ABSTRACT
BACKGROUND: Patients with increasing age and medical complexity are undergoing colorectal surgery. Medical complications are not uncommon and may contribute to higher mortality. We implemented a surgical comanagement (SCM) model in July 2014 at our institution, where the same 2 SCM hospitalists were dedicated to colorectal surgery year round. Each patient was screened daily by an SCM hospitalist for prevention and management of medical complications. Before SCM, hospitalists were typically consulted after medical complications had occurred. STUDY DESIGN: We conducted a pre/post study at an academic medical center with 938 patients in the pre-SCM group (July 2012 to June 2014), and 1,062 patients in the post-SCM group (July 2014 to May 2016). We evaluated whether SCM by hospitalists improved outcomes of patients in colorectal surgery. RESULTS: There was no significant difference in medical complications, patient satisfaction, or 30-day readmission rate to our institution for medical cause with the SCM intervention. This intervention was associated with a significant decrease in the proportion of patients transferred to the ICU after rapid response team calls (relative risk [RR] 0.25 [95% CI 0.05 to 0.84], p = 0.039), proportion of patients with length of stay (LOS) ≥ 5 days (RR 0.73 [95% CI 0.64 to 0.83], p < 0.001), use of medical consultants (RR 0.75 [95% CI 0.63 to 0.89], p = 0.001), and the median direct cost of care by 10.3% (p = 0.0002). CONCLUSIONS: 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.
Subject(s)
Colorectal Surgery , Hospitalists , Patient Care Team/organization & administration , Postoperative Complications/prevention & control , Academic Medical Centers/organization & administration , Female , Hospital Costs , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Models, Organizational , Patient Satisfaction , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of the study was to examine the impact of a surgical comanagement (SCM) hospitalist program on patient outcomes at an academic institution. BACKGROUND: Prior studies may have underestimated the impact of SCM due to methodological shortcomings. METHODS: This is a retrospective study utilizing a propensity score-weighted intervention (n = 16,930) and control group (n = 3695). Patients were admitted between January 2009 to July 2012 (pre-SCM) and September 2012 to September 2013 (post-SCM) to Orthopedic or Neurosurgery at our institution. Using propensity score methods, linear regression, and a difference-in-difference approach, we estimated changes in outcomes between pre and post periods, while adjusting for confounding patient characteristics. RESULTS: The SCM intervention was associated with a significant differential decrease in the proportion of patients with at least 1 medical complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.74-0.96; P = 0.008), the proportion of patients with length of stay at least 5 days (OR 0.75; 95% CI, 0.67-0.84; P < 0.001), 30-day readmission rate for medical cause (OR 0.67; 95% CI, 0.52-0.81; P < 0.001), and the proportion of patients with at least 2 medical consultants (OR 0.55; 95% CI, 0.49-0.63; P < 0.001). There was no significant change in patient satisfaction (OR 1.08; 95% CI, 0.87-1.33; P = 0.507). We estimated average savings of $2642 to $4303 per patient in the post-SCM group. The overall provider satisfaction with SCM was 88.3%. CONCLUSIONS: The SCM intervention reduces medical complications, length of stay, 30-day readmissions, number of consultants, and cost of care.
