Closing the clinics: would it close the teaching hospital?

Area of Science:

• Healthcare Management
• Hospital Operations
• Clinical Services

Background:

• Teaching hospitals often consider reducing clinic size to improve finances.
• The impact on inpatient services requires careful assessment before implementing such changes.

Purpose of the Study:

• To evaluate the effect of clinic size on the inpatient medical ward service.
• To determine the role of the clinic system in patient referrals and readmissions.

Main Methods:

• A retrospective study of the medical ward service at The New York Hospital during the 1981-1982 academic year.
• Analysis of patient admission sources, including clinic enrollment, prior institutional contact, and new patients.
• Tracking of patient disposition post-discharge (clinic, chronic care, community physician) and subsequent readmission rates.

Main Results:

• 50% of hospitalizations involved patients previously enrolled in the clinic system.
• Patients discharged to a clinic had a 20% readmission rate, significantly higher than those referred to community physicians (7%) or chronic-care facilities (3%).
• New patients primarily replaced those who died or were discharged to non-clinic settings.

Conclusions:

• The clinic system is the primary referral source for the inpatient ward service.
• Reducing clinic size will likely lead to a significant contraction of the inpatient service.
• Clinics are essential for ensuring patient readmission and maintaining hospital service levels.