Surgical Comanagement by Hospitalists in Colorectal Surgery

Rohatgi, Nidhi; Wei, Ping Ho; Grujic, Olgica; Ahuja, Neera

doi:10.1016/j.jamcollsurg.2018.06.011

Cited by 29 publications

(28 citation statements)

References 38 publications

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“…To our knowledge, this is one of the largest studies evaluating the benefits of SCM over 5.8 years. Similar to our prior studies on this SCM model of care, 5,7 other studies have reported a decrease in medical complications, 8-10 LOS, [11][12][13] and cost of care 14 with SCM.…”

Section: Discussionsupporting

confidence: 87%

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Rohatgi

Weng

Ahuja

2020

Journal of Hospital Medicine

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Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.

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Section: Discussionsupporting

confidence: 87%

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Rohatgi

Weng

Ahuja

2020

Journal of Hospital Medicine

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“…Despite the foregoing, some studies failed to nd decreased mortality in comanaged patients. [8][9][10][11][12][13] In contrast to our patient population, which by design was older (mean age 81.4) and with signi cant comorbidity, these studies tended to have patients that were younger, with fewer comorbid conditions, and were largely undergoing elective surgeries. This dichotomy was commented on by Siegal in noting that two roughly simultaneous studies involving the same hospitalists and orthopedic surgeons found contrasting patient outcomes, as one study focused on healthier elective arthroplasty patients and the other on hip fracture patients who were older, more comorbid, and at higher risk for complications.…”

Section: Discussionmentioning

confidence: 99%

“…This differs from ndings in other comanagement studies. [6][7][8]12,13,15,19 Interestingly, ndings of decreased LOS and decreased mortality were largely mutually exclusive. Comanagement programs which were associated with decreased LOS tended to have patients who were younger and who were undergoing elective surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…Bene ts of comanagement by internal medicine practitioners have been documented in a variety of surgical elds, including cardiothoracic surgery, orthopedics, neurosurgery, colorectal surgery, and vascular surgery. [6][7][8][9][10][11][12][13][14] Speci cally, comanagement of trauma patients was associated in prior studies with decreases in length of stay and in-hospital mortality. 15,16 It is in this context that we created the geriatrics-focused Trauma/Acute Care Surgery-Hospitalist Comanagement Program at our institution, a Level I regional trauma center.…”

Section: Introductionmentioning

confidence: 99%

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A Geriatrics-Focused Hospitalist Trauma Comanagement Program Improves Survival and Quality Measures for Older Adults: A Propensity Score-Matched Analysis

Zhang¹,

Sinvani²,

Leung³

et al. 2021

Preprint

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Background: Given the increasing age and medical complexity of trauma patients, medical comanagement has been adopted as a strategy for high-risk patients. This study aimed to determine whether a geriatrics-focused hospitalist trauma comanagement program improves outcomes.Methods: A pre- and post-implementation study compared older adult trauma patients who were comanaged by a hospitalist with those prior to comanagement at a Level 1 trauma center. Criteria for comanagement included: age 65+, multiple comorbidities, and use of high-risk medications. Comanagement focused on geriatric trauma management guidelines. One-to-one propensity score matching (PSM) was performed based on age, gender, Injury Severity Score, Charlson comorbidity index, and initial admission to the intensive care unit (ICU). Outcomes included hospital mortality, length of stay (LOS), and orders for geriatrics-focused quality indicators. Differences were compared with the Wilcoxon Rank Sum test for continuous variables and chi- square or Fisher’s exact test for categorical variables.Results: From 792 control and 365 intervention patients, PSM resulted in 290 matched pairs. Three intervention group patients died compared to 14 in the control group (p=0.0068). Hospital LOS, 30-day readmission, ICU LOS, and ICU upgrades were not significantly different between groups. There was an overall trend toward improved geriatrics-focused quality indicators in the intervention group. Intervention group was less likely to be restrained (p=0.04), received earlier physical therapy (p=0.01), more doses of acetaminophen compared to control patients (p<0.0001), and more subcutaneous enoxaparin rather than heparin (p=0.0027).Discussion: Our main findings highlight the higher medical complexity and increased risks in older adult trauma patients, as well as the mortality reduction and adherence increase to geriatrics-focused quality indicators. Limitations of our study included use of a single center, the possibility of selection bias in analyzing historical data, and a low sample size, all of which may limit generalizability. Conclusions: Our study demonstrates that a geriatrics-focused hospitalist trauma comanagement program improves survival and quality of care.

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“…Few studies have reported ICU admission rates in AMU care. One study on a surgical co-management model, which mainly focused on patients that required surgery, found a signi cant reduction in the ICU admission rate in the hospitalist group [35], compared to the non-hospitalist group. Other studies have reported no signi cant difference the ICU admission rates between the two types of care [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

Kim¹,

J²,

Jh³

et al. 2020

Preprint

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BACKGROUND: The present study aimed to assess a newly introduced, hospitalist-run, acute medical unit (AMU) model in Korea. The AMU in our institution started in October 2015. Four hospitalists managed patients with acute medical needs that were admitted through the emergency department (ED). STUDY DESIGN: We conducted a retrospective cohort study of all medical inpatients admitted through the ED from June 1, 2016 to May 31, 2017, at a tertiary care hospital. We evaluated 6391 patients whether the hospitalist care in the AMU improved patient outcomes compared to standard non-hospitalist care. METHODS: We created multivariate analysis models to compare the clinical outcomes of patients cared for by hospitalists with the outcomes of patients cared for by non-hospitalists. RESULTS: In the adjusted models, compared to the non-hospitalist group, the AMU hospitalist group had a lower in-hospital mortality (OR: 0.46, P <0.001), a lower intensive care unit (ICU) admission rate (OR: 0.39, P <0 .001), a shorter hospital length of stay (coefficient: -1.349, SE: 0.217; P <0.001), and a shorter ED waiting time (coefficient: -3.021, SE: 0.256; P <0.001). There were no significant differences in the 10-day or 30-day re-admission rates (P = 0.493, P = 0.201; respectively). CONCLUSIONS: The AMU hospitalist care model was associated with reductions in in-hospital mortality, ICU admission rate, length of hospital stay, and ED waiting time. These findings suggested that this AMU hospitalist care model might be adaptable to other healthcare systems to improve care for patients with acute medical needs.

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Surgical Comanagement by Hospitalists in Colorectal Surgery

Abstract: Surgical comanagement intervention was associated with a decrease in transfers to the ICU after rapid response team call, LOS, medical consultants, and the cost of care.

Cited by 29 publications

References 38 publications

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

A Geriatrics-Focused Hospitalist Trauma Comanagement Program Improves Survival and Quality Measures for Older Adults: A Propensity Score-Matched Analysis

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

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