Child/Adolescent Health

Use of pediatric hospitalists decreases hospital costs and stays without adversely affecting clinicians or parents

Pediatric hospitalists focus on hospital care and spend most of their working day at the hospital, while other pediatricians typically spend much of the day at the office and see their hospitalized patients during morning or evening rounds. Use of pediatric hospitalists decreases hospital costs and length of stay for hospitalized children. This approach does not adversely affect the experiences of the referring physician, parent, or hospital housestaff, concludes a study supported by the Agency for Healthcare Research and Quality (HS13333).

Christopher Landrigan, M.D., M.P.H., of Harvard Medical School, and colleagues systematically reviewed studies on pediatric hospitalist systems. They analyzed 20 studies presenting primary data on efficiency, financial performance, and clinical outcomes affecting family, referring provider, and housestaff experience in hospitalist systems. Demonstrated improvement in costs and/or length of stay in pediatric hospitalist systems was shown in six of seven studies that compared traditional and hospitalist systems of care. The average decrease in cost was 10 percent, and the average decrease in length of stay was 10 percent.

However, all three economic analyses demonstrated that efficiency gains did not generally translate into revenues for the hospitalist programs themselves. In fact, most hospitalist programs were losing money at the time of the study. Surveys of families, referring providers, and pediatric residents demonstrated neutral or improved experiences in hospitalist systems, although these data were less comprehensive. Data on quality of care were insufficient to draw conclusions.

More details are in "Pediatric hospitalists: A systematic review of the literature," by Dr. Landrigan, Patrick H. Conway, M.D., Sarah Edwards, B.A., and Rajendu Srivastava, M.D., F.R.C.P., M.P.H., in the May 2006 Pediatrics 117(5), pp. 1736-1744.

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