Relationship between Patient Perceptions of Hospitalist Communication and Length of Stay

Background:

Length of stay in U.S. hospitals has been trending downward, and correlations to both outcomes and patient satisfaction are mixed. We compared measures of patient satisfaction with hospitalists' communication skills to average patient length of stay and readmission rates for individual hospitalists working on a short‐stay inpatient unit.

Methods:

Patient satisfaction with hospitalist communication was measured using the Communication Assessment Tool (CAT), a psychometrically validated inslrument with 14 core items. Items are answered on a 5‐point Likert scale (poor, fair, good, very good, excellent). Results for each physician are reported as the percentage of “excellent” responses. The CAT was verbally administered to patients admitted between September 2008 and September 2009 to the hospital medicine service at a large, urban academic medical center, on the second or third day of admission. To obtain length of stay and readmission information, the medical center's combined clinical and administrative electronic database (Enterprise Data Warehouse) was queried for all adult patient admissions to the hospital's short‐stay unit from September 1, 2008, to September 1, 2009. Patients who expired during hospitalization were excluded. Length of stay in hours, discharging hospitalist, and presence of 30‐day readmission was obtained for each patient. For each of 24 hospitalists with at least 20 short‐stay unit patients meeting criteria, average length of stay and readmission rate were calculated. Pearson's R correlation was used to determine a relationship between hospitalists' CAT scores and their average patient length of stay and readmission rates.

Results:

Information from 3340 admissions was obtained from the database. Number of cases per hospitalist ranged from 24 to 513 (mean = 139.2, SD = 145). Hospitalist CAT scores ranged from 38.5% to 73.5% “excellent” rating (mean = 59.7%, SD = 9.3%). On the short‐stay unit, average patient length of stay ranged from 1.5 to 2.9 days (mean = 2.33 days, SD = 0.35 days). Proportion of readmissions by hospitalist ranged from 0.04 to 0.26 (mean = 0.14, SD = 0.05). A significant, positive correlation was found between hospitalists' CAT scores and their average patient length of stay (R = 0.58, P < 0.01). Hospitalists with higher communication ratings were found to have longer average patient length of stay, No correlation was found between CAT scores and readmission rates (R = 0.22, P = NS).

Conclusions:

Length of stay within a hospitalist‐run short stay unit is associated with patient‐rated communication skills of the discharging hospitalist. Patients with shorter length of stays may feel “rushed” and less informed about their care, resulting in lower satisfaction.

Author Disclosure:

D. Ferranli, none; M. Williams, none.