Background: Hospital Medicine is a relatively new medical speciality that dedicates to the care of hospitalized patients and experienced an exponential growth in the United States (US) during the last years. Nowadays there are more than 50.000 american hospitalists according to the Society of Hospital Medicine. Outside the US it is still brand new and incipient in most countries, including the so-called middle income countries like Brazil but an estimative of the number of hospitalists is still lacking. Since its creation in 2012 our team of hospitalists experienced a significant growth in the number of patients assisted that demanded a progressive increase in the number of professionals and weekly hours.
Purpose: The main purpose of this study was to analyze the growth of the Hospital Medicine Department in a tertiary Cancer Center in Brazil and its impact on the average length of stay (ALOS) considering both the co-managed patients and the patients under the main responsibility of the hospitalists from 2013 through 2016.
Description: We analyzed the number of patients assisted by the Hospital Medicine Department in a tertiary Cancer Center in Brazil and the average length of stay (ALOS) considering both the co-managed patients and the patients under the main responsibility of the hospitalist from 2013 until 2016. The total number of patients assisted increased from 1520 in 2013 to 1717 in 2016 (+ 11.29%). Proportionally, the number of patients under the main responsibility of the hospitalists increased significantly more, from a total of 488 patients in 2013 to 791 in 2016 (+ 15.6%) while the number of co-managed patients remained relatively stable (1032 in 2013 and 926 in 2016). Our instituition has approximately 400 hospital beds and assists patients from the public and private health system. The number of beds remained stable during the period of the study.
The number of medical visits provided by the team also increased from 17.641 in 2013 to 18.225 in 2016, while the total ALOS decreased from 11.61 days to 10.61 days (- 8.61%). The team was more effective in reducing the ALOS of its own patients (from 8.97 to 8.41 days, a reduction of 8.61%) than the co-managed patients ALOS (a decrease of 3%, from 12.86 to 12.49 days).
Concerning the number of professionals and weekly hours, in 2013 the team included 2 physicians working in the morning and 2 in the afternoon, each one with a 4-hour workload. This corresponded to a total of 112 weekly hours. By the end of 2016 we had 3 physicians in the morning and 2 in the afternoon, corresponding to 140 weekly hours.
Conclusions: The Hospital Medicine team has progressively increased both in number of professionals and patient volume while the ALOS has decreased since its implementation. There is room for additional improvement in the number and ALOS of the co-managed patients.