Background: The aging population along with increasing multi-morbidity and stricter regulations on house staff duty hours have played an integral role in fueling the drive for medical co-management of surgical patients. Parallel to these trends is an increasing demand for surgical services and risk for postoperative complications. While a positive impact on clinical outcomes has been described for other surgical co-management services, a dearth of programs exist regarding successful implementation of a Neurosurgery-Hospitalist Co-management model. Patients undergoing neurosurgical procedures are highly complex given the intricate nature of these surgeries, intensity of care coordination required and challenging post-operative medical issues encountered. Therefore, neurosurgical co-management programs can be daunting for hospitalists
Purpose: A Neurosurgery-Hospitalist co-management service was developed to integrate medical services into the care of neurosurgical patients with the goal of providing timely prevention, detection and intervention on medical complications for this high-risk population. The program set out to improve throughput, clinical outcomes and patient experience.
Description: Previously, neurosurgery used a group of 3 private doctors for medicine consultation, however, struggled with substandard throughput, quality and patient satisfaction metrics and looked to hospital medicine to positively impact these key indicators. We selected a core group of 5 hospitalists, each rotating on the service at 2 week intervals to maintain continuity but avoid potential burnout. A detailed agreement was created outlining objectives, roles and responsibilities as well as metrics that would be regularly measured and reported. Hospitalist’s responsibilities included daily multidisciplinary rounds in the Neurosurgical ICU (NSCU) to receive handoff on patients being transferred to their service, active management of 10-12 patients (with a working knowledge of about 20 patients), medication reconciliation, pre-operative evaluation, and care coordination with families, consultants, and outpatient providers. Our initial challenges included buy-in from the neurosurgeons and identifying patients appropriate for co-management. We were able to demonstrate reduction in transfers back to the NSCU, significant gains in patient satisfaction scores, specifically, with regard to pain management and communication with doctors. Additionally, positive trends were noted in excess day reduction, length of stay and 30 day readmissions.
Conclusions: Neurosurgery-Hospitalist Co-management offers a plethora of opportunities for hospitalists to positively impact patient throughput, delivery of high-quality care and patient experience. Through regular feedback, communication and data review, we were able to evolve and improve the program. Next steps include the incorporation of didactics to enhance hospitalist skillsets in neurosurgery and strategies to obtain more accurate and actionable data.