Prior studies of surgical co‐management have shown marginal benefits and mostly focused on the care of orthopedic patients. Hospitalized vascular surgery patients typically have multiple severe co‐morbidities, poor functional status, and high peri‐operative cardiac risks and thus may be ideal patients for collaborative care.
To improve patient care and outcomes in the vascular surgery service through implementation of a co‐management service team
This study took place at an urban academic tertiary care hospital between January 2012 and September 2013. Baseline data in 2012 were obtained for the 9 vascular surgeons participating in the co‐management program. Starting January 2013, a dedicated Hospitalist actively participated in the medical care of the surgical co‐management patients. The hospitalist attended daily rounds 7 days a week and communicated the plans and recommendations to the vascular surgery team (Attending Surgeon, House staff physicians and non‐physician providers) . The Hospitalists performed the pre‐operative medical evaluation and actively participated in the patient’s post‐operative medical care. All medical issues were addressed by the Hospitalist, including management of chronic diseases (e.g. diabetes mellitus, coronary disease, chronic kidney disease, chronic pulmonary disease, etc.), and acute medical complications (e.g. acute kidney injury, acute respiratory failure, acute coronary syndrome, sepsis, delirium etc.). They also participated in the daily multidisciplinary rounds. Length of stay (LOS), readmission rate, patient satisfaction and inpatient mortality rate were obtained from administrative sources and nurses’ satisfaction was assessed through surveys.
During the study period, 1008 patients were admitted to the Vascular surgery service; 515 during the baseline period and 493 in the intervention period. Mortality decreased from 1.7 % to 0.4 %, corresponding to a decrease in the risk‐adjusted observed:expected (O:E) ratio from 0.89 to 0.24 (p <0.05). The case mix index was greater during the intervention period (2.45 vs. 2.21). Readmission rate decreased (23.1% to 20.5%) and LOS decreased from an O:E ratio of 0.88 to 0.79. Patient satisfaction as assessed by the HCAHPS surveys was unchanged. Nurses reported strong perceived improvement of patient care nine months after program implementation
Our Vascular Surgery Co‐management Service was able to decrease mortality, LOS, and readmissions. The program also improved nurses’ perceptions on the quality of care. However, it had no impact on patient satisfaction scores. This study suggests that a highly structured co‐management program targeting the highest surgical risk patients can have a substantial impact on patient care and quality metrics.