When hospital medicine and surgical departments (usually orthopedics or neurosurgery) have joined in comanagement programs, improvements in quality metrics and patient satisfaction have often resulted.
At the Level 1 regional trauma center in which he works, Charles L. Kast, MD, and his colleagues wanted to try a comanagement agreement between hospital medicine and trauma surgery.
“The surgical team identified a need within their own department, which was to improve patient mortality and satisfaction in the inpatient setting,” said Dr. Kast, who is based at North Shore University Hospital, Manhasset, N.Y. “Their leadership sought out our hospital medicine leadership team, who then worked together to synthesize their metrics. We were able to identify other quality indicators, such as readmission rates and hospital-acquired conditions, which we felt could also benefit from our services in order to help them improve.”
Five hospitalists became members of the comanagement team. A single hospitalist rotated for 2 weeks at a time, during which they were relieved of routine hospital medicine rounding responsibilities. The hospitalist attended daily interdisciplinary rounds with the trauma surgery team, during which he/she identified patients that could benefit from hospital medicine comanagement: Patients who were over age 65 years, had multiple chronic medical conditions, or were on high-risk medications were preferentially selected. Approximately 10 patients were seen daily.
The comanagement program was well received by trauma surgeons, who talked about improved patient communication and a fostered sense of collegiality. Preliminary quality and patient satisfaction metrics were also positive.
A top takeaway is that the benefits of surgical comanagement can be demonstrated in “atypical” collaborations, depending on the needs of the department and the hospital’s vision.
“The gains in improved patient quality metrics are only half of the story,” Dr. Kast said. “Collaborating in surgical comanagement improves the satisfaction of the hospitalists and surgeons involved and can lead to future quality improvement projects or original research, both of which we are currently pursuing.”
Kast C et al. The successful development of a hospital medicine-trauma surgery co-management program [abstract]. J Hosp Med. 2017;12(suppl 2). Accessed Feb. 2, 2018.