• J Hosp Med · Jun 2014

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

    • Kara S Aplin, Susan Coutinho McAllister, Eric Kupersmith, and Jean-Sebastien Rachoin.
    • Department of Medicine, Division of Hospital Medicine, Cooper University Hospital, Camden, New Jersey; Department of Medicine, Division of Hospital Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
    • J Hosp Med. 2014 Jun 1;9(6):391-5.

    BackgroundObservation medicine is a growing field with increasing involvement by hospitalists. Little has been written regarding clinical outcomes in hospitalist-run clinical decision units (CDUs).ObjectiveTo 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.DesignRetrospective cohort study with pre- and post-implementation analysis.SettingUrban, academic, 600-bed teaching hospital in Camden, New Jersey.PatientsObservation patients discharged from medical-surgical units before and after CDU opening and those discharged from the CDU after CDU opening.InterventionCreation of a hospitalist-run, 20-bed geographic CDU, adjacent to the ED with order sets, protocols, and priority consults and testing.MeasurementsMedian 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.ResultsCDU 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.ConclusionsImplementing 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.© 2014 Society of Hospital Medicine.

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