Generalist vs specialist acute medical admissions – What is the impact of moving towards acute medical subspecialty admissions on efficacy of care provision?

Link to article at PubMed

Eur J Intern Med. 2021 Dec 22:S0953-6205(21)00409-X. doi: 10.1016/j.ejim.2021.12.007. Online ahead of print.


INTRODUCTION: The discussion surrounding generalist versus specialist acute medical admissions continues to stimulate debate and patients with certain conditions benefit from specialist care.

AIM: To determine whether a specialty medical admission program would reduce inpatient length of stay (LOS), mortality and readmission rates.

DESIGN/METHODS: A prospective cohort study of inpatients admitted under a general internal medicine (GIM) service before and after introduction of a specialty-directing programme. We hypothesized that early transfer of patient care to a specialty suited to their presenting complaint would reduce LOS and a specialty-directing early redistribution of care programme was introduced. Seven of the ten clinical teams participating in the GIM roster adopted the programme. On the morning following a specialty-directing team being on call for all new GIM admissions during a 24-hour period, specialty-directing teams were allocated one patient appropriate to their specialty.

RESULTS: 5,144 patient-care episodes were analysed over the two-year study period. LOS increased by greater than 15%, one year after introducing the specialty-directing programme (8.5±8.4 vs 7.3±7.5 days, p < 0.001). LOS did not differ between teams that participated and those who did not (8.4±8.1 vs 8.1±7.9 days, p = 0.298). No differences were found in the proportion of patients who were discharged home, died while an inpatient or re-admitted within 30 days of discharge. The proportion of patients aged greater than 80 years increased significantly also - from 24.7% in 2017 to 27.9% in 2019(p == 0.009).

CONCLUSION: Widespread adoption of specialist care may not be beneficial for all medical inpatients and physicians should continue to undergo dual specialist and GIM training.

PMID:34953654 | DOI:10.1016/j.ejim.2021.12.007

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