Which surgical patients require shared care?

Area of Science:

• Medicine
• Surgical Care
• Internal Medicine

Background:

• Hospitalized surgical patients often have complex medical comorbidities and polypharmacy.
• Significant postoperative complications can lead to in-hospital mortality, a phenomenon known as failure to rescue.
• Current patient selection criteria for shared care are often imprecise and may exclude suitable candidates.

Purpose of the Study:

• To discuss the selection criteria for shared care in surgical wards.
• To advocate for the universal application of shared care for all hospitalized surgical patients.

Main Methods:

• Review of existing literature and clinical practices regarding shared care in surgery.
• Analysis of factors contributing to failure to rescue and the role of internists in surgical wards.

Main Results:

• Existing shared care selection criteria are not standardized and can be difficult to apply.
• The presence of internists on surgical wards is a key factor in reducing failure to rescue.
• Failure to rescue impacts surgical mortality across diverse patient populations.

Conclusions:

• Shared care is essential for optimizing perioperative management and preventing postoperative mortality.
• All patients admitted to surgical departments should benefit from shared care, irrespective of selection criteria.
• Integrating internists into surgical wards enhances patient safety and reduces in-hospital mortality.