Background: In recent oncology care, the hospitalist model has emerged to reduce hospital stays, enhance inpatient capacity and alleviate burnout among oncologists, all while maintaining high quality inpatient care (Morris JC, et al. J Hosp Med. 2023;18(5):391-397). Oncology hospitalists-typically internal medicine physicians caring for acutely ill cancer patients-are shown to reduce hospital stays and improve inpatient capacity by enhancing communication, managing oncologic emergencies, and managing palliative care symptoms (Atlas KR, et al. Oncologist. 2020;25(12):e2006-e2009).

To our knowledge, Moffitt Cancer Center pioneers one of the first long-term, consistent and comprehensive studies into the hospitalist model for inpatient care, focusing on individuals with malignant hematology conditions and addressing their acute medical issues. The Heme Hospitalist service structure includes a hospitalist, a malignant hematology-trained advanced practice provider, and a malignant hematology-trained pharmacist to emphasize a comprehensive approach to drive high quality patient-centered care.

Objective: Evaluate the oncology hospitalist model on key quality outcomes within an inpatient malignant hematology setting through a single-center retrospective cohort study at Moffitt Cancer Center.

Methods: Electronic records were queried for patients >18 years of age that were admitted to inpatient services in Heme A and B (traditional) or the co-managed Heme C and M service (hospitalist model implemented in Oct 2022). Three time periods of 13-month duration: Traditional (Aug 2020-Aug 2021), Transition (Sept 2021-Sept 2022), Hospitalist Model Intervention (Oct 2022-Oct 2023) were compared for admissions, discharges, Average Length of Stay (ALOS), Inpatient (IP) Bed Days Used, and 30-day unplanned readmission rate. ANOVAs compared LOS, case mix index, mortality risk, and severity of illness. We excluded patients that were transferred between services.

Results: 4,813 admissions occurred during the Aug 2020-Oct 2023 study period. ALOS decreased significantly amongst all services, as did the gap between Vizient expected LOS versus actual LOS. Although total IP Bed Days Used increased during the same time period, if there was no decrease in ALOS, 1,688 additional IP Bed Days would have been needed (as based on volume of discharges in the Hospitalist Model Intervention period). Severity of illness, age and risk of mortality increased significantly. There was no significant difference in unplanned readmission rate (Table 1).

Conclusion: Significant ALOS reduction despite increased severity, age, and risk of mortality, and no change in unplanned readmission rates highlight the success of the co-managed Heme C and M hospitalist service in addressing acute medical problems and shaping future developments in inpatient malignant hematology programs.

Disclosures

Isenalumhe:Amgen: Consultancy; Jazz Pharmaceuticals: Consultancy.

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2024
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