Outcomes on an inpatient oncology service after the introduction of hospitalist comanagement

Abstract

Background: Smilow Cancer Hospital (SCH) introduced hospitalist comanagement to the inpatient oncology service to address long lengths of stay and oncologist burnout. Objective: To determine the impact of hospitalists on inpatient quality outcomes and oncologist experience. Interventions: Hospitalists were introduced to one of two inpatient oncology services at SCH. Patients were assigned to teams equally based on capacity. Outcomes on the oncologist-led, traditional service (TS) were compared with outcomes on the hospitalist service (HS) 6 months after program implementation. Main Outcomes and Measures: Outcomes included patient volume, length of stay (LOS), early discharge, discharge time, and 30-day readmission rate. Mixed linear or Poisson models that accounted for multiple admissions during the study duration were used. Oncologist experience was measured by survey. Results: During the study period, there were 713 discharges, 400 from the HS and 313 from the TS (p =.0003). There was no difference in demographics or severity of illness (SOI) between services. Following adjustment for age, sex, race/ethnicity, cancer type, and discharge disposition, the average LOS was 4.71 on the HS and 5.47 on the TS (p =.01). Adjusted early discharge rate was 6.22% on the HS and 2.06% on the TS (p =.01). Adjusted mean discharge time was 3:45 p.m. on HS and 4:16 p.m. on TS (p =.009). There was no difference in readmission rates. Oncologists reported less stress (p =.001) and a better ability to manage competing responsibilities (p