The Hospitalist Joins the Surgical Team

The principal providers of medical consultation for the surgical patient have been internists, family practitioners, cardiologists, and pulmonary physicians. The model for the medical consultant's roles and responsibilities in the care of this patient population has been to provide the surgeon with an assessment of medical problems and concise recommendations on the management of patients in the perioperative period (1). Sometimes, the surgeon retains full responsibility for carrying out the recommendations. Alternatively, the consultant serves as a comanager for all medical problems. A point of demarcation between these 2 models of consultation is the hospital setting. In community hospitals, the comanager model is the predominant practice, whereas in academic medical centers, the pure consultant approach is used. The existence of these 2 models raises a question. Do the 2 approaches differ in postoperative outcomes, such as length of stay, medical complications, surgeon and nursing staff satisfaction, and costs?

Huddleston and colleagues have completed a randomized, controlled trial of 526 patients undergoing total hip or knee arthroplasty (2). They compared a comanagement hospitalist–orthopedic team with standard postoperative care by orthopedic surgeons who received medical consultation. The measures of effectiveness were length of stay, postoperative medical complications, health care provider satisfaction, and inpatient costs. The study introduced a new model to the academic medical center: hospitalists who act as comanagers for perioperative care on an orthopedic surgery team. The primary role of hospitalists has been to provide the general medical care for patients admitted to the hospital with medical problems (3, 4). This system of inpatient care has improved both the efficiency and quality of care for hospitalized patients enrolled in controlled studies of hospitalist care (5-7). Five hundred twenty-six patients undergoing total hip and total knee arthroplasty at the Rochester Methodist Hospital in Rochester, Minnesota, were randomly …