Background:

Inpatient care of Oncology patients is a specialized field with care typically provided by Oncologists. These patients are usually very sick with multiple co‐morbidities, high case mix indices, long lengths of stay and high mortality.

Our hospital is associated with a specialized outpatient Cancer Center staffed by more than 20 Oncologists. Responsibility for caring for most patients admitted to the hospital from this large practice was assumed by our Hospital Medicine group in August 2012, in co‐management with one oncologist from the center. We did not participate in the care of patients with hematologic malignancies.

Purpose:

To establish Hospitalist care for Oncology patients, in co‐management with Oncology, and to asses the impact of this model of care on outcomes metrics.

Description:

We retrospectively reviewed the care of patients referred to our Hospital Medicine service from the Cancer Center from September 2012 to August 2013. For comparison purposes, we also reviewed care provided by Oncologists from the Cancer Center prior to the involvement of our Hospital Medicine group, from January to December 2011.

A total of 305 patients were admitted from January to December 2011 under Oncology care, and 684 patients were admitted from September 2012 to August 2013 under Hospitalist care.

Much of the care provided to these Oncology patients was medical in nature (cancer pain management, end of life care, infections in patients with malignanacies). Patients admitted for chemotherpy alone were excluded from this analysis.

Under Hospital Medicine care, the average length of stay was reduced by 1.6 days (7.3 days vs 8.9 days).

A measure of efficiency relative to expected performace, excess days per case, was examined. Under Hospitalist care, the excess days per case was reduced by nearly 50% (1.58 excess days per case under hospitalist care vs 3.37 excess days per case under oncologist care).

The mortality rate was 6.6% in both groups of patients.

Conclusions:

Our experience and data demonstrates that care for this group of complex patients with cancer can be efficiently and effectively provided by Hospitalists in co‐management with Oncology, with no adverse effect on mortality.