Implementation of a Hospitalist‐General Surgery Comanagement Service with an Emphasis on Hospitalist Satisfaction

Background:

A 2011 survey found that 85% of hospitalist groups had participated in some form of comanagement. Despite the widespread adoption of the comanagement model of care, there are few published data, mostly focused on orthopedic and neurosurgical services. Existing data suggests that comanagement services are not highly rated by their hospitalist participants.

Purpose:

To describe the implementation of a hospitalist comanagement service based in general surgery and report on hospitalist evaluations to date.

Description:

Leadership from the Divisions of General Surgery and Hospital Medicine collaborated to create a joint service agreement and plan for monthly interdepartmental meetings to review the implementation. Eligibility included any patient with an American Society of Anesthesia (ASA) physical status class III or IV who was admitted to the colorectal or pancreatic/endocrine services. The hospitalist was fully integrated into the surgical team structure; with the expectation to round daily on their patients, communicate directly with the surgical attending about major aspects of care and additionally, supervise and educate the surgical housestaff about hospital medicine. All hospitalist participants received additional training in perioperative medicine. To ensure the patient’s awareness of the service, specialized business cards were created which introduced the comanagement model of care and emphasized our collaborative management strategy. For evaluation, we surveyed participating hospitalists, in addition to surgical housestaff and nurses. We also surveyed patients upon discharge as to their awareness and satisfaction of the comanagement service. We are developing a plan to monitor the case‐mix index of patients and patient postoperative outcomes.

Conclusions:

We have successfully developed and implemented a hospitalist‐surgeon comanagement service based in the Divisions of Hospital Medicine and General Surgery. Surveyed hospitalist satisfaction with the service is very high, in part due to the high level of communication and collegiality with the surgical team. A central reason for this success was the strong, early bond between the hospitalist and surgical leadership and the structure of the rotation which emphasizes supervision of patient care and direct communication with the surgeons. Formal and informal data suggest that satisfaction is also high among the surgeons, housestaff, nurses and patients. To further improve patient awareness and satisfaction, a patient brochure will be created that will introduce this service to patients during the surgical preoperative office visit. Based on the positive feedback of the service, we have shifted our focus to the vascular surgery service, which cares for a large census of medically complex patients, which we believe provides a comanagement model with the best opportunity to improve outcomes. We will continue to monitor staff and patient satisfaction in addition to collecting outcomes data to evaluate our comanagement model of care.