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Improving Patient Care: Jeanne M. Huddleston, Kirsten Hall Long, James M. Naessens, David Vanness, Dirk Larson, Robert Trousdale, Matt Plevak, Miguel Cabanela, Duane Ilstrup, Robert M. Wachter the Hospitalist–Orthopedic Team Trial Investigators Medical and Surgical Comanagement after Elective Hip and Knee Arthroplasty: A Randomized, Controlled Trial Ann Intern Med 2004; 141: 28-38 [Abstract] [Full text] [PDF]

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Impact of hospitalists on emergency hip surgery outcomes

Archana Roy   (27 July 2004)

Impact of hospitalists on emergency hip surgery outcomes 27 July 2004
Archana Roy, MD Mayo Clinic, Jacksonville Send rapid response to journal: Re: Impact of hospitalists on emergency hip surgery outcomes roy.archana{at}mayo.edu Archana Roy	I congratulate Huddleston et al (Ann Intern Med. 2004; 141: 28-38) on their study documenting the benefit of orthopedist-hopsitalist comanagement approach for patients undergoing elective hip and knee surgery. As the authors discuss, additional research is needed to assess the clinical and economic impact of this model of care. It remains to be seen whether these findings will hold true in other situations (emergency surgery or other surgical patients). Further, the reason(s) for improved outcomes need to be investigated. I would like to present our experience regarding the effect of hospitalist comanagement of patients undergoing emergency hip surgery. The setting of our study is at a community-based academic hospital where community physicians as well as physicians affiliated with an academic institution admit patients. This provided us a unique opportunity to compare the outcomes of emergency hip-surgery patients whose pre-operative medical evaluation and post-operative medical care was provided by traditional primary care physician (P), medical teaching service consisting of residents under the supervision of a faculty attending (T), or a dedicated faculty hospitalist (H). Data from 120 consecutive patients admitted from emergency department with hip fracture in 2002 were retrospectively analyzed. Patients in the H group were able to proceed to surgery after a mean (95% CI) of 0.9 day (0.7-1.2) compared to 1.2 (0.8- 1.5) in T and 1.4 (1.2-1.7) in P group, (p=0.03). There were significantly fewer post-operative complications in the H group compared to the other two groups; 27% (95% CI 15-41) vs 50% (27-72) in T and 45% (31-60) in P group, (p=0.04). Mean (95% CI) length of stay in H group was shorter, but not statistically significant, 5 days (4.5-6.0) compared to 6.5 (5-10) in T and 6 (5-7) in P group, (P=0.09). Mean time to completion of pre- operative evaluation consult in H group was 3.3 hr (95% CI 1.2-5.4), compared to 15hr (11.8 – 18.4) in T and 14.2hr.(12.2-16.4) in P group, (P = <0.001). These observations, made in a different setting and patient population, compliment the findings reported by Huddleston et al, and suggest that the benefit of surgeon-hospitalist partnership may be generalizable. One reason for better outcome in the hospitalist group may be their round-the-clock availability. Clearly, that has financial implications. Further research is needed to better understand the mechanisms by which hospitalist model is beneficial, and to critically evaluate its cost-effectiveness. Conflict of Interest: None declared