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Update in Hospital Medicine
- Jeffrey G. Wiese, MD; and
- Russell L. Holman, MD
- From Tulane University School of Medicine, New Orleans, Louisiana, and Cogent Healthcare, Nashville, Tennessee.
2005–2006 Series: Update Sessions from ACP's 2005 Annual Session
This Update in Hospital Medicine summarizes 11 of the most important papers from 2004 for physicians with active inpatient practices. The articles were identified through a MEDLINE search and through a detailed review of 15 major medical journals. We polled local and national experts to determine which issues should be given priority and selected articles on the basis of their ability to confirm or change the hospitalist's clinical practice. This sample represents a diversity of study types and topics from the major subspecialties in medicine as they apply to the practicing hospitalist.
Hospitalist Comanagement
Hospitalist–Orthopedic Comanagement Reduced Minor Complication Rates without Increasing Length of Stay or Cost
This randomized, controlled trial assessed the effect of hospitalist comanagement on postoperative complications and length of stay. Secondary outcomes were inpatient costs and patient, nurse, and physician satisfaction. The investigators enrolled 526 patients who were undergoing elective orthopedic surgery and who were at increased risk for postoperative medical complications. Patients were randomly assigned to receive comanaged care from a medical hospitalist–orthopedic team or standard postoperative care from orthopedic surgeons with medical consultation. Management protocols, including laboratory studies, β-blocker therapy, prophylaxis for deep venous thrombosis, nursing care, and physical therapy, were similar for all patients in both groups.
Under the team approach, hospitalists had primary responsibility for patient management. They examined the patient before anesthesia was administered, coordinated all perioperative medical care and subspecialty consultations, and managed all issues related to the patient's discharge from the hospital. In the standard postoperative care group, these aspects of care were managed by the anesthesiologist, surgeon, or primary care physician as appropriate.
Patients assigned to receive hospitalist comanagement had fewer minor complications (such as fever, electrolyte imbalances, and urinary tract infections) than patients in the standard postoperative care group (30.2% vs. 44.3%; difference, −14.1 percentage points [95% CI, −22.7 to −5.3 percentage points]). …
