Staff-only pediatric hospitalist care of patients with medically complex subspecialty conditions in a major teaching hospital.

摘要

OBJECTIVE: To assess cost and length of stay for subspecialty patients on a staff-only general pediatric hospitalist service vs traditional faculty/housestaff subspecialty services in a major teaching hospital. DESIGN: Retrospective study of 2 cohort groups: a staff-only general pediatric hospitalist group and subspecialty faculty/housestaff gastroenterology and hematology/oncology groups. SETTING: Major referral center providing full-spectrum, complex surgical, and subspecialty care including transplantation. PARTICIPANTS: Nine hundred twenty-five pediatric patients with gastroenterologic and hematologic/oncologic diseases admitted and discharged between July 1, 2005, and June 30, 2006. Main Exposure Patients with gastroenterologic and hematologic/oncologic diseases were assigned to the hospitalist team when faculty/housestaff teams reached their maximum census of patients per intern. MAIN OUTCOME MEASURES: Cost, length of stay, mortality, and readmission to the hospital within 72 hours of discharge. RESULTS: Cost averaged Dollars 11 000 and Dollars 16 500, respectively, for patients on the hospitalist service compared with those on nonhospitalist services. On average, length of stay was 7.2 days and 9.8 days, respectively. In negative binomial regression analyses controlling for subspecialty, demographic data, disease severity, and average daily census, patients on the hospitalist service had 29% lower costs (P < .05) and 38% fewer hospital days (P < .01) per admission compared with patients on subspecialty faculty/housestaff services, with no clear differences in mortality and readmission rates. CONCLUSION: Compared with the subspecialist faculty/housestaff system, the staff-only pediatric hospitalist system was associated with a marked reduction in cost and length of stay for patients with medically complex subspecialty diseases. In this era of resident duty-hour restrictions and medical complexity of conditions in inpatients, staff-only hospitalist programs may have a vital role in pediatric teaching hospitals.