• Luci K Leykum, Vincent Huerta, and Eric Mortensen.
• South Texas Veterans' Health Care System, University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Hospital Medicine, 7703 Floyd Curl Drive, Room 5.070R Dental, San Antonio, TX 78229-3900, USA. Leykum@uthscsa.edu
• J Hosp Med. 2010 Nov 1; 5 (9): E2-5.

BackgroundWhile the impact of hospitalists on length of stay (LOS) for inpatient medicine services has been studied, there has been little work on the impact of hospitalist involvement in short-stay or observation units.ObjectiveThe primary objective was to examine the impact of a hospitalist-run observation unit on LOS. The secondary objective was to assess utilization of the unit through examining case-weight and LOS.DesignRetrospective cohort study with a preimplementation/postimplementation analysis.SettingUniversity Hospital, the 604-bed teaching hospital for Bexar County, San Antonio, Texas.PatientsAll patients discharged from the inpatient medicine and observation units with diagnoses of chest pain, asthma, syncope, cellulitis, and pyelonephritis.InterventionCreation of a hospitalist-run, nonteaching, 10-bed "Clinical Decision Unit" (CDU).MeasurementsThe overall LOS of the "top 5" most common diagnoses was compared for the 12 months preimplementation and postimplementation of the unit.ResultsThe overall LOS for all patients decreased from 2.4 to 2.2 days (P = 0.05) between the 12 months preimplementation and postimplementation. The greatest decreases were seen for cellulitis (2.4-1.9 days; P < 0.001) and asthma (2.2-1.2 days; P < 0.001).ConclusionsImplementation of a hospitalist-run observation unit was associated with a significantly decreased LOS for all patients regardless of location, suggesting that the unit has led to more efficient care.2010 Society of Hospital Medicine

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