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. Journal of Hospital Medicine 2014;9:391–395. © 2014 Society of Hospital Medicine