Comparison of a Teaching and Nonteaching Service at a Children's Hospital in the Community



      The impact of trainees on inpatient patient care is incompletely understood. This study sought to discern the impact of trainees on patient outcomes and costs at a children's hospital in the community. We hypothesized that there would be no differences in patient outcomes and costs on an inpatient teaching service compared to a nonteaching service. As a secondary goal, we analyzed trainee evaluations.


      The authors conducted a cohort study of patients hospitalized from October 1, 2016 to September 30, 2017 on an acute care unit in a children's hospital in the community. Using t test or Fisher exact test, the authors compared patient outcomes between teaching and nonteaching services including, length of stay, discharge times, readmission rates, rapid response team (RRT) calls, pediatric intensive care unit (PICU) transfers, hospital transfers, and costs.


      During the study period, there were 1066 patients admitted and discharged from the teaching service and 1038 from the nonteaching service. There were no statistically significant differences in patient demographics or patient complexity. Similarly, there were no differences in length of stay, discharge times, readmission rates, RRT calls, PICU transfers, hospital transfers or patient costs between services. Trainee evaluations of the inpatient experience were overwhelmingly positive.


      In a children's hospital in the community, there were no significant differences in patient outcomes and costs on a teaching service compared to a nonteaching service. Furthermore, trainee evaluations suggested a favorable learning experience, illustrating the feasibility of incorporating trainees into inpatient care in a nontraditional learner setting.


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        • Cameron J.M.
        The indirect costs of graduate medical education.
        N Engl J Med. 1985; 312: 1233-1238
        • Mechanic R.
        • Coleman K.
        • Dobson A.
        Teaching hospital costs: implications for academic missions in a competitive market.
        JAMA. 1998; 280: 1015-1019
        • Taylor Jr, DH
        • Whellan D.J.
        • Sloan F.A.
        Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries.
        N Engl J Med. 1999; 340: 293-299
        • Rosenthal G.E.
        • Harper D.L.
        • Quinn L.M.
        • et al.
        Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study.
        JAMA. 1997; 278: 485-490
        • Allison J.J.
        • Kiefe C.I.
        • Weissman N.
        • et al.
        Quality of care at teaching and nonteaching hospitals.
        JAMA. 2000; 284: 2994-2995
        • Burke L.G.
        • Frakt A.B.
        • Khullar D.
        • et al.
        Association between teaching status and mortality in US hospitals.
        JAMA. 2017; 317: 2105-2113
        • Eden J.
        • Berwick D.M.
        • Wilensky G.R.
        • et al.
        Graduate Medical Education That Meets the Nation’s Health Needs.
        The National Academies Press, Washington, DC2014: 209
      1. Health Resources & Services Administration. Children's Hospitals Graduate Medical Education (CHGME) payment program. 2021. Available at: Accessed August 6, 2021.

      2. 115th Congress (2017–2018), H.R.5385 - Dr. Benjy Frances Brooks Children's Hospital GME Support Reauthorization Act of 2018. 2018.

        • Committee on Pediatric Workforce
        • Rimza M.E.
        • Hotaling A.J.
        • Simon H.K.
        Financing graduate medical education to meet the needs of children and the future pediatrician workforce.
        Pediatrics. 2016; 137e20160211
        • Wachter R.M.
        • Goldman L.
        Zero to 50,000—the 20th anniversary of the hospitalist.
        N Engl J Med. 2016; 375: 1009-1011
        • Iannuzzi M.C.
        • Iannuzzi J.C.
        • Holtsbery A.
        • et al.
        Comparing hospitalist-resident to hospitalist-midlevel practitioner team performance on length of stay and direct patient care cost.
        J Grad Med Educ. 2015; 7: 65-69
        • Carek P.J.
        • Boggan H.
        • Mainous A.G.3rd
        • et al.
        Inpatient care in a community hospital: comparing length of stay and costs among teaching, hospitalist, and community services.
        Fam Med. 2008; 40: 119-124
        • Bekmezian A.
        • Chung P.J.
        • Yazdani S.
        Staff-only pediatric hospitalist care of patients with medically complex subspecialty conditions in a major teaching hospital.
        Arch Pediatr Adolesc Med. 2008; 162: 975-980
        • Tingle L.E.
        • Lambert C.T.
        Comparison of a family practice teaching service and a hospitalist model: costs, charges, length of stay, and mortality.
        Fam Med. 2001; 33: 511-515
        • Boyd 3rd, J
        • Samaddar K.
        • Parra-Roide L.
        • et al.
        Comparison of outcome measures for a traditional pediatric faculty service and nonfaculty hospitalist services in a community teaching hospital.
        Pediatrics. 2006; 118: 1327-1331
        • Perez Jr., JA
        • Awar M.
        • Nezamabadi A.
        • et al.
        Comparison of direct patient care costs and quality outcomes of the teaching and nonteaching hospitalist services at a large academic medical center.
        Acad Med. 2018; 93: 491-497
        • Khaliq A.A.
        • Huang C.Y.
        • Ganti A.K.
        • et al.
        Comparison of resource utilization and clinical outcomes between teaching and nonteaching medical services.
        J Hosp Med. 2007; 2: 150-157
        • Johnson D.P.
        • Browning W.L.
        • Gay J.C.
        • et al.
        Pediatric hospitalist perceptions regarding trainees’ effects on cost and quality of care.
        Hosp Pediatr. 2015; 5: 211-218
        • Simon T.D.
        • Haaland W.
        • Hawley K.
        • et al.
        Development and validation of the pediatric medical complexity algorithm (PMCA) version 3.0.
        Acad Pediatr. 2018; 18: 577-580
        • Dwight P.
        • MacArthur C.
        • Friedman J.N.
        • et al.
        Evaluation of a staff-only hospitalist system in a tertiary care, academic children’s hospital.
        Pediatrics. 2004; 114: 1545-1549
        • Tarchichi T.R.
        • Garrison J.
        • Jeong K.
        • et al.
        Comparison of patient outcome measures between a traditional teaching hospitalist service and a non-teaching hospitalist service at an academic children’s hospital.
        Pediatr Ther. 2017; 7: 336
        • Ryskina K.L.
        • Dynan L.
        • Stein R.
        • et al.
        Diagnostic testing during pediatric hospitalizations: the role of attending in-house coverage and daytime exposure.
        Acad Pediatr. 2020; 20: 508-515
        • Beard A.S.
        • Candy A.E.
        • Anderson T.J.
        • et al.
        Patient satisfaction with medical student participation in a longitudinal integrated clerkship: a controlled trial.
        Acad Med. 2020; 95: 417-424
        • Esguerra R.
        • Toro J.
        • Ospina J.M.
        • et al.
        The transition to a teaching hospital: patient satisfaction before and after the introduction of medical students.
        Med Teach. 2014; 36: 710-714
        • Holland B.C.
        • Patel N.
        • Sulaver R.
        • et al.
        Resident impact on patient & surgeon satisfaction and outcomes: evidence for health system support for urology education.
        Urology. 2019; 132: 49-55