Background:

Community hospitals have increasing difficulty providing E.D. and inpatient call coverage for General Surgery patients. Lower professional fees, higher malpractice costs, and a greater number of underinsured patients have made general surgeons less able to provide coverage. Employment of surgical hospitalists is an option for hospitals with this problem. Medical hospitalist programs provide a management model for surgical hospitalist programs.

Purpose:

To report the implementation of a general surgery hospitalist program at a community hospital modeled on the organization's traditional internal medicine hospitalist program.

Description:

The healthcare organization is a 260‐bed community hospital. In late 2004 the general surgeons on staff requested relief from E.D call coverage. After consultation with medical staff the organization started a general surgery hospitalist program. Duties of the new program are (1) Full surgical care of general surgery patients admitted through the E.D. (2) Full surgical care of inpatients requiring surgical consultation (3) Outpatient surgery care restricted to follow‐up of patients treated in the hospital (4) Central line placement (5) In‐house wound care (6) O.R. assisting and (7) Attending for low‐risk trauma patients.

Summary of Results:

Over 30 applicants inquired about the position, 11 were interviewed. Four applicants were offered a position and accepted. One offer was later withdrawn. Three general surgeons have been employed by the organization since August 05. The medical director of the medical hospitalist program manages the program. The three‐person group covers E.D. and inpatient call responsibilities in 12‐hour shifts. Surgical hospitalists cover 40 of 48 shifts in a 28‐day scheduling cycle. They provide coverage for their own practice 24/7 and work approximately 50 hours per week.

Practice statistics from 9/05 through 12/05 are an average of 63 patients admitted per month, an average morning census of 13.9 patients, an average of 63 surgeries per month, an average LOS of 4.0 days, and average hospital charges of $646,616 per month. The most commonly performed procedures were Appy/Lap Appy ‐ 98 (38.9%), Chole/Lap Chole ‐ 46 (18.3%), Exploratory laparotomy ‐ 26 (10.3%), Incise & Drain wound ‐ 21 (8.3%), Hernia repair ‐ 14 (5.6%), Bowel Resection ‐ 8 (3.2%), and Other ‐ 39 (15.5%).

Five of six private practice general surgeons requested to be off E.D. call responsibility. When questioned informally, no general surgeons had a significant loss in practice income. General Surgery caseloads have increased by 9.5% compared to the Sept through Dec time period last year (996 cases vs. 910 cases). Benefits include improved E.D. patient flow and improved O.R. flow. One life‐saving procedure was performed emergently (tracheostomy) since starting the program and would not have been possible if the surgical hospitalist program did not exist.

Author Disclosure Block:

L. Dimick, None; F. Lin, None; D.S. Mitchell, None.