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.
2010 Society of Hospital Medicine