Hospitalist Comanagement of Elderly Patients with Traumatic Falls

Background:

There is an increase in opportunities for hospitalists to comanage hospitalized patients. The benefits in regard to LOS, costs, and utilization of manpower are still being evaluated. As the elderly population with multiple comorbidities continues to grow, the need for comanagement will continue to increase. In this retrospective study at our tertiary‐care hospital, we evaluated the effects of hospitalist comanagement on LOS, mortality, and consultant involvement in patients with traumatic falls admitted to the surgical trauma service.

Methods:

A retrospective analysis was done, and data were obtained from the hospital trauma registry. Two groups of patients were compared: group 1 patients were more than 65 years old admitted to the trauma surgical service from July 2005 through June 2007 with a traumatic fall that was comanaged by a trauma surgeon and hospitalist (n = 193); group 2 patients were more than 65 years old managed by a trauma surgeon and optional consultants (traditional model) from July 2004 through June 2005 (n = 476). In group 1, the trauma service was advised to consult the hospitalist service at admission; however, She consult was not mandatory. The hospitalist would then determine the need for further subspecialty consults. In group 2, a traditional model was used, with internal medicine and subspecialty consults.

Results:

Both groups were found to have similar comorbidities in terms of diabetes, cardiac, renal, and pulmonary problems. Overall the median LOS was 6 days in both groups. In the comanaged group, patients were older, with a higher median injury severity score (16 vs. 10, P = 0.004) and longer median ICU LOS (1 day vs. 0 days, P ≤ 0.001). The comanaged patients also had a lower percentage of mortality (5.3% vs. 11.3%, P = 0.04), with each group having a similar percentage of DNR patients. Group 1 had less pulmonary consults and a trend toward less cardiology consults. Group 1 had more patients with supportive consults, PT/OT, PMR, and social services.

Conclusions:

Many questions remain about the patient population that will benefit most from hospitalist comanagement. In this study, the hospitalist comanagement model was used in older, more severely injured patients with a longer ICU LOS. Despite this patient group appearing more complex, the LOS in the comanaged group was not higher than that in the patients managed by the traditional model. In addition, mortality was lower in the comanaged group. The comanaged patients also underwent less subspecialty consults and more supportive care consults, which may improve the efficiency of patient care and discharge planning.

Author Disclosure:

M. Cratty, none.