Physician continuity may influence hospital length of stay, according to a recent study.
The study included all patients admitted in 2015 to the general medicine service at a tertiary care teaching hospital in Canada. Attending inpatient physician continuity was measured as the consecutive number of days each patient was treated by the same physician. The study used generalized estimating equation methods to model the adjusted association of attending continuity with daily discharge probability. Results were published online on June 13 by the Journal of General Internal Medicine.
Overall, the study assessed 6,301 admissions involving 41 internists, 5,134 patients (mean age, 68.0 years; 50.7% women), and 38,242 patient-days. Attending coverage was “notably fragmented,” with a median total duration of service of nine weeks among the 41 physicians (most also had varying degrees of outpatient care responsibilities). Each physician treated a median of 276 hospitalizations and a median of 1,035 patient-days during the study period.
Discharge likelihood significantly increased with greater attending continuity. Daily discharge probability increased for the average patient from 15.3% to 20.9% when the consecutive number of days the patient was treated by the same physician increased from one to seven. In contrast, the probability of daily discharge significantly decreased with greater severity of illness, higher annual mortality risk, and longer length of stay, as well as for elective admissions. Discharge was also less likely on the first day of admission (adjusted odds ratio, 0.40; 95% CI, 0.35 to 0.47) and on weekends and holidays (adjusted odds ratio, 0.61; 95% CI, 0.56 to 0.67).
Limitations of the study include its focus on only one patient outcome (daily discharge probability) and its single-center design, the study author noted. In addition, the analysis did not account for other factors that could influence the daily probability of discharge, including support from family and housestaff or nursing continuity. The findings “could be considered if physician or hospital administrators wish to classify hospital resource utilization as a factor when scheduling physician coverage,” the author wrote.