Medical Staff

Hospitalist extensivists reduce readmission and length of stay

Hospitalist Leadership Connection, October 19, 2010

Hospitalists who expand their role as extensivists can reduce readmissions and lower length of stay for high-risk patients, according to a new study from the Agency for Healthcare Research and Quality (AHRQ), “Medical ‘extensivists’ care for high-acuity patients across settings, leading to reduced hospital care,” published on October 13.

“Traditional hospitalist programs focus on managing the inpatient stay, with little or no effort made to ensure that patients receive needed care and services after discharge,” the article states.

With the expanded role of the employed hospitalist beyond the inpatient setting, however, these hospitalists broaden the definition of hospitalist (traditionally defined as a physician who practices only in the hospital).

Hospitalist extensivists care for high-acuity patients and split their time between the hospital and a skilled nursing facility and/or outpatient facility. They follow senior Medicare patients with diabetes and/or heart, lung, and kidney disease. They round on a smaller daily case load of six to eight patients, with support from intervention teams, nurse practitioners, and electronic medical record services to carefully monitor these high-risk patients.

Researchers found that length of stay averaged 3.2 days, down from 5.8 days for typical Medicare patients. They also found that 30-day readmission rate averaged 13.4%, compared to 16% before implementing the extensivist model.

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