Residency

House staff service produces same outcomes as hospitalist service, according to study

Residency Program Insider, December 23, 2008

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New research indicates that services covered by hospitalists and physicians can be just as efficient and have similar patient care outcomes as those that are covered by house staff.

Since duty hour regulations took effect in 2003, many academic medical centers have employed the services of hospitalists and physician assistants to cover services when residents are unavailable.

Researchers at Brigham & Women’s Hospital in Boston assessed the quality and efficiency of patient care on services staffed by residents and by hospitalists and physician assistants. They looked at the following: length of stay (LOS), cost of care, inpatient mortality rates, intensive care unit (ICU) transfers, readmissions, and patient satisfaction.

According to the study, published in the Journal of Hospital Medicine, cost of care was slightly lower on the hospitalists/physician assistant service. Differences between the LOS were not significant. Study authors saw no variation in inpatient mortality rates, ICU transfers, readmission, or patient satisfaction.

The findings of this study are especially interesting as the recent release of the Institute of Medicine’s (IOM) report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, which thrusts the issue of work-hour limitations into the forefront of graduate medical education.

In the report, the IOM calls for restrictions to shift lengths and protected sleep time for residents. The organization suggests that mid-level providers, such as hospitalists and physician assistants, provide coverage when residents are unavailable.



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