Clinical studyEffects of end-of-month admission on length of stay and quality of care among inpatients 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
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