Transition of a Neurology Subspecialty Service to a Pediatric Hospitalist Model of Care

Pediatric hospitalists have increasingly been relied on to care for hospitalized patients. While hospitalist care models have shown many benefits, studies examining the transition from subspecialist to hospitalist-led teams are lacking. This study aimed to monitor the impact of transitioning an inpatient pediatric neurology service to a hospitalist model on several key outcome measures, with the hypothesis that these measures would be unaffected by the transition.

In July 2019, the neurology service at a freestanding pediatric academic center transitioned a hospitalist model. Statistical process control charts tracked patient-level outcomes related to quality, safety, and patient/caregiver experience. A medical education-focused survey was distributed to residents before and after service transition with survey responses analyzed using descriptive statistics.

During the 42-month posttransition period, seizure length of stay (LOS) improved from 2.42 to 1.96 days, while headache LOS remained unchanged at 1.44 days. The days between both reported safety events reaching a patient and clinical deterioration events remained stable, although 5 clinical deterioration events were observed in the first 12 months after the transition. Top-box response percentage for posthospitalization survey questions about physicians improved from 70% to 81%. Survey-based medical education evaluations showed no significant changes in resident confidence or neurology knowledge around neurological issues.

Our institution successfully transitioned a pediatric neurology subspecialty inpatient service to a hospitalist-led model while monitoring the effect on quality, safety, patient/caregiver experience, and medical education outcome measures. Studying transitions in care models is necessary to understand their impact and value for pediatric patients.