Hospitalists discharge patients an average of almost 1 day earlier than do nonhospitalist physicians. The difference is greater for patients with conditions like stroke that require close monitoring, according to a study.
The likelihood of readmission or mortality is not greater in those discharged earlier, reported Dr. William Southern and colleagues at Montefiore Medical Center, Albert Einstein College of Medicine, New York.
Dr. Southern's study looked at data from all 9,037 patients seen at the center's teaching hospital, Weiler Hospital, from 2002 to 2004. The study compared the lengths of stay and outcomes of patients cared for by a hospitalist faculty-member team versus patients cared for by faculty who were not hospitalists and who spent no more than 2 months per year on inpatient service (Arch. Intern. Med. 2007;167:1869–74).
Their analysis showed patients seen by hospitalists stayed an average of 5.0 days, versus 5.9 days for those seen by nonhospitalists.
The biggest reductions in stay for the hospitalists were stroke patients (a mean of 8.6 days vs. 12.5 days), sepsis (8.6 days vs. 12.3 days), pneumonia (6.9 days vs. 8.4 days), heart failure (4.6 days vs. 5.8 days), and asthma/chronic obstructive pulmonary disease (3.5 days vs. 4.5 days).
Dr. Southern said these patients could likely benefit most from close monitoring.
Only arrhythmia patients had a longer stay in the care of a hospitalist (4.3 days vs. 4.0 days).
The complexity of discharge planning also appeared to be a factor, Dr. Southern said.
The study indicated that for patients going home, hospitalist care reduced the mean length of hospital stay by less than half a day. For those going to home health care, the reduction was about a day, and for those going to a skilled nursing facility, it was about 2 days.
These reductions can probably be attributed to hospitalist physicians having greater familiarity in working with ancillary staff, such as social workers or discharge planners, Dr. Southern said.
One shortcoming of the study was that only 5 hospitalist groups were included, versus 54 nonhospitalist groups. It would be easier for an outlier among the hospitalist groups to influence mean length of stay.
And although the study found no significant differences in 30-day mortality and in-hospital mortality, it was not large enough to detect small possible differences, he said.