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Surgical Comanagement by Hospitalists in Colorectal Surgery.
Surgical Comanagement by Hospitalists in Colorectal Surgery. Journal of the American College of Surgeons Rohatgi, N., Wei, P. H., Grujic, O., Ahuja, N. 2018Abstract
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 co-management (SCM) model in July 2014 at our institution where same two SCM hospitalists were dedicated to Colorectal surgery year round. Each patient was screened daily by a SCM hospitalist for prevention and management of medical complications. Prior to SCM, hospitalists were typically consulted after medical complications had occurred.STUDY DESIGN: 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 if 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 intensive care unit after rapid response team calls (RR, 0.25 [95% CI, 0.05 to 0.84], P = 0.039), proportion of patients with 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: SCM intervention was associated with a decrease in transfers to intensive care unit after rapid response team call, LOS, medical consultants, and the cost of care.
View details for PubMedID 30030136