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(Circulation. 2008;117:2637-2644.)
© 2008 American Heart Association, Inc.

Health Services and Outcomes Research

Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure

Jennifer L. Schuberth, MD, MPH; Tom A. Elasy, MD, MPH; Javed Butler, MD, MPH; Robert Greevy, PhD; Theodore Speroff, PhD; Robert S. Dittus, MD, MPH; Christianne L. Roumie, MD, MPH

From the St Thomas Medical Group, Nashville Tenn (J.L.S.); VA National Quality Scholars Fellowship Program (J.L.S., T.A.E., T.S., R.S.D.), Geriatric Research Education Clinical Center (J.L.S., T.A.E., R.G., T.S., R.S.D., C.L.R.), HSR&D Targeted Research Enhancement Program Center for Patient Healthcare Behavior (J.L.S., T.A.E., R.G., T.S., R.S.D., C.L.R.), and Clinical Research Training Center of Excellence (R.G., C.L.R.), Tennessee Valley Healthcare System, Nashville; Departments of Medicine (J.L.S., T.A.E., T.S., R.S.D., C.L.R.), Biostatistics (R.G., T.S.), and Preventive Medicine (T.S.), Vanderbilt University Medical Center, Nashville, Tenn; and Department of Medicine Cardiology Division, Emory University, Atlanta, Ga (J.B.).

Reprint requests to Christianne L. Roumie, MD, MPH, Nashville VA Medical Center, GRECC, 1310 24th Ave S, Nashville, TN 37212. E-mail christianne.roumie{at}vanderbilt.edu

Received September 14, 2007; accepted March 13, 2008.

Background— In response to residency work hour restrictions, programs restructured call schedules, increasing the use of short call (daytime admitting teams). Few data exist on the effect of short call on quality of patient care. Our objective was to examine the effect of short call admission on length of stay and quality of care for patients with acute decompensated heart failure.

Methods and Results— We conducted a retrospective cohort study of 218 patients admitted with acute decompensated heart failure to the Nashville VA Medical Center between July 1, 2003, and June 30, 2005. The primary exposure was short call, and the primary outcome was length of stay. The secondary outcomes—diuretic dosing, weight monitoring, and hospital complications—were determined through a combination of administrative data and chart review. Patients admitted to short call had a longer median length of stay than patients admitted to long call (5.2 days [25% to 75%, 3.2 to 8 days] versus 3.9 days [interquartile range, 2.7 to 6.5 days]; P=0.0004). After adjustment for covariates, short call had a 44% increase in length of stay (95% CI, 15 to 80) compared with long call. Short call patients received fewer diuretic doses in the first 24 hours of hospitalization (1.80 versus 2.12; P=0.014) and had a longer median time to the second dose of loop diuretics compared with long call patients (17.9 hours versus 16.2 hours; P=0.044).

Conclusions— Admission to short call is predictive of increased length of stay, a decreased number of diuretic doses, and delays in the timing of diuretics among patients with acute decompensated heart failure. Additional studies are needed to clarify the impact of short call admission on inpatient quality of care.

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CLINICAL PERSPECTIVE

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