Dennis Shung, MD1, Kenneth H. Hung, MD, MS2, Loren Laine, MD1, Michelle L. Hughes, MD2; 1Yale University, School of Medicine, New Haven, CT; 2Yale School of Medicine, New Haven, CT
Introduction: The hospitalist field has grown exponentially in internal medicine, pediatrics, and other specialties over the last 20 years. GI hospitalists have existed for years, but little is known about their impact on productivity. We aim to determine the effect of introducing a GI hospitalist model on endoscopic procedure volume. Our hypothesis was that inpatient endoscopic volume would increase and outpatient volume would rise given reduced inpatient responsibilities for other attending physicians. Methods: A two-attending GI hospitalist model was introduced at a large academic center 7/2019. GI hospitalists did not perform outpatient procedures. An interrupted time series design was deployed: pre-intervention time period was 9/1/2018 to 3/1/2019, matched to post-intervention time period 9/1/2019 to 3/1/2020 with a 2-month run-in time from 7/1/2019 to 9/1/2019 to allow for transition to the new model. Segmented regression was used to compare total procedure volume, both inpatient and outpatient, at the institution’s 4 endoscopy units. Assessment was stopped 3/1/2020 to reduce influence from COVID-19. Primary outcome was total endoscopic procedures. Results: A total of 29 providers were included. Other than addition of hospitalists, the number of endoscopy providers did not change from the pre-intervention to post-intervention period. Total endoscopic procedures increased 1077/5444 ((20%) p=0.01); with similar increases in inpatient procedures (328/1472 (22%), p=< 0.001) and outpatient procedures (752/3969 (19%), p=0.02) (Table 1). The pre- and post-implementation groups were similar in age and sex (Table 1). Discussion: Introduction of a GI hospitalist model increased overall endoscopy volume, with similar increases for inpatient and outpatient procedures. When gastroenterologists cover both inpatient and outpatient responsibilities, productivity may decrease due to need to cancel outpatient procedures while on inpatient service and reduced availability for urgent inpatient endoscopies related to outpatient responsibilities. A GI hospitalist model reduces these disruptions by using in-hospital providers to cover unpredictable inpatient needs, allowing outpatient providers to continue scheduled procedures without interruptions.
Implementing a GI hospitalist model resulted in increased procedural volume. However, further study is needed to evaluate the duration of this effect and to evaluate the effect on clinic productivity and quality metrics.
Segmented regression model showing endoscopic volume over time with a GI Hospitalist model introduced 7/2019
Procedure details pre- and post-GI hospitalist system
Demonstration of the distribution of inpatient service responsibilities pre- and post-GI hospitalist system
Disclosures: Dennis Shung indicated no relevant financial relationships. Kenneth Hung indicated no relevant financial relationships. Loren Laine indicated no relevant financial relationships. Michelle Hughes indicated no relevant financial relationships.