45.02 Hospital Teaching Status Impacts Surgical Discharge Efficiency

P. M. Dowzicky¹, C. Wirtalla¹, J. H. Fieber¹, I. Berger², S. Raper¹, R. R. Kelz^{1  1}University Of Pennsylvania,Surgery,Philadelphia, PA, USA ²University Of Pennsylvania,School Of Medicine,Philadelphia, PA, USA

Introduction:

There is a paucity of data regarding the efficiency of care provided by teaching hospitals.  Yet, instruction on transitions in care and an understanding of systems-based practice are key components of modern graduate medical education. We aimed to determine the relationship between hospital teaching status and the discharge efficiency from a surgical service.

Methods:

The Healthcare Cost and Utilization Project National Inpatient Sample was used to identify patients undergoing a general surgical procedure in 2012.  Patient stratification was based on treating hospital teaching status (TH vs NTH). Procedure-specific early discharge (PSED) was defined for each operation type as a discharge that occurred within the lowest 25^th percentile for overall length of stay.  PSED was used as the discharge efficiency metric.  To adjust for cofounders and hospital level clustering, multivariable mixed-effects logistic regression was used to examine the association between teaching status and PSED.  Sub-group analysis was performed by operation type.  Models were constructed with and without adjustment for inpatient complications. Bonferroni correction was used to account for multiplicity.

Results:

Of 272,090 patients, 140,878 (51.8%) received care at a TH. TH status was significantly associated with lower PSED (TH: 10.7% vs. NTH: 11.4%; p<.001) and longer length of stay (TH: 5.5 days vs. NTH: 4.5 days; p<.001).  In the adjusted model of the overall cohort, patients treated at a TH were 8% less likely to receive a PSED compared to those treated at a NTH (OR .92, 95%CI (.88, .97) ;p<.002).  Differences in the rates and odds of PSED were noted across the subgroups. [Table 1] 

Conclusion:

Teaching hospital status is associated with a reduced likelihood of PSED.  The effect of TH on PSED varied by procedure sub-group. Examining the recovery pathways and discharge practices at NTH may allow for the identification of more efficient methods of care that can be applied to the broader healthcare system.  Teaching efficient practices of care within TH will likely magnify the effects of these efforts as trainees’ transition to independence.