Implementation of a hospitalist-run observation unit and impact on length of stay (LOS): a brief report.

BACKGROUND

While 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.

OBJECTIVE

The 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.

DESIGN

Retrospective cohort study with a preimplementation/postimplementation analysis.

SETTING

University Hospital, the 604-bed teaching hospital for Bexar County, San Antonio, Texas.

PATIENTS

All patients discharged from the inpatient medicine and observation units with diagnoses of chest pain, asthma, syncope, cellulitis, and pyelonephritis.

INTERVENTION

Creation of a hospitalist-run, nonteaching, 10-bed "Clinical Decision Unit" (CDU).

MEASUREMENTS

The overall LOS of the "top 5" most common diagnoses was compared for the 12 months preimplementation and postimplementation of the unit.

RESULTS

The 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).

CONCLUSIONS

Implementation 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.