Implementation of a hospitalist-run observation unit and impact on length of stay (LOS): A brief report

BACKGROUND:: While the impact of hospitalists on length of stay (LOS) for inpatient medicine services has been studied, there has been little work on the impact of hospitalist involvement in short-stay or observation units. OBJECTIVE: The primary objective was to examine the impact of a hospitalist-run observation unit on LOS. The secondary objective was to assess utilization of the unit through examining case-weight and LOS. DESIGN: Retrospective cohort study with a preimplementation/postimplementation analysis. SETTING:: University Hospital, the 604-bed teaching hospital for Bexar County, San Antonio, Texas. PATIENTS: All patients discharged from the inpatient medicine and observation units with diagnoses of chest pain, asthma, syncope, cellulitis, and pyelonephritis. INTERVENTION: Creation of a hospitalist-run, nonteaching, 10-bed "Clinical Decision Unit" (CDU). MEASUREMENTS: The overall LOS of the "top 5" most common diagnoses was compared for the 12 months preimplementation and postimplementation of the unit. RESULTS:: The overall LOS for all patients decreased from 2.4 to 2.2 days (P = 0.05) between the 12 months preimplementation and postimplementation. The greatest decreases were seen for cellulitis (2.4-1.9 days; P < 0.001) and asthma (2.2-1.2 days; P < 0.001). CONCLUSIONS:: Implementation of a hospitalist-run observation unit was associated with a significantly decreased LOS for all patients regardless of location, suggesting that the unit has led to more efficient care.