Background: Communication, availability and timeliness of evaluation (all skills of Hospitalists) are key drivers for a successful co-management service. Our Hospital Medicine Group created a Urology Hospitalist co-management program in July of 2016. We designated a core group of highly specialized urologic hospitalists (UHOS) to work closely with the urologic surgeons to coordinate and improve the perioperative care of patients admitted to the urology service.
Purpose: Our UHOS co-management program set out to improve patient satisfaction, quality of care and operational performance. We reviewed the urology department’s yearly performance dashboard prior to and post July 2016.
Description: Starting in July 2016, the UHOS managed patients’ chronic and acute medical disease from date of admission to the hospital and continuing through their hospital stay. The UHOS can be reached by calling one dedicated pager 7 days a week 24 hours a day and patients are seen in a timely fashion. The UHOS communicates with the urology team several times a day with updates and has order-writing privileges on these patients. The UHOS also communicates directly with patient’s outpatient primary care provider as needed to minimize any communication gaps. On a given month, the UHOS co-manage around 75 distinct patients. Initially we started with 5 surgeons but now co-manage up to 22 surgeons on a weekly basis.Since the initiation of the Urology Hospitalist co-management program, there has been an upward trend in patient satisfaction with regard to likelihood to recommend the hospital and with communication with doctors going from 94% to 95% and 88% to 94% respectively. We attribute part of this change to the UHOS’ ability to efficiently spend time with patients, going over medical issues and helping to address any of their concerns.Quality performance has improved with a decrease in the readmission rate index from 1.5% to 1.1% since the implementation.Operational performance scores have also improved. CMI has increased from 1.57 to 1.9 partly due to UHOS documentation of co-morbidities and medical conditions. Additionally our oncological population has grown during the same time. Despite these changes the percentage of 30 day readmits has remained roughly the same at 12.5%. The LOS of the urology patients had an initial increase that coincided with the start of the co-management program and the arrival of an increased oncologic population to our institution. However, our LOS is slowly decreasing each year from 5.12 in 2017 to 4.90 YTD 2019.
Conclusions: A Hospital Medicine Urology co-management service can lead to improved patient outcomes. Creation of a small cohort of highly specialized hospitalist co-managers, as well as constant and close communication on a daily basis contribute to the success of a urology co-management program.