Correlating hospitalist work schedules with patient outcomes
Background: Studies show better outcomes, decreased length of stay, increased patient satisfaction, improved quality, and decreased readmission rates when hospitalist services are used. This study looks at how hospitalist schedules affect these outcomes.
Dr. Nausheen Ahmed
Study design: Retrospective cohort study.
Setting: 229 hospitals in Texas.
Synopsis: This cohort study used 3 years of Medicare data from 229 hospitals in Texas. It included 114,777 medical admissions of patients with a 3- to 6-day length of stay. The study used the percentage of hospitalist working days that were blocks of 7 days or longer. ICU stays and patients requiring two or more E&M codes were excluded since they are associated with greater illness severity.
The primary outcome was mortality within 30 days of discharge and secondary outcomes were 30-day readmission rates, discharge destination, and 30-day postdischarge costs.
Patients receiving care from hospitalists working several days in a row had better outcomes. It is postulated that continuity of care by one hospitalist is important for several reasons. Most importantly, the development of rapport with patient and family is key to deciding the plan of care and destination post discharge as it is quite challenging to effectively transfer all important information during verbal or written handoffs.
Bottom line: Care provided by hospitalists working more days in a row improved patient outcomes. A variety of hospitalist schedules are being practiced currently; however, these findings must be taken into account as schedules are designed.
Citation: Goodwin JS et al. Association of the work schedules of hospitalists with patient outcomes of hospitalization. JAMA Intern Med. 2020;180(2):215-22. doi: 10.1001/jamainternmed.2019.5193.
Dr. Ahmed is assistant professor in the division of hospital medicine, Loyola University Medical Center, Maywood, Ill.
