It is becoming increasingly common for hospitals to reach or even exceed their bed capacity, to divert arriving ambulances, and to make admitted patients wait many hours in an emergency department for a bed. In this context, we believe that the 1-day or 20% difference in median length of stay that we observed in our study is clinically meaningful, not "minor." We agree with Dr Terplan that discharge planning is an important ingredient in providing efficient care and believe it is possible that some of the differences we observed in our study were the result of more effective use of hospital discharge planning services by hospitalists. In light of their daily need to arrange for home health care services, short-term rehabilitation, and skilled nursing facility placement, it would not surprise us to learn that hospitalists were quicker to consult with discharge planners.
Lindenauer PK, Chehabeddine R, Pekow P, Fitzgerald J, Benjamin EM. The Impact of Hospitalists on Congestive Heart Failure—Reply. Arch Intern Med. 2002;162(22):2634. doi: