Best of Both Worlds: Sharpening Hospital Medicine Skills in High-Volume Military-Civilian Partnership

Military internists are expected to serve as subject-matter experts in hospital medicine in deployed environments. Many Military Treatment Facilities (MTFs) do not have a sufficient inpatient volume or disease acuity to sustain core hospital medicine skills essential for prolonged casualty care in the expeditionary environment. In 2022, the Las Vegas Military-Civilian Partnership (LV-MCP) incorporated internal medicine physicians from Mike O'Callaghan Military Medical Center (MOMMC) into regular hospitalist rotations at University Medical Center of Southern Nevada (UMC), a civilian level I trauma center. The quantitative and qualitative differences between hospitalized patients at the LV-MCP and the MTF highlight the beneficial impact MCP's have on enhancing the mission readiness of military internists.

Inpatient census data from MOMMC and the LV-MCP between January 1, 2023 and June 30, 2023 was collected and used to calculate and compare the average daily inpatient encounters per internist at each facility. Multiple objective measures representing patient acuity/complexity were compared between the 2 facilities including average lengths of stay, critical care time, inpatient surgical procedures, and death during hospitalization. Lastly, the most frequent primary ICD-10 code for inpatients was compared to show a qualitative difference in patient exposure.

Between January and June 2023, internists at MOMMC had an average of 4.65 inpatient encounters per day while those at the LV-MCP had 11.71. Patients seen at MOMMC had a lower average length of stay (2.4 vs. 9.3 days) and had a lower likelihood of experiencing critical care time (2.1% vs. 20.5%), surgical procedure (10.5% vs. 27.2%), or death (0.8% vs. 1.3%) during their hospitalization compared to the LV-MCP. The most frequent primary ICD-10 code at MOMMC was N179- Acute Kidney Injury at MOMMC, compared to A41.9-Sepsis at the LV-MCP.

Internists who rotate at the level I trauma center through the LV-MCP have 2.5 times as many inpatient encounters per day compared to their MTF. Furthermore, the ward patients seen at the LV-MCP have higher acuity and complexity as evidenced by multiple proxy metrics. Internists who regularly practice hospitalist medicine through military-civilian partnerships have lengthier exposure to more critically ill patients, better equipping them for prolonged casualty care in austere environments.