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Redefining the community pediatric hospitalist: the combined pediatric ED/inpatient unit
Scott D Krugman1, Adrienne Suggs, Hasnain Y Photowala
1Department of Pediatrics, Franklin Square Hospital Center, Baltimore, MD 21237, USA. Scott.Krugman@MedStar.net
Insights
Implementing a combined pediatric Emergency Department (PED) and inpatient unit improved hospitalist billing and ED patient satisfaction while reducing wait times. This model offers a potential solution for community hospitals seeking better financial and patient outcomes.
Area of Science:
- Pediatric hospital medicine
- Healthcare management
- Emergency medicine
Background:
- Community hospitals face challenges in providing high-quality, financially sustainable pediatric care.
- The demand for pediatric hospitalists has grown, necessitating innovative care delivery models.
Purpose of the Study:
- To assess the impact of integrating pediatric Emergency Department (PED) and inpatient services under a unified hospitalist model.
- To evaluate financial performance and patient satisfaction metrics following the implementation of a combined unit.
Main Methods:
- A community hospital transitioned from a traditional model to a combined PED/inpatient unit staffed by pediatric hospitalists.
- Key performance indicators, including Part B billings, patient satisfaction scores (Press Ganey), wait times, and risk-adjusted length of stay (ALOS), were compared pre- and post-implementation (2003 vs. 2004).
Main Results:
- Part B billings by pediatric hospitalists increased by 82% ($1.6M to $3.0M).
- Pediatric Emergency Department (PED) patient satisfaction scores significantly improved (75.8 to 83.4), alongside reduced wait times for treatment and overall ED throughput.
- Inpatient satisfaction scores showed no significant change, and risk-adjusted length of stay remained consistent.
Conclusions:
- A combined PED/inpatient unit model can enhance financial performance and patient satisfaction in community hospital settings.
- This integrated approach offers a viable strategy for pediatric hospitalist programs aiming to optimize both financial and clinical outcomes.
Background:
The use of pediatric hospitalists in community hospitals has increased over the past decade in response to the desire to provide high-quality pediatric care. Many hospitals are challenged to create financially independent and productive programs.
Objective:
To evaluate an alternative approach to traditional community hospital pediatric care of having pediatricians work in a combined pediatric Emergency Department (PED)/inpatient unit.
Design/Methods:
Franklin Square Hospital Center converted its pediatric hospitalist program from a traditional inpatient with partial Emergency Department (ED) coverage program to one that covers a combined PED/inpatient unit. Outcome categories were compared between the year before opening, 2003, to the year after, 2004. Measures included total part B billing, overall patient satisfaction scores for the PED and inpatient unit from the Press Ganey patient satisfaction survey, perception of wait times and time to admission, and risk-adjusted inpatient length of stay (ALOS).
Results:
Part B billings from the 5.5 Full Time Equivalent (FTE) pediatric hospitalists increased 82% from increased 61% from 2003 to 2004, from 1,631,583 dollars in 2003 to 2,967,715 dollars in 2004 as a result of increased volume of ED patients seen by pediatricians. The mean inpatient satisfaction score did not significantly change, 75.7 in 2003 and 79.0 in 2004 (P = 0.432), but the mean PED score significantly increased from 75.8 to 83.4 (P = 0.0001). Mean scores of the efficiency measures on the survey increased for PED patients, with the mean score for wait time to treatment increasing from 62.0 to 75.3 (P < 0.0001). Total throughput time through the ED improved significantly as well from 143 minutes to 122 minutes (P = 0.0003). Risk-adjusted length of stay performance did not change; for calendar year 2003, the mean monthly ALOS was 1.883 (95% range 1.503, 2.263), compared with a 2004 mean monthly ALOS of 1.869 (95% range 1.523, 2.216).
Conclusions:
Implementation of a combined PED/inpatient unit was associated with increased billing by hospitalists, increased satisfaction scores of ED patients, and decreased ED throughput times. Pediatric hospitalist programs that want to improve financial and patient outcomes in a community setting could consider adopting the combined unit approach.
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