Effect of 24/7 Hospitalist Coverage on Clinical Metrics

1IPC —
The Hospitalist Company, Denver, CO
2IPC —
The Hospitalist Company, North Hollywood, CA
3ICU Medicine, St. Louis, MO
4IPC—The Hospitalist Company, North Hollywood, CA

Meeting: Hospital Medicine 2007, May 23-25, Dallas, Texas

Abstract number: 18

Background:

There has been increasing discussion on whether hospitalists should provide 24/7 in‐hospital staffing. There have been no data to date that have shown a clinical advantage to this coverage arrangement. The goal of the study was to discover the magnitude of the differences between hospitals that utilized call from home versus hospitals that utilized 24/7 coverage on a number of dependent variables.

Methods:

The study was a retrospective analysis of data collected from January 1 through December 31, 2005. The study group consisted of 85 acute care hospitals that had full‐time hospitalist practices. The main predictor variable of interest, call system, was a between‐hospitals variable, with 8 hospitals having a full‐time 24/7 system, 6 utilizing moonlighters on a 24/7 system, and 71 hospitals utilizing a call‐from‐home system. The dependent variables were length of stay; readmit rate; in‐hospital mortality; patient satisfaction; and prescription at discharge of aspirin, beta‐ers, and angiotensin‐converting enzyme inhibitor or angiotensin receptor er (ACEI/ARB) to patients with acute myocardial infarction (AMI) and of ACEI/ARB prescription to patients with congestive heart failure. Linear regression models also controlled for visits per day per physician, physician age, time with IPC, severity of illness, and number of physicians in the practice group.

Results:

An analysis was performed comparing hospitals with a call‐from‐home system with all hospitals with 24/7 coverage of any type, pooling the data from those with full‐time coverage and those with moonlighter coverage. In multivariate linear regression, the only key variable with a statistically significant difference was in‐hospital mortality, with the patients treated at hospitals with 24/7 coverage having higher mortality. The practices providing 24/7 coverage through full‐time physicians were then separated from the practices providing coverage through the use of moonlighters, and these 2 groups were compared with those practices providing coverage through call from home. The means of the call‐from‐home group were much closer to the means of the full‐time 24/7 group than were those of the moonlighter group. In multivariate linear regression, the only variable in which a statistically difference persisted was again mortality, with patients treated at hospitals where moonlighters provided 24/7 coverage having higher mortality than patients treated by the reference, the call‐from‐home group.

Conclusions:

Despite recent moves toward having hospitalists provide 24/7 in‐hospital coverage, we found no difference between these programs and those where physicians took call from home in length of stay, readmission rate, patient satisfaction, or CMS quality indicators for AMI or congestive heart failure. The only variable for which there was a significant difference was in‐hospital mortality, which was higher for patients treated by the 24/7 group, specifically, those practices with nighttime coverage provided by moonlighters.

Author Disclosure:

K. R. Epstein, IPC, stock options or bond holdings, employment (full‐ or part‐time); E. Juarez, IPC, stock options or bond holdings, employment (full‐ or part‐time); K. Loya, IPC, stock options or bond holdings, employment (full‐ or part‐time); M. Gorman, IPC, stock options or bond holdings; A. Singer, IPC, stock options or bond holdings, employment (full‐ or part‐time).

To cite this abstract:

Epstein K, Juarez E, Loya K, Gorman M, Singer A. Effect of 24/7 Hospitalist Coverage on Clinical Metrics. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 18. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/effect-of-247-hospitalist-coverage-on-clinical-metrics/. Accessed September 22, 2019.

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