Patients Who See Multiple Physicians Have Lengthier Hospital Stays

An analysis of more than 10,000 hospitalized patient reveals that seeing different physicians (Hospitalists) prolongs patient hospital stays. The practice of acquiring hospital-based physicians to evaluate and treat patients may not be as beneficial for patients as it is for doctors.

Obtaining follow up appointments has also been identified as a quality of care issue. Study author, Kenneth R. Epstein, MD, from IPC The Hospitalist Company Inc, North Hollywood, California has defined the dilemma as fragmentation of care, or FOC, explaining: ...”if a patient who was hospitalized for 5 days saw 1 doctor for 3 days and other doctors the other 2 days, FOC would be 2 of 5, or 40%."

Dr. Epstein analyzed the medical records of patients across 16 states - 1724 patients admitted with pneumonia and complications, and 8509 patients admitted with heart failure and shock. Hospital admissions were between December 2006 and November 2007. The patients stayed at 223 hospitals. He concluded that greater fragmentation of care resulted in longer hospital stays for all patients with pneumonia and heart failure.

The exact reason for the extra days in the hospital is only speculative. Bryan Huang, MD, assistant clinical professor of medicine at the University of California, San Diego, says it is "anyone's guess, but there's no way to convey 100% of the information each time you hand off a patient to someone else. Dr. Huang says, “You don't know what the previous day was like, admitting that he is always reluctant to discharge a patient on the first day he has assumed care.

The use of Hospitalists has had a positive impact on clinicians by promoting a healthy work-life balance, " but much less focus has been given to the impact of discontinuity of care on patient length of stay and other utilization and quality metrics,according to Dr. Epstein.

If you find yourself or a family member in the hospital, you may want to discuss discharge plans before the “hand off”.

J Hosp Med. 2008;3(suppl 1):11. ◦

Patients Who See Multiple Physicians Have Lengthier Hospital Stays