Purpose: Work hour restrictions, external pressure to reduce hospitalization costs, and rising inpatient acuity have prompted a variety of changes in the ward-based educational models traditionally employed in residency training. The impact of these changes remains largely unstudied.
Method: The authors collected data retrospectively on hospital patients with advanced liver disease before (July 1, 2003, to May 31, 2004) and after (July 1, 2004, to May 31, 2005) implementation of a novel specialized housestaff service (SHS) model for those patients, supervised by a multidisciplinary hepatology team led by an attending hepatologist. The authors also assessed the satisfaction of the 118 internal medicine residents who had rotated through both the SHS model and a traditional housestaff service (THS) in cardiology.
Results: In univariate analysis, there was a trend toward a reduction in mean length of stay (LOS) after implementation of the liver service that did not meet statistical significance (P = .1). After adjustment for patient acuity and Model-for-End-Stage-Liver-Disease score, implementation of the liver service was associated with a statistically significant reduction in LOS (P = .05). In contrast, during the study period, there was an increase in LOS on a comparable, nonspecialized medicine housestaff ward even after adjustment for patient acuity (P < .01). With respect to housestaff satisfaction, 90% of housestaff reported being satisfied overall with their experience caring for patients under the SHS model, with a mean score of 4.1 on a 5-point scale.
Conclusion: The implementation of the SHS model of patient care is associated with a decreased LOS and increased trainee satisfaction when compared with the THS model of patient care.
Dr. Lai is a first-year gastroenterology fellow, University of California–San Francisco, San Francisco, California. At the time of this study, she was an internal medicine resident, New York Presbyterian Hospital–Columbia Presbyterian Medical Center, New York, New York.
Dr. Montero is assistant professor of internal medicine, Columbia University College of Physicians and Surgeons, New York, New York, and associate program director of the internal medicine residency program, New York Presbyterian Hospital–Columbia Presbyterian Medical Center, New York, New York.
Dr. Lebwohl is a second-year gastroenterology fellow, New York Presbyterian Hospital–Columbia Presbyterian Medical Center, New York, New York.
Dr. Brown is chief, Division of Abdominal Organ Transplantation, and Frank Cardile Associate Professor of Medicine and Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
Correspondence should be addressed to Dr. Brown, Center for Liver Disease and Transplantation, New York Presbyterian Hospital–Columbia Presbyterian Medical Center, 622 West 168th Street, PH 14 Center, New York, NY 10032-3784; telephone: (212) 305-0662; fax: (212) 305-4343; e-mail: (firstname.lastname@example.org).