Implementation of a hospitalist-run observation unit and impact on length of stay (LOS): a brief report

J Hosp Med. Nov-Dec 2010;5(9):E2-5. doi: 10.1002/jhm.642.


Background: While the impact of hospitalists on length of stay (LOS) for inpatient medicine services has been studied, there has been little work on the impact of hospitalist involvement in short-stay or observation units.

Objective: The primary objective was to examine the impact of a hospitalist-run observation unit on LOS. The secondary objective was to assess utilization of the unit through examining case-weight and LOS.

Design: Retrospective cohort study with a preimplementation/postimplementation analysis.

Setting: University Hospital, the 604-bed teaching hospital for Bexar County, San Antonio, Texas.

Patients: All patients discharged from the inpatient medicine and observation units with diagnoses of chest pain, asthma, syncope, cellulitis, and pyelonephritis.

Intervention: Creation of a hospitalist-run, nonteaching, 10-bed "Clinical Decision Unit" (CDU).

Measurements: The overall LOS of the "top 5" most common diagnoses was compared for the 12 months preimplementation and postimplementation of the unit.

Results: The overall LOS for all patients decreased from 2.4 to 2.2 days (P = 0.05) between the 12 months preimplementation and postimplementation. The greatest decreases were seen for cellulitis (2.4-1.9 days; P < 0.001) and asthma (2.2-1.2 days; P < 0.001).

Conclusions: Implementation of a hospitalist-run observation unit was associated with a significantly decreased LOS for all patients regardless of location, suggesting that the unit has led to more efficient care.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Asthma
  • Chest Pain
  • Cohort Studies
  • Hospitalists*
  • Hospitals, University
  • Humans
  • International Classification of Diseases
  • Length of Stay*
  • Outcome Assessment, Health Care
  • Patient Discharge
  • Program Development
  • Retrospective Studies
  • Texas
  • Watchful Waiting*