Staff-Only Pediatric Hospitalist Care of Patients With Medically Complex Subspecialty Conditions in a Major Teaching Hospital

Abstract

Compared with the subspecialist faculty/housestaff system, the staff-only pediatric hospitalist system was associated with a marked reduction in cost and length of stay for patients with medically complex subspecialty diseases. In this era of resident duty-hour restrictions and medical complexity of conditions in inpatients, staff-only hospitalist programs may have a vital role in pediatric teaching hospitals.

Pediatric hospitalist systems versus traditional models of care: Effect on quality and cost outcomes

“…Five of the 6 new studies, listed in Table 2, reported on length of stay and cost. Three showed some benefits for length of stay: Srivastava et al 17 reported improvement in length of stay and cost for asthma and dehydration, but not for all diagnoses together; Bekmezian et al 18 reported improved length of stay and cost for pediatric hospitalists for patients on a hematology and gastroenterology service; and Simon et al 19 attributes a generalized decrease in length of stay on a surgical service to implementation of hospitalist comanagement of their most complex patients, though hospitalists only comanaged 12% of the patients in the study. NOTE: Levels of evidence are assigned to studies, from 1a (systematic reviews of randomized controlled trials) to 5 (expert opinion only).…”

“…All attempted to adjust for diagnosis and severity using diagnosis-related groups (DRGs) or other methods. Dwight et al, 12 Bellet and Whitaker, 13 and Bekmezian et al 18 used retrospective or historical comparison alone, while Landrigan et al…”

“…Bellet and Whitaker, 13 Landrigan et al, 14 Ogershok et al, 16 and Bekmezian et al 18 reported reductions in cost for all patients varying from 9% to 29%, while Wells et al 15 and Srivastava et al 17 found reductions in cost only for patients with certain diagnoses. Srivastava et al 17 analyzed 1970 patients, admitted with primary diagnoses of asthma, dehydration, or viral illness, over a 5-year period from 1993 to 1997.…”

Pediatric Hospitalists’ Perspectives on the Care of Children With Medical Complexity

“…14 Two studies attempted to identify a model for delivering care to the hospitalized CMC to improve outcomes. However, the fi ndings of both studies are diffi cult to generalize because one represented subspecialty populations 15 and the other focused on a primary care physician who also treated CMC in the hospital. 16 The aims of our study are to identify pediatric hospitalists' perceived views of (1) barriers to delivering care to CMC and (2) their preferred model of inpatient health care delivery for CMC.…”

“…Bekmezian and colleagues 15 reported that their staff-only pediatric hospitalists care of Gastroenterology or HematologyOncology patients resulted in decreased length of stay and cost. Their study focused on two populations that are relatively homogeneous and may not be applicable to settings in which residents participate in the care of CMC.…”