377 - Comparative Analysis of Faculty vs Resident Performance in Facilitation of Direct Admissions

Publication Number: 4369.377

Grace E. Trello, Saint Louis University School of Medicine, St. Louis, MO, United States; Andrew Ellis, SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO, United States

Background: Direct admissions are a common modality for admission to pediatric hospitals nationwide. Safe and efficient facilitation of direct admissions has patient and system-level implications. Requests for direct admission were handled by pediatric residents at our tertiary, free-standing academic children's hospital prior to transitioning to faculty coverage during daytime, weekday hours in August 2023.

Objective: Following implementation of these faculty admission control shifts, we compared faculty and resident performance on patient and system-level outcomes to inform future education and quality improvement initiatives targeting improved facilitation of direct admissions. Manual chart review was performed for all direct admissions to general medicine between August 2023 and July 2025.

Design/Methods: Encounters were separated into resident-handled and faculty-handled cohorts. Analysis included statistical comparison of time from call request to acceptance, number of additional pages or calls (beyond the initial call), time from initiation request to admission, length of stay, ICU utilization, and discharge timing.

Results: 1,353 encounters were reviewed. Resident-handled direct admissions had a longer time from call initiation to acceptance (29.3 vs 19.2 min, p=0.0000003), more additional pages/calls prior to acceptance (21.1/100 vs 6.7/100 patients, p= 4.3 x 10^-16), shorter length of stay (2.0 vs 3.7 days, p=0.000007), and higher odds of discharge within 12 hours (OR 6.3, 95% CI 3.0-13.2) and 24 hours (OR 1.4, 95% CI 1.1-1.7). There was no difference in mean time from call initiation to admission, time from acceptance to admission, or ICU utilization metrics.

Conclusion(s): The results suggest differences in system-level outcomes without differences in patient-level outcomes. Faculty required less time and fewer additional pages to facilitate acceptance of a direct admission. These factors likely have a positive impact on facility and access center satisfaction. However, these factors did not correlate with more timely arrival to our facility, highlighting the complex interplay of other factors affecting the direct admission process. Within the faculty cohort, there was decreased incidence of discharge within 12 and 24 hours and no difference in ICU utilization. This finding suggest that more timely decision making did not compromise recognition of appropriateness for direct admission. Further study is needed to assess the impact of enhanced efficiency of direct admission acceptance on referral incidence, implications for residents, and quality improvement initiatives to enhance the direct admission process.

Table 1. Comparison of Resident and Faculty Performance on Patient and System Level Outcomes (August 2023 - July 2025)
This table shows the differences in patient and system level outcomes for direct admissions within the resident-handled and faculty-handled cohorts from August 2023 to July 2025. Values that reached statistical significance are shown in bold.