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An internist joins the surgery service: does comanagement make a difference?
D S Macpherson1, C Parenti, J Nee
1Department of Medicine, University of Pittsburgh, Pennsylvania.
Objective:
To determine the effect of internist comanagement of cardiothoracic surgical patients on patient outcome and resource utilization.
Design:
Before/after comparison.
Setting:
Tertiary care university-affiliated Veterans Affairs hospital.
Patients:
165 patients (86 before the intervention and 79 after the intervention) undergoing cardiothoracic surgery.
Interventions:
All patients were seen preoperatively and at least daily through discharge by a comanaging staff internist who was a full-time member of the surgical team.
Main Outcome Measures:
Length of stay, in-hospital mortality, and laboratory and radiology utilization.
Results:
Significant shortening of postoperative length of stay (18.1 days before and 12.1 days after, p = 0.05) and total length of stay (27.2 days before and 19.7 days after, p = 0.03) was noted. The in-hospital mortality rate for the patients undergoing surgery was 8.1% before the intervention versus 2.5% afterward (p = 0.17). There were significant reductions in the total number of x-rays (p = 0.02) and nearly significant reductions in total laboratory test utilization (p = 0.06). Referring physicians and surgeons both believed that the contribution of the internist was important.
Conclusions:
The addition of an internist to the cardiothoracic surgery service at a tertiary care teaching center was associated with decreased resource utilization and possible improved outcomes. Before becoming more widely adopted, this intervention deserves further exploration at other sites using stronger study designs.