Impact of an Attending-Only Pediatric Hospital Medicine Service on Patient Throughput

Children's hospitals face increasing patient volumes, prolonged length of stay (LOS), and constrained inpatient capacity. In response, our institution implemented Pediatric Hospital Medicine (PHM) service changes, including reduced teaching service (TS) patient caps and the addition of an attending-only service (AOS). We evaluated the association between the implementation of a PHM AOS and hospital throughput and discharge timeliness.

We conducted a retrospective review of 8294 PHM admissions at a single quaternary care pediatric hospital from October 2021 through December 2023. Monthly aggregate data were compared 1 year before and after AOS implementation in November 2022. Primary outcomes were discharge before 11 am and LOS. Secondary outcomes included all-cause return to the emergency department (ED) within 7 days of discharge and all-cause unscheduled readmission within 30 days. Outcomes were compared preimplementation vs postimplementation and between TS and AOS using 2-sample t-tests and chi-square tests.

There was no overall difference in discharge before 11:00 am for all PHM patients preimplementation vs postimplementation (8.0% vs 8.8%; P = .17). A greater proportion of patients had early discharge on the AOS compared with TS (12.25% vs 8.38%; P = .008). LOS did not differ by service or time period. There were no differences in postdischarge ED visits or readmissions.

The creation of a PHM AOS had no impact on overall patient early discharges or LOS but was associated with earlier discharges on the AOS without adversely affecting readmissions. More work is needed to assess other interventions to improve overall hospital throughput.