As part of a larger initiative to increase capacity for subspecialty patients, this university hospital (UH), a 573‐bed quaternary‐care facility in a large urban center, decreased the size of its general medicine service (GMS) by a third in the last 18 months. Because the UH is in an area with high hospitalization rates for “ambulatory care sensitive conditions,” this has led to severe overcrowding in the adult emergency department (ED). Currently, 14% of ED patients leave without being seen, the ED is on bypass over 20% of the time, and the average length of stay for patients requiring GMS admission is 15 hours.
In response to these challenges, the hospitalist program at UH created a general medical hospitalist service at a nearby community hospital (CH) that was staffed by UH hospitalist faculty and CH residents. A program was developed to transfer patients who present to the UH ED to hospitalist service at the CH. We describe our initial experience with our program.
From April through December 2007, we transferred 448 patients (1.64 patients/day). One of the major barriers to transfer has been the availability of inpatient beds at the CH. To improve bed availability, we were able to reach an agreement with the CH to reserve beds for that purpose. Prior to the agreement, the average transfer rate was 1.23 patients/day, and the census on the hospitalist service was 5.7 patients/day. Afterward, the transfer rate was 2.17 patients/day, and the census was 9.66 patients/day. Both differences were statistically significant (P = .0038 for transfers, and P = .0016 for the census.) The average age of transferred tients was 59 years (range 16‐96 years), and 20% were 80 years or older. Of the patients, 17.5% had private insurance, 72% had Medicaid or Medicare, and 10.5% were uninsured, comparable to patients admitted to the GMS at UH. The most common diagnoses (in order of frequency) were cellulitis, pneumonia, abdominal complaints (vomiting, diarrhea, and pain), UTI, and reactive airways disease. There have been no adverse patient outcomes. Sustaining the system, however, has required substantial administrative effort. We have achieved our initial goal of 2‐3 patients/day; however, further reductions in the size of the GMS mean that a higher (3‐5 patients/day) transfer rate is required. Having the service run by UH faculty has improved the rate of patient consent.
Transfer of ED patients requiring admission can be done safely, but such systems are complex and require ongoing time and effort to maintain. The effect on ED operations is unclear.
D. Lovinger, none.
To cite this abstract:Lovinger D, Walter J, Brown S, Potts S, Abbo E, Meltzer D, Whelan C. Experience with an Off‐Site Hospitalist Service to Receive Transfers of General Medical Patients from an Emergency Department in a University Hospital. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 113. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/experience-with-an-offsite-hospitalist-service-to-receive-transfers-of-general-medical-patients-from-an-emergency-department-in-a-university-hospital/. Accessed May 26, 2019.