Hospitalists as a staffing innovation: does it impact hospital efficiency?

Abstract

Background:

The use of “hospitalists”, a staffing innovation introduced in the US health care system in the mid-1990s, has grown rapidly in recent years. These hospital-based physicians have been found to be more efficient (reduced length of stay and costs) compared to their nonhospitalist counterparts. However, these studies have generally been conducted on single teaching or pediatric hospitals.

Purpose:

This study explored the association between the use of hospitalists and efficiency, as measured by length of stay (LOS), operating costs per inpatient day, and registered nurse (RN) staffing per bed.

Materials and methods:

A panel-design regression with hospital and year-fixed effects was conducted among a national sample of medical surgical acute care hospitals operating in the US between 2007 and 2010. Three separate fixed-effect regressions models were used for each of the three dependent variables: LOS, operating costs per inpatient day, and RN staffing per bed.

Results:

Our findings indicate that high hospitalist staffing intensity (hospitalist full-time equivalents per 1,000 adjusted inpatient days) is associated with lower LOS, but also higher operating costs and RN staffing per bed.

Conclusion:

Hospital managers should consider the potential implications of hospitalist use as an innovation strategy. While hospitals with higher hospitalist staffing intensity may experience lower LOS, this may come at the expense of increased operating costs and RN staffing.

Keywords::

• hospitalists
• staffing innovation
• efficiency
• costs
• RN staffing

Disclosure

The authors report no conflicts of interest in this work.