Staff‐Only Pediatric Hospitalist Care of Medically Complex Subspecialty Patients in a Major Teaching Hospital

Background:

General pediatric hospitalists are increasingly relied on to manage patients with subspecialty and/or complex medical conditions. Resident duty‐hour restrictions have limited resident coverage of these patients, prompting the proliferation of staff‐only pediatric hospitalist models. A staff‐only pediatric hospitalist model caring for medically complex subspecialty patients has never been studied in the United States. Our objective was to assess cost and length of stay (LOS) for subspecialty patients on a staff‐only general pediatric hospitalist service versus traditional faculty/house staff subspecialty services.

Methods:

This was a retrospective study of inpatients on the gastroenterology and hematology‐oncology services, quasi‐randomized to a staff‐only general pediatric hospitalist team or traditional faculty/house staff subspecialty teams. Information was obtained from the financial database for patients admitted and discharged between July 1, 2005, and June 30, 2006, to a major referral center providing full‐spectrum, complex surgical and subspecialty care, including transplantation. Outcomes measured included length of stay (LOS), actual variable direct cost (AVDC), mortality, and readmission to the hospital within 72 hours of discharge. A total of 925 pediatric gastroenterology and hematology‐oncology patients were analyzed.

Results:

Our patient population had higher all‐patient‐refined diagnosis‐related‐group severity weights (2.2 for hospitalists and 2.4 for nonhospitalists, P = .82) than previous pediatric hospitalist studies. On average, patients on the hospitalist service stayed 7.2 days, compared with 9.8 days for patients on nonhospitalist services. AVDC averaged $11,000 and $16,500, respectively. After adjustment for covariates (patient age, payer group, severity of illness), using multivariate negative binomial regression, patients on the hospitalist service had 36% fewer hospital days (P < .001) and 36% lower direct costs (P < .001) than did patients on the traditional services, with no obvious differences in readmission or mortality rates.

Conclusions:

In comparison with the traditional faculty/house staff subspecialty system, the staff‐only general pediatric hospitalist system was associated with large reductions in LOS and direct costs for medically complex subspecialty patients. In the current era of resident duty‐hour restrictions and increasing severity of illness and medical complexity of inpatients, staff‐only hospitalist programs may play a vital role in pediatric teaching hospitals.

Author Disclosure:

A. Bekmezian, none; P.J. Chung, none; S. Yazdani, none.