Evidence map›Paper›PMID 25990190›Full record

ArticleJournal of general internal medicine2015

Impact of an Overnight Internal Medicine Academic Hospitalist Program on Patient Outcomes.

Jed D Gonzalo, Ethan F Kuperman, Cynthia H Chuang, Erik Lehman, Frendy Glasser, Thomas Abendroth

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In one paragraph

Article in Journal of general internal medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Acute Medical Care by Nocturnists: A Narrative Review.Journal of general internal medicine · 2025
    Review
  5. Review
  6. Article
  7. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Jed D GonzaloPennsylvania State University College of Medicine, Hershey, PA, USA. jgonzalo@hmc.psu.edu.
Ethan F KupermanUniversity of Iowa Carver College of Medicine, Iowa City, IA, USA.
Cynthia H ChuangPennsylvania State University College of Medicine, Hershey, PA, USA.
Erik LehmanPennsylvania State University College of Medicine, Hershey, PA, USA.
Frendy GlasserPennsylvania State University College of Medicine, Hershey, PA, USA.
Thomas AbendrothPennsylvania State University College of Medicine, Hershey, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMany academic hospitals have implemented overnight hospitalists to supervise house staff and improve outcomes, but few studies have described the impact of this role.

objectiveTo investigate the effect of an overnight academic hospitalist program on patient-level outcomes. Secondary objectives were to describe the program's revenue generation and work tasks.

designRetrospective interrupted time-series analysis of patients admitted to the medicine service before and after implementation of the program.

participantsAll patients aged 18 and older admitted to the acute or intermediate care units between 7:00 p.m. and 6:59 a.m. during the period before (April 2011-August 2012) and after (September 2012-April 2014) program implementation.

interventionAn on-site attending-level physician directly supervising medicine house staff overnight, providing clinical care during high-volume periods, and ensuring safe handoffs to daytime providers. MAIN MEASURES: Primary outcomes included in-hospital mortality, 30-day hospital readmissions, length of stay, and upgrades in care on the night of admission and during hospitalization. Multivariable models estimated the effect on outcomes after adjusting for secular trends. Revenue generation and work tasks are reported descriptively. KEY

resultsDuring the study period, 6484 patients were admitted to the medicine service: 2722 (42 %) before and 3762 (58 %) after implementation. No differences were found in mortality (1.1 % vs. 0.9 %, p=0.38), 30-day readmissions (14.8 % vs. 15.6 %, p=0.39), mean length of stay (3.09 vs. 3.08 days, p=0.86), or upgrades to intensive care on the night of admission (0.4 % vs. 0.7 %, p=0.11) or during hospitalization (3.5 % vs. 4.2 %, p=0.20). During the first year, hospitalists billed 1209 patient encounters (3.3/shift) and 63 procedures (0.2/shift), and supervised 1939 patient admissions (6.12/shift) while supervising house staff 3-h/shifts.

conclusionsImplementation of an overnight academic hospitalist program showed no impact on several important clinical outcomes, and revenue generation was modest. As overnight hospitalist programs develop, investigations are needed to delineate the return on investment and focus on other outcomes that may be more sensitive to change, such as errors and provider/patient satisfaction.

Indexed as

Academic Medical CentersAdolescentAdultAfter-Hours CareAgedFemaleHealth Services ResearchHospital ChargesHospitalistsHospitalizationHospital MortalityHumansInternal MedicineLength of StayMaleMiddle AgedGraduate medical educationHealth services researchHospital medicinePatient outcomes

Identifiers

PMID25990190
PMCPMC4636563

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.