Pediatric hospitalists: A systematic review of the literature

BACKGROUND. Systematic reviews have demonstrated consistently decreased length of stay and costs in internal medicine hospitalist systems. Systematic reviews of pediatric hospitalist systems have not been conducted. OBJECTIVE. Our aim was to determine the effects of pediatric hospitalist systems on length of stay, costs, quality of care, and provider satisfaction and experience. METHODS. We searched PubMed, Medline, Cochrane Library databases, and the Pediatric Academic Societies National Meeting research abstracts for all primary-data studies published or presented on pediatric hospitalist systems. Studies presenting primary data on efficiency, financial performance, clinical outcomes, or family, referring provider, and housestaff experience in hospitalist systems were included; review articles and case studies were excluded. To minimize publication bias, we contacted all primary authors to obtain information about unpublished studies. RESULTS. Of 47 publications reviewed, 20 were primary-data studies that met criteria for inclusion. Six of 7 studies that compared traditional and hospitalist systems of care demonstrated improvements in costs and/or length of stay in pediatric hospitalist systems. The average decrease in cost was 10%; average decrease in length of stay was 10%. Three of 3 economic analyses, however, demonstrate that efficiency gains do not generally translate into revenues for the hospitalist programs themselves; most hospitalist programs are currently losing money. Surveys of families, referring providers, and pediatric residents demonstrate neutral or improved experiences in hospitalist systems, although these data are less comprehensive. Data on quality of care are insufficient to draw conclusions. CONCLUSIONS. Emerging research suggests that pediatric hospitalist systems decrease hospital costs and length of stay without adversely affecting provider, parent, or housestaff experiences. The quality of care in pediatric hospitalist systems is unclear, because rigorous metrics to evaluate quality are lacking. Studies of the processes and outcomes of hospital care are needed.