Background: Hospital scheduling and structure has the potential to smooth the flow and impact quality outcomes. The most predominant hospitalist schedule follows the seven-on/seven-off scheduling where hospitalists would switch off service after the 7th day, also known as switch day, to the next incoming provider. However, there is limited data on which hospitalist switch day is the most optimal for hospital operations. Our prior analysis showed changing the hospitalist start day from Monday to Tuesday resulted in a statistically significant increase in Monday discharges and a statistically significant reduction in Tuesday discharges. In this study, we aim to measure the impact of this change on unplanned readmission rates.
Methods: We conducted a retrospective observational study on six acute care general medicine units at an 885-bed urban, academic, quaternary care hospital located in New York City (New York University Langone Health). Each team was comprised of one hospitalist attending and either one advanced practice provider (APP) or one internal medicine resident with two interns. Starting on April 18, 2022, the hospitalist switch day was changed from Monday to Tuesday. The hospitalist attendings followed a 7-on / 7- off day-time scheduling block. Pre and post switch daytime periods were established to understand the effect of the intervention. The pre-intervention switch period was defined as April 1, 2021 – March 31, 2022. The post-intervention switch period was defined as May 1, 2022 – April 31, 2023. April 2022 was excluded in this study since this was during the rollout period of the intervention. The pre and post hospital switch day time periods were structured to analyze the relationship between the shift in the hospitalist switch day and unplanned readmission rates.
Results: Patient demographics during the pre- versus post-intervention periods were similar with regards to average patient age payor mix and discharge disposition (Table 1). There was, however, a statistically significant difference in patient’s initial admission sources, several Medicare Severity Diagnosis Related Groups (MS-DRGs), and the percentage of patients being discharged to acute rehab facilities and home (Table 1). Unplanned readmissions decreased by 1.5% (95% CI -2.7% to -0.5%, p = 0.003) following our switch day intervention. Unplanned readmission rates by discharge day of the week were unchanged (Table 2).
Conclusions: Many factors, such as continuity of care, hospitalist work schedules and physician characteristics, are associated with patient outcomes of hospitalizations. The impact of our switch day intervention on unplanned readmission rates suggests switching on Tuesday is favorable in promoting better patient outcomes. Our study saw an absolute decrease of 1.5% in unplanned readmissions (p = 0.003). Reducing unplanned readmissions can result in millions of dollars saved for the healthcare system. Additional studies are needed to further verify these findings in different hospital settings and to consider other switch day patterns with the goal of improving hospital metrics and patient care.
