The relationship between off-site inpatient gastroenterology consultations and timeliness of care delivery

Abstract

Introduction: Gastroenterologists are increasingly responsible for providing inpatient care at multiple facilities. Here, we hypothesized that a single gastroenterology team covering two facilities impacts care delivery outcomes such as length of stay (LOS). Materials and Methods: This retrospective cohort study included inpatient GI consultations over a three-year period performed at two hospitals within a single academic health system. One site, where complete endoscopic services are provided, was considered the “primary,” and the other a "satellite." These facilities are located approximately 10 minutes apart in walking time. Patients admitted to non-medical services were excluded. Outcomes included LOS, time from admission to consultation, use of inpatient endoscopy, and time from endoscopy to discharge. Results: Of 1,952 admissions with GI consultation, 700 (36%) occurred at the satellite. The median LOS was longer for patients admitted to the satellite (4.9 vs. 4.2 days, p[less than]0.001), primarily because there was a significantly longer time from admission to GI consultation (0.3 vs. 0.01 days, p[less than]0.001); however, median time from consultation to discharge was similar between facilities (p = 0.80). Patients admitted to the primary facility were more likely to undergo inpatient endoscopy (62% vs. 55%, p=0.003). After adjusting for potential confounders, including consult indication, there was a significant positive correlation between admission to satellite and increased LOS (beta coefficient 3.72, p[less than]0.001). Conclusions: Inpatient GI consults at satellite facilities are associated with longer LOS and lower use of inpatient endoscopy. Health systems should monitor the timeliness of inpatient subspecialty care at satellites and consider interventions to minimize delays.