Impact of hospitalist care model on patient outcomes in acute medical unit: a retrospective cohort study

Abstract

ObjectiveTo assess a newly introduced, hospitalist-run, acute medical unit (AMU) care model at a tertiary care hospital in the Republic of Korea.DesignRetrospective cohort study.SettingTertiary care hospital in the Republic of Korea.ParticipantsWe evaluated 6391 medical inpatients admitted through the emergency department (ED) from 1 June 2016 to 31 May 2017.InterventionsThe study compared multiple outcomes among medical inpatients from the ED between the non-hospitalist group and the AMU hospitalist group.Outcome measuresIn-hospital mortality (IHM), intensive care unit (ICU) admission rate, hospital length of stay (LOS), ED-LOS and unscheduled readmission rates were defined as patient outcomes and compared between the two groups.ResultsCompared with the non-hospitalist group, the AMU hospitalist group had lower IHM (OR: 0.43, p<0.001), a lower ICU admission rate (OR: 0.72, p=0.013), a shorter LOS (coefficient: −0.984, SE: 0.318; p=0.002) and a shorter ED-LOS (coefficient: −3.021, SE: 0.256; p<0.001). There were no significant differences in the 10-day or 30-day readmission rates (p=0.974, p=0.965, respectively).ConclusionsThe AMU hospitalist care model was associated with reductions in IHM, ICU admission rate, LOS and ED-LOS. These findings suggest that the AMU hospitalist care model has the potential to be adopted into other healthcare systems to improve care for patients with acute medical needs.

Economic evaluation of the hospitalist care model in an acute medical unit: a benefit–cost analysis

“…The AMU patients were evaluated and treated by four hospitalists with an average of 10 years of clinical experience in infectious diseases, pulmonology and critical care, nephrology and endocrinology. 9 Seven days per week, two AMU hospitalists were responsible for the care of the AMU patients admitted during the day. In addition, non-hospitalist inpatient care was provided by subspecialists and residents in a specialty medical ward, where residents were primarily responsible for inpatient care under the supervision of an attending physician.…”

“…In addition, non-hospitalist inpatient care was provided by subspecialists and residents in a specialty medical ward, where residents were primarily responsible for inpatient care under the supervision of an attending physician. 9 While hospitalist care in the AMU focused on general acute care, non-hospitalist care in the specialty medical ward emphasised long-term and specialised treatment. 9 …”

“…Since the implementation of the hospitalist care system in Korea, research on patient outcomes has been conducted 3 9 in terms of in-hospital mortality (IHM), intensive care unit (ICU) admission, emergency department-length of stay (ED-LOS) and total length of hospital stay (LOS). Although there have been many studies on the effectiveness of the hospitalist system, few studies have been undertaken on costs or involving economic evaluations.…”

“…Hence, we conducted an economic evaluation that accounted for both costs and benefits for the same patient population whose outcomes had been previously assessed. 9 …”

Effect of SMS Ward Round Notifications on Inpatient Experience in Acute Medical Settings: A Retrospective Cohort Study (Preprint)

“…In 2015, the Department of Internal Medicine at SNUBH established a hospitalist-run acute medical unit (AMU) to enhance patient safety and care efficiency for patients with acute medical conditions. Although the AMU improved patient outcomes by reducing overall length of stay and length of stay at the emergency department before admission [11], and also suggested reductions of in-hospital mortality and intensive care unit admission rates [12], patients' perceptions of inpatient care were found to be inconsistent, which could be attributed to the acuteness and complexity of clinical conditions, the hectic hospital environment, and heightened levels of anxiety.…”