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Background Readmission and length of stay (LOS) are two hospital-level metrics commonly used to assess the performance of hospitalist groups. Healthcare systems implement strategies aimed at reducing both. It is possible that tactics aimed at improving one measure in individual patients may adversely impact the other. Objective We sought to analyze the impact of length of stay on readmission risk in an inpatient general medical population to assess whether patients with a lower length of stays were readmitted more frequently to the hospital. Methods We performed a retrospective analysis of inpatient adult patients admitted to our institution between January 2016 and December 2019. We recorded demographic variables and the outcomes of LOS and 30-day readmission. We excluded patients who expired, left against medical advice, or were transferred to other hospitals. We performed both univariate and multivariate analyses. Results There were 91,723 patients included in the study of which 10,598 (11.6%) were readmitted. The geometric LOS for all patients was 5.37 days and was higher in readmitted patients (6.87 vs 5.18 days, respectively, p < 0.001). Patients with higher readmission rates were older, had a higher proportion of male gender, African-American ethnicity, and were more likely to have Medicare or Medicaid payors. After performing a multivariate regression analysis, we found that a high LOS was associated with a higher likelihood of readmission (P < 0.001). Conclusion Contrary to our initial hypothesis, we found that general medical patients with a higher LOS had a higher likelihood of being readmitted to the hospital after adjusting for other variables. It is possible that factors not captured in the current dataset may help explain both the increase in LOS and readmission risk.

BACKGROUND Observation medicine is a growing field with increasing involvement by hospitalists. Little has been written regarding clinical outcomes in hospitalist‐run clinical decision units (CDUs). OBJECTIVE To determine the impact of a hospitalist‐run geographic CDU on length of stay (LOS) for observation patients. Secondary objectives included examining the impact on 30‐day emergency department (ED) or hospital revisit rates. DESIGN Retrospective cohort study with pre‐ and post‐implementation analysis. SETTING Urban, academic, 600‐bed teaching hospital in Camden, New Jersey. PATIENTS Observation patients discharged from medical–surgical units before and after CDU opening and those discharged from the CDU after CDU opening. INTERVENTION Creation of a hospitalist‐run, 20‐bed geographic CDU, adjacent to the ED with order sets, protocols, and priority consults and testing. MEASUREMENTS Median LOS for observation patients was calculated for 7 months pre‐ and post‐CDU implementation. ED and hospital revisits requiring an observation or inpatient stay within 30 days of discharge were measured. RESULTS CDU observation patients had a lower median LOS than medical–surgical observation patients during the same period (17.6 hours vs 26.1 hours, P < 0.001). CDU LOS was lower than medical–surgical observation LOS in the 7 months 1 year prior to CDU implementation (17.6 hours vs 27.1 hours, P < 0.001). CDU patients had a similar 30‐day ED or hospital revisit rate compared with observation patients pre‐CDU. CONCLUSIONS Implementing a hospitalist‐run geographic CDU was associated with a 35% decrease in observation LOS for CDU patients compared with a 3.7% decrease for medical–surgical observation patients. CDU LOS decreased without increasing ED or hospital revisit rates. Journal of Hospital Medicine 2014;9:391–395. © 2014 Society of Hospital Medicine

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.