A Shorter, Sweeter Stay


A hospitalist-orthopedic comanagement model at Loyola University Medical Center in Maywood, Ill., improves both patient care and satisfaction, according to a study published in the July issue of Orthopedics (2009;32:495).

The approach, which dedicates two hospitalists to work with the orthopedists, was the culmination of a joint effort that began in 2005 to address communication issues between the hospitalist consultation service and the orthopedic surgery team, says Edward Gurza, MD, associate professor of medicine and director of the Division of General Internal Medicine at Loyola's Stritch School of Medicine in Chicago. “The idea was to have the same group of people to take care of patients pre-operatively, peri-operatively, and post-operatively,” Dr. Gurza says. “That’s absolutely critical. With orthopedics, one of the big issues is lack of continuity in the coordination of care.”

The study reports that the length of hospital stays was 0.693 days for 86 high-risk, comanaged patients with multiple comorbidities compared with 0.862 days for 54 patients in the control group. The severity of illness and risk of mortality scores were higher in the study group. The analysis found little effect on costs of care, but patient satisfaction scores for the test groups rose by 5% and 14%, respectively, in the categories of “communication with doctors” and “doctors treated you with respect.”

Dr. Gurza says the program needed no new funding, just a commitment from HM group leaders to dedicate staff to the concept. Hospitalists breed familiarity that cements a bond between physician and patient. “It flows naturally,” he says. “You’re not going out to specifically charm a patient. Hopefully, if you’re doing your job as an internist delivering proper care, patients understand that.”

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