Hospitalist Care for Boarders Can Reduce Length of Stay

CHICAGO — Designating a hospitalist to manage patients boarded in the emergency department enhances patient care and safety and has the potential to affect hospital length of stay, according to a pilot study presented at the annual meeting of the Society of Hospital Medicine.

A total of 4,363 patients were admitted during a 3-month period to the medicine service of a 1,121-bed, acute-care teaching hospital, of whom 3,555 qualified as boarders based on an ED stay of 2 hours or more. There was an average of 29 boarders per 24 hours, with a mean boarding time of 440 minutes.

A full-time hospitalist was on duty from 8 a.m. to 6 p.m. weekdays, and evaluated 634 of the boarders, averaging 8 per day.

The role of the hospitalist was to round on all medicine patients and to focus on patient safety, said Dr. Alan S. Briones, an internist at Mount Sinai Hospital and the Mount Sinai School of Medicine, New York. The hospitalist addressed any changes in patient status or stability and informed the primary teams, and ensured that vital home and hospital medications were administered and reconciled with inpatient orders.

Hospitalists acted on laboratory results for 472 (74.4%) boarded patients and followed up on medication orders for 506 (80%) of them.

Hospitalists discharged 46 (7.3%) patients or 1.3% of all ED boarders, and downgraded telemetry for 61 (9.6%) patients or 1.7% of all ED boarders.

“Designating a full-time hospitalist to care for admitted patients has the potential to impact ED throughput and hospital length of stay, as demonstrated by our discharge rate and our [telemetry] downgrade rate,” Dr. Briones said.

He noted that prolonged ED length of stay is the most frequent reason for overcrowding and that an estimated one-third of American hospitals experience ED overcrowding on a daily basis. He described Mount Sinai Hospital as experiencing periodic “moderate to severe” episodes of ED overcrowding.

“A 5% increase in hospital occupancy or census can cause a 14-hour delay time in the ED or holding time,” Dr. Briones said. “Overcrowding has important consequences on physician and patient satisfaction and quality of care.”

The researchers are further evaluating the data to determine the broader impact of the program on hospital length of stay and ED diversion rates.

The investigators reported no conflicts of interest.

CHICAGO — Designating a hospitalist to manage patients boarded in the emergency department enhances patient care and safety and has the potential to affect hospital length of stay, according to a pilot study presented at the annual meeting of the Society of Hospital Medicine.

A total of 4,363 patients were admitted during a 3-month period to the medicine service of a 1,121-bed, acute-care teaching hospital, of whom 3,555 qualified as boarders based on an ED stay of 2 hours or more. There was an average of 29 boarders per 24 hours, with a mean boarding time of 440 minutes.

A full-time hospitalist was on duty from 8 a.m. to 6 p.m. weekdays, and evaluated 634 of the boarders, averaging 8 per day.

The role of the hospitalist was to round on all medicine patients and to focus on patient safety, said Dr. Alan S. Briones, an internist at Mount Sinai Hospital and the Mount Sinai School of Medicine, New York. The hospitalist addressed any changes in patient status or stability and informed the primary teams, and ensured that vital home and hospital medications were administered and reconciled with inpatient orders.

Hospitalists acted on laboratory results for 472 (74.4%) boarded patients and followed up on medication orders for 506 (80%) of them.

Hospitalists discharged 46 (7.3%) patients or 1.3% of all ED boarders, and downgraded telemetry for 61 (9.6%) patients or 1.7% of all ED boarders.

“Designating a full-time hospitalist to care for admitted patients has the potential to impact ED throughput and hospital length of stay, as demonstrated by our discharge rate and our [telemetry] downgrade rate,” Dr. Briones said.

He noted that prolonged ED length of stay is the most frequent reason for overcrowding and that an estimated one-third of American hospitals experience ED overcrowding on a daily basis. He described Mount Sinai Hospital as experiencing periodic “moderate to severe” episodes of ED overcrowding.

“A 5% increase in hospital occupancy or census can cause a 14-hour delay time in the ED or holding time,” Dr. Briones said. “Overcrowding has important consequences on physician and patient satisfaction and quality of care.”

The researchers are further evaluating the data to determine the broader impact of the program on hospital length of stay and ED diversion rates.

The investigators reported no conflicts of interest.

CHICAGO — Designating a hospitalist to manage patients boarded in the emergency department enhances patient care and safety and has the potential to affect hospital length of stay, according to a pilot study presented at the annual meeting of the Society of Hospital Medicine.

A total of 4,363 patients were admitted during a 3-month period to the medicine service of a 1,121-bed, acute-care teaching hospital, of whom 3,555 qualified as boarders based on an ED stay of 2 hours or more. There was an average of 29 boarders per 24 hours, with a mean boarding time of 440 minutes.

A full-time hospitalist was on duty from 8 a.m. to 6 p.m. weekdays, and evaluated 634 of the boarders, averaging 8 per day.

The role of the hospitalist was to round on all medicine patients and to focus on patient safety, said Dr. Alan S. Briones, an internist at Mount Sinai Hospital and the Mount Sinai School of Medicine, New York. The hospitalist addressed any changes in patient status or stability and informed the primary teams, and ensured that vital home and hospital medications were administered and reconciled with inpatient orders.

Hospitalists acted on laboratory results for 472 (74.4%) boarded patients and followed up on medication orders for 506 (80%) of them.

Hospitalists discharged 46 (7.3%) patients or 1.3% of all ED boarders, and downgraded telemetry for 61 (9.6%) patients or 1.7% of all ED boarders.

“Designating a full-time hospitalist to care for admitted patients has the potential to impact ED throughput and hospital length of stay, as demonstrated by our discharge rate and our [telemetry] downgrade rate,” Dr. Briones said.

He noted that prolonged ED length of stay is the most frequent reason for overcrowding and that an estimated one-third of American hospitals experience ED overcrowding on a daily basis. He described Mount Sinai Hospital as experiencing periodic “moderate to severe” episodes of ED overcrowding.

“A 5% increase in hospital occupancy or census can cause a 14-hour delay time in the ED or holding time,” Dr. Briones said. “Overcrowding has important consequences on physician and patient satisfaction and quality of care.”

The researchers are further evaluating the data to determine the broader impact of the program on hospital length of stay and ED diversion rates.

The investigators reported no conflicts of interest.