Hospitalist and nurse discharge planner team reduced average costs and duration of hospital stay

Flanders, Assistant Professor Scott A.
Auerbach, Assistant Professor Andrew D.

University of California; San Francisco, USA

Abstracted from:Palmer C, Armistead N, Elnicki M, Halperin A, Ogershok P, Manivannan S, Hobbs G, Evans K. The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital. Am J Med 2001; 111: 627-632 .

Evidence-based Healthcare 6(3):p 120-121, September 2002.

BACKGROUND

A 'hospitalist' is a physician who cares for hospitalised patients and has interests in hospital care leadership, teaching and research. There are increasing numbers of hospitalists in the United States, although the efficacy of this model of care is unknown.

OBJECTIVE

To evaluate the effects of a hospitalist and nurse discharge planner on resource use and patient outcomes.

SETTING

Academic teaching hospital, West Virginia; 1998 to 1999.

METHOD

Controlled trial.

PARTICIPANTS

Twenty four hundred and sixty four people admitted to general internal medicine ward services; 49% male; average age 57 years.

INTERVENTION

Three internal medicine teams admitted patients every third day. One team was led by a hospitalist, one by a generalist and the third by a specialist. Team structure was identical (resident, attending physician, interns, medical students and pharmacy support), apart from a nurse discharge planner in the hospitalist group. Hospitalists were junior faculty with no special training. They attended wards for 4 months each year (compared to 1 month per year for other staff); were involved with formulating practice guidelines, and did not have outpatient responsibilities during ward months.

OUTCOMES

Average costs of hospitalisation; resource use; length of stay; inpatient mortality; 30-day readmission rates; patient satisfaction.

MAIN RESULTS

On average, patients attended by hospitalist-led teams had shorter hospital stays and lower inpatient costs. There were no differences in readmission rates or satisfaction among patients, residents or medical students. Mortality rates were higher for specialist-led teams (Table 1).

Table 1 Outcomes for inpatients attended by a hospitalist, generalist or specialist-led team
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AUTHORS' CONCLUSIONS

Hospitalist-led teams lowered costs and duration of hospital stay without impairing satisfaction or clinical outcomes.

NOTES

This study does not assess the relative effects of a nurse discharge planner compared to a hospitalist.