Redesign of a hospital's internal medicine service

Hospital internal medicine and family practice care were redesigned in July 1995 at Kaiser Permanente of Colorado. The objectives were to provide for a full time dedicated inpatient team, improve continuity of care, and establish a two-tiered process of admission. Physicians were divided into four tracks that marked varying degrees of time in the hospital. A position of triage physician was created that screened all potential admissions to internal medicine. Hospital inpatient days per thousand members, unadjusted lengths of stay, patient readmission rates, and satisfaction questionnaires were obtained both before and after the change. The change achieved significant reductions in unadjusted average lengths of stay and days per thousand without diminishing quality of care, as reflected by hospital readmission rates and by patient satisfaction surveys.