. INTERVENTION Creation of a hospitalist‐run, 20‐bed geographic CDU, adjacent to the ED with order sets, protocols, and priority consults and testing. MEASUREMENTS Median LOS for observation patients was calculated for 7 months pre‐ and post‐CDU implementation. ED and hospital revisits requiring an observation or inpatient stay within 30 days of discharge were measured. RESULTS CDU observation patients had a lower median LOS than medical–surgical observation patients during the same period (17.6 hours vs 26.1 hours, P < 0.001). CDU LOS was lower than medical–surgical observation LOS in the 7 months 1 year prior to CDU implementation (17.6 hours vs 27.1 hours, P < 0.001). CDU patients had a similar 30‐day ED or hospital revisit rate compared with observation patients pre‐CDU. CONCLUSIONS Implementing a hospitalist‐run geographic CDU was associated with a 35% decrease in observation LOS for CDU patients compared with a 3.7% decrease for medical–surgical observation patients. CDU LOS decreased without increasing ED or hospital revisit rates. Journal of Hospital Medicine 2014;9:391–395. © 2014 Society of Hospital Medicine

Impact of Length of Stay on Readmission in Hospitalized Patients

“…Multidisciplinary rounds, e.g., on a vascular surgery service, were found to decrease LOS but not lead to any significant effect on readmissions [10]. We have previously shown that decreasing observation LOS in a hospitalist-run clinical decision unit is not associated with an increased rate of emergency department visits or readmissions [11].…”

Impact of an emergency department‐run clinical decision unit on access block, ambulance ramping and National Emergency Access Target

“…7 These units are normally run by physicians/ surgeons and facilitate the rapid assessment and intensive management of patients by their relevant specialties. [7][8][9][10][11][12][13][14][15][16][17][18][19] The CDU model of care was commonly reported to be a cost-effective alternative to the clinical management of patients who may otherwise be hospitalised. 8 A preliminary MEDLINE literature search identified 13 studies assessing the impact of the introduction of these types of units on key performance indicators (KPIs) such as access block, hospital length of stay, re-presentation rate or time to tests or physician review.…”

“…8 A preliminary MEDLINE literature search identified 13 studies assessing the impact of the introduction of these types of units on key performance indicators (KPIs) such as access block, hospital length of stay, re-presentation rate or time to tests or physician review. [7][8][9][10][11][12][13][14][15][16][17][18][19] The CDU model of care was commonly reported to be a cost-effective alternative to the clinical management of patients who may otherwise be hospitalised. 8 The Hervey Bay CDU model Hervey Bay hospital is a public facility with 119 inpatient beds and an ED that sees approximately 35 000 patients per annum.…”

Impact of Frailty and Sociodemographic Factors on Hospital Admission From an Emergency Department Observation Unit

“…3,4 OUs decrease length of stay, readmission rate, and cost while improving outcomes and patient satisfaction. [5][6][7][8][9][10][11] OUs are useful for providing care to elderly patients who do not require prolonged admissions. They provide the opportunity to further evaluate a patients' functional status and home care needs, perform medication reconciliation, and provide multidisciplinary care.…”

“…3,4 OUs decrease length of stay, readmission rate, and cost while improving outcomes and patient satisfaction. 5-11…”