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Eur. J. Intern. Med. · Apr 2022
Generalist vs specialist acute medical admissions - What is the impact of moving towards acute medical subspecialty admissions on efficacy of care provision?
- Hannah Smyth, Sarah Gorey, Hannah O'Keeffe, Joanna Beirne, Shaunna Kelly, Cathal Clifford, Hilary Kerr, Martin Mulroy, and Tomás Ahern.
- Specialist Registrar in Geriatric Medicine and General Internal Medicine. Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland. Electronic address: hmsmyth@tcd.ie.
- Eur. J. Intern. Med. 2022 Apr 1; 98: 47-52.
IntroductionThe discussion surrounding generalist versus specialist acute medical admissions continues to stimulate debate and patients with certain conditions benefit from specialist care.AimTo determine whether a specialty medical admission program would reduce inpatient length of stay (LOS), mortality and readmission rates.Design/MethodsA prospective cohort study of inpatients admitted under a general internal medicine (GIM) service before and after introduction of a specialty-directing programme. We hypothesized that early transfer of patient care to a specialty suited to their presenting complaint would reduce LOS and a specialty-directing early redistribution of care programme was introduced. Seven of the ten clinical teams participating in the GIM roster adopted the programme. On the morning following a specialty-directing team being on call for all new GIM admissions during a 24-hour period, specialty-directing teams were allocated one patient appropriate to their specialty.Results5,144 patient-care episodes were analysed over the two-year study period. LOS increased by greater than 15%, one year after introducing the specialty-directing programme (8.5±8.4 vs 7.3±7.5 days, p < 0.001). LOS did not differ between teams that participated and those who did not (8.4±8.1 vs 8.1±7.9 days, p = 0.298). No differences were found in the proportion of patients who were discharged home, died while an inpatient or re-admitted within 30 days of discharge. The proportion of patients aged greater than 80 years increased significantly also - from 24.7% in 2017 to 27.9% in 2019(p == 0.009).ConclusionWidespread adoption of specialist care may not be beneficial for all medical inpatients and physicians should continue to undergo dual specialist and GIM training.Copyright © 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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