Clinical study
Effects of end-of-month admission on length of stay and quality of care among inpatients with myocardial infarction

https://doi.org/10.1016/S0002-9343(02)01216-0Get rights and content

Abstract

Purpose

We studied whether transfer of care when house staff and faculty switch services affects length of stay or quality of care among hospitalized patients.

Subjects and methods

We performed a retrospective analysis in 976 consecutive patients admitted with myocardial infarction from 1995 to 1998. Patients who were admitted within 3 days of change in staff were denoted end-of-month patients.

Results

Of 782 eligible patients, 690 (88%) were admitted midmonth and 92 (12%) at the end of the month. The median length of stay was 7 days for midmonth and 8 days for end-of-month patients (P = 0.06). End-of-month admission was an independent predictor of length of stay in multivariate models. In addition, a significant difference in length of stay was noted between patients admitted at the beginning and end of the academic year. There were no statistically significant differences in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, or lipid-lowering agents at discharge between midmonth and end-of-month patients. Mortality and in-hospital adverse events did not differ between the two groups, with the possible exception of a greater incidence of acute renal failure in the end-of-month patients.

Conclusion

Although admission during the last 3 days of the month is an independent predictor of length of stay, it does not have a large effect on quality of care among patients with myocardial infarction.

Section snippets

Setting and patients

Data were abstracted from medical charts of consecutive patients with myocardial infarction who had been admitted to our inpatient cardiology service, a 46-bed service including 10 beds in the coronary intensive care unit. During the study, there were two inpatient cardiology teams each month. Each team consisted of 1 attending cardiologist, 3 internal medicine residents, 3 interns, and varying numbers of medical students. One cardiology fellow supervised care in the coronary care unit only.

Results

Of the 976 patients with myocardial infarction in our database, 36% (n = 348) were admitted through the emergency department, 58% (n =569) were transferred from other hospitals, 3% (n = 28) were admitted directly from physicians’ clinics, and 3% (n = 31) were transfers from our other inpatient services. Ninety-seven patients (10%) had a length of stay less than 4 days. The in-house transfers, “short-stay” patients, and 1 patient with a stay longer than 90 days were excluded, leaving 847

Discussion

We found that among patients with myocardial infarction, admission during the last 3 days of the month and discharge following the inpatient team switch was associated with an increased length of stay of about 1 to 3 days, similar in magnitude to the effects of diabetes, peripheral vascular occlusive disease, and advanced age. We attribute this effect to the switch of the attending cardiologists and senior residents.

We did not address the effect of the intern switch, which occurs 1 week

References (30)

  • E. Chen et al.

    Variation in hospital length of stay for acute myocardial infarction in Ontario, Canada

    Med Care

    (1994)
  • I.S. Udvarhelyi et al.

    Teaching status and resource use for patients with acute myocardial infarctiona new look at the indirect costs of graduate medical education

    Am J Public Health

    (1990)
  • J.A. Cameron

    Indirect costs of medical education

    N Engl J Med

    (1985)
  • A.M. Garber et al.

    Case-mix, cost, and outcomes

    N Engl J Med

    (1984)
  • E.C. Rich et al.

    The relationship of house staff experience to the cost and quality of inpatient care

    JAMA

    (1990)
  • Cited by (0)

    View full text