Patient Satisfaction with a Psychology Consultation-Liaison Service at an Academic Medical Center.

One to two-thirds of all medically admitted patients have comorbid psychiatric concerns. To address the cognitive, behavioral, and emotional factors that affect medical hospitalization, psychological or psychiatric consultation-liaison (CL) services are consulted. The current study was designed to understand patient satisfaction with a CL psychology service and how it was associated with satisfaction with overall hospitalization, taking into consideration relevant factors. Adults medically admitted to an academic teaching hospital (N = 220), who were seen at least once by the CL psychology service, completed satisfaction and demographic questionnaires. Most patients reported being satisfied with the CL psychology service, with women reporting higher satisfaction than men. Satisfaction with the CL psychology service was associated with satisfaction with overall hospitalization, but did not differ based on age, race/ethnicity, education, income, length of stay, number of visits, or presence of psychiatric diagnosis. The results suggest that CL psychology services may contribute to improving overall patient experience.

Impact of Length of Stay on Readmission in Hospitalized Patients.

Background Readmission and length of stay (LOS) are two hospital-level metrics commonly used to assess the performance of hospitalist groups. Healthcare systems implement strategies aimed at reducing both. It is possible that tactics aimed at improving one measure in individual patients may adversely impact the other.  Objective We sought to analyze the impact of length of stay on readmission risk in an inpatient general medical population to assess whether patients with a lower length of stays were readmitted more frequently to the hospital. Methods We performed a retrospective analysis of inpatient adult patients admitted to our institution between January 2016 and December 2019. We recorded demographic variables and the outcomes of LOS and 30-day readmission. We excluded patients who expired, left against medical advice, or were transferred to other hospitals. We performed both univariate and multivariate analyses. Results There were 91,723 patients included in the study of which 10,598 (11.6%) were readmitted. The geometric LOS for all patients was 5.37 days and was higher in readmitted patients (6.87 vs 5.18 days, respectively, p < 0.001). Patients with higher readmission rates were older, had a higher proportion of male gender, African-American ethnicity, and were more likely to have Medicare or Medicaid payors. After performing a multivariate regression analysis, we found that a high LOS was associated with a higher likelihood of readmission (P < 0.001). Conclusion Contrary to our initial hypothesis, we found that general medical patients with a higher LOS had a higher likelihood of being readmitted to the hospital after adjusting for other variables. It is possible that factors not captured in the current dataset may help explain both the increase in LOS and readmission risk.

Discharge before noon: is the sun half up or half down?

OBJECTIVES: To analyze the impact of discharge before noon (DBN) on length of stay (LOS) and readmission of adult inpatients. STUDY DESIGN: Retrospective analysis of 78,826 patients from a single tertiary care center between January 1, 2016, and December 31, 2018. METHODS: The patient population was divided between patients discharged before and after noon. Outcomes were analyzed with univariate and multivariate analyses. RESULTS: DBN was independently associated with higher likelihood of LOS above the median (odds ratio [OR], 1.26; 95% CI, 1.18-1.35; P < .001) among medical patients. This association was not seen among surgical patients, in whom DBN was associated with a shorter LOS (OR, 0.78; 95% CI, 0.71-0.86; P < .001). Factors associated with higher LOS in both medical and surgical groups included higher case mix index, Medicaid payer, weekday discharges, and discharge to skilled nursing or rehabilitation facilities. For the variable of readmission, DBN in surgical patients was associated with a lower readmission rate (OR, 0.81; 95% CI, 0.69-0.95; P = .008). CONCLUSIONS: The finding that DBN was associated with higher LOS among medical patients suggests that some patients may have been able to be safely discharged the evening prior. In patients with surgical diagnoses, DBN was associated with a lower LOS and a lower risk of readmission. Patients with later discharges were more likely to be sent to a rehabilitation center or skilled nursing facility and were more frequently discharged during a weekday. Identification of these factors may help health systems transition patients safely and efficiently out of the hospital.

Caring for patients in a hospitalist-run clinical decision unit is associated with decreased length of stay without increasing revisit rates.

BACKGROUND: Observation medicine is a growing field with increasing involvement by hospitalists. Little has been written regarding clinical outcomes in hospitalist-run clinical decision units (CDUs). OBJECTIVE: To determine the impact of a hospitalist-run geographic CDU on length of stay (LOS) for observation patients. Secondary objectives included examining the impact on 30-day emergency department (ED) or hospital revisit rates. DESIGN: Retrospective cohort study with pre- and post-implementation analysis. SETTING: Urban, academic, 600-bed teaching hospital in Camden, New Jersey. PATIENTS: Observation patients discharged from medical-surgical units before and after CDU opening and those discharged from the CDU after CDU opening. INTERVENTION: Creation of a hospitalist-run, 20-bed geographic CDU, adjacent to the ED with order sets, protocols, and priority consults and testing. MEASUREMENTS: Median LOS for observation patients was calculated for 7 months pre- and post-CDU implementation. ED and hospital revisits requiring an observation or inpatient stay within 30 days of discharge were measured. RESULTS: CDU observation patients had a lower median LOS than medical-surgical observation patients during the same period (17.6 hours vs 26.1 hours, P < 0.001). CDU LOS was lower than medical-surgical observation LOS in the 7 months 1 year prior to CDU implementation (17.6 hours vs 27.1 hours, P < 0.001). CDU patients had a similar 30-day ED or hospital revisit rate compared with observation patients pre-CDU. CONCLUSIONS: Implementing a hospitalist-run geographic CDU was associated with a 35% decrease in observation LOS for CDU patients compared with a 3.7% decrease for medical-surgical observation patients. CDU LOS decreased without increasing ED or hospital revisit rates.