Purpose: Our group sought to develop a co-management agreement with our trauma surgery colleagues, with a focus on quality improvement and improved patient satisfaction. After a collaborative, transparent review of multiple quality metrics, opportunities for improvement in the care of these surgical patients were identified, including improving patient satisfaction, length of stay, transitions of care, and reductions in catheter-associated UTI, hospital-acquired VTE, and readmissions to the surgical intensive care unit.
Description: A group of 5 dedicated hospitalists were assembled as members of the trauma surgery co-management team. A single hospitalist rotates for two weeks at-a-time and is relieved of routine hospital medicine rounding responsibilities during that period. The hospitalist attends daily interdisciplinary rounds with the trauma surgery team, during which he/she identifies patients that may benefit from hospital medicine co-management; patients that are over the age of 65, have multiple chronic medical conditions, or are on high-risk medications such as anticoagulants, antiplatelets, insulin, or psychotropic medications are preferentially selected. Approximately ten patients are seen daily. These patients are seen daily throughout their hospitalization. After admission by the surgery team, the hospitalist places medical orders, determines the need for subspecialty consultation, and facilitates transition of care to the outpatient setting. A running database of all patients is maintained such that quality metrics can easily be obtained. A metrics dashboard was also developed, with plans to compare data to a cohort of patients that do not receive co-management.
Conclusions: The co-management program has been very well received by our trauma surgery colleagues, citing improved patient communication and a fostered sense of collegiality. Medical expertise in the management of high-risk medications and fall prevention in the elderly have become our focus. Preliminary quality and patient satisfaction metrics have been positive. Frequent reassessments of workflow and open communication between the groups have made the program an early success.