Impact of an Early Hospitalist Care Model on Emergency Department Operational Metrics

Boarding of admitted patients in the ED presents many challenges for patients and operations including poor satisfaction, delays in care, crowding, and increased length of stay (LOS). Interventions that accelerate inpatient team involvement of admitted patients may shorten several important operational metrics including hospital LOS. Our objective was to evaluate the impact of an "Early Hospitalist Care Model", where hospitalists assume care shortly after the decision to admit, on ED throughput, boarding duration, and patient safety.

A retrospective pre/post analysis following implementation of a dedicated ED early hospitalist care model in October 2025. Pre-intervention months were January-September 2025 and post-intervention months were October-December 2025. Outcomes included boarding hours, admitted patient length of stay, hospitalists ED discharge rates, time to covering clinician signup, rate of medication reconciliation, readmissions and 24 hour care escalation (step down unit/ICU). Means were compared using a two-sample t-test of unequal variances with p<0.05 achieving statistical significance.

A total of 21706 hospitalist admissions were included of which 5586 (25.7%) were in the post implementation period. Time to a covering provider assuming care decreased by 14.9% (165.3 min to 140.6 min, p<0.05). The time admitted patients remained under ED clinician care decreased by 38.8% (116.3 min/day to 71.2 min/day, p<0.05) following implementation. Hospitalist discharges from the ED increased 56.7% overall (p<0.001) with significant increases in discharge rates among patients with length of stay >24 hours (pre 2.59%, post 4.06%; p<0.001). Median inpatient LOS decreased by 23.8% (3683 mins to 2806 mins, p<0.05). Time to medicine reconciliations completion decreased by 28.3% (306.7 min to 220.0 min, p<0.05). Escalation to a higher level of care and 7 day readmission rates were unchanged.

Implementation of an early-assumption of care hospitalist model was associated with significant reductions in ED clinician boarding hours, admitted patient length of stay and increased ED discharges of admitted patients without evidence of increased 24-hour care escalations or readmissions. These findings support this model as a feasible operational strategy to improve throughput while maintaining safety.