Restructuring an Academic Pediatric Inpatient Service Using Concepts Developed by Hospitalists

Abstract

In an effort to increase continuity of inpatient care by attending physicians, decrease use of hospital resources, and improve medical education without compromising quality of care, an inpatient pediatric ward service was restructured by using concepts developed by hospitalists. This reorganization reduced the number of yearly inpatient attendings, added a consistent 14-day call schedule, and eliminated attending outpatient responsibilities during their ward service. The restructured ward service attending acted as the attending of record for all general and specialty patients, excluding hematology/oncology, with the subspecialists fulfilling a consultant role. To evaluate the impact of this restructuring, a baseline year of the traditional ward service (TWS) was compared with a subsequent year of the restructured ward service (RWS). Our goal was to evaluate the impact of this new system on average costs of hospitalization, length of stay, resource utilization, inpatient mortality, and 7- and 31-day readmission rates. Hospital costs per patient were lower by 13% (p=0.018) in the restructured system. Average lengths of stay in an observation bed were significantly lower on the RWS (p=0.007), but there was no significant difference in admission length of stay. There was decreased resource utilization for laboratory and radiology tests (p<0.01) on the restructured service. Readmission rates were not significantly changed, and satisfaction among attendings, housestaff, students, and patients was uniformly high in both groups. A reorganized academic pediatric medical service, which allows specific attendings to focus on inpatient care and teaching, can decrease hospital resource utilization without compromising the quality of patient care or medical education.

Pediatric hospitalists' influences on education and career plans

“…[2][3][4][5][6][7] However, this study suggests that this is not only a local or large academic center phenomenon, …”

“…1 Teaching by hospitalists is well received and valued by residents, but, to date, all such data are from single institution studies of individual hospitalist programs. [2][3][4][5][6][7] Less is known regarding what residents perceive about the differences in patient care provided by hospitalists as compared with traditional pediatric teaching attendings. There is a paucity of information about the level of interest of current pediatric residents in becoming hospitalists, including how many plan such a career, reasons why residents might prefer to become hospitalists, and their perceptions of Pediatric Hospital Medicine (PHM) careers as either long or short term.…”

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

“…Death is a rare occurrence in pediatric ward settings, and the seven studies conducted to date comparing pediatric hospitalist and traditional systems have been universally underpowered to detect differences in mortality. 9,[12][13][14][15][16][17][18] There is a need to better understand care processes as a first step in understanding and improving quality of care in hospitalist systems. 19 The Pediatric Research in Inpatient Settings (PRIS) Network was formed to improve the quality of care for hospitalized children through collaborative clinical research.…”

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

“…Wells et al 15 found significantly decreased LOS and cost for asthma patients but not for all diagnoses taken together, and Ogershok et al 16 found lower hospital costs but not length of stay. Five of the 6 new studies, listed in Table 2, reported on length of stay and cost.…”

“…Bellet and Whitaker, 13 Landrigan et al, 14 Ogershok et al, 16 and Bekmezian et al 18 reported reductions in cost for all patients varying from 9% to 29%, while Wells et al 15 and Srivastava et al 17 found reductions in cost only for patients with certain diagnoses. Srivastava et al 17 analyzed 1970 patients, admitted with primary diagnoses of asthma, dehydration, or viral illness, over a 5-year period from 1993 to 1997.…”